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Deep learning algorithms are used in various advanced applications, including computer vision, large language models and many others due to their increasing success over traditional approaches. Enabling these algorithms on various embedded systems is essential to extend the success of deep learning methods in the cutting-edge real-world systems and applications. The configurability of the embedded systems and software applications make them adaptable to different performance requirements such as latency, power, memory and accuracy. However, the vast number of combinations of hardware-software configurations makes the multi-objective optimization with respect to multiple performance metrics highly complex. Additionally, the lack of analytical form of the problem makes it harder to identify Pareto optimal configurations. To address these challenges, here we propose a fast, accurate and scalable search algorithm to efficiently solve these search spaces. We evaluate our algorithm, together with state-of-the-art methods, with different deep learning applications running on different hardware configurations, creating different search spaces, and show that our algorithm outperforms the other existing approaches by finding the Pareto frontier more accurately and with up to 15 times faster speed.

In February 2023, a series of earthquakes with high magnitudes affected 11 cities in Türkiye, a region with a population of over 13 million. With more than 50000 recorded deaths and more than 3 million survivors replaced, rescue and recovery efforts were challenging. The Psychiatric Association of Türkiye (PAT) immediately launched a "Disaster and Crisis Management," which urgently formed and installed a program for psychosocial support and psychiatric care. The program included immediate, medium, and long-term actions. Hundreds of recruitments followed a call for volunteers for on-site and online support. An online "Earthquake and Mental Health" library was launched immediately, and a series of webinars on psychological first aid and disaster psychiatry were organized in the first two weeks. Furthermore, in three major cities, separate interactive meetings where question and answer sessions with trauma experts have been possible were held weekly with smaller groups. Almost a hundred volunteer PAT members served in the region in the first few months after the earthquake. All colleagues in the field, including those who survived the earthquakes, benefited from the resources of the PAT for their needs in housing, food, and mobilization. Starting from the first days, the PAT organized regional centers for coordination, which required financial resources and staff. The demand was high and could only be met with close collaboration with the Turkish Medical Association and the financial support obtained from international agencies, WPA, and other national psychiatric associations. The PAT started an online support system with technical support from a professional company, targeting healthcare professionals and first responders in the earthquake area. Volunteering psychiatrists provided appointment slots, rendering the system available 12 hours a day, seven days a week. With time, as the national healthcare delivery recovered, the PAT activities transformed into coordination, education, and supervision. Furthermore, the psychiatry residency training, which was interrupted due to the disaster, has been supported through a nationwide mentorship program launched by the PAT. The experience of the Psychiatric Association of Türkiye with disasters paved the way for an organized response, which was made possible through national and international solidarity. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Postbiotics offer better properties than probiotics. This study investigated the antimicrobial activity of Lactiplantibacillus plantarum EIR/IF-1 postbiotics against pH-adaptive bacteria, namely Prevotella denticola, Fusobacterium nucleatum, and Streptococcus sanguinis. Cell-free culture media of L. plantarum EIR/IF-1 were used as postbiotics in either crude (acidic) or neutralized form to also understand non-pH-dependent antimicrobial potential. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and viable cell counts were determined for crude and neutralized postbiotics. Culture media adjusted to different pH values were also compared to adjusted media with postbiotics to understand the strength of organic acids in postbiotics. Antibiofilm activity of postbiotics was determined against polymicrobial biofilm formation. Finally, the toxicity of crude postbiotics was tested on human periodontal ligament fibroblast cells (hPDLFCs). MIC values of crude postbiotics were 12.5 mg/mL for all strains. F. nucleatum and P. denticola strains were sensitive to neutralized postbiotics after 48 h of incubation. Moreover, 12.5 and 25 mg/mL postbiotics inhibited biofilm formation and 2.5 mg/mL and lower concentrations of crude postbiotics showed no cytotoxicity in hPDLFCs. This study showed that postbiotics have antimicrobial activity against pH-adaptive oral bacteria and no cytotoxic effect on hPDLFCs depending on the dose. The non-acidic antimicrobial components of postbiotics could also enable their safe use in the oral cavity.

