Search

Advanced incurable diseases are often accompanied by numerous losses and burdens as the disease progresses, leading to a loss of autonomy, self-determination, and dignity for those affected, all of which can subsequently promote feelings of loneliness at the end of life. Declining health, increasing symptom burden, loss of social roles, and the fear of death and dying are among the key risk factors for loneliness towards the end of life. In this article, we provide an overview of the different dimensions of loneliness experienced at the end of life. We discuss existential loneliness alongside emotional and social loneliness, explore causes and health implications of loneliness at the end of life, suggest diagnostic tools for assessing loneliness, and finally provide recommendations for addressing emotional, social, and existential loneliness at the end of life. The loneliness of caregivers is also discussed. We suggest that addressing social and emotional loneliness early in the course of a terminal illness is crucial. Palliative, psychological, and spiritual support can strengthen interpersonal relationships, foster a sense of meaning and purpose, and alleviate the adverse effects of loneliness on mental and physical health as well as quality of life. In contrast, existential loneliness is considered an expression of profound emotional maturity and can offer opportunities for inner growth, contributing to a more refined sense of self while reinforcing identity, dignity, and transcendence at the end of life., (© 2024. The Author(s).)

Background: Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras., Methods: This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group., Results: Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K + , and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%., Conclusion: Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Introduction and Hypothesis: The primary aim was to examine the relationship between lower urinary tract symptoms (LUTS), toileting behaviors, and pelvic floor health knowledge in younger and older women. The secondary aim was to compare LUTS, toileting behaviors, and pelvic floor health knowledge in younger and older women., Methods: The study included 85 younger women and 81 older women. LUTS were evaluated using the International Consultation on Incontinence Questionnaire-Female LUTS (ICIQ-FLUTS), toileting behaviors using Toileting Behavior-Women's Elimination Behaviors (TB-WEB), and pelvic floor health knowledge using the Pelvic Floor Health Knowledge Quiz (PFHKQ)., Results: In terms of LUTS, the most common symptoms in younger women are urgency (31.8%), bladder pain (28.2%), and frequency of incontinence episodes (35.3%), whereas in older women, the most common symptoms observed are urgency (64.2%), frequency of incontinence episodes (61.7%), intermittency (46.9%), urgency urinary incontinence (58%), and frequency of incontinence episodes (49.4%). Most unhealthy toileting behaviors correlated with LUTS in both groups (p < 0.05). Although a weak negative correlation was detected between ICIQ-FLUTS total score and PFHKQ function in younger women (p < 0.05), no correlation was found in older women (p < 0.05). Whereas premature voiding, straining during voiding, TB-WEB total score were higher in older women than in younger women (p < 0.05), delayed voiding, position preference for voiding, and PFHKQ function/dysfunction scores were higher in younger women than in older women (p < 0.05)., Conclusions: Within the scope of preventive health services, it may be important to provide informative programs on healthy toileting behaviors and pelvic floor health to women of all ages in order to prevent LUTS., (© 2024. The International Urogynecological Association.)

To investigate cancer incidence in patients with ANCA-associated vasculitis (AAV), compare it with the age/sex-specific cancer risk of the Turkish population, and explore independent risk factors associated with cancer. This multicenter, incidence case-control study was conducted using the TRVaS registry. AAV patients without cancer history before AAV diagnosis were included. Demographic and AAV-related data of patients with and without an incident cancer were compared. Standardized cancer incidence rates were calculated using age-/sex-specific 2017 Turkish National Cancer Registry data for cancers (excluding non-melanoma skin cancers). Cox regression was performed to find factors related to incident cancers in AAV patients. Of 461 AAV patients (236 [51.2%] male), 19 had incident cancers after 2022.8 patient-years follow-up. Median (IQR) disease duration was 3.4 (5.5) years, and 58 (12.6%) patients died [7 with cancer and one without cancer (log-rank, p = 0.04)]. Cancer-diagnosed patients were older, mostly male, and more likely to have anti-PR3-ANCA positivity. The cumulative cyclophosphamide dose was similar in patients with and without cancer. Overall cancer risk in AAV was 2.1 (SIR) ((1.3-3.2), p = 0.004); lung and head-neck [primary target sites for AAV] cancers were the most common. In Cox regression, male sex and ≥ 60 years of age at AAV diagnosis were associated with increased cancer risk, while receiving rituximab was associated with decreased cancer risk. Cancer risk was 2.1 times higher in AAV patients than the age-/sex-specific cancer risk of the Turkish population population, despite a high rate of rituximab use and lower dose of cyclophosphamide doses. Vigilance in cancer screening for AAV patients covering lung, genitourinary, and head-neck regions, particularly in males and the elderly, is vital., (© 2024. The Author(s).)

Early detection is critical for successfully diagnosing cancer, and timely analysis of diagnostic tests is increasingly important. In the context of neuroendocrine tumors, the Ki-67 proliferation index serves as a fundamental biomarker, aiding pathologists in grading and diagnosing these tumors based on histopathological images. The appropriate treatment plan for the patient is determined based on the tumor grade. An artificial intelligence-based method is proposed to aid pathologists in the automated calculation and grading of the Ki-67 proliferation index. The proposed system first performs preprocessing to enhance image quality. Then, segmentation process is performed using the U-Net architecture, which is a deep learning algorithm, to separate the nuclei from the background. The identified nuclei are then evaluated as Ki-67 positive or negative based on basic color space information and other features. The Ki-67 proliferation index is then calculated, and the neuroendocrine tumor is graded accordingly. The proposed system's performance was evaluated on a dataset obtained from the Department of Pathology at Meram Faculty of Medicine Hospital, Necmettin Erbakan University. The results of the pathologist and the proposed system were compared, and the proposed system was found to have an accuracy of 95% in tumor grading when compared to the pathologist's report., (© 2024. International Federation for Medical and Biological Engineering.)

Inappropriate disposal of plastic wastes and their durability in nature cause uncontrolled accumulation of plastic in land/marine ecosystems, also causing destructive effects by bioaccumulating along the food chain. Microplastics may cause chronic inflammation in relation to their permanent structures, especially through oxidative stress and cytotoxic cellular damage, which could increase the risk of cancer development. The accumulation of microplastics in the liver is a major concern, and therefore, the identification of the mechanisms of their hepatotoxic effects is of great importance. Polymethyl methacrylate (PMMA) is a widely used thermoplastic. It has been determined that PMMA disrupts lipid metabolism in the liver in various aquatic organisms and causes reproductive and developmental toxicity. PMMA-induced hepatotoxic effects in humans have not yet been clarified. In our study, the toxic effects of PMMA (in the range of 3-10 μm) on the human liver were investigated using the HepG2/THP-1 macrophage co-culture model, which is a sensitive immune-mediated liver injury model. Cellular uptake of micro-sized PMMA in the cells was done by transmission electron microscopy. Determination of its effects on cell viability and inflammatory response, oxidative stress, along with gene and protein expression levels that play a role in the mechanism pathways underlying the effects were investigated. The results concluded that inflammation, oxidative stress, and disruptions in lipid metabolism should be the focus of attention as important underlying causes of PMMA-induced hepatotoxicity. Our study, which points out the potential adverse effects of microplastics on human health, supports the literature information on the subject., (© 2024. The Author(s).)

