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Background: Obstructive sleep apnea syndrome (OSAS) is a common health problem. It is characterized by hypopnea/apnea episodes during night sleep and upper airway obstruction. There are two types of strategies in OSAS therapy; conservative therapy and surgical therapy. Patients who are refractory to conservative therapy require some surgical approaches such as uvulopalatopharngoplasty (UPPP). It is well established that oxidative stress is correlated with OSAS, but effect of surgical therapy on oxidative damage markers in OSAS is not clear. We performed the present study to confirm whether there is a relationship between the OSAS and serum MDA and leukocyte 8-OHdG levels before and after UPPP. Methods: Blood samples from 49 patients with OSAS were collected before and after UPPP. We measured levels of MDA to determine lipid peroxidation by high pressure liquid chromatography with fluorescence detector and measured levels of 8-OHdG/106dG to determine DNA oxidative damage by high pressure liquid chromatography with electrochemical detector. Results: Our results showed that the pre-operative MDA levels (12.05±2.85) were higher than those in post-operative period (4.94± 1.96,p<0.01), which exhibited that UPPP decreases lipid peroxidation. Similarly, pre-operative 8-OHdG levels (2.35±1.03) were higher than those in post-operative period (0.48±0.36, p<0.01). There were significant positive correlations between apnea-hypopnea index (AHI) and DNA oxidation and between AHI and MDA (R=0.585, p<0.01; R=0.359, p<0.01, respectively). Conclusions: From the results obtained we concluded that, UPPP decreases both DNA oxidation and lipid peroxidation. [ABSTRACT FROM AUTHOR]

Purpose: To describe the experiences of parents of children treated for corrosive esophageal ingestion., Methods: In-depth interviews were conducted with 17 parents (nine mothers and eight fathers) of children who had suffered a corrosive esophageal ingestion requiring hospitalization. Online interviews were also conducted with parents of children who were still undergoing treatment for corrosive esophageal ingestion. The interview guide explored the parents' overall experiences and included research questions that explored the participants' perceptions, thoughts, feelings and problems. The interviews were digitally recorded and transcribed verbatim. Inductive reflective thematic analysis was performed using MAXQDA., Results: Analysis of the interview transcripts generated three themes and nine sub-themes describing parents' experiences: emotional consequences, social consequences and facilitators. The results reveal that caregivers experienced anxiety and difficulties, prompting them to seek support from their family and social environment., Conclusion: These findings highlight the importance of identifying and understanding parental experiences. This understanding will also enable healthcare professionals to optimize the parental experience in caring for children with corrosive esophageal ingestion within a holistic clinical service. Understanding the experiences of children with corrosive esophageal ingestion from the parents' perspective identifies opportunities for systematic treatment and care.

Background: So many risk factors for mobilization failure have been described so far. We aimed to identify the risk factors and search the possible effects of bone marrow fibrosis (BMF), CD56, c-myc, and cyclinD1 expression on mobilization., Methods: We evaluated 189 patients with MM who were admitted for stem cell mobilization before autologous stem cell transplantation (ASCT) between 2015 and June 2021. Clinical, laboratory, treatment features, and survival outcomes were compared in patients who were successfully mobilized and who were not., Results: Mobilization failure rate was 11.1 % (21) in our study group. Male gender, mobilization with only G-CSF, history of previous ASCT, lenalidomide exposure, and 2 lines of chemotherapy before stem cell mobilization were observed more commonly in mobilization failure group. There is no relationship between mobilization failure and BMF, CD56, c-myc, and cyclin D1 expression status in patients who received either only G-CSF or G-CSF+ chemotherapy for mobilization. Overall survival (OS) was not different in groups of patients who were successfully mobilized and who were not. Neutrophil engraftment was faster in patients who were transfused > 5 × 10 6 /kg stem cells (p = 0.015). ECOG performance status (p = 0.004), c-myc expression (p = 0.005), lenalidomide therapy before mobilization (p = 0.032), and mobilization with G-CSF+chemotherapy was found to be predictive factors for OS., Conclusion: Even though we could not find any predictive value of CD56, c-myc, and cyclin D1 expression on mobilization, c-myc was found to be associated with low OS. Further studies with large and homogenous study population would be more informative., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Nurses provide care to meet the complex needs of patients in the increasing workload in the health system and are at risk of compassion fatigue. The concept of compassion fatigue has begun drawing attention in the last decade, as it negatively affects nurses' physical and mental health, job performance and satisfaction, and therefore patient care quality., Objectives: This study was to examine compassion fatigue and predictive factors in paediatric surgery nurses., Participants and Research Context: The study was cross-sectional, predictive and quantitative. It was conducted with the 135 paediatric surgery nurses. The data were sent to the email addresses of the members via Google Survey. Research data were collected with the Nurse Information Form, Compassion Fatigue Scale, Life Satisfaction Scale and Multidimensional Perceived Social Support Scale., Ethical Considerations: After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent., Results: There was a difference between the level of compassion fatigue according to the paediatric surgery unit that worked the longest and the thought of changing their profession. Burn unit nurses and nurses who were considering changing professions have higher compassion fatigue scores. When the predictors of compassion fatigue were examined, the thought of changing the nursing profession and life satisfaction were significant predictors of compassion fatigue. The thought of changing the nursing profession and life satisfaction explained 22% of compassion fatigue. The same variables and the longest working period of the paediatric surgery unit were the estimators of the level of occupational burnout; explaining 29% of occupational burnout., Conclusions: Compassion fatigue, life satisfaction and perceived social support of paediatric surgery nurses are moderate. Compassion fatigue is affected by working time, the thought of changing the profession, life satisfaction and perceived social support., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To investigate the effect of perioperative nurse-led counselling intervention on unmet needs, sexual function and quality of life in colorectal cancer patients., Method: This quasi-experimental study included 82 patients who underwent colorectal cancer surgery (control n = 45, intervention n = 37). The telephone-based perioperative nurse-led counselling intervention, which contained implementation, follow-up, and assessment, was applied to start from pre-surgery to post-surgery 3rd month. Data were collected with the Unmet Needs of Cancer Survivors Scale, European Organisation for Treatment and Research of Cancer Quality of Life Scale-30, Colorectal-29, Female Sexual Function Index, and International Index of Erectile Function pre- and post-surgery 3rd-6th months. The control data was collected before the pandemic, and the intervention group throughout the pandemic. The Mann-Whitney-U, Wilcoxon rank test was used., Results: Compared to the control group, intervention group patients reported lower unmet and total needs scores (p = 0.000); higher quality of life (p = 0.000), physical, emotional (p = 0.000), role (p = 0.001), and social functioning scores (p = 0.002); lower fatigue (p = 0.000), constipation (p = 0.034), pain (p = 0.018), nausea-vomiting (p = 0.004), and insomnia scores (p = 0.003); and higher body image, anxiety (p = 0.000) and weight scores (p = 0.003), lower urinary frequency buttock pain (p = 0.000), dysuria (p = 0.001), abdominal pain (p = 0.001), fluctuance (p = 0.000), stool frequency (p = 0.002), and faecal incontinence (p = 0.006) scores at the sixth month (p < 0.05). There were no statistically significant differences between male and female sexual function scores (p > 0.05)., Conclusions: Perioperative nurse-led counselling reduced unmet needs and increased the overall quality of life by decreasing symptom levels but did not affect sexual health outcomes in patients with colorectal cancer surgery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study was aimed to analyze in detail how the fatigue effects to kinematic parameters of body weight squat exercise (BSQ) by dividing a squat cycle into four different regions. Twenty-one male athletes participated in this study. Participants were divided into two groups according to their lower limb muscle ratio (LLMR). The BSQ was performed until participants were unable to continue the exercise due to the fatigue. Linear and angular kinematics were obtained by motion analysis software which has high validity and reliability. There was no significant but had large effect size interaction between fatigue conditions and LLMR groups in terms of knee ROM in the extension phase and hip angular velocity in braking phase of the flexion (0.08 > p >0.05, 0.18 > [Formula: see text] > 0.16). Fatigue condition did not have a significant effect on the duration in the acceleration and braking phases of BSQ (p > 0.05). There were many significant main effects on kinematics in the different regions due to the fatigue (0.01 < p <0.05, 0.44 > [Formula: see text] > 0.14). In the fatigue condition, there was a polynomial relationship between velocity of shoulder and hip joints (R2flex = 0.82, R2ext = 0.72) rather than linear (R2flex = 0.64, R2ext = 0.53) and coefficient correlations also decreased (rflex = 0.88 to 0.80, rext = 0.92 to 0.73). The sticking region was observed in the non-fatigue condition and disappeared when fatigue occurred. These results suggest that LLMR may be taken into consideration in the squat exercises, joint tracking may vary for velocity-based squat training and pre-test for sticking region observation may be apply with the BSQ., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Erman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The purpose of this study was to assess the differences in muscle activation (EMG) and body weight distribution (%BW) between suspension (TRX™ push-up and TRX™ inverted row) and conventional exercises (bench press and lying barbell row) using different contraction types (isometric and isotonic) and position variations (feet on the ground [FG] and feet on suspension device [FD]). It was also used to determine the intensity of the force applied to the straps of the suspension device corresponding to one repetition maximum (1-RM). Twelve male athletes (ages-24.5±4.2 years (mean±standard deviation [SD]); Height-181.0±6.8 cm; body mass-83.08±6.81 kg) participated in this study. Two suspension devices were used, one for the FD variation and one for the FG variation pectoralis major (PM) and triceps brachii (TRI) activations were assessed during the TRX™ push-up and bench press exercises. Transversus trapezius (TRA) and biceps brachii (BB) activations were assessed during the TRX™ inverted row and lying barbell row exercises. The results showed significant differences between exercises (FG and FD variations of TRX™ push-up and bench press) in PM activities (isometric and isotonic) (p≤0.05). However, these differences were only observed during isometric TRI activation (p≤0.05). In the FG and FD variations of the TRX™ inverted row and lying barbell row exercises, there were only differences in the isometric contractions of the TRA and BB (p≤0.05). In the suspension device of push-ups and inverted row for the FD variations, 70.5% and 72.64% of 1-RM intensity were obtained, respectively. Similar responses to training intensities and muscle activations can be obtained in suspension exercises and conventional exercises. FD variations of suspension exercises can be more effective in terms of muscle activations than FG variations, and isotonic suspension exercises increase exercise intensity more than isometric suspension exercises., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Vural et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Allogeneic stem cell transplantation (ASCT) is a crucial therapeutic strategy for hematological and non-hematological disorders. Poor graft function (PGF) after ASCT presents a critical challenge that does not have a standardized treatment approach. A thrombopoietin-mimetic oral drug eltrombopag shows promise in some bone failure syndromes. This study aimed to analyze the efficacy of eltrombopag in treating PGF after ASCT., Methods: Patients receiving eltrombopag for PGF after ASCT between 2017 and 2020 were retrospectively evaluated. Patients' characteristics, details for ASCT, timing, treatment, and possible contributors for PGF, response to eltrombopag treatment, and overall response rate (ORR) were analyzed.  Results: Eighteen patients were assessed. Eltrombopag treatment yielded a favorable response in 11 patients, resulting in an ORR of 61%. The ORR in secondary PGF was better than that in primary PGF (83% and 17% respectively). There was a marked enhancement in platelet and hemoglobin levels following eltrombopag treatment ( p=0.001 and p=0.030 , respectively), while neutrophil values exhibited no significant change ( p=0.8 ). Among the responding patients, four individuals (22%) underwent a tapering and discontinuation of eltrombopag. No toxicity was observed above grade one, and no patient discontinued eltrombopag because of intolerability or adverse events., Conclusion: Our findings affirm that eltrombopag can treat poor graft function after allogeneic stem cell transplantation without significant toxicities. These results contribute to the growing body of evidence supporting the use of eltrombopag in poor graft function after allogeneic stem cell transplantation, providing insights into its potential benefits and limitations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Arslan Davulcu et al.)

