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Objective: Understanding the relationship between genetic structure and the molecular changes involved in endometrial cancer (EC) provides an opportunity to personalize treatments and incorporate targeted therapies., Method: We compared cytogenetic and molecular features observed in tumoral and adjacent healthy tissue endometrium samples in EC patients., Results: Non-clonal chromosome aberrations (NCCAs) frequently in patients with EC, especially in 10,15,17,22, X chromosomes and were monitored in 73.7%, clonal chromosomal alterations were observed in 26.3% of the patients. Down POLE gene expression in 42.1%, up p53gene expression in 57.9%, PTEN down-regulation in 47.3%, down ARID1A gene expression in 42.1%, PIK3CA up-regulation was observed in 68% of patients., Conclusion: The up-regulation of tumor suppressor genes in our study shows that not only these genes are involved but also different pathways and factors play a role in tumorigenesis. Furthermore, an increased number of NCCAs shows an essential role in the development of ECs.

Background: The proportion of female ophthalmologists in Germany has risen to approximately 50% in recent years, and approximately 66% of medical students are women. This represents a reversal of the past situation with a male predominance. Despite this change, many international studies show that women are still underrepresented at scientific conferences, particularly among invited speakers, chairpersons, and program committees. This study aims to investigate whether these differences in gender representation are also reflected at German ophthalmological congresses and whether the situation has changed in recent years., Methods: Data collection covered the years 2013, 2022, and 2023 and included the congresses of the five large German ophthalmological associations: the German Ophthalmological Society (DOG), German Ophthalmic Surgical Society (DOC), German Ophthalmological Academy (AAD), German Society of Cataract and Refractive Surgery (DGII) and the German Retinological Society (RG). Data were collected based on online programs and information provided by the offices and the managing committees. The numbers of female and male speakers and chairpersons were identified, as were the gender distributions of the specific program committees., Results: Overall, the percentage of female speakers across all years and conferences surveyed averaged 25%, while female chairs averaged 17%. The percentage of females in the program committees ranged from 0% to 17%. There was an increase in the percentage of female speakers over 10 years (2013-2023). For the DOG (p trend  < 0.01) and the DOC (p trend  = 0.01) there was a significant rise, while it was highest at the DOG (37%) and lowest at the DGII (11%). The percentage of female chairs was in general lower than the percentage of female speakers for all conferences (between 11% and 26% in 2023). Only for the DOG was there a statistically significant increase over the 10 years (p trend  < 0.01)., Conclusion: The representation of women as speakers and chairpersons at German ophthalmology conferences is low; these continue to be predominantly male dominated. Although there has been an increase in female representation over time, it remains lower than the overall proportion of women in the profession in 2023. Significant differences are observed between the various ophthalmological conferences. Further investigation into the underrepresentation of women at these conferences is necessary, and measures to encourage greater female participation at congresses should be implemented., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: E. Arslan, V. Brücher, G. Demir und A. Liekfeld geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This study introduces a highly efficient tripolyphosphate -tethered cellulose sorbent for cadmium (Cd 2 ⁺) removal from aqueous solutions. Characterization through FTIR and SEM revealed the material's structural properties. The sorbent achieved 99% Cd 2 ⁺ removal even at a minimal dosage of 0.05 g. Optimal sorption occurred within the pH range of 4-6, influenced by the sorbent's weak acidic functional groups. Rapid kinetics, reaching equilibrium within a minute, and a high sorption capacity (up to 18.03 mg/g at 50 °C) were observed. Langmuir isotherm modeling confirmed monolayer sorption, and thermodynamic studies indicated a spontaneous, endothermic process with increased randomness at the solid-liquid interface. Selectivity studies demonstrated strong Cd 2 ⁺ removal performance in the presence of competing ions, with minimal interference from monovalent ions but notable effects from divalent ions. The sorbent exhibited consistent reusability over multiple cycles. XPS analysis conclusively established an ion exchange mechanism between Cd 2 ⁺ and negatively charged P 3 O 10 5- groups as the primary removal pathway. This research highlights the potential of TPP-tethered cellulose as a promising sorbent for effective Cd 2 ⁺ remediation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

3 M syndrome is a well-known autosomal recessive skeletal genetic disorder caused by biallelic pathogenic variants in the CUL7, OBSL1, and CCDC8 genes. Affected individuals exhibit profound pre- and postnatal growth retardation, distinctive facial features with normal intelligence. This study aims to provide insight into the comprehensive evaluation of clinical, laboratory, and radiological findings, expand the mutational spectrum of the disease, and establish a genotype-phenotype correlation in the present cases. A total of 25 patients from 19 unrelated families were included in the study. Genetic etiology was determined in probands through the utilization of Sanger sequencing and/or targeted gene panel analysis. The clinical, laboratory, and genetic features of all patients at admission and during follow-up were documented. Genotype-phenotype correlation was carried out in the CUL7 and OBSL1 groups. The genetic etiology was established in all patients (n = 25/25, 100%). We identified 15 distinct variants in CUL7, OBSL1, and CCDC8 genes, with eleven being novel. CUL7 variants were present in 13 patients (n = 13/25, 52%), while OBSL1 variants were found in 11 patients (n = 11/25, 44%). No notable distinctions were found in mean birth weight, height, and standard deviation scores between the CUL7 and OBSL1 mutation groups (p > 0.05). Patients with CUL7 variants exhibited significantly lower height standard deviation scores both at admission and at the last examination, as well as lower weight standard deviation scores at the last examination, compared to those with OBSL1 variants (p < 0.05)., Conclusion: To date, genotype-phenotype correlations have been identified in a limited number of studies. Further research involving larger cohorts is necessary to solidify these correlations., What Is Known: • 3M syndrome is a well-known skeletal dysplasia caused by biallelic pathogenic variants in CUL7, OBSL1, and CCDC8 genes. • Despite genetic heterogeneity, clinical, and radiologic features show homogeneity in affected individuals., What Is New: • Genotype-phenotype correlations have been established in limited studies. • The CUL7 group exhibited significantly lower height SDS at both admission and the final evaluation and lower weight SDS at the final examination compared to the OBSL1 group. • The frequency of variants in the OBSL1 gene among Turkish patients exceeds the rates reported in the literature. • Gradenigo syndrome is being reported for the first time in a patient with 3M syndrome., Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital Noninvasive Clinical Research Ethical Committee (approval number: 2024/69). Consent to participate: Written informed consent was obtained from the parents. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Multiple epiphyseal dysplasia (MED) is a heterogeneous group of chondrodysplasia characterized by arthralgia, early onset osteoarthropathy, and the radiographic findings of small, flat, and irregular-shaped epiphyses. Some patients with MED have mild short stature as well. MED is genetically heterogeneous caused by pathogenic variants in COMP, MATN3, COL9A1, COL9A2, COL9A3, and SLC26A2. In 2017, pathogenic variants in CANT1, which are responsible for Desbuquois dysplasia, have also been reported in the genetic etiology of MED. To date, only three patients have been reported with CANT1-related MED. Herein, we present clinical and radiographic findings of six additional patients from five unrelated families, all sharing the same c.375G > C; p.(Trp125Cys) variant in CANT1 gene. These patients exhibited the features of multiple epiphyseal dysplasia, along with some similarities to Desbuquois dysplasia, thereby broadening the clinical spectrum of CANT1-related disorders., (© 2024 Wiley Periodicals LLC.)

Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes., (© 2024 The Author(s). International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Objective: This study aims to evaluate the off-label use of the MiniMed™ 780G system in children under seven years old., Methods: Children under seven years with type 1 diabetes (T1D) using MiniMed™ 780G were retrospectively compared with children of similar age and gender using MiniMed™ 640G and multiple-dose insulin (MDI) therapy with continuous glucose monitoring systems (CGMs). CGM metrics, total daily insulin dose (TDI), and HbA1c levels were evaluated retrospectively at baseline and at the 3rd, 6th, and 12th months., Results: At the initiation of MiniMed™ 780G therapy, the mean age was 5,25±1,22 years (range: 2,8–6,8 years). Glucose management indicator (GMI) and HbA1c remained lower in the MiniMed™ 780G group at the 3rd, 6th, and 12th months compared to baseline (p=0,009 and p<0,001, respectively), Time Above Range (TAR) was significantly lower at the 3rd, 6th, and 12th months (p=0,018, 0,017, 0,04, respectively), and Time in Range (TIR) was higher at the 3rd and 12th months (p=0,026 and 0,019, respectively) compared with the other groups. No instances of ketoacidosis or severe hypoglycemic events were observed in any of the children during the follow-up period., Conclusions: The absence of significantly higher levels of hypoglycemia compared to other groups at any time point, along with a significant decrease in TAR across all time points, a significant increase in TIR at the 3rd and 12th months, and a significant decrease in HbA1c and CV, indicates that the MiniMed™ 780G system is both safe and effective for children under seven years old.