Introduction and Hypothesis: The objective was to investigate the effects of spinal stabilization exercises (SSEs) focusing on the pelvic floor with regard to urinary symptoms, pelvic floor muscle strength (PFMS), core stability, quality of life (QoL), and perception of subjective improvement (PSI) in women with overactive bladder (OAB)., Methods: Patients were randomly divided into SSE (n=23) and control (n=24) groups. The SSE group received SSEs focusing on the pelvic floor for 3 days a week for 8 weeks and recommendation. The control group received only recommendation. Before (BT) and after treatment (AT), urinary symptoms were evaluated with Overactive Bladder Questionnaire-Version 8 (OAB-V8) and bladder diary. PFMS, core stability, and QoL were assessed using the Modified Oxford Scale (MOS), Sharman test, and King's Health Questionnaire (KHQ) respectively. AT, PSI with a Likert-type scale, and compliance with recommendations using a visual analog scale were assessed., Results: The OAB-V8 and the KHQ scores, the number of voids per day and voids per night decreased and the MOS and the Sharman scores increased in the SSE group (p<0.05). In the control group, the OAB-V8 and incontinence effect, social limitations, emotional state, and sleep sub-dimension scores related to KHQ decreased (p<0.05). The OAB-V8, role and physical limitations, emotional state, and sleep sub-dimension scores decreased more, and the MOS, the Sharman, the PSI, and the compliance with recommendations scores increased more in the SSE group than in the control group (p<0.05)., Conclusions: The SSEs focusing on the pelvic floor improved urinary symptoms, PFMS, core stability, QoL, and PSI. This exercise approach may be beneficial in the management of OAB., (© 2023. The International Urogynecological Association.)

Aim: Malnutrition is a common geriatric syndrome with multiple negative outcomes including mortality. However, there is a scarcity of literature that focuses on the relationship between malnutrition risk and its clinical implications on geriatric syndromes and mortality among cancer patients. The aim of this study is to determine the clinical importance of malnutrition risk in geriatric oncology practice., Method: 180 patients with cancer who were ≥ 65 years were included in the study. All patients were questioned in terms of geriatric syndromes, including polypharmacy, frailty, probable sarcopenia, fall risk, dynapenia, depression, cognitive impairment, insomnia, and excessive daytime sleepiness. Mini Nutritional Assessment scores > 23.5 and 17-23.5 were categorized as well-nourished and malnutrition risk, respectively., Results: Of the 180 patients (mean age 73.0 ± 5.6 years, female: 50%), the prevalence of malnutrition risk was 28.9%. There was no statistically significant difference between the groups in terms of age, gender, education, marital status, body mass index, and comorbidities except for chronic obstructive pulmonary disease (p > 0.05). After adjustment for age, sex, and body mass index; polypharmacy (odds ratio [OR]: 3.17; 95% confidence interval [CI], 1.48-6.81), reduced calf circumference (OR: 3.72; 95% CI, 1.22-11.38), fall risk (OR: 2.72; 95% CI, 1.03-7.23), depression (OR: 6.24; 95% CI, 2.75-14.18), insomnia (OR: 4.89; 95% CI, 2.16-11.05), and frailty (OR: 2.44; 95% CI, 1.75-3.40) were associated with malnutrition risk compared to well-nourished patients (p < 0.05). Median survival in patients with malnutrition risk was 21.3 months (range 14.1-28.4 95% CI) and median survival in patients who were defined as well nourished was not reached (p < 0.001)., Conclusion: The risk of malnutrition was associated with a higher risk for all-cause mortality in older patients with cancer, and was associated with many geriatric syndromes, including polypharmacy, fall risk, frailty, insomnia, and depression., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Aim: Morphea, also known as localized scleroderma, is an immune-mediated disease and the most common form of scleroderma in children. It is a localized sclerosing disease of the skin, but can also involve such adjacent tissues as the fascia, muscle, bone, and underlying tissues. This multicenter study aimed to evaluate Turkish pediatric morphea patients, regarding demographics, treatments, and response to treatment., Materials and Methods: The study was performed by the Pediatric Rheumatology Academy and included pediatric morphea patients from 6 Turkish pediatric rheumatology centers who were followed up for ≥6 months. Demographic, clinical, and laboratory findings and treatment modalities were analyzed. The patients were divided into 3 groups according to treatment response, as follows: group 1: topical treatment response, group 2: methotrexate response, and group 3: methotrexate resistance. Clinical findings were compared between the 3 groups., Results: The study included 76 patients, of which 53 (69.7%) were female. Mean age at diagnosis of morphea was 9.7 ± 4.3 years and mean duration of follow-up was 3.2 ± 2.9 years. Linear morphea was the most common form, accounting for 43.4% (n = 33) of the patients. Extracutaneous features were noted in 17 patients (22.4%) and anti-nuclear antibody positivity was noted in 32 (42.1%). In all, 14.4% of the patients received topical treatment only, whereas 86.6% received both topical and systemic treatment. The methotrexate response rate was 76.9% in the patients that received systemic immunosuppressive therapy. The overall relapse rate while under treatment was 19.7%., Conclusion: In this study, most of the pediatric morphea patients responded well to methotrexate. Bilateral lesions were more common in the methotrexate-resistant group. Multiple involvement, and bilateral lesions, were more common in relapsed patients than in non-relapsed patients. Key points • Most of the pediatric morphea patients respond well to MTX. • Multiple involvement, and bilateral involvement, were more common in relapsed patients than in non-relapsed patients. • Presence of extracutaneous findings in patients increased relapse rate 5.7 times., (© 2023. International League of Associations for Rheumatology (ILAR).)

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.)