Objective: To use metaphor to evaluate stoma perceptions among adults with ostomies to conceptualize and portray their lived experiences using a figurative approach., Methods: A qualitative research design was used. Participants were 27 adults with an ostomy who were followed up in the stoma therapy unit. Individuals were included in the study if they had had a temporary or permanent ostomy for at least 2 months and spoke Turkish. Participants were asked to complete the sentence: "Stoma is like…/similar to… because…." The researchers used content analysis to evaluate participants' responses. Interpretation of the metaphors developed by participants was carried out in five phases: coding, example metaphor compilation, theme development, ensuring trustworthiness, and transferring., Results: Participants expressed a total of 17 unique and 10 repeated metaphors for the concept of "stoma." These metaphors were grouped under three different themes: positive (lifesaving), negative (punishment/enemy), and neutral (temporary/necessity for life). The most commonly used metaphors were life, savior, comfort, difficulty, fear, punishment, and necessity., Conclusions: Individuals with an ostomy mostly had negative metaphorical associations with stomas. The authors recommend that hospitals implement multifaceted interventions to bring positive metaphors to individuals with ostomies., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction . Assigned female at birth transgender people go through a gender-affirming hormone therapy using testosterone. We aimed to define the histological changes in the removed ovaries of these patients and investigate the correlation of these changes to factors like chronological age and duration of hormone therapy. Methods . The ovaries of 84 patients who had at least 6 months of testosterone therapy before surgery were examined. Tunica albuginea thickness, cortical thickness, and number of different stages of follicles were recorded. Results . The mean age was 27.2 ± 4.9 years. Testosterone duration 25.8 ± 13.1 months. The mean tunica albuginea thickness was 356.4 ± 152.6 µm. The mean cortical thickness was 799.6 ± 245.6 µm. The number of primordial (C1) follicles was 18.03 ± 13.6 and antral (C3) follicles was 3.1 ± 1.9 per cm². When grouped as using therapy under or over 2 years the groups did not have differences in histological findings. Hormone duration did not correlate with histological findings except for a positive correlation with atretic follicle number. However, age was negatively correlated with number of follicles at all stages except atretic follicles and positively correlated with cortical thickness ( P  < .05). Conclusion . Testosterone therapy induces multifollicularity, stromal hyperplasia, and luteinization in some patients. Hormone duration did not correlate with ovarian histology whereas chronological age did suggesting an effect of age on ovarian reserve rather than duration of hormone therapy.