Background: Neurotrophic tyrosine receptor kinase (NTRK) gene fusions represent rare somatic mutations in many types of cancer and have enabled the use of promising targeted therapies. In clinical studies, increased response rates to tropomyosin receptor kinase inhibitors have been demonstrated in NTRK fusion-positive cancer types; however, real-world experiences on these targeted agents are scarce., Objective: We evaluated the clinical characteristics and treatment responses of NTRK fusion-positive patients who received entrectinib treatment within the scope of an early access program in Turkey., Patients and Methods: This multicenter, retrospective analysis involved 17 patients with solid tumors harboring NTRK fusions or rearrangements from 14 oncology centers between June 2019 and 31 March 2024. Demographic and clinical data were obtained via retrospective review of medical records with a cutoff date of 31 March 2024., Results: The median age at diagnosis of the patients in our study was 42 [interquartile range (IQR) 33-60] years. Nine different types of solid tumors were diagnosed in these patients. The most common NTRK gene rearrangements involved NTRK1 (n = 8), followed by NTRK3 (n = 7). The median duration of entrectinib usage was 6.9 (IQR 3.1-16.1) months. Dose reductions due to side effects were performed in four patients: two due to leukopenia, one due to visual disturbance, and one due to troponin elevation. Leukopenia was the most commonly observed side effect. The objective response rate (ORR) was 35.3% (95% confidence interval (CI) 14.2-62.7), with complete response (CR) achieved in four patients. The duration of response (DOR) in patients who responded after initiating entrectinib was 9.8 (95% CI 0-30.7) months, the median overall survival (mOS) in all patients was 20.8 (95% CI 0-48.5) months, and the time-to-treatment failure (TTF) was 6.4 (95% CI 0-13.5) months., Conclusions: In this retrospective study, we aimed to obtain real-world data concerning the use of entrectinib in patients with solid tumors harboring NTRK fusion genes. Although our findings are partially similar to the results of clinical studies, prospective studies in larger patient groups with more diverse tumor types and different demographic characteristics are needed to confirm the findings., Competing Interests: Declarations Funding The authors received no financial support for the research, authorship, and/or publication of this article. Conflict of interest statement Feride Yılmaz, Serkan Yaşar, Nil Molinas Mandel, Turgut Kaçan, Melek Özdemir, Gamze Gököz Doğu, Nilay Şengül, Nezih Meydan, Fatma Buğdaycı Başal, Pınar Kubilay Tolunay, Melda Berber Hamamcı, Oğuz Salih Dinçer, Aykut Bahçeci, Leyla Özer, Miraç Ajredini, Önder Kırca, Özlem Yersal, Orçun Can, Meral Günaldı, Gökhan Demir, and Şuayib Yalçın declare that they have no conflicts of interest that might be relevant to the contents of this article. Ethics declarations The study was conducted in accordance with the Declaration of Helsinki and its amendments and with Good Clinical Practice guidelines. Ethical approval (approval date and number 2 April 2024, 23/536) for this study was obtained from the Hacettepe University Health Sciences Research Ethics Board, Turkey. Consent to participate The need for consent for this study was waived by the institutional review board (Hacettepe University Health Sciences Research Ethics Board) because of its retrospective design. Consent to publish Not applicable. Availability of data and materials Since the participants in this retrospective study, which was conducted with the permission of the Hacettepe Health Sciences Ethics Committee, did not give written consent for their data to be disclosed to the public, supporting data are not available owing to the sensitive nature of the research. Code availability Not applicable. Author contributions Feride Yilmaz: conceptualization; data curation; formal analysis; investigation; methodology; validation; visualization; writing—original draft. Nil Molinas Mandel, Turgut Kaçan, Melek Özdemir, Gamze Gököz Doğu, Oğuz Salih Dinçer, Leyla Özer, Miraç Ajredini, Önder Kırca, Özlem Yersal: conceptualization; data curation; investigation; methodology; validation; visualization. Serkan Yaşar and Şuayib Yalçın: conceptualization; data curation; methodology; writing, review and editing. Nilay Şengül Samancı, Nezih Meydan, Fatma Buğdaycı Başal, Pınar Kubilay Tolunay, Melda Berber Hamamcı: conceptualization; data curation; methodology; supervision; writing, review and editing. Aykut Bahçeci, Orçun Can, Meral Günaldı, Gökhan Demir: conceptualization; methodology; supervision; validation; review and editing. Şuayib Yalçın: conceptualization; data curation; methodology; supervision; validation; review and editing., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Presence of pes planus is known to effect balance. In this study, it was aimed to examine the immediate effects of IASTM and PMT on static and dynamic balance in young adults with pes planus., Method: The navicular drop test was used to diagnose pes planus. 51 individuals were included in the study and divided into three groups [IASTM (n:15), percussive massage (n:18) and control (n:18) groups] by simple randomization. Flamingo and Y Balance test was assessed before and immediately after intervention. Repeated Measures ANOVA test was used for the intergroup comparison, and the One-Way ANOVA test was used for the intragroup comparison, also post-hoc test with Tukey correction was performed., Results: There was no significant difference in static balance between the three groups (p > 0.05). There was a significant difference in dynamic balance between groups (p < 0.05). Only IASTM group had significant differences at before and after intervention of all directions except for posterolateral direction of Y Balance Test (p < 0.05)., Conclusion: IASTM applied to the plantar fascia of individuals with pes planus have immediate effects on dynamic balance when compared to no intervention and percussive massage even within a small sample size., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Dyggve-Melchior-Clausen dysplasia (DMC) and Smith-McCort dysplasia (SMC types 1 and 2) are rare spondylo-epi-metaphyseal dysplasias with identical radiological and clinical findings. DMC and SMC type 1 are allelic disorders caused by homozygous or compound heterozygous variants in DYM, while biallelic causative variants in RAB33B lead to SMC type 2. The terminology "skeletal golgipathies" has been recently used to describe these conditions, highlighting the pivotal role of these two genes in the organization and intracellular trafficking of the Golgi apparatus. In this study, we investigated 17 affected individuals (8 males, 9 females) from 10 unrelated consanguineous families, 10 diagnosed with DMC and seven with SMC type 2. The mean age at diagnosis was 9.61 ± 9.72 years, ranging from 20 months to 34 years, and the average height at diagnosis was 92.85 ± 15.50 cm. All patients exhibited variable degrees of short trunk with a barrel chest, protruding abdomen, hyperlordosis, and decreased joint mobility. A total of nine different biallelic variants were identified, with six being located in the DYM gene and the remaining three detected in RAB33B. Notably, five variants were classified as novel, four in the DYM gene and one in the RAB33B gene. This study aims to comprehensively assess clinical, radiological, and molecular findings along with the long-term follow-up findings in 17 patients with DMC and SMC type 2. Our results suggest that clinical symptoms of the disorder typically appear from infancy to early childhood. The central notches of the vertebral bodies were identified as early as 20 months and tended to become rectangular, particularly around 15 years of age. Pseudoepiphysis was observed in five patients; we believe this finding should be taken into consideration when evaluating hand radiographs in clinical assessments. Furthermore, our research contributes to an enhanced understanding of clinical and molecular aspects in these rare "skeletal golgipathies," expanding the mutational spectrum and offering insights into long-term disease outcomes., (© 2024 Wiley Periodicals LLC.)