This study investigated whether a systematic instruction package was effective in child acquisition of question answering using an iPad-based speech generating device (SGD). The study was conducted with two children with autism using a multiple probe across behaviors design. Results demonstrated that the systematic instruction package consisting of graduated guidance, discrete trial teaching, time delay, and reinforcement resulted in acquisition of answering all questions. Follow-up data were collected one, three, and five weeks after instruction ended. For all participants, skills maintained during follow-up and generalized to novel settings and skills. Social validity data were also collected and indicated that teachers without experience using SGDs found them to be effective and feasible for teaching communication skills., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Healthcare professionals (HCP) play an important role in the practical application of genetic screening tests but often feel inadequately prepared for cancer genetic testing (CGT) in clinical care. As the complexity of gene-related malignancies increases, it demands HCPs' preparedness to cater to patients' needs. Therefore, the aim of our study is to assess the knowledge, attitude, and practices of HCPs in Pakistan regarding the application of cancer genetics. Our cross-sectional survey was conducted from April 2022 to June 2022 amongst HCPs at a private and a governmental institution in Karachi, Pakistan. Non-probability random convenience sampling was used to select the population; however. non-clinical HCPs, as well as Interns, were excluded from our study. A total of 210 HCPs, 56.7% (119) bearing an experience of over 5 years of clinical experience, were included in this study. Most respondents from both hospitals deemed their knowledge inadequate, with only 2% (2) and 1.8% (2) being extremely knowledgeable, respectively. 68.6% (144) HCPs displayed a positive attitude towards CGT, with 55.2% (116) participants perceiving CGT in a positive light. As compared to the private sector, significantly more HCPs in the public sector dedicated ≥ 5 h/week for CME (P = 0.006), and were better prepared to counsel patients (P = 0.021) and interpret results concerning CGT (P = 0.020). Additionally, screening tests for specific cancer types were popularly considered a worthwhile avenue of investment to improve the current state of CGT in our healthcare system [47.6% (N = 100)]. Demonstrating a lack of knowledge among Pakistani doctors, our results call upon the need for additional training concerning CGT in both the public and private sectors alike. Understanding specific gaps in knowledge may further help enhance post-graduate training programs and eventually lead to effective incorporation of CGT into our healthcare setting., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: This paper investigates the effect of a religious holiday ( Eid-ul-Fitr in Pakistan) on compliance behaviour instituted during the COVID-19 pandemic. Longstanding religion-based norms of behaviour during the Eid holidays (traveling to meet family members, praying in large gatherings, hugging) may counteract newly established (and weaker) norms of health-preserving behaviours., Method: We study the impact of Eid-ul-Fitr on compliance with COVID guidelines for a sample of university students. Our effects are identified by unprompted delays in fielding a survey measuring compliance with prescribed behaviours., Results: We find that compliance with guidelines declines immediately after the religious holiday in our sample of students, with no observable decline in other well documented predictors of compliance behaviour (risk perceptions, trust in the authorities). We find that this decline in compliance is largely attributable to male participants, with one important exception. We further confirm our results by conducting robustness checks incorporating matching techniques and a smaller follow-up study where we randomize invitations to the survey., Conclusion: We conclude that amid the pandemic, newly formed norms pertaining to healthcare guidelines (focusing on social-distancing) emerged, and were subsequently undercut by longstanding norms of behaviour following a religious celebration: Eid-ul-Fitr . This paper underscores the fragility of these newly emerged norms, especially when challenged by a more well-entrenched, traditional norm., Competing Interests: Conflicts of interestThe authors have no relevant financial or non-financial interests to disclose., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Japanese quails reared under high stocking density (SD) were evaluated for the effects of grape seed powder (GSP) and meal (GSM) supplementation on performance, blood biochemistry, thigh and breast muscle fatty acids, antioxidant status, and HSP70 gene expression. We randomly assigned 288 (15-day-old) quail chicks to six treatment groups in a factorial design (2 × 3) with four replicates, involving two density levels [160 cm 2 /bird (LD) and 80 cm 2 /bird (HD)] and three feed forms (FFs) [no supplementation, grape seed powder (3% GSP), grape seed meal (3% GSM)]. SD had a significant effect on live weight, but not on weekly feed intake, daily weight gain, and feed conversion ratio. Serum creatinine and aspartate aminotransferase levels were significantly affected by FF and SD × FF (p < 0.05). A high SD reduced the n-3/n-6 ratio of breast muscle and a significant interaction was found between FF (p < 0.001). The SD × FF interaction reduced the Σn-6 ratio in HDM's thigh muscle, whereas in LDM, the ratio increased (p < 0.01). At high SD, neither GSP nor GSM reduced biological markers of oxidative stress (p > 0.05). Compared to GSP, GSM had higher efficacy at reducing HSP70 levels related to high SD levels. Despite this, at high SD, a diet containing 3% of GSP and GSM was not effective in overcoming oxidative stress. Therefore, more studies using different doses of GSM and GSP in quail diets would be beneficial., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction and Hypothesis: The objective was to investigate the effects of interferential (IF) current stimulation on pelvic floor symptoms, prolapse stages, pelvic floor muscle (PFM) strength/endurance, quality of life (QoL), sexual function, perception of subjective improvement (PSI), and satisfaction in women with pelvic organ prolapse (POP)., Methods: The patients were randomly divided into the IF (n=13) and sham groups (n=12). Lifestyle advice was given in both groups. Active IF current was applied in the IF group and sham IF was applied in the sham group 3 days a week for 8 weeks. The following tools were used for data evaluation: pelvic floor symptom severity with the Pelvic Floor Distress Inventory-20 (PFDI-20), POP with the simplified POP-quantification system, PFM strength/endurance with a perineometer, QoL with the Prolapse Quality of Life Scale (P-QoL), and sexual function with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Scale (PISQ-12). Evaluations were made before treatment (BT), mid-term (MT, 4th week), and after treatment (AT). PSI and satisfaction were evaluated AT with Likert-type scales., Results: In the intergroup comparison AT, a greater increase in PFM strength/endurance, P-QoL-role limitations, P-QoL-sleep/energy scores, PSI, and satisfaction level, and a decrease in cystocele stages were observed in the IF group than in the sham group (p<0.05). Further, there was a greater increase in PFM endurance in the IF group in MT (p<0.05)., Conclusions: Interferential current stimulation was effective in improving POP stage, PFM strength/endurance, and QoL in women with POP. IF current stimulation can be used as a complementary treatment method in women with POP., (© 2022. The International Urogynecological Association.)

Alzheimer's disease (AD) is the common type of dementia and is currently incurable. Existing FDA-approved AD drugs may not be effective for everyone, they cannot cure the disease nor stop its progression and their effects diminish over time. Therefore, the present review aimed to explore the role of natural alternatives in the treatment of AD. A systematic search was conducted using Ovid MEDLINE, CINAHL, Cochrane and PubMed databases and reference lists up to November 30, 2021. Only randomized control trials were included and appraised using the National Institute of Health framework. Data analysis showed that herbs like Gingko Biloba, Melissa Officinalis, Salvia officinalis, Ginseng and saffron alone or in combination with curcumin, low-fat diet, NuAD-Trail, and soy lecithin showed significant positive effects on AD. Moreover, combination of natural and pharmaceuticals has far better effects than only allopathic treatment. Thus, different herbal remedies in combination with FDA approved drugs are effective and more promising in treatment of AD., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Refugee adolescents' quality of life (Qol) was not investigated during the Covid-19 pandemic which have a potential impact on refugee adolescents' Qol. In this study, it is planned to investigate refugee adolescents' Qol and its association with depression and quality of life., Methods: 301 refugee adolescents aged between 14 and 18 who immigrated from Syria was included in the study. Personality Inventory for DSM-5 Brief Form (PID-5 BF), Beck Depression Scale, and Life Quality Scale was used as assessment tools. The data were tested using structural equation modeling., Results: Both depressive symptoms and personality traits are associated with low Qol. Also, depression mediated the relationship between personality disorder and Qol., Conclusion: This is the first study that investigates Qol in Syrian refugee adolescents during the pandemic. This study draws attention to the importance of depressive symptoms and personality traits management for improvement of Qol in Syrian refugee adolescent population., Highlights: • Depressive symptoms are associated with low Qol in refugee adolescents.• Personality traits are associated with low Qol in refugee adolescents.• Depressive symptoms have a mediator role between personality traits and Qol., (© The Author(s), under exclusive licence to Springer Nature B.V. 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