Purpose: This study aimed to evaluate the relationship between androgens and the retinal thickness by comparing the macular thickness (MT), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) thickness of female-to-male transgender men (TGM), women with polycystic ovary syndrome (PCOS), and cisgender women (CW)., Methods: Thirty-four eyes of 34 TGM, 34 eyes of 34 women with PCOS, and 45 eyes of 45 CW were evaluated by optical coherence tomography. One-way analysis of variance and body mass index (BMI)-adjusted one-way analysis of covariance were conducted to test the differences between groups for statistical evaluation., Results: The parafoveal MT in TGM was significantly higher than women with PCOS and CW ( p <0.001 and p =0.022, respectively). After adjusting for BMI, the perifoveal MT in TGM was significantly higher than women with PCOS and CW ( p =0.041 and p =0.021, respectively). The nasal RNFL thickness in TGM was significantly higher than women with PCOS and CW ( p =0.021 and p =0.009, respectively). The means of average and inferior RNFL, fovea, and the mean of all GCC values were higher in the TGM group than women with PCOS and CW, but these results were not statistically significant., Conclusions: In this study, there was a significant difference between the TGM group and the CW group for the thickness of the nasal RNFL and parafoveal and perifoveal macular area. Androgens may have the potential to increase retinal thickness in TGM; however, there is a need for validation in larger study groups. Clinical Trial Registration Number: HNEAH-KAEK 2021/4., Competing Interests: The authors have no conflicts of interest to declare., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Purpose: Langerhans cell histiocytosis (LCH) is a rare disease that can affect all tissues and organs. Our study evaluated the clinical characteristics and treatment outcomes of adult-onset LCH patients in a tertiary center., Materials and Methods: Adult patients diagnosed with LCH were retrospectively evaluated. Their initial symptoms, stratification according to disease involvement, treatment details, treatment responses, and overall and progression-free survival (PFS) were analyzed., Results: Thirty-three patients were included. There were 21 single system LCH, 10 multisystem LCH, and 2 pulmonary LCH patients. Patients with single system unifocal involvement were successfully treated with local therapies such as surgery and radiotherapy. Most of the multisystem LCH patients and patients with single system multifocal involvement were treated with systemic chemotherapy. Cladribine was the first choice in 10 out of 11 patients who received chemotherapy. Among all patients, the overall response rate (ORR) was 97%. Among those who had cladribine in the first-line the ORR was 81%. All these patients achieved a complete remission and were alive at the last visit. The median follow-up was 38 (range, 2-183) months. The median PFS has not yet been reached. Ten-year PFS was 90.9%., Conclusion: Besides successful local treatments with surgery and radiotherapy, our study provides information for front-line cladribine treatment., (© 2023. The Author(s).)

Objective: It has been suggested that non-uterine endometrial implants can express thyroid-stimulating hormone receptors, thus inducing the formation of thyroid-stimulating immunoglobulin. We aimed to compare the autoantibody positivity in patients with and without endometriosis and to determine whether there is a difference in the incidence of thyroid diseases., Methods: This prospective observational study was conducted on 102 women who had been operated on for benign gynecological diseases. Cases enrolling in the study were divided into two groups: the study group with endometriosis (n=51) and the control group without endometriosis (n=51). The blood tests for thyroid-stimulating hormone, free thyroxine (fT4), thyroid-stimulating immunoglobulin, and anti-thyroid peroxidase antibody levels were checked., Results: The mean thyroid-stimulating immunoglobulin level was found to be higher in the endometriosis group than in the control group. However, this difference was not statistically significant. No significant difference was detected between endometriosis and control groups in terms of anti-thyroid peroxidase antibody and thyroid-stimulating hormone levels. The mean fT4 value (0.97±0.13 ng/dL) of the endometriosis patients was found to be significantly lower than the control group (1.08±0.21 ng/dL) (p=0.002; p<0.05). The mean anti-thyroid peroxidase antibody value of cases with bilateral endometrioma (82.21±252.29 IU/mL) was significantly higher than cases with unilateral endometrioma (15.81±83.13 IU/mL) (p=0.028; p<0.05). There is a positive and significant relationship between the size of endometriosis and anti-thyroid peroxidase antibody values (p=0.011; p<0.05)., Conclusion: This study points to an association between endometrioma diameter and anti-thyroid peroxidase antibody values which can be a stepping stone for new studies evaluating this hypothesis further.

Aim: To determine the unmet needs and challenges in management, diagnosis, treatment, follow-up and patient-physician communication in acute leukemia (AL). Materials & methods: The study was based on a modified Delphi approach. A questionnaire including the major potential obstacles was circulated twice among 13 hematologists. Results: The obstacles in AL management were limited access to the novel treatments and genetic tests, limited bed capacity, insufficient level of knowledge among allied health personnel, limited availability of psycho-oncological support and low levels of awareness in the population about the importance of stem cell donation. Conclusion: The challenges in the management of AL are critical to guide the efforts to improve the quality of healthcare delivery and the evidence-based decision making at treatment of AL patients.

Purpose: The diagnosis of polycystic ovary syndrome (PCOS) remains a challenge to clinicians due to heterogeneous clinical presentation and diagnostic criteria. This study investigated the utilization of Anti-Müllerian hormone (AMH) alone or replacing polycystic ovarian morphology (PCOM) in the PCOS diagnostic criteria., Methods: A total of 401 women were categorised as PCOS (n:154), nonPCOS with polycystic ovarian morphology (PCOM) (n:105), and nonPCOS with normal ovarian morphology (NOM) (n:142). First, the diagnostic performance of AMH for PCOS diagnosis in Rotterdam, Androgen Excess Society, and National Institutes of Health (NIH) criteria was analyzed. Second, AMH was used instead of PCOM in Rotterdam criteria and we searched diagnostic performance for PCOS phenotypes., Results: AMH levels were positively correlated with LH, testosterone, hirsutism score, menstrual cycle length, and antral follicle count (p < 0.05). AMH alone had specificity and sensitivity for PCOS diagnosis were 84.9% and 72.4% in Rotterdam (AUC: 0.866); 84.4% and 72% in Androgen Excess Society (AUC: 0.857); 83.3% and 66.4% in National Institute of Health criteria (AUC: 0.825). AMH alone had satisfactory diagnostic potential for phenotype A, but not other phenotypes. The replacement of PCOM with AMH in Rotterdam criteria had a high diagnostic potential for PCOS (AUC: 0.934, sensitivity:97.4%, specificity: 90.67%). Phenotype A and phenotype D were diagnosed with 100% sensitivity and 94.5% specificity. Phenotype C was recognised with 96.15% sensitivity and 94.5% specificity., Conclusion: AMH may be used with high diagnostic accuracy instead of PCOM in the Rotterdam PCOS criteria., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This cross-sectional and descriptive study aimed to determine care burden of families of children with corrosive esophageal injuries. The study involved 112 parents who had children with corrosive esophageal injury. Caregiver's Stress Scale and Reactions to Helping Family Members Scale were used to assess care burden of families. Caregiver's Stress Scale median score was 7.0 [interquartile range 5.0], and Reactions to Helping Family Members Scale median score was 45.0 [interquartile range 14.0]. The burden of family caregivers was thus found to be high. Factors affecting the care burden were found to be child's age, parents' age, child's weight, substance type and pH, surgery status, and number of surgeries. Nurses should consider these factors when advising and educating these families. Additionally, initiatives including support groups should be planned with regard to the needs of these families with a high care burden.

