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Abstract The coronavirus disease 2019 pandemic had a major impact on most medical services. Our aim was to assess the outcome of acute cholecystitis during the nationwide lockdown period. All patients admitted to our emergency department for AC were analysed. Patient characteristics, performance status, AC severity, treatment modality and outcome of AC were assessed during the lockdown period (Period II: 1 April 2020–30 November 2021) and compared to a historical control period (Period I: 1 May 2017–31 December 2018). AC admissions increased by 72.8% in Period II. Patients were younger (70 vs. 74 years, p = 0.017) and greater in number in the CCI 1 group (20.4% vs. 11.2%, p = 0.043) in Period II. The unplanned readmission rate (6.3 vs. 0%, p = 0.004) and the gallbladder perforation (GP) rate was higher (18.0 vs. 7.3%, p = 0.006) in Period II. Percutaneous transhepatic gallbladder drainage (PTGBD) was more frequent (24.1 vs. 12.8%, p = 0.012) in Period II. In addition to a drop in patient age and CCI, a significant rise in the prevalence of acute cholecystitis, GP and unplanned readmissions was observed during the nationwide lockdown due to the COVID-19 pandemic. PTGBD was more frequent during this period, whereas successful conservative treatment was less frequent.

This study presents an incubation experiment that investigates the effects of adding composted and uncomposted gyttja on a clayey soil’s structural stability and other properties. For this purpose, 3% (w/w) of the composted and uncomposted gyttja was added to pots with and without grass pea (Lathyrus sativus L.) seeds and incubated for nine months under greenhouse conditions. In the third, sixth, and ninth months of the experiment, soil samples were tested. The results show that the time elapsed during the incubation period greatly affected the physical (average weighted diameter, aggregate stability, and volume weight) and chemical (pH, EC, organic matter, N, P, K, Ca, Mg, and Na) properties of the soil. The input of composted and uncomposted gyttja caused significant changes in soil properties, but these were less pronounced in soils with composted gyttja. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine tumors (PNETs) are rare forms of pancreatic malignancies which are classified according to functionality. Coexistence of two functional PNETs is extremely rare, but case reports are encountered in the literature. We present a 23-year-old male patient who was referred for recurrent hypoglycemic symptoms while investigating for pituitary adenoma. In addition to overt hypoglycemia, the patient's laboratory examination was compatible with primary hyperparathyroidism, hyperprolactinemia and acromegaly. Prolonged fasting test revealed hypoglycemia due to endogenous hyperinsulinism. Multiple hypodense mass lesions in the tail and body of pancreas were detected on the computed tomography scan. After surgical excision of these lesions, histopathologic examination of the specimens showed a grade 1 NET, which was positive for glucagon and chromogranin, negative for insulin. Histopathologic and immunostaining evaluation suggested that there were two pancreatic NETs with different characteristics. The patient was diagnosed as multiple endocrine neoplasia type-1 (MEN-1) syndrome due to clinical coexistence of the all 3 components, family history and genetic confirmation (frameshift mutation in MEN1 gene due to pathogenic deletion). After the operation, hypoglycemic symptoms were ameliorated. After 9 years of lost to follow-up period, the patient admitted to the emergency Department with complaints of nausea, vomiting and abdominal pain. In the evaluation of patient, recurrences of hyperparathyroidism, pituitary adenoma and PNET were observed. Coexistence of insulinoma and glucagonoma is a rare condition and the underlying physiopathological mechanisms have not been fully understood. However, it is important to note that two simultaneous functional tumors may coexist in PNETs associated with MEN-1 syndrome.

A technology to improve the tribological and mechanical surface properties of iron alloys is developed based on the electroless nickel plating. The technology combines sol-gel and electroless deposition technique. Novel nanocomposite coatings are obtained consisting of Nickel-phosphorus-nanodiamond (Ni-P-ND). The ND sol is added directly to the electroless Ni-P solution. A suitable surfactant is added to achieve well-dispersed ND particles in the electroless solution to facilitate their embodiment and equal distribution in the coating. Substrates of steel 17CrNiMo6 and spheroidal graphite cast irons are used for the manufacture of the iron alloys specimens. The surface morphology and microstructure observation performed by scanning electron microscopy (SEM) and optical metallography confirms the influence of ND particles on the coating structure. The structural phase investigation by X Ray analysis indicates a transformation of the amorphous phase to a crystalline one such as Ni, Ni3P after coatings' heat treatment. The microhardness investigation by Knoop Method and wear resistance measurement in accordance with the Polish Standard PN-83/H-04302 of Ni-P and Ni-P-ND composite coatings are evaluated and compared with each other. The increase in the value of hardness and wear resistance of Ni-P composite coatings in the presence of ND particles and after heat treatment is obtained.

The tribological characteristics of spheroidal graphite cast irons with and without nanosized additives are investigated. The tests are performed as in cast iron condition as well after austempering. The spheroidal graphite irons are undergone to austempering in the bainite field, including heating at 900 °С for an hour, after that isothermal retention at 280 °С, 2 h and at 380 °C, 2 h. The lower bainitic and upper bainitic structures are formed during the process. Nanosized additives of titanium carbonitride and titanium nitride TiCN+TiN influence on the graphite phase characteristics and on the microstructure of the cast and austempered spheroidal graphite irons. The changes in the micro structure the irons with nanoadditives lead to an abrasive wear resistance increase. The formation of the strain induced martensite from the retained austenite in the friction contact area during wear is determined in the austempered irons. This is the reason for the wear resistance increase of the irons. The experimental testing of the wear is carried out by cinematic scheme tapper-discunder friction on the fixed abrasive. The microstructure of the patterns is observed by optical and quantitative metallography, X-Ray analysis, SEM and EDX analysis. The hardness testing is performed by Brinnel and Vickers methods.

This study was carried out to compare the most relevant biological characteristics and field resistance to economically important diseases of the new (Zlatka and Pozna Plava) and standard plum cultivars (Čačanska Lepotica and Čačanska Rodna) in the Region of Čačak. The experimental area climate belongs to the temperate type. The mean annual air temperature during the experimental period was 12.65°C, and humidity was 80.4%. The average annual rainfall was 571.2 mm. The ripening time of the cv. Zlatka occurred between August 3-23, while the cv. Pozna Plava ripened between August 26-September 25. Compared to cv. Čačanska Lepotica, cv. Zlatka had a significantly lower mean fruit weight, reducing sugars and total acids content, but a significantly higher proportion of flesh, yield and sucrose content. Compared to cv. Čačanska Rodna as the standard cultivar, cv. Pozna Plava had a significantly higher mean individual fruit weight and total acids content, but also a significantly lower orchard yield and sweetness measured as fruit soluble solids, total sugars, reducing sugars and sucrose content. As regards the field resistance to economically important diseases such as red leaf spot, rust, fruit root, pockets plum disease and sharka disease, both new cultivars demonstrated better results than the reference cultivars.

Evaluation was performed of the effect made by integrated and conventional production systems on phenolic composition and antioxidant capacity of cv. Senga Sengana strawberry grown under greenhouse conditions over two consecutive years. The experiment also involved three different types of fertilizer. The integrated production system provides significantly larger quantities of polyphenols as well as a higher antioxidant capacity, compared to values obtained using the conventional system. The investigation into total phenolics content and total antioxidant capacity, as well as individual flavonols and phenolic acids (except gallic acid) content reveals a pronounced effect of the applied biofertilizers (PGPR 1 and PGPR 2). On the other hand, applied chemical fertilizer (Multi KMg) gives the best results in terms of anthocyanins content. These results indicate that there were significant differences in phenols content among integrated and conventional production systems, as well as between biofertilizers and a chemical fertilizer.