Purpose: To compare the outcomes of intravitreal dexamethasone implant used as either an adjuvant or a switching therapy for diabetic macular edema in patients with poor anatomic response after three consecutive monthly injections of ranibizumab., Methods: This retrospective study included patients with diabetic macular edema who received three consecutive doses of ranibizumab as initial therapy and demonstrated poor response. A single dose of intravitreal de xamethasone implant was administered to these patients. The patients were divided into two groups according to the treatment modalities: the adjuvant therapy group, consisting of patients who continued treatment with ranibizumab injection after receiving intravitreal dexamethasone implant, and the switch therapy group, consisting of patients who were switched from ranibizumab treatment to intravitreal dexamethasone implant as needed. The main outcome measurements were best corrected visual acuity and central retinal thickness at baseline and at 3, 6, 9, and 12 months of follow-up., Results: In this study that included 64 eyes of 64 patients, the best corrected visual acuity and central retinal thickness values did not significantly differ between the groups at baseline and at 6 months of follow-up (p>0.05). However, at 12 months, the best corrected visual acuity values in the adjuvant and switch therapy groups were 0.46 and 0.35 LogMAR, respectively (p=0.012), and the central retinal thickness values were 344.8 and 270.9, respectively (p=0.007)., Conclusions: In a real-world setting, it seems more reasonable to use intravitreal dexamethasone implant as a switch therapy rather than an adjuvant therapy for diabetic macula edema refractory to ranibizumab despite three consecutive monthly injections of ranibizumab. Patients switched to intravitreal dexamethasone implant were found to have better anatomic and visual outcomes at 12 months than those who continued ranibizumab therapy despite their less-than-optimal responses.

In this study, spatiotemporal analysis of forest fires in Turkiye was undertaken, with a specific focus on the large-scale atmospheric systems responsible for causing these fires. For this purpose, long-term variations in forest fires were classified based on the occurrence types (i.e. natural/lightning, negligence/inattention, arson, accident, unknown). The role of large-scale atmospheric circulations causing natural originated forest fires was investigated using NCEP/NCAR Reanalysis sea level pressure, and surface wind products for the selected episodes. According to the main results, Mediterranean (MeR), Aegean (AR), and Marmara (MR) regions of Turkiye are highly susceptible to forest fires. Statistically significant number of forest fires in the MeR and MR regions are associated with global warming trend of the Eastern Mediterranean Basin. In monthly distribution, forest fires frequently occur in the MeR part of Turkiye during September, August, and June months, respectively, and heat waves are responsible for forest fires in 2021. As a consequence of the extending summer Asiatic monsoon to the inner parts of Turkiye and the location of Azores surface high over Balkan Peninsula result in atmospheric blocking and associated calm weather conditions in the MeR (e.g. Mugla and Antalya provinces). When this blocking continues for a long time, southerly winds on the back slopes of the Taurus Mountains create a foehn effect, calm weather conditions and lack of moisture in the soil of Antalya and Mugla settlements trigger the formation of forest fires., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Diencephalic-mesencephalic junction dysplasia syndrome is a rare neurogenetic disorder reported to be caused by variants in several genes. Phenotypic presentation is characterized by clinical findings including developmental delay, hypotonia, spasticity, and dyskinetic movements in combination with distinctive imaging features on brain magnetic resonance imaging (MRI)., Methods: Whole exome sequencing was conducted to unveil the molecular etiology of patients presenting with neurological manifestations from two unrelated families., Results: To the best of our knowledge, here we report the third family affected with diencephalic-mesencephalic junction dysplasia caused by a novel variant in GSX2 and two siblings with a PCDH12 variant exhibiting a less severe phenotype. The siblings with a PCDH12 variant were positioned at the milder end of the phenotypic spectrum. Although both exhibited a clinical phenotype resembling cerebral palsy, one showed partial fusion of the hypothalamus and mesencephalon, whereas MRI was unremarkable in the other. Biallelic GSX2 variants have been implicated in basal ganglia agenesis, and similarly, our patients had basal ganglia hypoplasia along with hypothalamic-mesencephalic fusion., Conclusion: Identifying variants associated with the syndrome in different genes will contribute to genotype-phenotype correlation., Competing Interests: The authors have no conflict of interest to declare., (© 2024 S. Karger AG, Basel.)

Background: There may be severe difficulties in determining the severity of LMCA (left main coronary artery) lesions. The use of intravascular ultrasound (IVUS) facilitates decisions about lesion severity in these patients. The aim of this study was to investigate the relationship between the UHR (uric acid to HDL-C ratio) and lesion severity in patients who underwent LMCA IVUS., Methods: This study included 205 patients with ICS (intermediate coronary stenosis) in the LMCA who underwent IVUS. In the IVUS measurements of these patients, the plaque burden (PB) and the minimal lumen area (MLA) showing lesion severity were measured., Results: The patients were separated into two groups according to plaque burden (< 65% and ≥ 65%). The UHR was significantly greater in the high plaque burden group (479.5 vs. 428.6, P = 0.001). When the patients were separated into two groups according to the MLA (< 6mm 2 and ≥ 6mm 2 ), the UHR was determined to be significantly greater in the group with low MLA (476.8 vs. 414.9, P < 0.001). In the ROC analysis performed according to the MLA and plaque burden values, the UHR cutoff value of 450 was found to have similar sensitivity and the same specificity for both parameters., Conclusions: The results of this study suggested that there is a relationship between UHR and MLA < 6mm 2 and plaque burden ≥ 65%, which are independently evaluated as critical in IVUS, and this could predict anatomically significant lesions in patients with a moderate degree of LMCA stricture., (© 2024. The Author(s).)

The study was carried out to determine the psychosocial outcomes of advanced hybrid closed-loop (AHCL) systems in children and adolescents with type 1 diabetes (T1D). Single-center and cohort study with a duration 6 months consisted of 60 children and adolescents with T1D. Standard clinical procedures, including both glycemic indicators, e.g., sensor-measured time within the 70-180 mg/dL range and glycated hemoglobin (HbA1c) levels, and psychosocial metrics were used for data collection. The psychosocial metrics included the Pediatric Quality of Life Inventory (PedsQL) 3.0 Diabetes Module for both children (8-12 years) and parents; the Quality of Life for Youth scale for adolescents (13-18 years); the Strengths and Difficulties Questionnaire (SDQ); the Hypoglycemia Fear Survey for Children (HFS-C); the Revised Child Anxiety and Depression Scale (R-CADS); and AHCLS-specific DTSEQ satisfaction and expectation survey. These metrics were evaluated at the baseline and after 6 months of AHCL use. Of the 60 children and adolescents with T1D for whom the AHCL system was utilized, 41 of them, 23 female and 18 male, completed the surveys. The mean age of the 41 children and adolescents was 12.5 ± 3.2 (min. 6.7, max. 18) years. The time spent within the target glycemic range, i.e., time-in-range (TIR), improved from 76.9 ± 9% at the baseline to 80.4 ± 5% after 6 months of AHCL system use (p = 0.03). Additionally, HbA1c levels reduced from 7.1% ± 0.7% at the baseline to 6.8% ± 0.8% after 6 months of AHCL system use (p = 0.03). The most notable decline in HbA1c was observed in participants with higher baseline HbA1c levels. All patients' HFS-C and AHCL system-specific DTSEQ satisfaction and expectation survey scores were within the normal range at the baseline and remained unchanged during the follow-up period. No significant difference was found in the R-CADS scores of children and adolescents between baseline and after 6 months of AHCL system use. However, there was a significant decrease in the R-CADS scores of the parents. Patients' PedsQL scores were high both at the baseline and after 6 months. The SDQ scores were high at baseline, and there was no significant improvement at the end of 6 months.  Conclusion: This is the first study to investigate in detail the psychosocial outcomes of AHCL system use in T1D patients and their parents. Although state-of-the-art technologies such as AHCL provide patients with more flexibility in their daily lives and information about glucose fluctuations, the AHCL resulted in a TIR above the recommended target range without a change in QOL, HFS-C, SDQ, and R-CADS scores. The scores obtained from the R-CADS conducted by the parents of the children indicated that the use of pumps caused a psychological improvement in the long term, with a significant decrease in the R-CADS scores of the children and adolescents with T1D. What is Known: • Previous studies focused on clinical outcomes of AHCL systems in pediatric T1D patients, showing glycemic control improvements. • Limited attention given to psychosocial outcomes of AHCL systems in children and adolescents with T1D. • Crucial psychosocial factors like quality of life, emotional well-being, and fear of hypoglycemia underexplored in AHCL system context. What is New: • First study to comprehensively examine psychosocial outcomes of AHCL systems in pediatric T1D patients. • Study's robust methodology sets new standard for diabetes technology research and its impact on qualiy of life., (© 2024. The Author(s).)