In this study, we have investigated the chemotherapeutic potential of titanium dioxide (TiO 2 ) nanoparticles on skin and breast cancer cells. The cells have treated with a 75 µg/ml concentration of titanium dioxide because it is a recommended dose with proven effectiveness in vitro studies and then the cells were exposed to UV-A radiation. The combined effects of titanium dioxide and UV-A radiation on cell viability, cell cycle, plasma membrane, mitochondrial membrane potentials and apoptotic activity of the cells were investigated. The viability of SK-MEL 30 cells was measured by MTT assay and apoptotic activity of cells was determined by Annexin-V FITC/PI staining. As a result of the research, an increase was observed in the viability of cells treated with 75 µg/ml titanium dioxide concentration, while a significant decrease in cell viability was observed for both cell types when UV-A radiation and TiO 2 were applied together. The results also showed that the percentage of apoptotic cells increased as a result of UV + TiO 2 exposure. Accordingly, it can be said that TiO 2 nanoparticles may research as potential chemotherapeutic agents for skin and breast cancers, especially in the presence of UV radiation., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Low-dose chemotherapy in advanced stages of cancer does not give a positive response in treatment. The use of high-dose antineoplastic drugs creates significant side effects. The limiting situation in treatment creates a need for new generation drugs with less side effects and new treatment methods that will enable low-dose drug use. Electroporation (EP), a phenomenon, is a technique in which the membrane permeability is increased by the establishment of hydrophilic pores in the cell membrane with short and high-voltage electrical pulses. In the present investigation study, we aimed to inspect the effects of EP plus bleomycin, cisplatin, and calcium administration (CaEP) on cell viability, apoptotic activity, gene expression p53, Bax/Bcl-2 rate mitochondrial membrane potential (ΔΨm), and cell cycle in HeLa cervical cancer cell line. The permeabilization of the membrane was evaluated in flow cytometry with the PI method, and cell viability was measured in an ELISA reader with the WST-8 method. For bleomycin and cisplatin doses applied to HeLa cells, the concentration values (IC 50 ) that inhibited 50% of the cells were found to be 214.11 ± 4.7 µM and 35.16 ± 3.3 µM, respectively. The IC 50 values of the groups administered together with EP were calculated as 0.44 ± 0.3 µM for bleomycin and 20.55 ± 4.3 µM for cisplatin. There was no change in cell viability in calcium alone application, but a statistically notable reduction in cell vitality was observed in CaEP application. An increase in ΔΨm was found in bleomycin and CaEP exposure with EP. It was determined that EP exposure caused G0/G1 arrest in the cell cycle at all electric field intensities. It was determined that EP application in HeLa cells increased bleomycin cytotoxicity 487 times and cisplatin cytotoxicity 1.71 times, and CaEP could be an alternative treatment method., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Quercetin, a polyphenolic compound found in a variety of plant products possesses various biological activities and beneficial effects on human health. Schizophrenia (SZ) is one of the neuropsychiatric disorders in human beings with rapid mortality and intense morbidity which can be treated with antipsychotics, but these commercial drugs exert adverse effects and have less efficacy to treat the full spectrum of SZ. The present study was conducted to evaluate neuroprotective effects of quercetin in the preventive and therapeutic treatment of SZ. Quercetin was administered as pre- and post-regimens at the dose of 50 mg/kg in dizocilpine-induced SZ rat model for two weeks. Rats were then subjected for the assessment of different behaviors followed by biochemical, neurochemical, and inflammatory marker analyses. The present findings revealed that quercetin significantly reverses the effects of dizocilpine-induced psychosis-like symptoms in all behavioral assessments as well as it also combats oxidative stress. This flavonoid also regulates dopaminergic, serotonergic, and glutamatergic neurotransmission. A profound effect on inflammatory cytokines and decreased %DNA fragmentation was also observed following the administration of quercetin. The findings suggest that quercetin can be considered as a preventive as well as therapeutic strategy to attenuate oxidative stress and cytokine toxicity, regulate neurotransmission, and prevent enhanced DNA fragmentation that can lead to the amelioration of psychosis-like symptoms in SZ., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, known for its heterogeneous clinical presentation. Although it is rarer in children, a more severe clinical course can be seen than in adults. It is known that sleep has physiological and developmental importance in children, and there are many studies on sleep quality in adult SLE patients. The aims of this study are to evaluate the sleep habits of children and adolescents with SLE and to compare them with their healthy peers., Methods: The study included 48 children and adolescents with SLE and 64 healthy peers as a control group. The Children's Sleep Habits Questionnaire was used to evaluate the sleep characteristics of children., Results: The age and gender of the children were similar across groups. The bedtime resistance and night waking scores of SLE patients were significantly higher than those of the control group. Total sleep score was higher in patients with SLE than in the control group, but there was no significant difference (47.13±7.63 vs 44.61±8.17; p=0.051). Similarly, the rate of sleep disorders in the patient group (75%) was higher than that of the control group (61%), though the differences were not statistically significant (p = 0.156). There was no correlation between disease severity and sleep problems., Conclusion: This research demonstrated that sleep disorders tend to increase in children and adolescents with SLE. Therefore, clinicians should pay attention to sleep disorders during the follow-up sessions of children and adolescents with SLE. Key Points • Sleep disorders tend to increase in children and adolescents with SLE. • Disease severity is not associated with sleep problems., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Objectives: Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease related to several comorbidities. Anxiety is an important comorbidity in PsA and the data is scarce. We aimed to understand the rates before biologic agents and change in anxiety with the treatment., Methods: PsA patients from the Hacettepe University biologic database (HUR-BIO) were assessed for the high anxiety level (score ≥ 4) using the patient self-reported measure of anxiety on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12). The rate and scores of anxiety were determined before starting biologic agents, at the first visit within 6 months. Changes in anxiety scores were assessed according to favorable treatment responses, and the correlation was evaluated by Spearman correlation analysis., Results: From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score both at baseline and first visit within 6 months. Both the frequency of high anxiety level and mean (SD) scores decreased at the first visit [63.9% vs. 41.4%, 4.8 (3.4) vs. 3.2 (3.1) respectively, p < 0.001 for both] after a mean (SD) follow-up of 105.7 (22.2) days. There was also a positive correlation between the change in anxiety scores and all parameters tested for treatment response: pain, PGA, BASDAI, HAQ-DI, DAS-28, and also PsAID-12., Conclusion: Anxiety is a more frequent problem at biologic initiation than rates observed in the general PsA population. The rates show a decreasing trend and correlates with treatment response but is still high within 6 months under treatment., Key Points: • As high as 65% of patients had a high anxiety levels before the initiation of bDMARDs. • The disease activity control is essential in reducing anxiety; however, rates are still high within 6 months. • Decreased anxiety scores and rates of the high anxiety level are linked to better outcomes., (© 2021. International League of Associations for Rheumatology (ILAR).)

Publication speed is one of the important aspects of scholarly communication since various research performance evaluation systems are based mostly on published papers. This study aims to reveal the factors affecting the publication speed of journals. In this context, six information science journals: ASLIB Journal of Information Management, Journal of Documentation, Journal of Informetrics, Journal of the Association for Information Science and Technology, Online Information Review, and Scientometrics are analysed in terms of time to publication (from submission to decision). Our results show that publication time is significantly shorter when an editorial board member or a productive author of a given journal is one of the authors, in compare with the articles. submitted by other authors. The number of authors has a time-prolonging effect on publication time, as expected. On the other hand, publications with more citations were accepted in a shorter time. The papers with authors from central countries and high-income countries have an advantage of shorter publication time. Thus, this study shows that researchers who publish papers with popular and successful researchers from central countries have the advantage of the speed of publication which may have substantial effects on the future academic work, especially of early career researchers., Competing Interests: Conflict of interestThe authors have declared no conflict of interest., (© The Author(s) 2022.)