Spherical cap shaped liquid crystal drops have potential for use in tunable multifocal optical lenses. To achieve this, one needs to understand the liquid crystal director structure in various external fields. We present detailed experimental and theoretical studies of the director structure in magnetic fields of less than 1 mm diameter nematic liquid crystal drops on glass surfaces (x-y plane), forming spherical cap shape with average molecular directions initially perpendicular to the boundaries. We show that at sufficiently high magnetic fields a Néel wall-type metastable inversion wall forms in the middle of the drop and then moves outward when the field is applied in x direction. Applying fields above a critical angle between the plate of the spherical cap and the magnetic field, a uniform director structure forms. Drops with uniform director structure can be used as tunable optical lenses, where the focal length can be controlled by light polarization, viewing angle, magnetic, or electric fields. We also propose a theory that explains the texture variation in small magnetic fields and accounts for the formation and motion of the inversion wall. The theory explains the physical origin of the movement and gives the right magnitude of the speed at the first 10–15 min of the motion.

Raspberry (Rubus idaeus L.) cultivar Willamette has long been the most commonly grown raspberry cultivar in Serbia, which is owing to high adaptability of the cultivar to respective agro-environmental conditions. Massive dieback of full bearing plantings is a major problem in raspberry growing hence quality planting material is a must when establishing new raspberry plantings. The study was conducted under protected conditions (in screenhouse) on plants obtained by micropropagation in vitro. In order to achieve optimal vegetative potential, plants were grown for two consecutive years (2004-2005) on two substrates (Steckmedium and Seedling) using three foliar fertilizers (Wuxal, Murtonik and Ferticare). The study revealed optimal vegetative growth in plants studied, excess manganese (150.60-214.52 mg/g), optimum iron content (94.00-123.50 mg/g), and zinc (28.60-31.00 mg/g) and copper (3.10-4.00 mg/g) deficiencies, based on the referent values of microelements content. The assessment of nutritional status of plants by the DOP index suggested significant differences in microelements imbalance when different foliar fertilizers and substrates are applied.

Biogas is a renewable energy resource with high increasing developed in last few decades. It’s big opportunity for stabilization rural areas, concretely agriculture sector. This technology can decentralize supply of energy. The number of operated biogas plants is rapidly increasing. Biogas plants require a high level of intensity and stableness of the process of anaerobic fermentation with biogas production for efficiency treatment, also for good quality of development biogas and fertilization effect of the rest of fermentation. If this is not completed the operator has problem to keep the process in optimal condition for anaerobic fermentation. Researchers have tried different techniques to enhance biogas production. In order to achieve the aforementioned state, it is essential to ensure increased activity of microorganisms that contribute to the anaerobic fermentation. The metabolic activity of microorganisms is preconditioned by availability of easily decomposable solids. Adding of bacterial and enzymatic cultures into a fermented substrate represents one of the possibilities. The enzymes contained in this preparation are responsible for better exposing methanogenic bacteria to the material. The tested bio-enzymatic preparation, APD BIO GAS, is a mixture that contains bacteria and enzymes which are essential for the efficient progress of anaerobic fermentation. The reference biogas laboratory of the Mendel University in Brno was used for the purpose of testing of APD BIOGAS in mesophilic conditions of anaerobic fermentation on a substrate consisting of a mixture of maize silage and liquid manure. The producer of this preparation declare enhancement of quality and quantity of developed biogas, elimination of smell level of the rest of fermentation its higher homogenity. For the test were used lab scale fermenters of batch type with work volume 0.12 m3. An increase of biogas production by 15% was determined in connection with addition of the preparation, also with higher decrease of total solids and decrease of organic substance in total solids in the fermenter where were used this preparation.

Numerous gold alloys posses the ability for thermal hardening, and this property is attractive for improving jewels strength, because the most noble alloys are weak. The thermal treating below the recrystallization temperature, is kind of tempering but also age-hardening. In this paper is made an attempt for studying the possibility for thermal hardening of 585 golden alloy. The goal is to increase the mechanical properties. Those demands could be reached by metallurgical controlling of phase transformations аnd proper thermal treating. Here is studied behavior of quenched and cold deformed gold alloy 585 after tempering/ageing in temperature region 50 - 600 °C, in intervals of 50 °C. The highest hardness values are obtained at temperatures about 200 °C for both initial states.

Scorpions can be considered living fossils because they have changed so little during the last 400 million years. They are venomous arthropods of the Arachnida class and regarded as relatives of spiders, ticks and mites. The aim of the present study was to evaluate the toxicity of Androctonus crassicauda (Olivier, 1807) venom and its effects on the acetylcholinesterase (AchE) activity and on electrolytes levels in rats. Animals were divided into seven groups of five rats each. Test groups received 250µg/kg of venom solution while control group was treated with 200µl of physiological saline solution (PSS). Blood samples were collected from the animals on the 1st, 2nd 4th, 8th, 12th, and 24th hours after subcutaneous injection of venom. Animals were monitored for 24 hours. Androctonus crassicauda venom significantly reduced AchE activity on the 12th hour when compared with control group. A statistically negative correlation between Na+ and K+ (p

Thalassemia intermedia (TI) is a heterogeneous disease, in terms of both clinical manifestations and underlying molecular defects. Some TI patients are asymptomatic until adult life, whereas others are symptomatic from early childhood. In contrast with patients with Thalassemia major (TM), the severity of anemia is less and the patients do not require transfusions during at least the first few years of life. Many patients with TI, especially older ones, have been exposed to the multiple long-term effects of chronic anemia and tissue hypoxia and their compensatory reactions, including enhanced erythropoiesis and increased iron absorption. Bone marrow expansion and extramedullary hematopoiesis lead to bone deformities and liver and spleen enlargement. Therapeutic strategies in TI are not clear and different criteria are used to decide the initiation of transfusion and chelation therapy, modulation of fetal hemoglobin production, and hematopoietic stem cell transplantation on an individual basis. The clinical picture of well-treated TM patients with regular transfusionchelation therapy is better from TI patients who have not received adequate transfusion therapy. There is a significant role of early blood transfusion to prevent and treat complications commonly associated with TI, such as extramedullary erythropoiesis and bone deformities, autoimmune hemolytic anemia, leg ulcers, gallstones, pseudoxantoma elasticum, hyperuricosuria, gout and pulmonary hypertension, which are rarely seen in thalassemia major. Nowadays, indications of transfusion in patients with TI are chronic anemia (Hb < 7 g/dL), bone deformities, growth failure, extramedullary erythropoiesis, heart failure, pregnancy and preparation for surgical procedures. Conclusion: Adequate (regular or tailored) transfusion therapy is an important treatment modality for increasing the quality of life in patients with thalassemia intermedia during childhood. 就临床表象和潜在的分子缺陷而言，中间型地中海贫血(TI) 是一种混杂疾病。 有些中间型地中海贫血患者为无症状，直到成年，而其他的患者则是在儿童早期就表现出症状。 和重型地中海贫血患者相比，贫血的严重程度更低，至少在生命最初的几年，患者不需要输血。 患中间型地中海贫血的患者，尤其是年龄较大的患者，受到慢性贫血和组织缺氧以及其代偿反应的多次长期影响，代偿反应包括增强的红血球生成和增加的铁吸收。 骨髓扩张和髓外造血导致骨畸形和肝脾肿大。 中间型地中海贫血的治疗方法还不清楚，不同的标准用于决定启动输血和螯合治疗、调制生产胎儿血红蛋白和基于个别基础上移植造血干细胞。 受到良好的常规输血螯合治疗的重型地中海贫血患者临床表现要好于没有接受到足够的输血治疗的中型地中海贫血患者。 早期输血对阻止和治疗中型地中海贫血并发症具有重要作用，如：髓外血红球生成与骨畸形、自身免疫性溶血性贫血、腿部溃疡、胆结石、弹性假黄色瘤、高尿酸血、痛风和肺动脉高血压，这些在重型地中海贫血中极为罕见。 如今，中间型地中海贫血患者输血的适应症为慢性贫血（血红蛋白< 7 g/dL）、骨畸形、成长失败、髓外红血球生成、心脏衰竭、妊娠、以及外科手术准备。 结论： 充足的（常规的或定制的）输血治疗是提高中间型地中海贫血患者童年时期生命质量的重要治疗方法。