Objective: We evaluate the energy and nutrient intake of children, adolescents, and young adults with type 1 diabetes (T1D) who started to use automated insulin delivery (AID) systems before the transition and during follow-up for 6 months in a real-world setting., Research Design and Methods: Twenty-nine people with T1D (PwD) who started to use MiniMed 780G TM participated in the study. Participants' 3-day food diaries and glycemic outcomes were analyzed at baseline and after (the 3 rd and 6 th month) switching to an advanced hybrid closed-loop system (a-HCL)., Results: Mean carbohydrate, protein, and fat intake (energy %) at baseline were 49.1 ± 4.5, 17.8 ± 2.3, and 33.0 ± 3.9, respectively, and there were no statistically significant differences during the follow-up period. However, low fiber (<14 g/1000 kcal) and high saturated fat (>10 energy %) intake in PwD, both baseline and follow-up period. The median auto-correction bolus ratio was 14.0 (9.5)% at auto mode after 14 days, 18.0 (11.0)% at the 3 rd month, and 19.0 (7.5)% at the 6 th month (p < 0.05). A negative correlation was present between auto-correction boluses with TIR in both the 3 rd (r:-0.747, p < 0.01) and 6 th month (r:-0.395, p < 0.05). A negative correlation was present between auto-correction boluses with TIR in both the 3 rd (r:-0.747, p < 0.01) and 6 th month (r:-0.395, p < 0.05)., Conclusions: a-HCLS systems offer better glycemic control. Using the Minimed 780 G TM insulin pump system didn't change the energy and nutrient intake of PwD. This real-world follow-up study suggests that children, adolescents, and young adults with T1D consume saturated fat above and fiber intake lower than recommendations independent of the use of a-HCLS., Clinical Trials Registration Number: NCT05666596., (© 2024. The Author(s).)

The aim of this study was to investigate the effect of pes planus level on counter movement jump (CMJ) performance parameters in amateur female and male volleyball players. In this context, amateur volleyball players aged between 18 and 23 years actively playing in the university school volleyball team were included in the study. Pes planus levels of the participants were analyzed using the navicular drop test (NDT). My Jump Lab application was used for CMJ measurement. Within the scope of CMJ, the participants' jump height, force, relative force, power, relative power, average speed, take-off speed, impulse, and flying time were analyzed. According to the linear regression results between NDT and CMJ parameters, force in males (t = 12.93, P = .049) and average speed in females (t = -3.52, P = .017) were significantly associated with NDT. NDT was similar in men and women (P > .05). However, all CMJ parameters were highly different between genders (P < .001). In the correlation analysis between sport age and physical characteristics and CMJ parameters; height (r = .386, P = .046), weight (r = .569, P = .002), leg length (r = .389, P = .045), foot length (r =. 558, P = .005), foot width (r = .478, P = .018), force (r = .407, P = .039), impulse (r = .460, P = .018) parameters, and sport age. The results suggest that the average speed in females and force in males both significantly influenced NDT, highlighting the significance of both factors in predicting NDT scores. Moreover, all CMJ measures showed significant variations between genders, although the NDT scores did not. Furthermore, the correlation analysis demonstrated a strong correlation between a number of physical attributes and CMJ parameters, highlighting the multifaceted nature of athletic performance and indicating the possible impact of these attributes on CMJ results., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Based on the CheckMate 649 trial, nivolumab plus chemotherapy is the recommended first-line treatment for HER2-negative unresectable advanced or metastatic gastric, gastroesophageal junction (GEJ), or esophageal adenocarcinoma. This nationwide, multicenter, retrospective study evaluated the real-world effectiveness of this regimen in Turkish patients and identified subgroups that may experience superior outcomes. Conducted across 16 oncology centers in Turkey, this study retrospectively reviewed the clinical charts of adult patients diagnosed with HER2-negative unresectable advanced or metastatic gastric, GEJ, or esophageal adenocarcinoma from 2016 to 2023. This study included 111 patients (54 women, 57 men) with a median age of 58 years. The median progression-free survival (PFS) and overall survival (OS) were 11.7 months and 18.2 months, respectively, whereas the objective response rate (ORR) was 70.3%. Multivariable analyses revealed that previous curative surgery was a favorable independent prognostic factor for both PFS and OS. Conversely, an Eastern Cooperative Oncology Group performance status of 2 emerged as an adverse independent prognostic factor for OS. The safety profile of nivolumab plus chemotherapy was found to be manageable. Our findings support the use of nivolumab plus chemotherapy for the first-line treatment of Turkish patients with HER2-negative unresectable advanced or metastatic gastric, GEJ, or esophageal adenocarcinoma. Patient selection based on clinical characteristics is crucial for optimizing treatment outcomes.

Background & Aims: Prognostic factors of metastatic rectal cancer are not well known. We aim to determine prognostic factors affecting survival for metastatic rectal cancer patients and also to investigate the effect of tumor localization on overall survival., Methods: Metastatic rectal cancer patients who received treatment in 5 different centers between 2012 and 2022 were included. Prognostic factors for survival were evaluated using univariate and multivariate analysis. The statistical methods included Pearson's chi-square test, Fisher exact test, Log-rank test, and Cox regression model., Results: A total of 283 patients with metastatic rectal cancer were included in the study. The median OS was not significantly different among the three groups (upper rectum 30.1 months, middle rectum 28.3 months, and low rectum cancer 24.8 months; log-rank p = 0.25). In univariate analysis, Grade 3, ECOG performance status 2, the presence of multiple metastatic sites, the presence of KRAS mutation, the presence of liver metastases, the presence of nonregional lymph node metastases, and the presence of bone metastases were significant predictors of poor survival. In multivariate analysis, Grade 3, ECOG performance status 2, and the presence of multiple metastatic sites were determined as indicators of worse prognosis., Conclusion: Our findings, primary tumor location did not affect survival in metastatic rectal cancer. The most important factors affecting survival were multiple metastatic sites, tumor grade, and ECOG performance status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Unal, Akay, Semiz, Keser, Demir, Capar, Demirciler, Yavuzsen, Degirmencioglu, Demir, Oktay, Gulmez and Arayici.)

Mucolipidosis type-II (ML-II) is an ultra-rare disorder caused by deficiency of N-acetylglucosaminyl-1-phosphotransferase enzyme due to biallelic pathogenic variants in GNPTAB gene. There are a few known about the natural history of ML-II. In this study, we presented the natural course of 24 patients diagnosed with ML-II. Mean age at diagnosis was 9.3 ± 5.7 months. All patients had coarse face, developmental delay, and hypotonia. The mean survival time was 3.01 ± 1.4 years. The oldest patient was 6.5 years old. Twelve patients died due to lung infection and respiratory failure. We observed early and significant radiological findings of ML-II were different from typical dysostosis multiplex such as femoral cloaking, rickets-like changes, and talocalcaneal stippling. These are significant findings observed in the fetal or newborn period which is considered to be highly characteristic of ML-II and disappears in the first year. Cloaking, rickets-like changes, and stippling were not observed in patients older than three months of age and this suggests that these findings disappear within the first year. These radiological features can be used as important clues for diagnosis. We detected eight different pathogenic variants in GNPTAB gene, three of them were novel., (© 2024 Wiley Periodicals LLC.)