The diagnosis of autism spectrum disorder (ASD) in a child affects family processes, increases parenting stress and marital conflicts, and may lead to parental psychopathology. It may also affect the prognosis for their children. The aim of this study is to determine depression and burnout levels as well as their predictors among parents of children with ASD compared with those of healthy children. We also sought to evaluate rate of complementary and alternative medicine (CAM) interventions among parents and explore the associations of this phenomenon in an exploratory fashion. 145 children with ASD and 127 control children were enrolled along with their mothers and fathers. Beck Depression Inventory and Maslach Burnout Inventory were used to evaluate parents' depression symptoms and burnout levels. Symptoms of children with ASDs were evaluated according to the Childhood Autism Rating Scale by the clinicians. Family, child and CAM variables were screened by means of a sociodemographic data form. Descriptive, bivariate and correlation analyses were used in statistical evaluations. Predictors of burnout were evaluated with multiple regression analysis. Burnout and depression levels among parents of children with ASD were significantly elevated compared to controls. Burnout levels of mothers were significantly elevated compared to fathers while depression scores of fathers were significantly elevated compared to mothers. Maternal burnout was significantly predicted by presence of functional speech in child while paternal burnout was significantly predicted by paternal vocation. Maternal depression was associated with paternal depression, lack of speech in child and attendance of child to special education services. Paternal depression was associated with autistic symptom severity and maternal depression. More than half the parents sought CAM interventions. Education level did not affect search for CAM interventions while both maternal and paternal psychopathology and presence of epilepsy among children increased use of CAM methods. Psychological support should be provided to both mothers and fathers of a child receiving a diagnosis of ASD. Addressing parents' burnout and stress levels and facilitating their negotiation of knowledge on etiology and treatments for ASD may be beneficial for the family unit as a whole., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Peripheral lymphadenopathy (LAP) is an important and common abnormal finding of the physical exam in general medical practice. We aimed to reveal the LAP etiology and demographic, clinical and laboratory variables that may be useful in the differential evaluation of LAP. This multicenter, nested case-control study including 1401 patients between 2014 and 2019 was conducted in 19 tertiary teaching and research hospitals from different regions in Turkey. The ratio of infectious, malign and autoimmune/inflammatory diseases was 31.3%, 5% and 0.3%, respectively. In 870 (62%) of patients had nonspecific etiology. Extrapulmonary tuberculosis (n: 235, 16.8%) was the most frequent cause of LAP. The ratio of infective etiology of LAP was significantly lower in patients older than 65 years-old compared to younger patients with the rate of 66.67% and 83.84%, respectively (p 0.016, OR 0.386, 95% Cl 0.186-0.803). The probability of malign etiology was higher both in patients who are older than 45 years-old (p < 0.001, OR 3.23, 95% Cl 1.99-5.26) and older than 65 years-old (p 0.002, OR 3.36, 95% Cl 1.69-6.68). Age, localization and duration of LAP, leukocytosis, anemia, thrombocytopenia, CRP and sedimentation rate were important parameters to differentiate infections. Size of lymph node and splenomegaly in addition to the parameters above were useful parameters for differentiating malign from benign etiology. Despite the improvements in diagnostic tools, reaching a definite differential diagnosis of lymphadenopathy is still challenging. Our results may help clinicians to decide in which cases they need an aggressive workup and set strategies on optimizing the diagnostic approach of adulthood lymphadenopathy., (© 2021. Società Italiana di Medicina Interna (SIMI).)

Myocardial injury caused by COVID-19 was reported in hospitalized patients previously. But the information about cardiac consequences of COVID-19 after recovery is limited. The aim of the study was comprehensive echocardiography assessment of right ventricular (RV) in patients recovered from COVID-19. This is a prospective, single-center study. After recovery from COVID-19, echocardiography was performed in consecutive 79 patients that attended follow-up visits from July 15 to November 30, 2020. According to the recovery at home vs hospital, patients were divided into two groups: home recovery (n = 43) and hospital recovery (n = 36). Comparisons were made with age, sex and risk factor-matched control group (n = 41). In addition to conventional echocardiography parameters, RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS) were determined using 2D speckle-tracking echocardiography (2D STE). Of the 79 patients recovered from COVID-19, 43 (55%) recovered at home, while 36 (45%) required hospitalization. The median follow-up duration was 133  ±  35 (87-184) days. In patients recovered from hospital, RV-GLS and RV-FWS were impaired compared to control group (RV-GLS: -17.3  ±  6.8 vs. -20.4  ±  4.9, respectively [p = 0.042]; RV-FWS: -19.0  ±  8.2 vs. -23.4  ±  6.2, respectively [p = 0.022]). In subgroup analysis, RV-FWS was impaired in patients severe pneumonia (n = 11) compared to mild-moderate pneumonia (n = 28), without pneumonia (n = 40) and control groups (-15.8  ±  7.6 vs. -21.6  ±  7.6 vs. -20.8  ±  7.7 vs. -23.4  ±  6.2, respectively, [p = 0.001 for each]) and RV-GLS was impaired compared to control group (-15.2  ±  6.9 vs. -20.4  ±  4; respectively, [p = 0.013]). A significant correlation was detected between serum CRP level at hospital admission and both RV-GLS and RV-FWS (r = 0.285, p = 0.006; r = 0.294, p = 0.004, respectively). Age (OR 0.948, p = 0.010), male gender (OR 0.289, p = 0.009), pneumonia on CT (OR 0.019, p = 0.004), and need of steroid in treatment (OR 17.424, p = 0.038) were identifed as independent predictors of impaired RV-FWS (> -18) via multivariate analysis. We demonstrated subclinic dysfunction of RV by 2D-STE in hospitalized patients in relation to the severity of pneumonia after recovery from COVID-19. 2D-STE supplies additional information above standard measures of RV in this cohort and can be used in the follow-up of these patients., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: The novel coronavirus infection (COVID-19) disease has spread rapidly and posed a great threat to global public health. The laboratory parameters and clinical outcomes of the disease in discharged patients remain unknown. In this study, we aimed to investigate the laboratory and echocardiographic findings of patients with COVID-19 after discharge and the relation between left ventricular global longitudinal strain (LVGLS) and inflammatory parameters in discharged patients., Methods: A total of 75 patients recovering from COVID-19 as the study group were prospectively recruited from the COVID-19 outpatient clinic for their follow-up visits at a median 6 months after discharge. Patients were classified into groups according to pneumonia severity and impairment in LVGLS. Laboratory findings of patients both at admission and after discharge were evaluated and the relation with pneumonia severity at admission and LVGLS after discharge were analyzed., Results: Serum ferritin, lactate dehydrogenase (LDH) and prohormone B-type natriuretic peptide (pro-BNP) levels after discharge were significantly higher in the study group than the control group (n = 44). Ferritin was found to be related to pneumonia severity. Serum ferritin and LDH values after discharge were significantly higher in patients with impaired LVGLS than those with preserved. There was a significant correlation between LVGLS, serum ferritin and LDH values after discharge (r = -0.252, p = 0.012; r = -0.268, p = 0.005, respectively)., Conclusions: Clinicians should pay close attention to the serum ferritin and LDH levels in discharged patients for predicting the severity of COVID-19 disease and early identification of subclinical left ventricular myocardial dysfunction., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Mitral regurgitation may develop due to left ventricular (LV) remodeling within 3 months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR). Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3rd month in patients with ST elevation MI (STEMI). Fourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According to presence of prior angina within 72 h before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at 1st, 3rd days and 3rd month. IMR was evaluated by proximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson's method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups. Although PISA-r, EROA and Rvol were similar in both groups at 1st and 3rd days, all were significantly decreased (p = 0.012, p = 0.007, p = 0.011, respectively) and EF was significantly increased (p< 0 .001) in angina (+) group at 3rd month. NTpro-BNP and hs-TnT levels at 1st day and 3rd month were similar, however CK-MB level at 3rd month was found to be significantly lower in the angina (+) group (p = 0.034). At the end of the 3rd month, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72 h prior to STEMI, suggesting a relation with IPC., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Herpes simplex virus encephalitis (HSE) is the most common sporadic fatal encephalitis. Although timely administered acyclovir treatment decreases mortality, neuropsychiatric sequelae is still common among survivors. Magnetic resonance imaging is frequently utilized for the diagnosis of HSE, which typically involves temporal lobe(s) and can be mixed with brain tumors involving the same area. Here, we report a case of HSE, who received acyclovir with a delay of 90 days because of presumptive tumor diagnosis and survived with minimal sequelae.