This study is providing key information on the agricultural situation in Turkey and the role of women for sustainable agriculture. Also it is mainly attempts to provide an objective analysis of capacity development and strengthening women role in agricultural organization in Turkey. The study has been prepared mainly based on statistical information from Eurostat, OECD and State Institute of Statistics (SIS) in Turkey, as available in October 2007.

ABSTRACT The present study investigated the seroprevalance of Visna Maedi Virus (VMV) and Border Disease Virus (BDV) infections in sheeps in regions in and around Van province, Turkey. Sample materials were taken from 360 sheep sent to slaughterhouses around Van. All serum samples were examined using ELISA for antibodies for Visna Maedi (VMV) and Border Disease (BDV) viruses. Of these, 38 (10.5%) tested positive for Visna Maedi virus antibodies and 163 (45.2%) for Border Disease virus antibodies. Varying numbers of samples were positive for both virus antibodies across the towns of Erciş, Çaldıran, Erçek and Başkale in Van, Ağrı and Hakkari provinces. Both infections should be eliminated by informing veterinarians and animal owners, identifying and eliminating persistently infected animals from flocks, and conducting appropriate eradication measures. Economic support should be provided for this.

Background and Objective: Saliva has been proposed as a potential more convenient, cost-effective, and easier sample for diagnosing SARS-CoV-2 infections, but there is limited knowledge of the impact of saliva volumes and stages of infection on its sensitivity and specificity., Methods: In this study, we assessed the performance of SARS-CoV-2 testing in 171 saliva samples from 52 mostly mildly symptomatic patients (aged 18 to 70 years) with a positive reference standard result at screening. The samples were collected at different volumes (50, 100, 300, and 500 µl of saliva) and at different stages of the disease (at enrollment, day 7, 14, and 28 post SARS-CoV-2 diagnosis). Imperfect nasopharyngeal (NP) swab nucleic acid amplification testing was used as a reference. We used a logistic regression with generalized estimating equations to estimate sensitivity, specificity, PPV, and NPV, accounting for the correlation between repeated observations., Results: The sensitivity and specificity values were consistent across saliva volumes. The sensitivity of saliva samples ranged from 70.2% (95% CI, 49.3-85.0%) for 100 μl to 81.0% (95% CI, 51.9-94.4%) for 300 μl of saliva collected. The specificity values ranged between 75.8% (95% CI, 55.0-88.9%) for 50 μl and 78.8% (95% CI, 63.2-88.9%) for 100 μl saliva compared to NP swab samples. The overall percentage of positive results in NP swabs and saliva specimens remained comparable throughout the study visits. We observed no significant difference in cycle number values between saliva and NP swab specimens, irrespective of saliva volume tested., Conclusions: The saliva collection offers a promising approach for population-based testing., (© 2024. The Author(s).)

Purpose: To assess how living with patients with acromegaly affects people's psychology and quality of life (QoL)., Methods: Acromegaly patients and their cohabitants included in this study. Patients were administered Acromegaly Quality of Life Questionnaire (AcroQoL), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Cohabitants were administered quality of life questionnaire (SF-36), BAI, BDI, and Zarit Caregiver Burden Interview (ZBI)., Results: This study included 84 patients with acromegaly and 84 cohabitants. Sixty-nine patients (n = 84, 82.1%) had an acromegalic appearance. Cohabitants who were affected by the acromegalic appearance had higher BAI, BDI, and ZBI scores than those who were not affected (p < 0.001 for all). Cohabitants who were affected by the acromegalic appearance had a significantly lower SF-36 score (p = 0.015). The BAI (r=-0.535, p < 0.001), BDI (r=-0.592, p < 0.001), and ZBI (r=-0.465, p < 0.001) scores of the cohabitants showed a negative correlation with AcroQoL. SF-36 scores showed correlation with AcroQoL (r = 0.387, p < 0.001)., Conclusion: The chronic process of acromegaly and the external appearance of patients with this disease can negatively affect both the patients and the people living with them. Physicians being aware of this effect and taking counteractive measures may contribute positively to the course of acromegaly., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: This study aimed to develop machine learning (ML) algorithms for the differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS) based on biochemical and radiological features., Methods: Logistic regression algorithms were used for ML, and the area under the receiver operating characteristics curve (AUROC) was used to measure performance. We used Shapley Contributed Comments (SHAP) values, which help explain the results of the ML models to identify the meaning of each feature and facilitate interpretation., Results: A total of 106 patients, 80 with Cushing's disease (CD) and 26 with ectopic ACTH syndrome (EAS), were enrolled in the study. The ML task was created to classify patients with ACTH-dependent CS into CD and EAS. The average AUROC value obtained in the cross-validation of the logistic regression model created for the classification task was 0.850. The diagnostic accuracy of the algorithm was 86%. The SHAP values indicated that the most important determinants for the model were the 2-day 2-mg dexamethasone suppression test, the > 50% suppression in the 8-mg high-dose dexamethasone test, late-night salivary cortisol, and the diameter of the pituitary adenoma. We have also made our algorithm available to all clinicians via a user-friendly interface., Conclusion: ML algorithms have the potential to serve as an alternative decision support tool to invasive procedures in the differential diagnosis of ACTH-dependent CS., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aim: To investigate the relationship of serum lipoprotein(a) [Lp(a)] and other serum lipids with presence of Graves' ophthalmopathy (GO). Methods: A total of 99 consecutive patients diagnosed with Graves' disease (GD), aged 18-65 years, who had not received prior treatment for GO, thyroid surgery, or radioactive iodine therapy, were recruited between June 2020 and July 2022. In addition, 56 healthy controls (HCs) were included as the control group. All patients underwent an ophthalmological examination, and were classified based on the presence of GO into the GO group ( n  = 45) and no GO group ( n  = 54). Fasting blood samples were collected from all participants to analyze serum lipid parameters, including Lp(a), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Results: The median serum levels of Lp(a) were 5.7 [4.3-9.2] in the GO group, 6.7 [3.7-9.9] in the no GO group, and 4.7 [3-7.6] in the HC group. The intergroup comparisons of serum Lp(a) levels showed no significant result. The serum levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were also similar between the groups ( P  > 0.05 for all). However, when analyzing only euthyroid GD patients and the control group, the serum LDL cholesterol levels were found to be significantly higher in the euthyroid GO group [median: 132 interquartile range (IQR) (110-148) mg/dL] than in the HCs [median: 96 IQR (94-118) mg/dL] ( P  = 0.002). Conclusion: The findings of our study did not support the association between serum Lp(a) levels and GO.