The sustainable development goals (SDGs) were established by the United Nations as an international call to eradicate poverty, safeguard the environment, and guarantee that everyone lives in peace and prosperity by 2030. The SDGs aim to balance growth and sustainability in three dimensions: social, economic and environmental. However, in the post-pandemic era, when resources for public development policies are scarce, nations face the problem of prioritizing which SDGs to pursue. A lack of agreement is one of the determinants of low performance levels of the SDGs, and multicriteria decision analysis tools can help in this task, which is especially relevant in developing countries that are falling behind in achieving the SDGs. To test the feasibility and appropriateness of one of these tools, the Fuzzy Logarithm Methodology of Additive Weights, we apply it to prioritize the SDGs in the Dominican Republic, to see if the priorities established are consistent. Seventeen experts were surveyed, and the main result was that Decent work and economic growth was the most important goal for the country. Our findings, consistent with the literature, show the path to similar applications in other developing countries to enhance performance levels in the achievement of the SDGs., (© 2024. The Author(s).)

Trace elements are cofactors in various enzymes in the antioxidant defense and cell homeostasis required in the tissue during inflammation. In acute kidney injury induced by lipopolysaccharide (LPS), renal cells are affected by cytotoxicity. Renal evacuation and gastrointestinal absorption rates are important in regulating plasma levels of trace elements. Simvastatin is a widely used anti-lipidemic drug with known anti-inflammatory effects. This study aimed to examine the effect of simvastatin on trace elements and electrolyte levels in kidney tissue in rats with LPS-induced sepsis. Adult male Wistar albino rats were divided into four groups: control, LPS (20 mg/kg, i.p., single dose), simvastatin (20 mg/kg, o.p., 5 days), and LPS + Simvastatin (LPS + Sim). Sodium, potassium, calcium, magnesium, selenium, zinc, copper, and histological structural changes were examined in kidney tissue samples 4 h after LPS execution. The inductively coupled plasma optical emission spectroscopy technique (ICP-OES) was used to determine the tissue trace element levels. In rats with sepsis-induced LPS, selenium, calcium, sodium, and magnesium levels significantly decreased while copper, potassium, and zinc levels significantly increased compared to other experimental groups. In sepsis treated with the simvastatin (LPS + Simvastatin) group, trace elements and electrolyte levels are like the control groups, apart from selenium levels. Selenium levels were significantly decreased in the LPS + Simvastatin group compared to the controls. As a result of examining the kidney tissues under a light microscope, simvastatin improved tissue damage caused by LPS-induced acute kidney injury. LPS-induced renal injury and simvastatin caused significant changes in the oxidant/antioxidant system. In septic rats, simvastatin was shown to balance some trace element levels, and it may improve damage in the kidney tissue., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Large amounts of collagen-rich by-products are generated in poultry processing. In particular, gelatin from the by-products of turkey processing is limited. Gelatin extraction from turkey and chicken MDRs (mechanically deboning residue) was the purpose of this study. Both materials were modified at the highest swelling pH for chemical denaturation of collagen and hot water extraction of gelatin was performed at the optimum temperature-time, which was determined to be pH 1.0 and 80°C-6 h, respectively. In these conditions, yields of 9.90% turkey gelatin (TG) and 13.85% chicken gelatin (CG) were produced. They demonstrated similar viscosity, gel strength, and lightness values of 72-73 g, 2.5-2.7 mPas, and 31, respectively. These results are close to those of bovine gelatin (BG). TG with 239.78 g Bloom exhibited higher strength than CG (225.27 g) and BG (220.00 g). The melting and gelation temperatures of CG and BG were 21 and 30°C, respectively, while those of TG were 19 and 28°C. Imino acids (proline + hydroxyproline) of TG (22.82%) were higher than those of CG (20.73%). Fourier transform infrared spectroscopy (FTIR) analysis revealed secondary structure and functional groups of CG and TG similar to those of BG. CG displayed a higher thermal transition temperature than BG, while TG exhibited the highest temperature sensitivity, according to the differential scanning calorimetry (DSC) analysis. In conclusion, TG showed higher potential for effective utilization with higher bloom and imino acids. Overall, turkey and chicken MDRs are a promising and potential alternative source to produce gelatin with comparable properties to bovine gelatin for intended food applications as well as for pharmaceutical and cosmetic fields., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: In recent years, the online gambling market has rapidly developed, and betting has become one of the most popular forms of gambling. The aim of this study was to analyse the interest of the Malawian population in terms related to betting, sports betting, alcohol, cigarettes, and some psychoactive drugs through the relative search volumes of Google Trends., Methods: Internet search query data related to betting, sports betting, alcohol, cigarettes, and psychoactive drugs were obtained monthly from Google Trends for the period 2010-2022. Comparisons of interest levels in these topics were conducted in Malawi, and correlation coefficients were calculated., Results: In Malawi, relative search volumes for betting and sports betting terms were the highest (average RSVs: 66% and 30%). It was found that from 2019 onwards, the interest in betting and sports-related search topics and keywords increased significantly (p < 0.001). Strong positive correlations were found between betting-related keywords and alcohol and gross domestic product (r = 0.831 and r = 0.901, p < 0.001). A positive correlation was found between betting and psychoactive drug-related terms (minimum r = 0.417, p < 0.01)., Conclusions: This study concludes that the interest of the Malawian population in betting has increased in recent years, while interest in psychoactive drugs and alcohol remains high. Gross domestic product is highly correlated with society's interest in betting. It was additionally found that Google Trends can be used as a tool to predict and monitor future risky behaviours, such as gambling disorder., Competing Interests: The authors has no relevant financial or non-financial interests to disclose., (© 2024 Kamuzu University of Health Sciences.)