This study investigates the dynamic effects of the shadow economy and environmental pollution on the energy stock prices in the case of the Organization for Economic Co-operation and Development (OECD) countries via generalized methods of moments (GMM) and during the years from 2004 to 2014. Results suggest significant links between the volume of shadow economies, energy stock prices, and environmental pollution. Negative effects of carbon dioxide emissions on energy stock prices are found in this study. Furthermore, a U-shaped relationship is also found between the shadow economy and energy stock prices; that is the initial levels of the shadow economy the response of energy stock prices is negative; then, beyond a trough point, its response starts to be positive at the further stages of the level of shadow economies. Despite energy consumption raises energy stock prices, environmental pollution mitigates the value of energy stock prices.

Forecasting is one of the methods applied in many studies in the library and information science (LIS) field for numerous purposes, from making predictions of the next Nobel laureates to potential technological developments. This study sought to draw a picture for the future of the LIS field and its sub-fields by analysing 97 years of publication and citation patterns. The core Web of Science indexes were used as the data source, and 123,742 articles were examined in-depth for time series analysis. The social network analysis method was used for sub-field classification. The field was divided into four sub-fields: (1) librarianship and law librarianship, (2) health information in LIS, (3) scientometrics and information retrieval and (4) management and information systems. The results of the study show that the LIS sub-fields are completely different from each other in terms of their publication and citation patterns, and all the sub-fields have different dynamics. Furthermore, the number of publications, references and citations will increase significantly in the future. It is expected that more scholars will work together. The future subjects of the LIS field show astonishing diversity from fake news to predatory journals, open government, e-learning and electronic health records. However, the findings prove that publish or perish culture will shape the field. Therefore, it is important to go beyond numbers. It can only be achieved by understanding publication and citation patterns of the field and developing research policies accordingly., (© The Author(s) 2020.)

Plant heterotrimeric G proteins are a major group of signaling molecules involved in regulation of critical processes including stress adaptation, seed size, grain quality and immune responses. Despite an abundance of in situ functional studies; purification of the individual subunits of the plant heterotrimer for biophysical and structural characterization and for studies on their interactions are lacking. In this study cloning of the genes encoding the β subunit AGB1 of A. thaliana and its γ-subunits AGG1 and AGG2 using different E. coli expression vectors and screening of expression in several strains are reported. AGB1 could be expressed albeit at very low levels and in all cases it was accompanied by overexpression of E. coli chaperone proteins. AGG1 could only be detected in inclusion body fractions, whereas AGG2 was obtained in soluble fractions and was purified. Purified AGB1 and AGG2 subunits were shown to dimerize in vitro. Further characterization of AGG2 by small angle X-ray scattering measurements and by dynamic light scattering revealed that AGG2 formed homodimers with extended shape in solution. These results are also consistent with those from circular dichroism spectroscopy which yielded 39.4% helical and 50% random coil content for AGG2. This is the first study showing heterologous expression of a plant heterotrimeric G protein β subunit individually and presenting its interaction with a plant γ-subunit in vitro. Results also show that the AGG2 subunit has a disordered structure, which would account for its role in diverse interactions for establishing selectivity in signal propagation.

Pistachio contains polyphenolic compounds including flavonoids and anthocyanins which have antioxidant and antiinflammatory activity. Present study was aimed to evaluate the protective effects of pistachio on neurobehavioral and neurochemical changes in rats with Parkinson's disease (PD). Animal model of PD was induced by the injection of rotenone (1.5 mg/kg/day, s.c.) for 8 days. Pistachio (800 mg/kg/day, p.o.) was given for two weeks in both pre- and post-treatment. At the end of treatment brain was dissected out and striatum was isolated for biochemical and neurochemical analysis. Memory was assessed by Morris water maze (MWM) and novel object recognition (NOR) test while open field test (OFT), Kondziela inverted screen test (KIST), pole test (PT), beam walking test (BWT), inclined plane test (IPT) and footprint (FP) test were used to observe motor behavior. Rotenone administration significantly (p < 0.01) impaired the memory but pistachio in both pre- and post-treatment groups significantly (p < 0.01) improved memory performance. Rotenone-induced motor deficits were significantly attenuated in both pre- and post-pistachio treatment. Increased oxidative stress and decreased DA and 5-HT levels induced by rotenone were also significantly attenuated by pistachio supplementation. Furthermore, raised apolipoprotein E (APoE) levels in rotenone injected rats were also normalized following treatment with pistachio. Present findings show that pistachio possesses neuroprotective effects and improves memory and motor deficits via increasing DA levels and improving oxidative status in brain.

Introduction/objectives: Primary Sjögren syndrome (pSS) is usually encountered between the fourth and sixth decades. It is known that the age of onset in autoimmune diseases may affect the clinical features. In this study, we aimed to investigate the clinical and laboratory characteristics of early onset pSS patients., Method: The data of 352 pSS patients were analyzed retrospectively. The patients were divided into two groups as those with the onset age of 35 or younger (early-onset) and those with the onset age of older than 35. The clinical, laboratory, and serological characteristics of the two groups were compared. p < 0.05 was considered statistically significant., Results: Forty patients in the group with an onset age of 35 or younger (11.4%) and 312 patients with an onset age of older than 35 (88.6%) were analyzed. The frequency of skin (22.5% vs 1.9%, p < 0.001) and renal involvement (10% vs 2.2%, p = 0.026) was significantly higher in the early-onset group than the late-onset group. There was no significant difference between the two groups in terms of xerostomia, eye dryness, arthritis, and other systemic involvement. Anti-Ro52 positivity (p = 0.04), elevated serum IgG levels (p = 0.004), and low C4 (p = 0.002) presence were more frequent in the early-onset group., Conclusions: Consequently, it is seen that the clinical phenotype of early-onset pSS patients may be different to those with later onset. Especially the more frequent observation of poor prognostic factors at early-onset ages shows the necessity to monitor these patients more regularly., Key Points: • The clinical and laboratory features of patients with early-onset primary Sjogren syndrome may differ from late-onset patients.