Purpose: Some proliferative and neoplastic changes can be seen in the endometrium of breast cancers using tamoxifen adjuvant therapy (TMX-BC). Identifying risk groups is crucial, but methods and frequency of endometrial follow-up are still controversial. This study aimed to investigate the clinical, ultrasonographic, and inflammatory factors to differentiate pathological endometrium in TMX-BC., Methods: This study retrospectively analyzed endometrial biopsy results of TMX-BC (n 361). Normal endometrium (Group I, n 237) and pathological endometrium (Group II, n 124) were compared for clinical, ultrasonographic, and inflammatory features. Neutrophil and platelet to lymphocyte ratio (NLR; PLR), mean platelet volume (MPV), platelet distribution width (PDW), red blood cell distribution width (RDW), and lymphocyte-monocyte ratio (LMR) were the inflammatory markers., Results: The majority of TMX-BC with endometrial biopsy were asymptomatic (72.6%) and had normal endometrium (65.7%). Pathologic endometrium included endometrial polyp (31.9%), endometrial hyperplasia (1.7%), and endometrial cancer (0.8%). The duration of tamoxifen, cancer stage, vaginal bleeding, and menopause was similar in Group I and Group II (p > 0.05). Group II had increased endometrial thickness (11.22 ± 5.44 mm) compared to Group I (8.51 ± 3.43 mm). Group II had higher RDW and PDW than Group I (p < 0.05). Endometrial thickness ≥ 10 mm had significant diagnostic potential in postmenopausal women (AUC 0.676, p 0.000, CI 0.5-0.7), but not in premenopause., Conclusion: PDW and RDW may be promising markers for pathological endometrium differentiation, but these preliminary findings should be validated by clinical studies. Measurement of endometrial thickness in asymptomatic patients may predict high-risk women with pathological endometrium in postmenopausal women. Further studies are needed in premenopausal women and those using tamoxifen for more than 5 years., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aimed to understand the postoperative nutritional experiences of parents of children who had undergone gastric transposition surgery after corrosive esophageal injury. The study had a descriptive qualitative research design, and used a structured interview form as a result of the COVID-19 pandemic. The population of the study consisted of the parents of 12 children who had undergone gastric transposition surgery at the pediatric surgery clinic of a university hospital in an urban area in Turkey. Thematic analysis was conducted on the transcripts using the MAXQDA program. Four main themes emerged and five supporting sub-themes were identified. The main themes were what we experienced in the postoperative nutrition process, coping with how we live, what we want to know, and our recommendations to healthcare professionals. Family-centered care should be a main focus when caring children who have had gastric transposition surgery, and children and their parents should be supported by a multidisciplinary team.

Objective: To compare the total vaginal wall thickness (TVT) and total mucosal thickness (TMT) measurements of premenopausal and postmenopausal women measured by ultrasonography and to determine the association of these measurements to findings and symptoms of genitourinary syndrome of menopause METHODS: Healthy volunteers, 80 postmenopausal and 80 premenopausal, were included. Ultrasonographic TVT and TMT measurements, vaginal health index (VHI) scores and pH values were recorded. The daily impact of vaginal aging (DIVA) scale was administered to women in the postmenopausal group., Results: TVT measurements of the postmenopausal group (6.55 ± 2.00 mm) were lower than the premenopausal group (10.37 ± 2.11 mm) (p: 0.000). TMT measurements of the postmenopausal group (1.46 ± 0.50 mm) were lower than the premenopausal group (2.19 ± 0.60 mm) (p: 0.000). The VHI scores of the postmenopausal group were significantly lower than the premenopausal group, the pH value was higher (p < 0.05). Considering all women TVT and TMT measurements were inversely correlated with pH values and positively correlated with total VHI scores. There was no significant correlation between any component scores of the DIVA scale and TVT, TMT, pH, and VHI total (p > 0.05)., Conclusions: TVT and TMT measurements in postmenopausal women are significantly lower than premenopausal women. Examination findings and thickness measurements are correlated. Transabdominal ultrasonography is a method that can be used in the evaluation of vaginal thickness which is not painful for the patient, is easy to apply and gives results consistent with the examination findings. However, measurements and examination findings do not correlate with the DIVA scores in postmenopausal women., (© 2022 Japan Society of Obstetrics and Gynecology.)

Purpose: Preparing a patient cognitively, psychosocially and emotionally for an operation is important for the healing process. The purpose of this study is to investigate the psycholinguistic and psychometric properties of the Turkish version of The Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ-TR)., Design: Methodological study., Methods: The sample consisted of 220 patients. Patients who underwent operation or reoperation for colorectal cancer were included. The language validity, content validity, discriminant validity and construct validity (confirmatory factor analysis) analyses were performed. The item analysis and internal consistency were examined., Findings: Item total score correlations were between 0.38 and 0.85. The Cronbach's alpha was 0.97 for the overall PCSQ-TR and ranged between 0.85 and 0.91 for its domains. Discriminant validity revealed a statistically significant moderate positive correlation between the patients' mean score for the overall PCSQ-TR and their subjective preparedness for surgery score (r = 0.64, P = .000). In the confirmatory factor analysis, the fit indexes were χ2/df = 2.5; P = .00, RMSEA = 0.08, CFI = 0.92, IFI = 0.92, RMR = 0.18, GFI = 0.79., Conclusions: PCSQ-TR is a valid and reliable scale that can be used to determine colorectal cancer patients' preparedness for surgery and recovery. PCSQ-TR can be administered in writing or online and can help identify patients who do not feel ready for the surgical recovery process and need advanced nursing care support., (Copyright © 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effects of testosterone on carotid intima-media thickness (CIMT) and serum inflammatory markers compared within transgender males (TGM-Former called female-to-male) and polycystic ovary syndrome (PCOS). Methods: The prospective observational study included 30 TGM, 30 patients with PCOS, and 30 healthy women. Groups were compared for CIMT and hematologic inflammatory markers white blood cell (WBC), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and mean platelet volume (MPV). Results: The CIMT of the TGM group was 0.48 ± 0.09 mm was significantly higher than PCOS (0.41 ± 0.09 mm, p  = .005) and the control group (0.38 ± 0.7 mm, p  = .001). The mean NLR, LMR, and MPV values were similar ( p  > .05). TGM had higher WBC levels compared to control women ( p  = .029). TGM had significantly lower PLR compared to PCOS and the control group ( p  = .001). CIMT were related to age ( r  = .390, p  = .04) and body mass index (BMI) ( r  = .392, p  = .03) in TGM. Conclusion: Increased CIMT in TGM individuals is not associated with inflammation; it seems to be a deleterious effect of exogenous testosterone exposure. Since increased CIMT may be a sign of serious cardiovascular problems developing in the future, it is suggested that it will be beneficial for these individuals should undergo clinical and radiological evaluation at regular intervals.

Objective: Studies comparing the efficacy and safety of prophylactic regimens for central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) are scarce in adults. This multicenter retrospective study aimed to compare the efficacy of prophylactic regimens with and without CNS irradiation on the development of CNS relapse during follow-up., Materials and Methods: This was a multicenter comparative cohort study. A total of 203 patients were included from four tertiary care centers in Turkey. Patients were divided into two groups according to whether they received CNS irradiation or not. The groups were analyzed retrospectively regarding patient and disease characteristics, with the main focus being CNS relapse., Results: While 105 patients received chemotherapy-based prophylaxis, 98 patients received additional CNS irradiation. These groups were statistically comparable in terms of demographic characteristics and risk factors for CNS involvement. In the irradiation group, patients were younger and had more stem cell transplants. In a median of 23.8 (11.1-62.4) months, there was no difference between the two groups regarding CNS relapse-free survival (log-rank p=0.787)., Conclusion: Craniospinal irradiation may not be indispensable for every adult patient with ALL, similarly to pediatric patients. It is crucial to avoid the long-term toxicities of radiation, especially in patients with long life expectancy. Craniospinal irradiation may be reserved for therapeutic use in cases of CNS relapse and prophylaxis for some high-risk patients., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Hematology | Turkish Journal of Hematology, Published by Galenos Publishing House)

Objective: Peripheral T-cell lymphomas (PTCLs) are an uncommon and quite heterogeneous group of disorders, representing only 10%-15% of all non-Hodgkin lymphomas. Although both molecular and clinical studies have increased in recent years, we still have little knowledge regarding real-life practice with PTCLs. In this study, we aimed to investigate the clinical characteristics and treatment outcomes of a large population-based cohort of patients presenting with systemic non-cutaneous PTCL., Materials and Methods: We conducted a multicenter retrospective analysis of 190 patients consecutively diagnosed and treated with non-cutaneous PTCLs between 2008 and 2016., Results: Considering all first-line treatment combinations, the overall response rate was 65.9% with 49.4% complete remission (n=81) and 16.5% partial response (n=27). The 5-year overall survival and event-free survival rates were significantly different between the transplant and non-transplant groups (p<0.01, and p=0.033, respectively)., Conclusion: The retrospective analysis of a large volume of real-life data on the Turkish experience regarding non-cutaneous PTCL patients showed consistent results compared to other unselected PTCL cohorts with some minor differences in terms of survival and transplantation outcomes. The long-term outcome of patients who receive autologous hematopoietic cell transplantation as part of upfront consolidation or salvage therapy is favorable compared to patients who are unable to receive high-dose therapy., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Hematology | Turkish Journal of Hematology, Published by Galenos Publishing House)