Introduction: Physical activity (PA) promotion among school-aged youth is a global health priority. Recommendations for such promotion include implementing whole-of-school approaches that maximize resources across the school environment. This study examined schools' participation in an annual, government-led, and emirate-wide initiative in Dubai, called the Dubai Fitness Challenge, in which the goal is to accrue 30 minutes of PA every day for 30 days (as such, the initiative is colloquially referred to as "Dubai 30x30")., Methods: A mixed-methods design was employed for this study. Three schools were recruited using convenience sampling. Participants were 18 physical education teachers, 20 classroom teachers, 2 principals and 45 students. Data sources included surveys, focus groups, and interviews. Data were analyzed using descriptive statistics, multinomial logistic regression, and open and axial coding to develop themes., Results: School staff reported that most Dubai 30x30 activities were provided in physical education, at break times during school, and before and after school. Students reported that they mainly participated in Dubai 30x30 activities during physical education and occasionally participated in activities after school and on weekends. During school, students were more likely to reach higher PA intensity levels when they were in contexts other than the regular classroom setting. Among school staff, physical education teachers were most involved and classroom teachers were least involved in promoting Dubai 30x30. Parent engagement was high. Staff perceived that Dubai 30x30 brought the community together, but physical education teachers also indicated there was a lack of implementation guidance and they felt burdened. Participants believed Dubai 30x30 increased PA participation and helped to promote their schools., Discussion: This study provides an initial glimpse into schools' participation in Dubai 30x30 and suggests that a whole-of-school PA lens is useful in gleaning information that could help to increase and optimize PA opportunities for students., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 McMahon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Acne scar (AS) is a frequent sequela in patients with acne. In addition to advanced treatment methods, microneedling (MN) is still used as an effective option in the treatment of AS. However, similar to most diseases in dermatology, there is no objective tool to determine the severity of AS and to evaluate the treatment outcome., Objectives: In the current study, we aimed to evaluate skin elasticity in AS patients who have undergone MN therapy. Furthermore, other purposes were to determine the relationships between the history of isotretinoin use, demographic data, and changes in skin elasticity., Methods: In order to evaluate the skin elasticity of 20 patients with AS, shear wave elastography (SWE) was performed before and after MN treatment. The physician's clinical assessment was evaluated with quantitative AS severity scale. In order to show that SWE is a consistent method, three repeated measurements were performed on 24 healthy participants., Results: A significant increase was found between the shear-wave velocity (SWV) values that were measured baseline and after treatment in the patient group (P = 0.033). In the control group, there was no significant difference between the three repeated measurements (P > 0.05). A statistically significant decrease was also detected in the AS severity scores (P < 0.005)., Conclusions: In AS patients who underwent MN treatment, a significant increase was found in skin elasticity compared to the baseline. We argued that SWE is a method that can be useful to evaluate skin elasticity before and after similar cosmetic procedures and dermatological diseases., (© 2023 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Aims: The no-reflow phenomenon (NRP) is a common complication of saphenous vein graft (SVG) interventions. The aim of this study was to investigate the effect of the stress hyperglycemia ratio (SHR) on the development of NRP in patients with acute coronary syndrome (ACS) undergoing percutaneous SVG intervention., Methods: The study included 223 patients who presented at our center with ACS, had a history of coronary artery bypass graft and underwent a saphenous graft procedure. The relationship between SHR calculated at the time of presentation from glucose and HbA1c values, and the development of NRP evaluated after the procedure with angiography was determined with univariate and multivariate binary regression analysis., Result: The study population was separated into two groups as those who developed and did not develop NRP. Mean age was determined to be significantly higher in the group that did not develop NRP compared to the group with NRP (p: 0.004). Angiographically, the thrombus burden was determined to be significantly higher in the group that developed NRP (p < 0.001). Patients were separated into 3 tertiles according to the SHR level (T1, T2, T3), and the rate of NRP development was determined at a significantly higher rate in the T3 group (p < 0.001)., Conclusions: This study showed that SHR, a parameter that can be easily calculated noninvasively, is an independent predictor of NRP development in ACS patients undergoing saphenous interventions. In addition, high thrombus burden and predilatation before stenting were also found to be factors that increase the likelihood of developing NRP., (© 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Objective: We aimed to evaluate the effects of cardiopulmonary bypass (CPB) machines used in coronary artery bypass grafting surgeries on cerebral perfusion by performing cerebral oximetry monitoring [near-infrared spectroscopy (NIRS)], S100-β protein measurements, and neurocognitive function assessment tests using both pulsatile and non-pulsatile modes., Methods: A total of 44 patients, 22 non-pulsatile (Group NP) and 22 pulsatile (Group P), were included in the study. Hemodynamic parameters, arterial blood gas values, NIRS values and blood S100β protein levels were analyzed at five points: pre-induction (T1), initiation of CPB (T2), termination of CPB (T3), end of surgery (T4), and postoperative 24 h (T5). Two different neuropsychological tests were administered to patients in the preoperative and postoperative periods., Results: There were no significant differences between the groups for demographic characteristics such as age, gender, body mass index, aortic cross-clamping, CPB, and operation durations. The mean arterial blood pressure and PaO 2 values for the T2 measurements were significantly higher in group NP ( P < 0.05). Regional cerebral oxygen saturation (rSO 2 ) (NIRS) values at T3 and T4 were significantly higher in group P ( P < 0.05). Serum S100β measurement values at T3 and T5 were significantly higher in group NP than in group P ( P < 0.05). Serum S100β protein levels at T3 correlate with rSO 2 results. There was no statistically significant difference between the two groups in terms of pH, lactate, glucose, partial pressure of carbon dioxide, and peripheral oxygen saturation values., Conclusion: Despite no difference between the two groups for neurocognitive function tests, we believe that pulsatile perfusion may be more beneficial for cerebral perfusion when S100β protein and NIRS values are considered. Further clinical studies are needed to evaluate the benefits of the pulsatile technique for cerebral perfusion., Competing Interests: Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose., (©Copyright 2024 by the Turkish Anesthesiology and Reanimation Association / Turkish Journal of Anaesthesiology & Reanimation is published by Galenos Publishing House.)

Hereditary angioedema is a rare, potentially life-threatening disease. There is a lack of data describing the clinical course of hereditary angioedema (HAE) in children. We aimed to evaluate the clinical characteristics of pediatric patients with hereditary angioedema: The age of disease onset, age at diagnosis, the frequency of angioedema attacks, the total number of attacks before diagnosis, the regions where angioedema attacks were observed, accompanying abdominal pain, and serum levels of C4 and C1 esterase inhibitor were obtained and recorded. In addition, the results of SERPING1 (C1INH) gene sequence analysis of the patients in this group were also collected from medical records and recorded. While none of the patients reported a skin rash as a symptom of attack, there was formication observed in the region of angioedema in 46.9% (n = 15) of the patients and pruritus in 6.2% (n = 2) of the patients. At disease onset, the complaints of the patients regarding location of edema were on the hands of 32.3% (n = 10), on the feet of 9.7% (n = 3), on the faces of 25.7% (n = 8), and abdominal attacks in 32.3% of the patients (n = 10). Four different variants, one of which was novel, were detected in the SERPING1 gene in eight different families. The results of this study suggest that hereditary angioedema is diagnosed only when the patient requests examination following recurrent angioedema. Severe laryngeal edema attacks in patients without a diagnosis of HAE are fatal at a higher rate than attacks in patients with a diagnosis. Thus, awareness of the symptoms of HAE is necessary, and correct diagnosis is essential to proper treatment.

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life., Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered., Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18-89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10-48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440-5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128-1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034-1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 - 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084-1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004-1.041]; p = 0.014), were determined as factors affecting quality of life., Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background White blood cell count (WBC) and mean platelet volume (MPV) have been shown to be hematologic parameters of prognostic significance in acute coronary syndrome. We sought to determine the relationship between the WBC/MPV ratio (WMR), coronary artery disease (CAD) complexity, and long-term clinical outcomes in patients with non-ST elevation myocardial infarction (NSTEMI). Hypothesis WMR has a relationship with the complexity of CAD and long-term clinical outcomes in NSTEMI patients. Methods A total of 289 NSTEMI patients who underwent coronary angiography were divided into two groups according to the median WMR (>970 or ≤970). CAD complexity was assessed with the SYNTAX score. Results The WMR was not associated with the synergy between percutaneous coronary intervention (PCI) with Taxus and cardiac surgery (SYNTAX) score on multivariate linear regression analysis (ß=0.08, 95% CI = -0.76-2.21, p = 0.14). However, it was of prognostic significance on Kaplan-Meier survival analysis in overall patients (log-rank p = 0.03) and in patients with a SYNTAX Score <22 (log-rank p = 0.01). Follow-up data showed that major adverse cardiac events (MACE) (p = 0.02), death (p < 0.001), non-fatal MI (p = 0.03), ischemia-driven revascularization (p = 0.03), and heart failure (p = 0.04) were more frequent in the high WMR group. After adjustment for age, sex, eGFR, troponin levels, and the Global Registry of Acute Coronary Events (GRACE) score in Cox regression models, the association of high WMR with the cumulative incidence of MACE was preserved (overall patients (HR=1.85, 95% CI 1.1-3.12, p=0.02) and patients with a SYNTAX score <22 (HR=2.06, 95% CI 1.15-3.67, p=0.01). Conclusion The WMR was not related to CAD complexity, but it was associated with long-term clinical outcomes in patients with NSTEMI who underwent coronary angiography., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Demir et al.)

Background: Optic nerve sheath diameter (ONSD) measurement is a noninvasive method that can be used for intracranial pressure monitoring. Several studies have investigated normal ONSD values in children, but no general consensus has been reached yet., Objectives: The aim of our study was to reveal normal ONSD, eyeball transverse diameter (ETD), and ONSD/ETD values on brain computed tomography (CT) in healthy children aged 1 month to 18 years., Methods: Children admitted to the emergency department with minor head trauma and had normal brain CT were included in the study. The demographic characteristics of the patients (age and sex) were recorded, and the patients were divided into four age groups: 1 month to 2 years, 2 to 4 years, 4 to 10 years, and 10 to 18 years., Results: The images of 332 patients were analyzed. When the median values of all measurement parameters (right and left ONSD, ETD, and ONSD/ETD) were compared between the right and left eyes, no statistically significant differences were found. When the same parameters were compared according to age group, the ONSD and ETD values differed significantly (values of males were found to be higher), but the ONSD proximal/ETD and ONSD middle/ETD values did not differ significantly., Conclusion: In our study, normal ONSD, ETD, and ONSD/ETD values were determined according to age and sex in healthy children. As the ONSD/ETD index did not statistically significantly differ according to age and sex, diagnostic studies for traumatic brain injuries can be performed using the index., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Immunoskeletal dysplasia with neurodevelopmental abnormalities (ISDNA) caused by Exostosin-Like Glycosyltransferase 3 (EXTL3) biallelic mutations is a very rare syndrome with only 16 cases reported in the literature. Skeletal dysplasia, neurodevelopmental delay, immunodeficiency, liver, and kidney cysts are the most common findings of this syndrome. Case Presentation: Here, we report on a patient who exhibited a lethal phenotype with clinical characteristics of this syndrome and had a homozygous pathogenic mutation in EXTL3 gene. Conclusions: ISDNA should be kept in mind in the differential diagnosis of patients presenting with neuro-immuno-skeletal dysplasia phenotype.