Symptoms are decisive in the quality of life of patients. Progression of the underlying disease leads to many physical and psychological symptoms in patients. Increases in these symptoms often prevent patients from complying with treatment. Therefore, the symptoms must be recognized, evaluated, and controlled for the treatment to be effective. This study determined the unmet needs of patients undergoing chemotherapy treatment and the effects of these needs on the patients' quality of life. Four hundred fifty patients were studied. Data were collected using the Patient Information Form, the Nightingale Symptom Assessment Scale (N-HAQ), the Supportive Care Requirements Questionnaire (DBGÖ), and the FACT-G (v4) Quality of Life Scale. The areas in which patients needed the most support were pain, weakness/fatigue, bad feelings, sadness, mood swings, difficulty in doing home-related tasks, fear of the cancer spreading, inability to control the situation, worries about the future, fear of death, worries about upsetting relatives, and being in need of information regarding their sexual lives. The results showed that for patients who had higher support requirements, higher incidences of symptoms led to a reduced quality of life. Consequently, frequently evaluating these symptoms to meet the needs identified, frequently measuring the quality and efficiency of care and advising these patients on their needs is recommended.

Introduction and Hypothesis: To translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Turkish and test its validity and reliability., Methods: The study included 341 women. The translation of the PIKQ, which comprised of the urinary incontinence (PIKQ-UI) and pelvic organ prolapse (PIKQ-POP) sections, was performed in accordance with international recommendations. The Incontinence Quiz (IQ) and the Visual Analog Scale (VAS) were applied to assess the level of knowledge about POP and UI. Psychometric analyses consisted of assessing the following: (1) construct validity by confirmatory factor analysis, (2) criterion and known group validity, (3) internal consistency reliability by the KR-20 coefficient, and (4) test-retest reliability over 1 week with the intraclass correlation coefficient (ICC)., Results: All fit indices except the Standardized Root Mean Square Residual indicated acceptable fit for the final models. Criterion validity was supported by moderate correlations between the PIKQ-UI and the IQ (rho = 0.679, p < 0.001). There were positive and weak linear correlations between the PIKQ-UI and PIKQ-POP scores and their corresponding perceived knowledge scores (rho = 0.351, p = 0.013 and rho = 0.345, p = 0.014, respectively). The known group validity did not show differences indicating that participants did not have enough knowledge about UI and/or POP even when they had the condition or acquaintance with them (p = 0.852 and p = 0.185, respectively). Reliability was excellent as indicated by the ICCs of 0.91-0.90, and KR-20 of 0.67-0.75 indicated good internal consistency for the PIKQ-UI and PIKQ-POP, respectively., Conclusions: The Turkish version of the PIKQ is a valid and reliable instrument to assess the knowledge of UI and POP.

Düzce is one of the cities located in the western Black Sea region of Turkey with a population of 377,610 in 2017 (TUIK, 2017). There is no satisfying scientific information available to address the contribution of primary and secondary sources of carbonaceous aerosols to the observed PM 10 levels in the city. The main objective of the study is to determine the levels and sources of carbonaceous aerosols in PM 10 . For this purpose, PM 10 samples were collected at urban and suburban locations in Düzce during winter and summer season in 2015. Average summer OC and EC concentrations in the urban area were 9.5 and 1.3 μg m -3 , respectively, while the corresponding concentrations were observed as 28.5 and 2.3 μg m -3 , respectively for winter season. Summer mean OC and EC levels at the suburban site were 5.46 and 0.37 μg m -3 , respectively, while those for winter were found as 6.68 and 0.61 μg m -3 .The contributions of OC and EC to measured PM 10 levels were found in the range of 10% to 60% and 1% to 7%, respectively, at the urban station while the associated contributions were in the range of 10% to 50% and 0.6% to 6%, respectively, at the suburban station. The concentrations measured during winter months in both areas were found to be higher than those measured during summer months. The EC tracer method was used in order to estimate the SOC contribution. The contribution of SOC concentrations to the total PM 10 mass was found to be higher during winter in the urban area and during summer in the suburban area.

This paper focuses on the environmental flow assessment (EFA) methods that maintain the river ecosystem and its integrity for hydropower plants (HPP) with their implementations on a run-off river type HPP. EFA is a crucial phenomenon in terms of electricity production and sustaining river integrity simultaneously. The novelty of this study is that it consists both a comparison of widely used preferred EFA methods and a detailed investigation of the river with pre and post-dam flow regimes. The research shows that by expanding the content and scope of the methods, their relative reliabilities increase. However, this situation requires much more expert, money, and time. Apart from most of the relevant literature, pre and post-dam situations are investigated with a flow duration curve (FDC). It is concluded that the dramatic difference between the flow characteristics of pre and post-dam situations affects long-term aquatic life. Furthermore, a case study is conducted using the selected hydrological flow assessment methods, Tennant and Tessman methods, and comparisons are made. The calculated flows are compared with monthly average flow values before dam construction, projected environmental flow data, and the current situation. Accordingly, Tennant's "good classification" is proposed to determine the environmental flow (EF) for the considered case study.

Breast cancer is one of the leading cancer type among women in worldwide. Many breast cancer patients die every year due to the late diagnosis and treatment. Thus, in recent years, early breast cancer detection systems based on patient's imagery are in demand. Deep learning attracts many researchers recently and many computer vision applications have come out in various environments. Convolutional neural network (CNN) which is known as deep learning architecture, has achieved impressive results in many applications. CNNs generally suffer from tuning a huge number of parameters which bring a great amount of complexity to the system. In addition, the initialization of the weights of the CNN is another handicap that needs to be handle carefully. In this paper, transfer learning and deep feature extraction methods are used which adapt a pre-trained CNN model to the problem at hand. AlexNet and Vgg16 models are considered in the presented work for feature extraction and AlexNet is used for further fine-tuning. The obtained features are then classified by support vector machines (SVM). Extensive experiments on a publicly available histopathologic breast cancer dataset are carried out and the accuracy scores are calculated for performance evaluation. The evaluation results show that the transfer learning produced better result than deep feature extraction and SVM classification.

The new ruthenium (III) complex has been synthesized and characterized by elemental analysis, FT-IR, UV-Vis, EI-Mass, EPR spectroscopy, and magnetic susceptibility measurement. Cytotoxic effects of organoruthenium (II/III) complexes 1a, 1b, and 2a, and their ligands (TSC 1 and TSC 2 ) in cultured human ovarian (A2780, SKOV-3, and OVCAR-3) and colon (DLD, CCD18Co, and Caco-2) cells have been investigated comparing reactivity of the Ru (II/III) complexes and their free TSC ligands. The complexes exhibit higher cytotoxicity in three cancer cell lines than in normal cells. The binding with CT-DNA and BSA of the all complexes were weak compared with their ligand in spite of the cellular uptake of these complexes into the cytoplasm and then nucleus while their cytotoxic effects were vice versa. All the results showed that Complex 1b has more efficient cytotoxicity on the colon cancer cells than ovarian cancer cells. However, Complex 2a is a better drug candidate especially for antitumor therapy of metastasized ovarian cancer.