This case report was made to understand the emotions, thoughts, and experiences of the mother, who was lying in the long-term neonatal intensive care unit. An individual in-depth interview was conducted once with the mother of the infant with the diaphragm hernia. The interview recorded and lasted approximately 30 min. The data were analyzed by inductive method and themes and codes were created. The mother of the infant with a diaphragmatic hernia was 31 years old, married with 2 children, and employed full-time. The infant was diagnosed antenatally at 37 weeks old, weighed 3.000 g, and was male. As a result of the interview, 3 main themes were identified: "Facing the disease," "Experiences in intensive care," and "Change in family life." The results show that having an infant with congenital anomaly affects the life of all family members and shows the problems experienced strikingly., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Thrombotic microanjiopathy (TMA) is a pathological diagnosis characterized by abnormalities of small vessels leading to microvascular thrombosis of arterioles and capillaries. The current prospective, non-interventional, multicenter study aimed to define the distribution of different TMA forms in adult Turkish patients who were referred for therapeutic plasma exchange (TPE) for presumptive diagnosis of TMA. Patients with serum ADAMTS13 activity <5% were diagnosed as having acquired thrombotic thrombocytopenic purpura (aTTP). Patients presenting with ADAMTS13 activity 6-10 % / normal renal function and patients with ADAMTS13 activity >10 %, normal renal function and no secondary TMA were treated as unclassified TMA. The study included a total of 80 patients (women: 50; man: 30) with a median age of 48 (20-74). Detailed evaluation at 1 month after hospital admission revealed aTTP, secondary TMA, infection/complement-associated hemolytic uremic syndrome and unclassified TMA in 29 (36.2 %), 22 (27.5 %), 23 (28.8 %) and 6 (7.5 %) patients respectively. As subclassification of various TMAs will dictate specific therapy, proper diagnosis in a timely manner is of utmost clinical significance., (Copyright © 2022. Published by Elsevier Ltd.)

Purpose: To evaluate the use of transperineal ultrasonography while diagnosing stress urinary incontinence (SUI) by comparing the urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND) during rest and Valsalva maneuver in continent women and women with SUI., Materials and Methods: This prospective observational study was conducted with 50 women with SUI and 50 continent women. Transperineal ultrasonography was performed at rest and during Valsalva maneuver. Q-tip test was performed., Results: During the Valsalva maneuver, both α and β angles were significantly higher in women with SUI (p < 0.001). The difference between Valsalva and rest measurements of α and β angles (R α, R β) were also significantly higher in women with SUI (p < 0.001). The cut-off point determined for the R α in the diagnosis of stress incontinence was 16° (80% sensitivity, 98% specificity). A statistically significant strong correlation was found between Q-tip test angle and R α value (p=0.000; r=0.890). Q-tip VAS pain scores were significantly higher than ultrasonography VAS pain scores (p < 0.001). In relation to the bladder neck descent comparison between the two groups showed that BND was significantly higher in SUI group (p < 0.001). The cut-off point determined for BND in the diagnosis of SUI was >11mm (90% sensitivity, 98% specificity)., Conclusion: Transperineal ultrasonography is a practical, reliable, non-invasive and comfortable method for evaluation of SUI. It has the advantage of dynamic evaluation during the Valsalva maneuver. Rotation angles and BND have high sensitivity and specificity for detection of SUI. The change in α angle with Valsalva (Rα) can be used as an alternative to Q-tip test., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objective: We evaluated the efficacy and safety of pomalidomide, bortezomib, and dexamethasone (PVd) vs bortezomib and dexamethasone (Vd) by age, renal function, and high-risk cytogenetic abnormalities in lenalidomide-pretreated patients with multiple myeloma at first relapse., Methods: OPTIMISMM was a phase 3, multicenter, open-label, randomized study (NCT01734928; N = 559). The primary endpoint was progression-free survival (PFS)., Results: Overall, 226 patients had received one prior line of therapy. PVd significantly prolonged PFS vs Vd in patients aged ≤65 years (median, 22.0 vs 13.1 months; P = .0258) and >65 years (median, 17.6 vs 9.9 months; P = .0369). Median PFS in patients with renal impairment (RI; creatinine clearance <60 mL/min) was 15.1 months with PVd vs 9.5 months with Vd (hazard ratio [HR], 0.67 [95% CI, 0.34-1.34]). In patients without RI, median PFS was 22.0 vs 13.1 months (HR, 0.45 [95% CI, 0.27-0.76]). In patients with high-risk cytogenetics, median PFS was 14.7 vs 9.9 months (HR, 0.39 [95% CI, 0.13-1.17]). PVd significantly improved overall response rate vs Vd in all subgroups. The safety profile of PVd was consistent with previous reports., Conclusions: These findings confirmed the benefits of PVd at first relapse, including in patients with poor prognostic factors., (© 2021 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.)

Background: The inflammatory markers are associated with adverse clinical outcomes in endometrial cancers (EC), but hematopoietic aging may affect the results., Objective: To compare inflammatory markers in geriatric and nongeriatric EC., Methods: This study included 342 women with endometrial cancers (n: 171) and age-matched controls (n: 171). Geriatric (⩾ 65 years old) and nongeriatric women in each group was compared for inflammatory markers, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW)., Results: Geriatric EC had more common nonendometrioid tumors, myometrial invasion, lymph node metastasis, advanced stage, and low overall survival (OS). Nongeriatric EC had low MPV, high NLR, and PDW compared to nongeriatric control. Geriatric EC had low MPV, lymphocyte, and high NLR, PLR compared to geriatric control (p< 0.05). Geriatric EC had significantly low PDW and high NLR, PLR compared to nongeriatric EC in early stages, not in advanced stages. Lymphocyte count was significantly low in geriatric EC with all stages (p< 0.05). In nongeriatric EC, stage was related to platelet count (r: 0.341, p: 0.0019), and PLR (r: 0.252, p: 0.01). OS was negatively related to PLR (r: -0.267, p: 0.007) and NLR (r: -0.353, p: 0.000). In geriatric EC, myometrium invasion was negatively related to lymphocyte count (r: -0.268, p: 0.035). OS was related to neutrophil count (p: 0.352, p: 0.01). MPV was negatively related to stage (r: -0.335, p: 0.01) and OS (r: -0.337, p: 0.02)., Conclusions: The inflammatory responses of geriatric and nongeriatric EC were different in the early and advanced stages. Geriatric EC had low PDW and high NLR, PLR compared to nongeriatric EC in early stages. Decreased lymphocyte count was the most prominent feature of geriatric EC in the early and advanced stages. These results suggested that decreased lymphocyte count may reflect an aggressive course of disease in the elderlies. Future inflammation studies may direct anticancer treatment strategies in geriatric EC. Further research on inflammaging and geriatric EC is needed to increase our understanding of aging and carcinogenesis.