Aim: To investigate the autoimmune and genetic relationship between primary hypophysitis (PH) and celiac disease (CD)., Methods: The study was retrospective and patients with PH followed in our clinic between 2007 and 2022 were evaluated. Clinical, endocrinologic, pathologic, and radiologic findings and treatment modalities were assessed. Patients diagnosed with CD in the Gastroenterology outpatient clinic in 2020-2022 were included in the study as a control group. Information such as sociodemographic data, year of diagnosis, human leukocyte antigen (HLA) DQ2/8 information, CD-specific antibody levels, pathologic results of duodenal biopsy, treatment received, follow-up status, additional diseases, hormone use, and surgical history was obtained from patient records at PH.In patients diagnosed with PH, a duodenal biopsy was obtained, and the tissue was examined for CD by experienced pathologists. Anti-pituitary antibody (APA) and anti-arginine-vasopressin (AAVP) antibody levels of individuals with PH and CD were measured., Results: The study included 19 patients with lymphocytic hypophysitis, 30 celiac patients, and 30 healthy controls. When patients diagnosed with lymphocytic hypophysitis were examined by duodenal biopsy, no evidence of CD was found in the pathologic findings. The detection rate of HLA-DQ2/8 was 80% in celiac patients and 42% in PH (p=0.044). (APA and AAVP antibodies associated with PH were tested in two separate groups of patients and in the control group. APA and anti-arginine vasopressin (AAVP) levels in PH, CD and healthy controls, respectively M [IQR]: 542 [178-607];164 [125-243]; 82 [74-107] ng/dL (p=0.001), 174 [52-218]; 60 [47-82]; 59 [48-76] ng/dL (p=0.008) were detected. The presence of an HLA-DQ2/8 haplotype correlates with posterior hypophysitis and panhypophysitis (r=0.598, p=0.04 and r=0.657, p=0.02, respectively)., Conclusion: Although patients with PH were found to have significant levels of HLA-DQ2/8, no CD was found in the tissue. Higher levels of pituitary antibodies were detected in celiac patients compared with healthy controls, but no hypophysitis clinic was observed at follow-up. Although these findings suggest that the two diseases may share a common genetic and autoimmune basis, the development of the disease may be partially explained by exposure to environmental factors., Competing Interests: The authors have no conflicts of interest to declare., (Thieme. All rights reserved.)

In this study, we aimed to reveal the pro-inflammatory effects of serum 25-hydroxyvitamin D3 (Vit D) deficiency and insufficiency in new-onset type 2 diabetes mellitus (T2DM) and prediabetes. We recruited 84 prediabetes patients, 94 new-onset T2DM patients and 113 healthy participants. We measured the levels of C-reactive protein (CRP), fibrinogen, ferritin, interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) in the serum of the participants. ANOVA Bonferroni and Kruskal-Wallis Dunn tests were used to compare the inflammation markers and vitamin D levels between the groups. Based on covariance analysis with age, gender and BMI, the Vit D levels of the T2DM group were significantly lower ( p < 0.003). Pro-inflammatory markers and CRP were significantly higher in prediabetic and diabetic subjects. In the prediabetes group, IL-1β, IL-6, IL-8, TNF-α and MAPK were significantly higher in those with Vit D insufficiency and deficiency groups. In the T2DM group, IL-1β, IL-6, IL-8, TNF-α, NF-κB, MAPK and CRP were significantly higher in those with Vit D insufficiency and deficiency. Our study emphasizes the pro-inflammatory effects of Vit D deficiency and insufficiency in new-onset type 2 diabetes mellitus and prediabetes.

Purpose: This study aimed to investigate the long-term effects of radioiodine treatment (RAI) on blood cell counts in patients with differentiated thyroid cancer (DTC) and to describe the characteristics of patients at high risk for blood cell count abnormalities., Methods: The study included patients with DTC who underwent RAI treatment between 2007 and 2017. Patients with regular complete blood counts for at least 5 years were included, while those with diseases or treatments that could influence blood count parameters were excluded. Blood cell count abnormalities were defined according to the Common Terminology Criteria for Adverse Events version 5.0, and factors influencing these abnormalities were examined., Results: A total of 225 patients were analyzed. The mean age at diagnosis was 45.8 ± 13.9 years, and 76.5% of patients were female. In the first year after RAI, leukocyte, neutrophil, and lymphocyte counts were significantly reduced compared with baseline values. The leukocyte and neutrophil counts returned to baseline values by the third year, while the decrease in lymphocytes continued until the fifth year. Blood cell count abnormalities developed in 16 patients (7.1%) within the first year after RAI. Risk factors for blood cell count abnormalities within the first year after RAI included male sex, older age, T4, N1, and M1 disease, as well as higher RAI doses. In logistic regression analysis, only RAI dose remained independently associated with blood cell count abnormalities., Conclusion: These results suggest an association between RAI dose and blood cell count abnormalities, characterized by mild lymphopenia, and indicate that the risk of mild lymphopenia persists over time. Careful consideration should be given when planning high-dose RAI for patients at a high risk of blood cell count abnormalities, such as males with metastatic disease and of advanced age., (© 2023. The Author(s), under exclusive licence to Hellenic Endocrine Society.)

Objective: Investigate the changes in the characteristics of presentation, in patients with acromegaly over a period of approximately half a century., Methods: The medical records of patients diagnosed with acromegaly between 1980 and 2023 were retrospectively reviewed. The collected data were examined to assess any changes observed over the years and a comparison was made between the characteristics of patients diagnosed in the last decade and those diagnosed in previous years., Results: A total of 570 patients were included in the study, 210 (37%) patients were diagnosed in the last decade. Patients diagnosed before 2014 had longer symptom duration before diagnosis, advanced age, larger pituitary adenomas, higher incidence of cavernous sinus invasion, and higher GH and IGF-1 levels than those diagnosed last decade (p < 0.05, for all). Furthermore, the patients diagnosed before 2014 had a lower rate of surgical remission (p < 0.001), and a higher prevalence of comorbidities such as diabetes, hypertension, colon polyps, and thyroid cancer at the time of diagnosis (p < 0.05, for all)., Conclusion: There may be a trend for earlier detection of patients with acromegaly., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To investigate the prevalence of microalbuminuria and factors associated with microalbuminuria in Graves' Disease (GD)., Methods: This cross-sectional and single-center study included 99 patients with GD and 47 healthy controls (HC). Exclusion criteria such as active infection, uncontrolled diabetes, and chronic kidney disease were applied to the participants. The participants' clinical findings, comorbidities, drug use, laboratory tests, and thyroid antibody levels were recorded. Spot urine samples were collected and stored at - 80 ℃ to analyze the presence of microalbuminuria., Results: The prevalence of microalbuminuria in patients with GD was 12.1%. The median microalbumin/creatinine ratio in spot urine (UACR) in patients with GD (9.49 mg/g [5.09-18.10]) was higher than in the HC group (7.99 mg/g [3.48-12.88], p = 0.033). UACR was correlated with thyroid-stimulating hormone receptor antibody (TRAb), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT3) levels (p = 0.020, p = 0.006, p = 0.009 respectively). In the regression analysis, only the relationship between TRAb level and UACR remained (p = 0.040)., Conclusion: This study demonstrates an increased prevalence of microalbuminuria in patients with GD. There was a significant correlation between microalbuminuria and TRAb level in patients with GD. This relationship suggests that one of the underlying mechanisms of microalbuminuria seen in patients with GD may be autoimmunity., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