In this study, PM 10 concentrations and elemental (Al, Fe, Sc, V, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Mo, Ag, Cd, Sn, Sb, Ba, Pb, and Bi) contents of particles were determined in Düzce, Turkey. The particulate matter samplings were carried out in the winter and summer seasons simultaneously in both urban and sub-urban sampling sites. The average PM 10 concentration measured in the winter season was 86.4 and 27.3 μg/m 3 , respectively, in the urban and sub-urban sampling sites, while it was measured as 53.2 and 34.7 μg/m 3 in the summer season. According to the results, it was observed that the PM 10 levels and the element concentrations reached higher levels, especially at the urban sampling site, in the winter season. The positive matrix factorization model (PMF) was applied to the data set for source apportionment. Analysis with the PMF model revealed six factors for both the urban (coal combustion, traffic, oil combustion, industry, biomass combustion, and soil) and sub-urban (industry, oil combustion, traffic, road dust, soil resuspension, domestic heating) sampling sites. Loadings of grouped elements on these factors showed that the major sources of the elements in the atmosphere of Düzce were traffic, fossil fuel combustion, and metal industry-related emissions.

The brain is highly susceptible to the damaging effects of oxidative reactive species. The free radicals which are produced as a consequence of aerobic respiration can cause cumulative oxygen damage which may lead to age-related neurodegeneration. Scopolamine, the anti-muscarinic agent, induces amnesia and oxidative stress similar to that observed in the older age. Studies suggest that antioxidants derived from plant products may provide protection against oxidative stress. Therefore, the present study was designed to investigate the attenuation of scopolamine-induced memory impairment and oxidative stress by walnut supplementation in rats. Rats in test group were administrated with walnut suspension (400 mg/kg/day) for four weeks. Both control and walnut-treated rats were then divided into saline and scopolamine-treated groups. Rats in the scopolamine group were injected with scopolamine (0.5 mg/kg dissolved in saline) five minutes before the start of each memory test. Memory was assessed by elevated plus maze (EPM), Morris water maze (MWM), and novel object recognition task (NOR) followed by estimation of regional acetylcholine levels and acetylcholinesterase activity. In the next phase, brain oxidative status was determined by assaying lipid peroxidation, and measuring superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) activities. Results showed that scopolamine-treatment impaired memory function, caused cholinergic dysfunction, and induced oxidative stress in rats compared to that saline-treated controls. These impairments were significantly restored by pre-administration of walnut. This study demonstrates that antioxidant properties of walnut may provide augmented effects on cholinergic function by reducing oxidative stress and thus improving memory performance.

The amounts of elements emitted from industrial, domestic, and vehicle sources in Düzce through the analyses of lichens, which are bioindicators of air pollution, were determined in this research. Concentrations of Al, Fe, Cr, Mn, Co, Ni, Cu, Zn, As, V, Cd, Hg, and Pb in the lichens that were collected from 40 different points were analyzed using an inductively coupled plasma (ICP-MS) device. The highest concentration values were detected for Fe and Al, while the lowest concentration values were detected for Cd and Hg. Distribution maps of elements were created using geographic information systems. The distribution maps showed how the concentrations of elements for Düzce have changed across the city. According to our results, the elements sourced from traffic and combustion, such as Cr, Co, Ni, Cu, As, and V, have the highest concentrations in the city center near the traffic.

Purpose: The purpose of the current prospective study was to evaluate the effects of low sodium dialysate on oxidative stress parameters, blood pressure (BP) and endothelial dysfunction in maintenance hemodialysis (HD) patients., Methods: After baseline measurements were taken, the dialysate sodium concentration was reduced from 140 to 137 mEq/L. Oxidative stress parameters and flow-mediated dilatation (FMD %) were measured before and after 6 months of HD with low sodium dialysate. Interdialytic weight gain (IDWG) and pre- and post-dialysis BP were monitored during the study., Results: A total of 52 patients were enrolled and 41 patients completed the study. There was a significant reduction in systolic blood pressure at the end of the study [130.00 (90.00-190.00) vs. 120.00 (90.00-150.00), p < 0.001]. Similarly, there were significant improvements in IDWG [2670.00 (1670.00-4300.00) vs. 1986.00 (1099.00-3998.00), p < 0.001] and FMD % [7.26 (4.55-8.56) vs. 9.56 (6.55-12.05), p < 0.001]. Serum MDA levels (p < 0.001) were significantly decreased; serum SOD (p < 0.001) and GPx (p < 0.001) activities were significantly increased after low sodium HD compared to standard sodium HD., Conclusion: Our data seem to suggest a potential role of 137 mEq/L sodium dialysate for improving hemodynamic status, endothelial function and reducing oxidative stress than 140 mEq/L sodium dialysate in maintenance HD patients.

Purpose: Insulin resistance (IR) and increased oxidative stress (OS) are the characteristics of polycystic ovary syndrome (PCOS). In this study, we aimed to evaluate the effects of oral glucose tolerance (OGTT) and mixed meal tests (MMT) on plasma total oxidant (TOS) and total antioxidant status (TAS) in patients with PCOS and the relationship between these parameters and IR, calculated via homeostasis of model assessment-IR (HOMA-IR) and Matsuda's insulin sensitivity index (ISI) derived from OGTT and MMT., Methods: Twenty-two patients with PCOS, and age- and body mass index (BMI)-matched 20 women as controls were enrolled into the study. Five-hour OGTT and MMT were performed on different days, and before and after these tests, plasma TOS and TAS levels were investigated. IR was calculated with HOMA-IR and Matsuda's ISI., Results: HOMA-IR levels were higher in patients with PCOS, compared to controls, while Matsuda's ISI derived from OGTT and MMT was higher in controls. Plasma TOS levels before OGTT and MMT were higher in patients with PCOS than controls, while TAS levels were similar. After OGTT, plasma TOS levels became decreased at 5th hour, when compared to baseline values in PCOS group. Likewise, the same decrement was found in controls, but the decrement was not significant. After OGTT and MMT at 5th hour, no changes were observed in TAS levels, compared to baseline., Conclusion: Matsuda's ISIs derived from OGTT and MMT can be used instead of each other, and interestingly, we found a decrease in TOS levels after OGTT in patients with PCOS.

Magnesium (Mg) is the fourth most abundant biological mineral essential for good health. Neuroprotective, anxiolytic and antidepressant effects of magnesium following stress and brain injuries are well established. In present study, we analyzed the protective effects of magnesium in rats exposed to sub-chronic noise stress. Magnesium Chloride (MgCl2, 100 mg/kg) was administered intraperitoneally once daily for 15 days prior exposure to noise stress. Rats were exposed to noise stress for 4 h after administration of magnesium for 15 days. At the end of treatment behavioral alterations were assessed. Animals were decapitated following behavioral testing and the brains were dissected out for neurochemical estimations by HPLC-EC. Improvement in noise-induced memory deficits as assessed by novel object recognition (NOR) test and elevated plus maze (EPM) test was found in magnesium treated rats. This improvement in noise-induced behavioral deficits following treatment with magnesium may be attributed to a significant decrease (p < 0.01) in dopamine (DA) and serotonin (5-hydroxytryptamine; 5-HT) turnover as compared to control rats observed in present work. These results suggest that treatment with magnesium can attenuate the noise-induced deficits and may be used as a therapy against noise-induced neurodegeneration. Moreover an adequate amount of magnesium in daily diet may help to develop the ability to resist against or cope up with stressful conditions encountered in daily life.