Thrombotic microangiopathy(TMA) is a pathological diagnosis characterized by abnormalities of small vessels leading to microvascular thrombosis of arterioles and capillaries. The current prospective, non-interventional, multicenter (n:18) study aimed to define distribution of different TMA forms in adult Turkish patients who were referred for therapeutic plasma exchange (TPE) for a presumptive diagnosis of TMA. Patients with serum ADAMTS13 activity <5% were diagnosed as acquired thrombotic thrombocytopenic purpura (aTTP). Patients presenting with ADAMTS13 activity 6-10 % / normal renal function and patients with ADAMTS13 activity >10 %, normal renal function and no secondary TMA were treated as unclassified TMA. The study included a total of 97 patients (female: 60; male: 30) with a median age of 48 (18-74). Detailed evaluation at 1 month after hospital admission revealed aTTP, secondary TMA, infection/complement-associated hemolytic uremic syndrome and unclassified TMA in 32 (33 %), 33 (34 %), 26 (27 %) and 6 (6%) patients respectively. As subclassification of various TMAs will dictate specific therapy, proper diagnosis in a timely manner is of utmost clinical significance., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Immunocompromised individuals, particularly autologous hematopoietic stem cell transplant (auHSCT) recipients, are at high risk for herpes zoster (HZ). We provide an in-depth description of humoral and cell-mediated immune (CMI) responses by age (protocol-defined) or underlying disease (post-hoc) as well as efficacy by underlying disease (post-hoc) of the adjuvanted recombinant zoster vaccine (RZV) in a randomized observer-blind phase III trial (ZOE-HSCT, NCT01610414). 1846 adult auHSCT recipients were randomized to receive a first dose of either RZV or placebo 50-70 days post-auHSCT, followed by the second dose at 1-2 months (M) later. In cohorts of 114-1721 participants, at 1 M post-second vaccine dose: Anti-gE antibody geometric mean concentrations (GMCs) and median gE-specific CD4[2+] T-cell frequencies (CD4 T cells expressing ≥2 of four assessed activation markers) were similar between 18-49 and ≥50-year-olds. Despite lower anti-gE antibody GMCs in non-Hodgkin B-cell lymphoma (NHBCL) patients, CD4[2+] T-cell frequencies were similar between NHBCL and other underlying diseases. The proportion of polyfunctional CD4 T cells increased over time, accounting for 79.6% of gE-specific CD4 T cells at 24 M post-dose two. Vaccine efficacy against HZ ranged between 42.5% and 82.5% across underlying diseases and was statistically significant in NHBCL and multiple myeloma patients. In conclusion, two RZV doses administered early post-auHSCT induced robust, persistent, and polyfunctional gE-specific immune responses. Efficacy against HZ was also high in NHBCL patients despite the lower humoral response.

Purpose: To compare the effects of testosterone on intraocular pressure (IOP), thicknesses of retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), macula and on ocular blood flow between female-to-male transgender (FMT) persons who use testosterone and healthy women and healthy men., Method: The study included 39 eyes of 20 FMT(Group 1), 40 eyes of 20 healthy women (Group 2), and 42 eyes of 21 healthy men (Group 3). In all subjects, RNFL, GCC and, macular thicknesses (MT) were measured by optical coherence tomography (OCT). Ocular blood flow was measured by Color Doppler Ultrasonography in all subjects., Results: IOP levels in FMT were significantly higher than men (p = 0.025). Superior (Sup), inferior (Inf) thicknesses of parafovea, and nasal thickness of perifovea in FMT were significantly higher than the Group 2 (p = 0.024, p = 0.037, p = 0.018). Sup thickness of perifovea in FMT was significantly higher than Group 3 (p = 0.011). Inf thickness of perifovea in FMT was significantly higher than Group 2 and 3 (p = 0.038, p = 0.002). Mean thickness of RNFL Inf in FMT was significantly higher than the Group 2 and 3 (p = 0.039, p = 0.032). Avg and Inf thicknesses of GCC in FMT were significantly higher than group 2 (p = 0.02, p = 0.005). In correlation test, systole/diastole ratio(S/D) in ophthalmic artery (OA) (r = 0.504, p = 0.028) and Inf thickness of perifovea (r = 0.485, p = 0.035) were positively correlated with the serum levels of testosterone in FMT., Conclusions: We found that the use of supraphysiologic testosterone dose increased IOP and the thicknesses of macula, RNFL, and GCC in FMT. Serum testosterone level was positively correlated with S/D ratio in the OA., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: Although inhibition of the complement system at different steps is a promising therapy modality in patients with paroxysmal nocturnal hemoglobinuria (PNH), allogeneic hematopoietic stem cell transplantation (HCT) is still the only curative therapy, especially for patients with intractable hemolysis or bone marrow failure. The aim of this study is to evaluate the outcomes of allogeneic HCT in PNH patients with aplastic anemia (PNH-AA) or without., Materials and Methods: Thirty-five PNH/PNH-AA patients who were treated with allogeneic HCT in 10 transplantation centers in Turkey were retrospectively analyzed., Results: Sixteen (45.7%) and 19 (54.3%) patients were diagnosed with classical PNH and PNH-AA, respectively. The median age of the patients was 32 (18-51) years. The 2-year overall survival (OS) rate and rate of graft-versus-host disease-free, failure-free survival (GFFS) was 81.2% and 78.1%, respectively. The 2-year OS in cases of classical PNH and PNH-AA was 81.3% and 79.9%, respectively (p=0.87), and 2-year GFFS in cases of PNH and PNH-AA was 79% and 76% (p=0.977), without statistical significance. The OS and GFFS rates also did not differ between transplantations with matched sibling donors (MSDs) and matched unrelated donors (MUDs)., Conclusion: Allogeneic HCT with MSDs or MUDs is a good option for selected patients with classical PNH and PNH-AA. In particular, patients with debilitating and refractory hemolysis and patients with bone marrow failure might form an excellent group of candidates for allogeneic HCT.

The pathophysiology of endometriosis is still unknown and treatment options remain controversial. Searches focus on angiogenesis, stem cells, immunologic and inflammatory factors. This study investigated the effects of etanercept and cabergoline on ovaries, ectopic, and eutopic endometrium in an endometriosis rat model. This randomized, placebo-controlled, blinded study included 50 rats, Co(control), Sh(Sham), Cb(cabergoline), E(etanercept), and E + Cb(etanercept + cabergoline) groups. After surgical induction of endometriosis, 2 nd operation was performed for endometriotic volume and AMH level. After 15 days of treatment: AMH level, flow cytometry, implant volume, histologic scores, immunohistochemical staining of ectopic, eutopic endometrium, and ovary were evaluated at 3 rd operation. All groups had significantly reduced volume, TNF-α, VEGF, and CD 146/PDGF-Rβ staining of endometriotic implants comparing to the Sh group (p < 0.05).TNF-α staining of eutopic endometrium in all treatment groups was similar to Sh and Co groups (p > 0.05). E and E + Cb groups significantly decreased TNF-α staining in the ovary comparing to Sh, Co, and Cb groups (p < 0.05). All treatment groups had significantly higher AFC compared to the Sh group. CD25 + Cells' median percentage was significantly increased in the E + Cb group compared to Co, Sh, Cb, and E group. E + Cb group had a significantly higher CD5 + Cells' level than the Co group (p = 0.035). In conclusion; Etanercept and/or Cabergoline decreased volume, TNF-α, VEGF, and CD 146/PDGF-Rβ staining of the ectopic endometrial implant. E and E + Cb treatment decreased TNF-α levels in the ovary. E + Cb also increased peripheral blood CD25 + & CD5 + Cell's., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: This study aims to analyze inflammatory markers among patients with endometrial cancer, hyperplasia with atypia/endometrial intraepithelial neoplasia, hyperplasia without atypia, and normal controls, thus observing the stage at which inflammation becomes the most significant., Methods: A total of 444 patients who had endometrial sampling were included in the study (endometrial cancer, n=79; endometrial hyperplasia with atypia/endometrial intraepithelial neoplasia, n=27; endometrial hyperplasia without atypia, n=238; and normal controls, n=100). Neutrophil count, lymphocyte count, platelet count, platelet distribution width, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, CA-125, and endometrial thickness of the patients were recorded., Results: Comparing the groups for neutrophil count, the hyperplasia with atypia group had higher values compared with both the hyperplasia without atypia group and the control group (p=0.003). When compared for the lymphocyte count, the hyperplasia with atypia group had lower values compared with the control group (p=0.014). Neutrophil/lymphocyte ratio of the hyperplasia with atypia group was higher than all other groups, and neutrophil/lymphocyte ratio of the cancer group was higher than the control group (p=0.001). Platelet count, mean platelet volume, platelet distribution width, and platelet/lymphocyte ratio values were not significantly different among groups (p>0.05)., Conclusions: Considering the inflammatory markers, the most prominent result was that the hyperplasia with atypia group had neutrophilia, lymphopenia, and increased neutrophil/lymphocyte ratio compared with other groups.