Objective  To examine the relationship between nurses' sleep quality and their tendency to commit medical errors. Materials and Methods  The research was conducted in a state hospital, a private hospital, and a university hospital in a province located in the west region of Turkey (n = 378 nurses) between September 2020 and October 2021. Data was collected using a sociodemographic data form, the Medical Error Tendency Scale in Nursing (METSN), and the Pittsburgh Sleep Quality Index (PSQI). Verbal and written consent were obtained from the nurses who participated in the study. The data were collected through face-to-face interviews. Results  The mean score of the nurses was of 8.25 ± 4.81 on the PSQI and of 230.29 ± 14.15 on the METSN. A significant difference was found regarding age, marital status, level of schooling, weekly working hours, and the shift schedule of nurses and their sleep quality ( p  < 0.001). A significant difference was found regarding age, marital status, level of schooling, the hospital the nurses worked in, and the tendency to commit medical errors ( p  < 0.001). There was a statistically significant negative and moderate correlation between the PSQI and METSN scores ( p  < 0.001; r = -0.548). Conclusion  The tendency of nurses to commit medical errors was determined as low, and their sleep quality was poor. We have also determined that, as the sleep quality worsened, the tendency of nurses to commit medical errors increased., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

In this study, polyamide 6 (PA6)/thermoplastic elastomer (TPE) blends were prepared to decrease the notch sensitivity of PA6 for automotive applications, and the morphological, rheological, mechanical, and thermal properties of PA6/TPE blends, which are partially miscible or immiscible depending on the TPE ratio, were significantly improved in the existence of polyhedral oligomeric silsesquioxane (POSS) nanoparticles with multiple reactive epoxy groups as compatibilizers. An unstable phase morphology was obtained with the addition of TPE into PA6 without POSS nanoparticles, whereas interfacial interactions between phases in the presence of POSS were enhanced as a result of a significant decrease in the average particle size from 1.39 to 0.41 μm. The complex viscosity value of the 70PA6/30TPE blend, which was 20 kPa/s -1 at 0.1 rad/s angular frequency, reached 380 kPa/s -1 with the addition of POSS due to the formation of long chains by the generation of graft and/or block copolymers, which resulted in a 65% increase in Young's modulus value. Most notably, the Izod impact strength of pure PA6, which was 10 kJ/m 2 , increased by 290% with the incorporation of POSS. It was confirmed by FTIR analysis that the reactive multiple epoxy groups of MultEpPOSS and EPPOSS nanoparticles react with the proper groups of PA6 and/or TPE, and also, a partial hydrogen bonding interaction occurs between PA6-TPE from the shifting of N-H and carbonyl peaks. In conclusion, it can be suggested that POSS nanoparticles can serve as highly effective compatibilizers for PA6/TPE blends and have potential commercial applications, especially in the automotive sector., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Background: Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known., Objectives: The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process., Methods: The research was conducted in Antalya, one of the most populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care., Results: The mean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98., Conclusion: It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001)., Discussion: It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune, inflammatory disease of the central nervous system affecting the optic nerves and spinal cord. Most NMOSD patients have autoantibodies against the astrocyte water channel protein aquaporin-4 (AQP4). Eculizumab treatment is used effectively and safely in AQP4-IgG+ NMOSD. Our study evaluated the prognosis and outcomes of all clinical trial (PREVENT) patients from Turkey who received eculizumab treatment for AQP4-IgG+ NMOSD., Method: Clinical and demographic data of all patients enrolled in the PREVENT and OLE clinical trial in Turkey were analyzed during the study period and after the study ended. Clinical follow-up results were recorded in detail in patients who had to discontinue eculizumab treatment., Results: The study included 10 patients who participated in PREVENT and OLE. Seven patients completed the studies, three patients did not continue the study and were switched to other treatments. Only one of the seven patients was able to continue treatment after eculizumab was approved in AQP4-IgG+NMOSD. The other six patients could not continue treatment due to reimbursement conditions. Four of the six patients who could not continue eculizumab treatment experienced early relapse (within the first three months after stopping the drug). All of these patients had high disease activity before eculizumab and had never relapsed under eculizumab treatment over the long term., Conclusion: Eculizumab was used effectively and safely in Turkish AQP4-IgG+NMOSD patients with high disease activity. Disease reactivation and relapse may occur after discontinuation of eculizumab treatment in patients with a long-term stable course. In these cases, close monitoring for disease reactivation is recommended., Competing Interests: Declaration of Competing Interest S. Sen and A. Tuncer has received honoraria or consultancy fees for participating to advisory boards, giving educational lectures and/or travel and registration coverage for attending scientific congresses or symposia from F. Hoffmann-La Roche Ltd, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma. R. Karabudak has received honoraria for giving educational lectures, consultancy fees for participating advisory boards, and travel grants for attending scientific congresses or symposia from Roche, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma of Turkey, Abdi İbrahim İlac, Deva and ARIS. H. Efendi has received honoraria or consultancy fees for participating to advisory boards, giving educational lectures and/or travel and registration coverage for attending scientific congresses or symposia from F. Hoffmann-La Roche Ltd, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma of Turkey and Abdi İbrahim İlac. A Siva has received honoraria or consultancy fees for participating to advisory boards, giving educational lectures and/or travel and registration coverage for attending scientific congresses or symposia from F. Hoffmann-La Roche Ltd, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma of Turkey and Abdi İbrahim İlac. The rest of authors declares no conflict of interest with the study project., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The aim of the study is to determine the levels of death anxiety and death-related depression in the elderly during the COVID-19 pandemic. The sample of the descriptive-relational study includes 344 elderly people registered in a family health center. It was determined that the most dreaded fear reported by the elderly who got COVID-19 infection was death, and there was a highly significant positive correlation between death anxiety and death-related depression ratings of the elderly and that as the average death anxiety score of the elderly rises, so does the degree of death-related depression., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