The etiopathogenesis of metabolic syndrome (MetS) has not been fully understood yet, and chronic low-grade inflammation is thought to be associated with the development of complications related to MetS. We aimed to investigate the role of Nuclear factor Kappa B ( NF-κB ), Peroxisome Proliferator-Activated Receptor- α and γ (PPAR-α, and PPAR-γ) which are the main markers of inflammation in older adults with MetS. A total of 269 patients aged≥18, 188 patients with MetS who met the diagnostic criteria of the International Diabetes Federation, and 81 controls who applied to geriatrics and general internal medicine outpatient clinics for various reasons were included in the study. Patients were separated into four groups: young with MetS (< 60, n=76), elderly with MetS (≥60, n=96), young control (< 60, n=31), elderly controls (≥60, n=38). Carotid intima-media thickness (CIMT) and NF-κB , PPAR-α, and PPAR-γ plasma levels were measured in all of the participants. Age and sex distribution were similar between MetS and control groups. C-reactive protein (CRP), NF-κB levels (p=0.001) and CIMT (p<0,001) of MetS group were significantly higher than in the control groups. On the other hand, the PPAR-γ (p=0.008) and PPAR-α (p=0.003) levels were significantly lower in MetS. ROC analysis revealed that the NF-κB, PPAR-α, and PPAR-γ could be used to indicate MetS in younger adults (AUC: 0.735, p<0.000; AUC: 0.653, p=0.003), whereas it could not be an indicator in older adults (AUC: 0.617, p=0.079; AUC:0.530, p=0.613). It seems that these markers have important roles in MetS-related inflammation. In our results, suggest that the indicator feature of NF-κB , PPAR-α and PPAR-γ in recognizing MetS in young individuals is lost in older adults with Mets., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objectives Elongation of the styloid process causes different symptoms with varying degrees of severity in some people. This elongation can be detected haply during routine reading of panoramic X-ray. The aim of this study is to determine the prevalence rate of Eagle's syndrome among a population from Damascus, Syria, and to evaluate the accompanying clinical symptoms. Methods This is a descriptive epidemiological study including 3,962 patients who attended one of the many dental clinics of educational and/or healthcare institutions in Damascus. All digital panoramic radiographs were reviewed, and the styloid processes were measured and assessed for elongation. Patients with styloid process of more than 3 cm in length were contacted and their consents were obtained to participate in the study to assess the presence of clinical symptoms. Results Radiographic elongation of the styloid process was found in 179 out of the 3,962 assessed dental records (prevalence rate was 4.5%). Length ranged from 30 to 90 mm, with an average of 55.9 mm. Of the patients with elongated styloid process, 10.2% had undergone tonsillectomy. All patients who underwent tonsil surgeries were symptomatic with at least three of the studied symptoms. Symptoms included peri-orbital pain (40.9%), orbital pain (35.2%), neck and shoulders pain (52.3%), ipsilateral headache (58%), earache (30.7%), tinnitus (37.5%), articular clicking (29.5%), throat pain (31.8%), globus sensation (22.7%), and dysphagia (21.6%). Conclusions The prevalence of Eagle's syndrome according to this study was 4.5%. Patients who had undergone tonsillectomy were more likely to be more symptomatic. The most common symptom was severe headache (migraine) on the same side of styloid elongation. Panoramic radiography is a low-cost means that can be helpful in the diagnosis of vague pain and symptoms caused by Eagle's syndrome in the head and neck regions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al-Khanati et al.)

In this study, the mutagenic effects of different doses and exposure times of oryzalin and Nitrogen Protoxide (N 2 O) were tested for stimulating polyploid on 41 B and Fercal grapevine rootstocks seedlings. Ploidy changes were examined by morphological, cytological, macroscopic, and microscopic methods. Leaf thickness, chlorophyll contents, stomatal sizes, and chloroplast numbers of polyploid seedlings stimulated with mutagens increased but their stomatal densities decreased. Flow cytometry (FC) analyses were performed on 50 samples selected by morphological and microscopic preliminary determinations. In FC analyses, 1 tetraploid seedling and 4 mixoploid seedlings from Fercal offspring and 1 mixoploid seedling from 41 B offspring were verified. The nuclear DNA content of tetraploid and mixoploid seedlings were increased by 2.00 and 1.34-fold, respectively, when compared to their diploid parents. Chromosome counts in root tip samples propagated in vitro from the tetraploid Fercal offspring confirmed a 2-fold increase compared to the diploid parent. In polyploidy induction studies, it was deemed appropriate to use FC analysis and chromosome count together to confirm the ploidy levels of mutants. Oryzalin and N 2 O applications at different doses and exposure times were found to be effective for inducing polyploidy in 41 B and Fercal grapevine rootstocks., (Copyright © 2023 by JAPANESE SOCIETY OF BREEDING.)

The study is an investigation of aggressive tumor features, prognosis, and disease-specific mortality rates of differentiated thyroid cancer (DTC) in the presence of concomitant Hashimoto's Thyroiditis (HT). The data of patients with DTC followed in our tertiary care center between 2000-2022 were analyzed. Variables such as patient age, gender, preoperative serum autoantibody levels, tumor characteristics, and treatment modalities were obtained from medical records. The diagnosis of HT was based either on the presence of a positive result in the pathological examination and/or on antibody positivity. A total of 637 patients [mean±SD age, 44.9±13.5 years; 485 women [76.1%)] were included in the analysis. The overall prevalence of coexistent HT was 22.9% (n=146). The disease-specific mortality associated with DTC was 2.9%. DTC patients with HT compared to those without; have more positive lymphovascular invasion (p<0.001), and lymph node metastases (p<0.001). According to the Kaplan-Meier curves, disease-specific survival rates among DTC patients without HT were significantly higher than patients with HT (log-rank p=0.002). The disease-specific mortality rate was 4.79% in DTC patients with HT, it was 1.43% in those without HT. Hashimoto thyroiditis was not associated with a 10-year recurrence-free survival (p=0.059). Differentiated thyroid cancers with concomitant HT are associated with some aggressive tumor features (such as lymphovascular invasion and nodal metastasis) and lower survival. In staging systems based on tumor risk factors, it may be useful to evaluate the presence of concomitant HT as a prognostic factor., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Aim: To evaluate the cardiometabolic risk in patients with CAH (21 (OH) enzyme deficiency) on the basis of the visceral adiposity index (VAI), which indicates dysfunction of the visceral adipose tissue (VAT). Materials and Methods: A total of 41 patients and 38 body mass index (BMI), age, and gender-matched healthy controls (HC) were included. The patients' and HCs' age, gender, waist circumference (WC), BMI information and total cholesterol (TC), high-density lipoprotein (HDL), triglyceride (TG) values, smoking, and medication history were obtained from medical charts. Weight, height, WC, and blood pressure levels were measured. Patients' and HCs' BMI, Framingham risk scores (FRS), VAI and Ferriman-Gallwey scores were calculated. The patients' and HCs' age, gender TC, HDL, and TG, androstenedione, dehydroepiandrosterone sulfate (DHEASO 4 ), 17 hydroxyprogesterone (17(OH)P) values, smoking, and medication history were obtained from medical charts. Body fat and muscle mass levels were measured with Tanita T 6360. Results: Gender distribution, mean age, and BMI of patients with CAH were 34/7, 30 ± 8, 27 ± 5.4; HC subjects 30/8, 30 ± 6, 27 ± 3.8 ( P  = 0.9, 0.6, 0.9, respectively). The VAI values of patients with a diagnosis of CAH 3.7 (2.3-6.9) were found to be significantly higher than those of HC patients 2.5 (1.8-3.9; P  = 0.02). The mean glucocorticoid doses of the patients were 17 ± 9 mg/day. The glucocorticoid dose level was determined as independent risk factor on the FRS ( P  = 0.03, β = 0.04) and VAI ( P  = 0.018, β = 0.17). Conclusion: Glucocorticoid dose optimization should be done more carefully to improve metabolic and cardiovascular outcomes in CAH patients.