Background/aim: The aim of this study is to assess the efficacy and safety of ruxolitinib in patients with myelofibrosis., Materials and Methods: From 15 centers, 176 patients (53.4% male, 46.6% female) were retrospectively evaluated., Results: The median age at ruxolitinib initiation was 62 (28–87) and 100 (56.8%) of all were diagnosed as PMF. Constitutional symptoms were observed in 84.7%. The median initiation dose of ruxolitinib was 30 mg (10–40). Dose change was made in 69 (39.2%) patients. Forty seven (35.6%) and 20 (15.2%) of 132 patients had hematological and nonhematological adverse events, respectively. The mean spleen sizes before and after ruxolitinib treatment were 219.67 ± 46.79 mm versus 199.49 ± 40.95 mm, respectively (p < 0.001). There was no correlation between baseline features and subsequent spleen response. Overall survival at 1-year was 89.5% and the median follow up was 10 (1–55) months. We could not show any relationship between survival and reduction in spleen size (p = 0.73)., Conclusion: We found ruxolitinib to be safe, well tolerated, and effective in real-life clinical practice in Turkey. Ruxolitinib dose titration can provide better responses in terms of not only clinical benefit but also for long term of ruxolitinib treatment., Competing Interests: none declared., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: The aim of this study was to evaluate the effectiveness of cryotherapy on the prevention of oral mucositis (OM) and on the oral pH value in patients with multiple myeloma undergoing autologous stem cell transplantation., Data Sources: This nonrandomized controlled clinical trial was carried out in Bone Marrow Transplant Centers of three hospitals with total 32 patients. In addition to standard oral care, a total of 80 minutes of cryotherapy was applied to the experimental group. OM was assessed according to the World Health Organization's Oral Toxicity Scale before chemotherapy and for 21 days after chemotherapy (every day in the first 14 days, then every other day until the 21st day [if not discharged])., Conclusion: According to the findings, cryotherapy did not change the incidence of oral OM, and neither affected the severity of nor decreased the duration of it. Oral pH value was found to be significantly different between the patient groups only before and 1 day after chemotherapy., Implications for Nursing Practice: Cryotherapy is an inexpensive, easy-to-use method with no side effects; it would be beneficial to continue cryotherapy to prevent the development of OM in patients with cancer receiving drugs with a short half-life such as melphalan. It is also recommended to conduct further studies with different chemotherapy drugs with short half-lives to determine its effect on the prevention of OM development., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Patients with relapsed/refractory multiple myeloma (RRMM) experience several relapses, and become refractory to successive therapies. In the ICARIA-MM trial (NCT02990338), isatuximab plus pomalidomide-dexamethasone prolonged median progression-free survival (PFS) in patients with RRMM. This subgroup analysis of ICARIA-MM assessed the treatment benefit of isatuximab by prior lines of therapy and refractory status. A total of 307 patients were randomized to isatuximab-pomalidomide-dexamethasone (n = 154) or pomalidomide-dexamethasone (n = 153). Isatuximab (10 mg/kg intravenously) was given weekly in the first 28-day cycle, then every other week. Standard pomalidomide-dexamethasone doses were given. PFS was assessed by prior lines and refractory status. Overall, 102 (66 %) patients receiving isatuximab-pomalidomide-dexamethasone and 101 (66 %) patients receiving pomalidomide-dexamethasone had received 2-3 prior lines; 52 (34 %) and 52 (34 %) had received >3 prior lines, respectively. Median PFS was higher with isatuximab-pomalidomide-dexamethasone versus pomalidomide-dexamethasone for patients who received 2-3 prior lines of therapy (12.3 vs. 7.8 months) and >3 prior lines of therapy (9.4 vs. 4.3 months). Median PFS was higher with isatuximab-pomalidomide-dexamethasone versus pomalidomide-dexamethasone for patients who were lenalidomide-refractory (11.4 vs. 5.6 months), lenalidomide-refractory at last line (11.6 vs. 5.7 months), refractory to a proteasome inhibitor (PI) (11.4 vs. 5.6 months), and double-refractory (11.2 vs. 4.8 months). Overall response rate (ORR) in patients receiving isatuximab-pomalidomide-dexamethasone versus pomalidomide-dexamethasone was 59.0 % versus 31.4 % in lenalidomide-refractory; 60.2 % versus 32.2 % in PI-refractory; and 58.6 % versus 29.9 % in double-refractory patients. Isatuximab-pomalidomide-dexamethasone improved PFS and ORR regardless of prior lines of therapy or refractory status, consistent with the benefit in the overall population., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Human carbonic anhydrase I and II isoenzymes (hCA I and II) are important metabolic enzymes. In this study, a new series of thiazol-(2(3H)-ylideneamino)benzenesulfonamide derivatives were synthesized and also some inhibition parameters including IC 50 (hydratese) and inhibition constant values (K i , esterase) were determined. All studied compounds exhibited potent inhibition against these enzymes. They inhibited carbonic anhydrases (CAs) with the IC 50 values of 113 to 395.8 nM (K i  = 77.38-319.59 nM) for hCA I and 91.9 to 516 nM (K i  = 62.79-425.89 nM) for hCA II. Among the compounds, 5c was found to be the most active one (K i : 77.38 nM) for hCA I and 5g was found for hCA II with the value of 62.79 nM., (© 2020 Wiley Periodicals LLC.)

Hepatic sinusoidal obstruction syndrome (HSOS) is a potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). We retrospectively evaluated the incidence, risk factors, treatment and survival for HSOS after allo-HSCT in Turkey. We also reported our experience of defibrotide (DF) for HSOS prophylaxis in high-risk (HR) patients. Across Turkey, 1153 patients from 10 centers were enrolled in the study. We evaluated the medical records of patients who were treated with allo-SCT between January 2012 and December 2015. The study included 1153 patients (687 males/466 females) with median age of 38 (15-71) years. The incidence of HSOS was 7.5 % (n = 86). The incidences of HSOS in the HR/DF+, HR/DF- and standard risk (SR) group were 8%, 66.7 % and 6.2 %, respectively. The rate of HSOS development was not statistically different between HR/DF + and SR group (p = 0.237). HSOS prophylaxis (defibrotide) was significantly decreased HSOS-related mortality (p = 0.004). The incidence of HSOS was found similar to literature in this large Turkish cohort. Defibrotide prophylaxis appears to be associated with low incidence of HSOS development and reduced HSOS-related mortality. Although these results are promising, future studies are needed to support the efficacy of defibrotide prophylaxis in patients with risk of HSOS., Competing Interests: Declaration of Competing Interest There are no conflicts of interest to report., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: In countries where frontline drug approval is limited to first-generation proteasome inhibitors or immunomodulatory drugs, relapses have been both more frequent and less durable. We investigated real world data on the efficacy and safety of daratumumab monotherapy among patients with relapsed refractory multiple myeloma (RRMM) from Turkey using a prospective early access program., Patients and Methods: A total of 42 patients with RRMM after a minimum of 3 previous lines of proteasome inhibitor/immunomodulatory drug-based treatments were included from 25 centers across Turkey. Daratumumab monotherapy was administered intravenously at a dose of 16 mg/kg weekly (cycles 1-2), on alternate weeks (cycles 3-6), and monthly thereafter., Results: The median daratumumab monotherapy duration was 5.5 months (range, 0.2-28.7 months). The overall response rate was 45.2%, including 14 (33.3%) partial responses, 4 (9.5%) very good partial responses, and 1 (2.4%) complete response. The median duration of response was 4.9 months. The median progression-free survival (PFS) was 5.5 (95% confidence interval, 2.6-8.4 months) with 12- and 18-month PFS rates of 35.7% and 31.0%, respectively. The median overall survival was not reached; the 12- and 18-month overall survival rates were 64.3% and 59.5%, respectively. The depth of response had a significant effect on PFS (log-rank test, P = .026). Overall, of the 76 adverse events reported, 33 (43.4%) were grade ≥ 3; only 4 (9.52%) were grade 3 infusion-related reactions. No infusion-related reactions or adverse events led to treatment discontinuation., Conclusion: The present findings from our daratumumab early access program have confirmed the efficacy and safety profile of daratumumab monotherapy in heavily pretreated Turkish patients with RRMM., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