High-calorie diet, alcohol, and multiple drug use increase reactive oxygen species (ROS) and cause liver damage. ROS are crucial in the initiation/progression of liver diseases. Antioxidants have beneficial effects but produce clinically complex results. The hydrogen sulfide (H 2 S) pathway is considered a promising therapeutic target since it plays role in the pathogenesis/treatment of liver diseases. Sildenafil exerts antioxidant and hepatoprotective effects by increasing specific antioxidants such as superoxide dismutase, glutathione peroxidase, and regulating the Keap1/Nrf2 pathway which are common mechanisms underlying the effects of H 2 S. We aimed to determine if H 2 S has a role in the hepatoprotective and antioxidant effects of sildenafil. The effect of sildenafil on endogenous H 2 S production was elucidated with an H 2 S microsensor in the presence/absence of pyrogallol-induced oxidative stress and H 2 S synthesis inhibitor aminoxyacetic acid (AOAA) in the liver. The relation between the antioxidant effect of sildenafil and H 2 S was determined by luminol and lucigenin chemiluminescence. Sildenafil increased L-cysteine-induced H 2 S synthesis in the healthy liver and prevented the pyrogallol-induced reduction in H 2 S production. Sildenafil decreased the ROS production induced by pyrogallol and its protective effect was inhibited by AOAA. These results reveal that H 2 S is a new pharmacological mechanism of action of sildenafil on the liver. Therefore, sildenafil can be a potential therapeutic agent in treating many liver diseases in which H 2 S bioavailability is impaired. Additionally, the hepatoprotective effect of sildenafil by increasing endogenous H 2 S synthesis advances our knowledge in terms of developing H 2 S-targeting molecules., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Antibiotic resistance is a global health threat. We urgently need better strategies to improve antibiotic use to combat antibiotic resistance. Currently, there are a limited number of antibiotics in the treatment repertoire of existing bacterial infections. Among them, rifampicin is a broad-spectrum antibiotic against various bacterial pathogens. However, during rifampicin exposure, the appearance of persisters or resisters decreases its efficacy. Hence, to benefit more from rifampicin, its current standard dosage might be reconsidered and explored using both computational tools and experimental or clinical studies. In this study, we present the mathematical relationship between the concentration of rifampicin and the growth and killing kinetics of Escherichia coli cells. We generated time-killing curves of E. coli cells in the presence of 4, 16, and 32 μg/mL rifampicin exposures. We specifically focused on the oscillations with decreasing amplitude over time in the growth and killing kinetics of rifampicin-exposed E. coli cells. We propose the solution form of a second-order linear differential equation for a damped oscillator to represent the mathematical relationship. We applied a nonlinear curve fitting solver to time-killing curve data to obtain the model parameters. The results show a high fitting accuracy., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Early detection of glycemic dysregulation and optimization of glycemic control at cystic fibrosis related diabetes (CFRD) is associated with improved pulmonary function and decreased mortality. The standard 2-hour oral glucose tolerance test (OGTT) is the current routine screening test for CFRD. However, hyperglycemia can be detected by continuous glucose monitoring systems (CGMS) in patients with normal OGTT evaluation. High-dose acarbose is an important alternative, in the treatment of glycemic dysregulation especially accompanied by hypoglycemia. A 7-year-old boy with cystic fibrosis (CF) presented with hyperglycemia. Hypoglycemia (29 mg/dL) and hyperglycemia (400 mg/dL) were demonstrated by OGTT and intermittent CGM (iCGMS). Thickener was added to nutritional solutions and acarbose was initiated as 3x12.5 mg /dose and increased to 6x25 mg without any side effects. On the 20th day of treatment, glycemic dysregulation was resolved. In the early detection of CFRD, screening with OGTT after the age of 10 is insufficient; therefore, routine use of continous or intermittent glucose monitoring systems should be considered. In addition, in CFRDs with severe hypoglycemia, acarbose is an important alternative in the high and increased dose range.

Objectives: This study aimed to evaluate parents' attitudes toward lumbar puncture (LP) for their children with suspected central nervous system infection to determine the reasons for rejection and related factors., Methods: The survey was provided to parents of children (1 month to 18 years old) for whom LP was recommended because of a concern for central nervous system infection. Sociodemographic characteristics and other related factors of parents who did and did not approve of LP were compared statistically. The reasons for the disapproval of parents who refused LP were revealed., Results: A total of 100 parents were included in the study. Eighty-two percent of the participating parents were mothers, and the median age of the mothers was 31 years (min: 17 years; max: 70 years). The median age of the fathers was 37 years (min: 22 years; max: 60 years). Among the parents, 34% did not give consent for LP. The most common reason for the participants to refuse LP was fear of paralysis of their children due to the procedure (82.3%). There was a statistical difference between the approval of the LP procedure and the person who informed the parents about the LP procedure and read the informed consent form ( P = 0.004 and P = 0.038, respectively).As a result of the binary logistic regression analysis, it was seen that the rate of acceptance of the LP procedure by the parents informed by the specialist doctors was 7.1-fold ( P = 0.02; 95% confidence interval, 1.3-37.6) higher than the parents informed by the resident physicians., Conclusion: The informed consent process mainly influenced parents' attitudes toward LP. To increase the acceptance rates of LP, we should standardize the informed consent process so that it is not affected by factors such as seniority of the physician., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Diabetic macular edema (DME) is the most common cause of visual deterioration in patients with diabetes mellitus. Various treatment options have been used for DME, including intravitreal injection of steroids and anti-vascular endothelial growth factors., Objectives: To evaluate and compare the functional and anatomical outcomes of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) treatments in patients with DME., Design: Retrospective study., Methods: Four hundred three eyes of 235 naïve patients who underwent IVR or IVA treatment for DME followed up to 36 months included in the study. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline, year 1, 2 and 3. Primary endpoint of the study was the change in BCVA and CMT each year from baseline and requirement of additional treatment (laser/steroid injection)., Results: There were 198 eyes in IVR group and 205 eyes in IVA group. The changes in mean BCVA were 0.09 ± 0.32 versus 0.17 ± 0.41 Logarithm of the minimum angle of resolution (logMAR) ( p  = 0.042) at year 1, 0.09 ± 0.37 versus 0.12 ± 0.45 logMAR ( p  = 0.512) at year 2 and 0.13 ± 0.36 versus 0.15 ± 0.48 logMAR ( p  = 0.824) at year 3 in IVA and IVR groups, respectively. The baseline mean BCVA were lower ( p  = 0.004) in IVA group. The mean total number of injections was 7.93 ± 3.38 versus 7.42 ± 3.05 ( p  = 0.112)., Conclusion: At year 1, change in mean BCVA was statistically significantly higher in IVA group; however this difference did not persist at years 2 and 3. Although the mean total number of injections was similar between groups, the requirement for adjuvant steroid treatment was significantly higher in ranibizumab group, which may affect the number of visits and treatment costs. Both ranibizumab and aflibercept treatments achieved a good long-term visual and anatomical response in DME patients., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2023.)

Objective: Diabetic ketoacidosis (DKA) is a life-threatening, acute complication of type 1 diabetes mellitus (T1DM). Infection is the most common precipitating factor for DKA, being responsible for more than 50% of such complications. The frequency and severity of DKA in children with T1DM, before and during the coronavirus disease 2019 outbreak were evaluated and compared with pre-pandemic presentation and severity rates., Methods: In total, 199 patients younger than 18 years were included in the study. Patients were divided into two groups: the Coronavirus disease-2019 (COVID-19) pandemic group (new onset T1DM presenting from March 2020 to March 2021; the control group included new onset T1DM from March 2016 to March 2020., Results: The rate of DKA at presentation was similar (p=0.393) during the pandemic period (58.3%) compared to the pre-pandemic years (44.8-64.3%). Although the percentage of DKA was similar, the rate of severe DKA in the COVID-19 group was higher than previous years. Although not significant, the duration of diabetes symptoms was longer in the COVID-19 period than the previous years., Conclusion: This study suggests that the rate of severe DKA, but not the overall rate of DKA, has increased during the COVID-19 pandemic compared to the prior four years. This may be due to the behavior of the parents of sick children and the limited access to the healthcare system. Despite this limited access, parental concern may have been sufficiently high to seek medical attention for their children, avoiding an increased frequency of DKA as the first presentation of new-onset T1DM.

An integrated approach to understanding all measured pollutants with multi-discipline in different time scales and understanding the mechanisms hidden under low air quality (AQ) conditions is essential for tackling potential air pollution issues. In this study, the air pollution of Sivas province was analyzed with meteorological and PM 2.5 data over six years to assess the city's AQ in terms of PM 2.5 pollution and analyze the effect of meteorological factors on it. It was found that the winter period (January-February-November-December) of every year except 2019-which has missing data-is the period with the highest air pollution in the province. In addition, the days exceeding the daily PM 2.5 limit values in 2016, 2017, 2020, and 2021 were also seen in the spring and summer months, which inclined the study to focus on additional pollutant sources such as long-range dust transport and road vehicles. The year 2017 has the highest values and was analyzed in detail. Pollution periods with the most increased episodes in 2018 were analyzed with the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) and Dust Regional Atmospheric Model (DREAM) models. As a result of the study, the average PM 2.5 values in 2017 were 31.66 ± 19.2 µg/m 3 and a correlation of -0.49 between temperature and PM 2.5 . As a result of model outputs, it was found that the inversion is intensely observed in the province, which is associated with an increase of PM 2.5 during the episodes. Dust transport from northwestern Iraq and northeastern Syria is observed, especially on days with daily average PM 2.5 values above 100 µg/m 3 . Additionally, planetary boundary layer (PBL) data analysis with PM pollution revealed a significant negative correlation (r = -0.61). Air pollutants, particularly PM 2.5 , were found to be higher during lower PBL levels., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)