Introduction: Obesity and aging negatively affect the immune system and host defense mechanisms, increasing vulnerability to and worsening prognosis of infectious diseases, leading to vaccine failure. Our aim was to investigate the antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike antigens and the risk factors affecting antibody levels in elderly patients living with obesity (PwO) after inactive SARS-CoV-2 vaccine (CoronaVac) administration., Methods: One hundred twenty-three consecutive elderly patients with obesity (age ≥65 years, body mass index [BMI] ≥30 kg/m2) and 47 adults with obesity (age 18-64 years, BMI ≥30 kg/m2) admitted between August and November 2021 were enrolled. Seventy-five nonobese elderly people (age ≥65 years, BMI 18.5-29.9 kg/m2) and 105 nonobese adults (age 18-64 years, BMI 18.5-29.9 kg/m2) were recruited from subjects who visited the Vaccination Unit. SARS-CoV-2 spike protein antibody titers were measured in patients with obesity and nonobese controls who received two doses of CoronaVac., Results: SARS-CoV-2 levels of patients with obesity were found to be significantly lower than those of nonobese elderly individuals who had non-prior infection. There was no difference in SARS-CoV-2 levels between patients with obesity and nonobese individuals with prior infection. Age and SARS-CoV-2 level were found to be highly correlated in the correlation analysis in the group of elderly individuals (r: -0.184). In multivariate regression analysis, when SARS-CoV-2 immunoglobulin class G (IgG) was regressed on age, sex, BMI, type 2 diabetes mellitus, and hypertension (HT), HT was found to be an independent factor of the SARS-CoV-2 level (β: -2,730)., Conclusion: In the non-prior infection group, elderly patients with obesity generated significantly reduced antibody titers against SARS-CoV-2 spike antigen after CoronaVac vaccine compared to nonobese people. It is anticipated that the results obtained will provide invaluable information about SARS-CoV-2 vaccination strategies in this vulnerable population. Antibody titers may be measured, and booster doses should be delivered accordingly in elderly PwO for optimal protection., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Aim: Although atherosclerosis and osteoporosis (OP) are seen in elderly patients, it is still a matter of research whether there is an age-independent relationship between them. In our study, we planned to investigate the relationship between carotid intima-media thickness (CIMT), OP, and bone turnover parameters in patients with type 2 diabetes mellitus (DM2) of both sexes. Materials and Methods: A total of 69 patients and 40 healthy volunteers with chronic diseases such as DM2, hypertension, hyperlipidemia, and OP. Group 1 had 27 patients with DM2 and OP, group 2 had 42 patients with DM2 and no OP, and group 3 had 40 healthy volunteers without DM2 and OP. Results: In the control group, CIMT was measured lower than the patients with DM2 (0.8 + 0.1 and 1.1 + 0.3, P  < 0.001, respectively). Femur T score and lumbar T score values of patients with DM2 were lower than the control group (-0.48 + 1.1 and 0.7 + 0.6, P  < 0.001, and -1.3 + 1.5 and 0.6 + 0.5, P  < 0.001, respectively). Bone turnover markers in DM2 compared to the control group (C-terminal telopeptide of type 1 collagen: 240.9 ± 211.1 and 606.5 ± 200.8, P  < 0.001; bone-specific alkaline phosphatase: 47.9 ± 15.5 and 431.5 ± 140, P  < 0.001; and osteocalcin: 13.2 ± 5.0 and 19.7 ± 9.2, P  < 0.001, respectively) were lower. Patients with femoral region (TSF) T score and lumbar region (TSL) T score below -2.5 were found to have higher CIMT values than those without (1.2 ± 0.23 mm and 0.9 ± 0.23 mm, P  = 0.006, and 1.1 ± 0.28 mm and 0.95 ± 0.21 mm, P  = 0.003, respectively). In linear regression analysis, age ( β  = 0.01, P  < 0.001), OP ( β  = 0.166, P  = 0.001), and DDM2 ( β  = 0.222, P  = 0.04) were found to be effective on CIMT, while DM2 ( β ) = -0.754, P  < 0.001), CIMT ( β  = -0.258, P  = 0.021), body mass index ( β  = 0.355, P  = 0.028), and age ( β  = -0.229, P  = 0.029) were found to be independent factors on TSF. Conclusion: Bone turnover and bone mineral density are decreased in DM2 patients. In addition, subclinical atherosclerosis is more common in DM2 patients. Findings suggest that there is a relationship between subclinical atherosclerosis and OP due to metabolic factors other than age.

Introduction Osteoarthritis is one of the most common disorders of the temporomandibular joint (TMJ). The complex etiopathogenesis of the temporomandibular disorders (TMDs), and the variability of symptoms make it difficult to adopt standardized therapeutic protocols. Recently, platelet-rich plasma (PRP) injections have been applied into the TMJ in patients with TMJ osteoarthritis. On the other hand, arthrocentesis has received a widespread acceptance, as a minimally-invasive surgical procedure for TMDs. This study aimed to assess and compare the effect of each of these protocols (arthrocentesis, PRP injection, combination of them) in the management of TMJ osteoarthritis. Methods A single-blinded randomized clinical trial was conducted on a sample of 33 participants with limited mouth opening, pain on function and joint sounds due to TMJ osteoarthritis. Participants were assigned randomly into three groups: Arthrocentesis with PRP group; PRP group; Arthrocentesis group. Maximum mouth opening (MMO), pain and joint sounds were re-evaluated during a six-month observation period. Intra- and inter-group comparisons regarding these variables were performed. Results Participants in all study groups showed statistically significant improvement in terms of MMO and pain during the six-month postoperative period (p<0.05), and showed no significant improvements regarding joint sounds (p>0.05). Pain evaluations showed better outcomes in arthrocentesis with PRP group in comparison to arthrocentesis or injectable PRP alone after six months of follow-up (p<0.05). There were no significant differences in the outcomes of MMO and joint sounds evaluations between the three groups after six months. Conclusions Within the limitations of this study, it can be concluded that the three assessed treatment protocols were effective in improving limited mouth opening and pain in patients with TMJ osteoarthritis. A combination of TMJ arthrocentesis and PRP intra-articular injections showed the best outcomes regarding pain symptoms. None of the tested treatment protocols showed improvement in terms of articular sounds., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Abbadi et al.)