In the randomized phase-3 OPTIMISMM study, the addition of pomalidomide to bortezomib and low-dose dexamethasone (PVd) resulted in significant improvement in progression-free survival (PFS) in lenalidomide-pretreated patients with relapsed or refractory multiple myeloma (RRMM), including lenalidomide refractory patients. Here, we report health-related quality of life (HRQoL) results from this trial. Patients received PVd or Vd in 21-day cycles until disease progression or discontinuation. HRQoL was assessed using the EORTC QLQ-C30, QLQ-MY20, and EQ-5D-3L instruments on day 1 of each treatment cycle. Mean score changes for global QoL, physical functioning, fatigue, side effects of treatment domains, and EQ-5D-3L index were generally stable over time across treatment arms. The proportion of patients who experienced clinically meaningful worsening in global QoL and other domains of interest was similar. These HRQoL results with PVd along with previously demonstrated improvement in PFS vs Vd continue to support its use in patients with RRMM.

Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details., Materials and Methods: Data were gathered from participating centers from different regions of Turkey using IBM SPSS Statistics 23 for Windows. Hepatitis B virus surface antigen (HBsAg), anti-HBs antibody, anti-HB core antigen antibody (anti-HBcAg), HB viral load, anti-hepatitis C virus (HCV) antibody, HCV viral load results were analyzed., Results: One hundred and four patients were reported. Hepatitis C virus positivity was observed in only one patient. However, hepatitis B virus surface antigen (HBsAg) positivity was observed in 11.2% and HBsAg and/or anti-HB core antigen antibody (anti-HBcAg) positivities were seen in 34.2% of the patients. The median age was 60 years (range=35-87). Median follow-up duration was 21.2 months (range=00.2-212; 23.2 months for surviving patients). Median overall survival was not reached. Estimated 3-year and 10-year survival rates were 84.8% and 68.9%, respectively. Older age, no splenectomy during follow-up, platelet count of <90x10 3 /μL, lower albumin, higher lactate dehydrogenase, higher β 2 -microglobulin, and HBsAg positivity were associated with increased risk of death. Only albumin remained significant in multivariable analysis., Conclusion: These results indicate that hepatitis B virus may be a possible risk factor for SMZL in our population. It may also be an indirect prognostic factor.

Purpose: The purpose of this study was to evaluate the content validity and interrater reliability of a Turkish language version of the Pittman Ostomy Complication and Severity Index (OCSI)., Design: Psychometric evaluation of instrument., Subjects and Setting: The sample comprised 90 individuals living with an ostomy for 2 to 6 months. Their mean age was 59.48 years (SD 13.292); 52.2% were female. Almost two-thirds (73.3%, n = 66) had experienced at least 1 ostomy complication. The study was conducted in the Wound and Stoma Therapy Unit of the Dokuz Eylül University Hospital General Surgery Clinic and Polyclinic in Izmir, Turkey., Methods: A Turkish language version of the OCSI was created using a translation, back-translation technique. The instrument's content validity was analyzed by 26 experts. Interrater reliability test was evaluated using Cohen's κ and intraclass correlation coefficients. Data were collected between January 15, 2017 and July 30, 2017 through face-to-face interviews conducted in our Wound and Stoma Therapy Unit., Results: The overall content validity index was 0.95. Cohen's κ coefficient varied from 0.70 and 1.0 for all items. The Pearson correlation coefficient and intraclass correlation coefficient were 0.982 (P = .000) and 0.986 (P = .000), respectively, indicating good internal consistency. The most prevalent complications were leakage (41.1%), peristomal moisture-associated skin damage (42.2%), and stomal retraction (27.7%)., Conclusions: Findings indicate that the Turkish language version of the Pittman OCSI is a reliable and valid instrument for assessment of presence and severity of early postoperative complications in individuals with an ostomy. We found the instrument parsimonious, easy-to-use, and clinically practical. It can be used to determine appropriate interventions to prevent or treat complications and evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.

Objective: Tyrosine kinase inhibitors (TKIs) which efficiently inhibit BCR-ABL are highly effective for clinical treatment of chronic myeloid leukemia (CML), but development of resistance to TKIs is a big challenge to treatment. Sunitinib is a multitargeted TKI targeting vascular endothelial growth factor receptor and is defined a safe and effective candidate target, but its effect on other signaling pathways is unknown. To investigate the cytotoxic and apoptotic effect of sunitinib in CML cell model K-562 on JAK-STAT signaling pathway components, suppressor genes and oncogenes, hematopoiesis-related genes, cell cycle and VEGF pathway components, and mRNA level expression changes was aimed., Materials and Methods: Sunitinib's effective dose cytotoxic IC 50 was determined by trypan blue and WST-1 cell proliferation assay tests. Expression levels of target genes were determined by quantitative reverse transcriptase polymerase chain reaction simultaneously after sunitinib application. Protein expression analysis was determined by "WesternBreeze Chromogenic Kit-Anti-Rabbit" based on the principles of the application kit by Western blot analysis., Results: Assessing the cytotoxicity of K-562 cells following sunitinib treatment revealed that sunitinib decreased cell proliferation in a time- and dose-dependent manner. According to the sunitinib inhibition curve, IC50 dose was calculated as 3.5 μM at 48 th h for K-562 cells and apoptosis assays pointed that sunitinib induces apoptotic cell death of leukemic cells at moderate levels., Conclusion: Our study supports that sunitinib might be used as a novel therapeutic target to trigger apoptosis in CML cells which in turn might accelerate therapeutic response in regard to inhibiting oncogenes and enhancing tumor suppressors in cooperation with cell cycle regulatory genes., Competing Interests: None

This descriptive, cross-sectional study in hospital ORs in İzmir, Turkey, assessed the environmental and physical ergonomic conditions that may place perioperative personnel at risk for injury or illness. We used an ergonomic conditions and risk factor description form to collect data in 58 ORs in nine different hospitals. We identified that the noise level and general air quality in the ORs were within recommended levels. However, none of the ORs had a surgical smoke evacuation system, pressure-absorbing mats, or special equipment to facilitate patient moving and lifting. Approximately 70% of the ORs had high stools to provide short periods of rest for the surgical personnel. In addition, perioperative personnel did not wear protection to prevent intraoperative radiation exposure. These results indicate that although some environmental factors were within acceptable limits, other physical ergonomic risks were not adequately addressed, thereby placing perioperative staff members at risk for health concerns., (© AORN, Inc, 2019.)