Dental implants are one of the best valid tooth replacement options, though these are not always appropriate in growing young patients. Tooth autotransplantation can be indicated then. However, this is not the only scenario where dental transplantation can be indicated. This comprehensive literature review discusses a wide range of unusual indications of dental transplantation as reported throughout the medical literature. Surprisingly, these indications include management of some developmental dental anomalies, hypodontia, oroantral communications, alveolar clefts, deficient alveolar ridges, ectopic teeth, and maxillofacial injuries. Limited high-quality evidence in this field regarding most of these unusual indications warrants further research of high-quality design., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Al-Khanati et al.)

Aim: Obesity is a disease complicating the course of COVID-19 and SARS-CoV-2 vaccine effectiveness in adults with obesity may be compromised. Our aim is to investigate the spike-protein receptor-binding domain antibody titers against BNT162b2 mRNA and inactivated SARS-CoV-2 (CoronaVac) vaccines in people with severe obesity. It is anticipated that the results to be obtained may provide invaluable information about future SARS-CoV-2 vaccination strategies in this vulnerable population., Methods: A total of 124 consecutive patients with severe obesity (age > 18 years, BMI ≥ 40 kg/m 2 ) presenting between August and November 2021 were enrolled. The normal weight control group (age > 18, BMI 18.5-24.9 kg/m 2 ) was recruited from 166 subjects who visited the vaccination unit. SARS-CoV-2 spike-protein antibody titers were measured in patients with severe obesity and in normal weight controls who received two doses of BNT162b2, or CoronaVac vaccines. SARS-CoV-2 IgG Nucleocapsid Protein antibody (NCP Ab) testing was performed to discover prior SARS-CoV-2 infection. Blood samples were taken from individuals at 4th week and after 2nd dose of vaccination. SARS-CoV-2 IgG antibody titers were determined by quantitative serological methods., Results: A total of 290 individuals (220 female, 70 male) who have received two doses of BNT162b2 or CoronaVac vaccines were enrolled in the study. Seventy had prior SARS-CoV-2 infection. In 220 subjects (non-prior infection) vaccinated with BNT162b2 or CoronaVac, the antibody titers against SARS-CoV-2 spike antigen of patients with severe obesity were significantly lower than normal weight controls (p = 0.001, p = 0.001 respectively). In seventy subjects with prior SARS-CoV-2 infection, spike antigen antibody titers in patients with severe obesity, vaccinated with BNT162b2 or CoronaVac, were not significantly different from normal weight controls (p = 0.1, p = 0.1 respectively). In patients with severe obesity, with and without prior SARS-CoV-2 infection, spike antigen antibody levels of those vaccinated with BNT162b2 were found to be significantly higher than those vaccinated with CoronaVac (p = 0.043, p < 0.001 respectively)., Conclusion: Patients with severe obesity generated significantly reduced antibody titers against SARS-CoV-2 spike antigen after CoronaVac and BNT162b2 vaccines compared to people with normal weight. Antibody levels in patients with severe obesity vaccinated with BNT162b2 were found to be significantly higher than those vaccinated with CoronaVac. People living with severe obesity should be prioritized for COVID-19 vaccination and BNT162b2 vaccine may be recommended for this vulnerable population., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Dental autotransplantation is a dental treatment whereupon a natural donor tooth from the same person replaces a missing tooth at the recipient site. This treatment modality has been ignored by many clinicians for decades. This paper discusses the "poor" prognosis of autotransplantation of teeth with complete root formation as described in a recent publication. It delivers a straightforward message indicating that success and failure are multifactorial., Competing Interests: Each named author has no conflict of interest, financial or otherwise., (© 2022 The Author(s).)

Objective: To develop machine learning (ML) models that predict postoperative remission, remission at last visit, and resistance to somatostatin receptor ligands (SRL) in patients with acromegaly and to determine the clinical features associated with the prognosis., Methods: We studied outcomes using the area under the receiver operating characteristics (AUROC) values, which were reported as the performance metric. To determine the importance of each feature and easy interpretation, Shapley Additive explanations (SHAP) values, which help explain the outputs of ML models, are used., Results: One-hundred fifty-two patients with acromegaly were included in the final analysis. The mean AUROC values resulting from 100 independent replications were 0.728 for postoperative 3 months remission status classification, 0.879 for remission at last visit classification, and 0.753 for SRL resistance status classification. Extreme gradient boosting model demonstrated that preoperative growth hormone (GH) level, age at operation, and preoperative tumor size were the most important predictors for early remission; resistance to SRL and preoperative tumor size represented the most important predictors of remission at last visit, and postoperative 3-month insulin-like growth factor 1 (IGF1) and GH levels (random and nadir) together with the sparsely granulated somatotroph adenoma subtype served as the most important predictors of SRL resistance., Conclusions: ML models may serve as valuable tools in the prediction of remission and SRL resistance., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: Ivabradine (IVA) reduces heart rate (HR) by inhibiting hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in sinoatrial node. Studies suggest that IVA has other beneficial effects on cardiovascular system that are not related to its effect on HR such as prevention of endothelial injury and the antioxidant effects. In addition to sinoatrial node, HCN channels exist in other tissues and their expression pattern differs in certain pathologies such as hypertension and hypertrophy. We investigated the mechanism of IVA effect in the setting of streptozotocin (STZ)-induced cardiovascular damage. Direct effects of IVA and their mechanism on thoracic aorta as well as possible prevention of vascular dysfunction in diabetes were investigated in this study., Methods and Results: The effects of IVA on vascular function were investigated in control and STZ-diabetic rats. Some control and diabetic rats were treated with IVA. IVA treatment prevented diabetes-induced increase in plasma p-selectin and vascular cell adhesion molecule-1 levels and the decrease in nitric oxide content in the aortas of diabetic animals. When added to isolated organ bath, IVA induced concentration-dependent relaxations in thoracic aorta. Pre-incubation with Nω-Nitro- L -arginine methyl ester reduced IVA-induced relaxations. Expression patterns of all isoforms of HCN proteins were affected by both diabetes and IVA treatment., Conclusion: IVA improves vascular function in diabetes and HCN channels support vascular activity against damaging effects of diabetes. IVA may be added to prevent diabetic cardiovascular dysfunction with these beneficial effects that are unrelated to its primary mechanism of action., (Copyright © 2021. Published by Elsevier B.V.)

Background: The effect of diabetic polyneuropathy (DPN) and autonomic neuropathy (AN) on bone turnover in type 2 diabetes mellitus (DM) is uncertain due to the lack of data. In this study, we tried to determine the effect of DPN and AN on bone metabolism. Materials and Methods: The study included patients with type 2 DM (aged 18-80 years) and age-matched healthy individuals who presented to the Departments of Metabolism and Diabetes, Geriatrics, and General Internal Medicine, Cerrahpaşa Medical School, Istanbul University. The patients were examined to find out whether they had AN, and neuropathy scores were recorded by exploring peripheral neuropathy. Bone mineral density was measured by dual-energy X-ray (DXA). Demographic characteristics, the presence of microvascular complications, and biochemical data were obtained from patients' files. Serum cross-linked C-telopeptide (Ctx), osteocalcin, and bone-specific alkaline phosphatase (B-ALP) were analyzed. Results: The study comprised a total of 64 patients: 23 had type 2 DM and osteoporosis (OP) (duration of diabetes 10.1 ± 7 years; mean age 63 ± 9.1 years; female/male 18/5; Group 1), 41 had type 2 DM and non-OP (duration of diabetes 10.3 ± 7.6 years; mean age 58 ± 7.4 years; female/male 30/11; Group 2), and 26 healthy volunteers made up the control group (mean age 62 ± 11.9 years; female/male 14/12; Group 3). The bone turnover parameters were lower in type 2 DM individuals. The levels of osteocalcin (13.3 ± 5.2 ng/mL) and B-ALP (44.7 ± 10.9 IU/L) in patients with type 2 DM were lower than those of healthy subjects: osteocalcin (20.6 ± 10 ng/mL) and B-ALP (111 ± 31.4 IU/L; P  = 0.001 and P  = 0.000, respectively). Ctx levels (193.5 ± 49.3; 207.6 ± 40 ng/mL) were recorded to be similar ( P  = 0.2). AN was also noted as a risk factor for OP. For patients without AN, the likelihood of developing OP (odds ratio) was 0.7. The corresponding ratio for patients with AN was 9.3. Conclusions: Among the independent variables, the neuropathy score was determined to have an impact on bone turnover. AN was identified to be a significant risk factor for OP.

Introduction: The aim of this study was to investigate the antibody titers against SARS-CoV-2 spike antigens and the risk factors affecting antibody levels in people living with obesity (PwO) after inactive SARS-CoV-2 vaccine (CoronaVac) administration., Methods: 169 consecutive patients with obesity who visited the Center for Obesity Management at Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospitals, between May and August 2021, were invited to the study. The nonobese control group was recruited from 191 subjects who visited the Cerrahpaşa Hospitals Vaccination Unit. The study group and the nonobese control group have already received two doses of inactive SARS-CoV-2 vaccine. The SARS-CoV-2 IgG nucleocapsid antibody test was administered to patients and control subjects to discover those who had prior SARS-CoV-2 infection. Forty-one patients who had prior infection and received two doses of vaccine were also included in the study as a subgroup. Blood samples were taken on the 3rd to 4th week after the second vaccination. SARS-CoV-2 IgG antibody titers were determined by quantitative serological methods., Results: Antibody titers against SARS-CoV-2 spike antigen of individuals with BMI ≥30.0 kg/m2 were significantly lower than those with BMI <30 kg/m2 (p = 0.001) in the study group. Moreover, the antibody titers in people with BMI ≥30.0 kg/m2 were significantly lower than in those having a BMI <30.0 kg/m2 in the subgroup (p = 0.03). Age (p = 0.03), BMI (p = 0.006), and hypertension (p = 0.03) were found to be independent risk factors for antibody response in PwO. Women with non-prior SARS-CoV-2 infection showed a significantly higher antibody response then men (p = 0.001)., Conclusion: SARS-CoV-2-Immunoglobulin G antibody levels against inactive (CoronaVac) vaccine were found to be lower in PwO compared to nonobese individuals. Antibody titers may be measured, and booster doses should be delivered accordingly in PwO for optimal protection., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.

Based on the possible effects of androgens on the course of COVID-19, it can be posited that Gender-Affirming Hormone Therapy (GAHT) may affect the course of the disease in people with GD. We aimed to investigate the relationship between GAHT and contracting COVID-19, as well as the severity of the disease in individuals with Gender Dysphoria (GD). The single center, cross-sectional, web-based survey was completed by people with GD who received GAHT. The questionnaire contained three parts: a sociodemographic data form; a GAHT data form; a COVID-19-related data form. Of the 238 participants, 179 were individuals with female-to-male (FtM) and 59 male-to-female (MtF) GD. We detected that the risk of contracting COVID-19 increased 3.46 times in people with FtM GD, who had received testosterone therapy, in comparison to people with MtF GD, who received estrogen and anti-androgen therapy. Additionally, people with FtM GD who contracted COVID-19 had received longer testosterone therapy when compared to those who did not contract COVID-19. Our findings indicate that individuals with FtM GD who receive testosterone treatment within the scope of GAHT are at higher risk of contracting COVID-19 and that the clinicians who follow-up on GAHT should be more careful about this issue.

Introduction: the purpose of this study was to assess the orthopaedic surgeons' perceptions and attitudes on COVID-19 related changes in their practice., Methods: an online survey was shared with orthopaedic surgeons practicing in different countries., Results: this study showed that orthopaedic surgery plan management was adapted to respond more effectively to the COVID-19 pandemic while maintaining the continuity of health care and ensuring protection of medical staff and patients. Among the introduced measures, elective surgery was postponed to free-up beds for suspected or COVID-19 positive patients requiring hospitalization. Additionally, the number of outpatient visits was considerably decreased and non-urgent visits were postponed to reduce the flow of patients in and out of hospitals and therefore minimize the risk of contamination. Interestingly, data revealed the willingness of orthopaedic surgeons to take care of COVID-19 positive patients and support their colleagues in intensive care units, if needed., Conclusion: orthopaedic surgery departments have adapted their programs to face the unprecedented challenges due to the COVID-19 pandemic. Quick measures were taken to reduce the risk of contamination in patients, medical staff and to allow hospitals to free up beds for treatment of patients with positive or suspected COVID-19., Competing Interests: The authors declare no competing interests., (Copyright: Nadhir Meraghni et al.)

Background and Purpose: Carvedilol is a third-generation β-adrenoceptor antagonist, which also stimulates β-arrestins. β-arrestins initiate intracellular signalling and are involved in insulin release and sensitivity. Carvedilol is superior in effectiveness to other drugs that are used for similar indications and does not cause insulin resistance or diabetes, which can occur with other β-antagonists. We have shown that carvedilol increased glucose usage in C2C12 cells. We investigate the biased agonist efficacy of carvedilol on β-arrestins., Experimental Approach: Streptozotocin (STZ)-induced diabetes rat model was used to induce metabolic and cardiac disorders. After 8 weeks of diabetes, animals were treated with carvedilol or vehicle for another 4 weeks. In vitro heart function was evaluated at baseline as well as with increasing concentrations of isoprenaline. Effects of diabetes and carvedilol treatment on β-arrestins, ERK, PPARα, CD36 proteins and pyruvate kinase activity were evaluated. β-arrestins were silenced in C2C12 cells by using siRNA. Acute effects of carvedilol on ERK, CD36, mitochondrial transcription factor A, cardiolipin proteins and citrate synthase activity were investigated., Key Results: Carvedilol reversed the deterioration of cardiac function in diabetes and diabetes-induced decrease in β-arrestins in rats. Carvedilol decreased the expression of CD36 in diabetes and increased mitochondrial transcription factor A and cardiolipin proteins. Silencing of β-arrestins in cells prevented the effects of carvedilol on these proteins., Conclusion and Implications: The metabolic effects of carvedilol seem to be related to biased activation of β-arrestins. Patients with cardiovascular and metabolic disorders may benefit from new compounds that selectively act on β-arrestins., (© 2020 The British Pharmacological Society.)