Gender identity may be experienced within a broad spectrum beyond the binary understanding of sex concerning genital characteristics. In people with gender identities not congruent with the gender culturally associated with the sex assigned at birth, distress related to biopsychosocial correlates of this condition may arise. In current diagnostic systems, this is considered within the framework of "Gender Incongruence" (ICD-11) and "Gender Dysphoria" (DSM 5). Although this diversity is known to be present throughout the ages, the terms related to gender identity were introduced to medical literature a hundred years ago. They were popularized with the advances in medical procedures that assist individuals in acquiring physical features aligning with their gender identity and expression. There has been an increase in research interest with increasing numbers in medical centers working on gender-affirmative medical procedures. Starting from the 1970s, international organizations prepared guidelines on the standards of care for trans and gender diverse (TGD) individuals. Despite all the progress in the gender-affirming medical care provided to TGD individuals and the changes in the legal recognition of gender, health inequalities persist globally. The discrepancy in mental and physical health conditions has long been shown to be associated with "minority stress." The minority stress perspective suggests that distal and proximal chronic stressors arising from society are associated with adverse health outcomes for TGD individuals. Resilience against these stressors is more robust with better coping styles and social support. Lately, structural stigma and discrimination have been shown to be an important source of inequality. Therefore, much more progress is still required with respect to societal inequalities, human rights, and structural transphobia for the improvements in medical care to impact the global health condition of TGD people. However, lately, there have been attempts to restrict TGD individuals' access to medical care and their legal rights, even if they were not close to the level they ought to be. This backlash mostly sits on the discussion on the management of TGD adolescents and children. Models of care for these age groups have been developed for decades, and despite evidence of the protective and beneficial effects on health and development, in many countries, there are attempts to block their access to medical care. Growing debate on TGD care turned into a political combat, where scientific evidence and human rights perspectives are often ignored. These tendencies present a strong challenge for public health and the professional identity and practice of healthcare professionals. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Abstract Streptococcus mutans is one of the main factors in formation of cariogenic biofilms. New strategies need to be developed to reduce the formation of cariogenic biofilms. For this purpose, bacterial exopolysaccharides (EPS) could be considered as new agents against biofilms. Therefore, cell-bound (b-EPS) and released exopolysaccharides (r-EPS) were extracted from the strains Apilactobacillus kunkeei K1.10 and Latilactobacillus curvatus Kar.9b isolated from the microbiota of honeybees, and their antibiofilm effects on S. mutans biofilm formation were determined. The highest reduction in biofilm formation was achieved by r-EPS of L. curvatus Kar.9b and A. kunkeei K1.10. Scanning electron micrographs (SEM) showed that r-EPS inhibited biofilm formation by reducing adhesion of S. mutans. To increase the production of r-EPS from A. kunkeei K1.10, the effects of different incubation conditions were also analyzed. The highest EPS production was obtained during 48 h-incubation at 37ºC in a medium containing 1% fructose. r-EPS can be used as a raw material to inhibit cariogenic biofilms. Further studies revealing the detailed structural analysis of r-EPS and the mechanism of action of its antibiofilm effect could be beneficial. Finally, b-EPS and r-EPS from lactic acid bacteria were found to have very different properties in terms of their antibiofilm properties.

This study investigates the effects of the antiperspirant aluminum chlorohydrate on the development of antibiotic resistance in commensal Staphylococcus epidermidis isolates. The isolates were exposed to aluminum chlorohydrate for 30 days. The bacteria that developed resistance to oxacillin and ciprofloxacin were isolated, and the expression levels of some antibiotic resistance genes were determined using quantitative reverse transcriptase PCR. Before and after exposure, the minimum inhibitory concentration (MIC) values of the bacteria were determined using the microdilution method. A time-dependent increase was observed in the number of bacteria that developed resistance and increased MIC values. Consistent with the ciprofloxacin resistance observed after exposure, an increase in norA, norB/C, gyrA, gyrB, parC, and parE gene expression was observed. In addition to aluminum chlorohydrate exposure, oxacillin resistance was observed in all test bacteria in the group only subcultured in the medium, suggesting that phenotypic resistance cannot be correlated with chemical exposure in light of these data. The increase in mecA gene expression in selected test bacteria that acquired resistance to oxacillin after exposure compared with control groups suggests that the observed resistance may have been related to aluminum chlorohydrate exposure. To our knowledge, this is the first time in the literature that the effects of aluminum chlorohydrate as an antiperspirant on the development of antibiotic resistance in Staphylococcus epidermidis have been reported.

Mastitis is one of the most important and multi-factorial diseases affecting dairy cows. This study was conducted to evaluate the effect of postbiotics secreted by lactic acid bacteria on mastitis. Within this aim, a total of 10 raw milk samples of healthy dairy cows were processed for the isolation of microbiota-derived bacteria. Following the isolation protocol, 24 isolates showing phenotypic characters similar to Lactobacillus species on specific MRS agar were selected and screened for their antibacterial activity against important mastitis-causing pathogens using the agar well diffusion method. According to the screening of the isolates, only one strain was found effective against all tested pathogens and selected for further assays. The isolate that exhibited a remarkable inhibitory effect was then identified as Lactobacillus sakei by 16S rRNA sequence analysis. The minimum inhibitory concentration of the postbiotics secreted by L. sakei into the culture medium was defined between the range of 40–50 mg/L. The antibacterial activity was also determined to be an acid-dependent effect, and HPLC analysis confirmed the presence of lactic acid (21.42 mg/mL) as the most common acid in the postbiotics. Among the 37 fatty acids, only oleic acid, palmitic acid, and stearic acid were detected. In addition to its antibacterial activity, postbiotics significantly reduced the biofilm formation of pathogens following the co-incubation, pre-treatment, and eradication assays, confirmed by confocal-laser and scanning electron microscopy. In conclusion, postbiotics with antibacterial and antibiofilm activity against important mastitis-causing pathogens can be used as a promising and natural agent in the prevention of mastitis.HIGHLIGHTS Lactobacillus sakei EIR/CM-1 was isolated from Holstein cow’s milk microbiota. Postbiotics from the strain EIR/CM-1 displayed the highest antibacterial activity against ruminant mastitis-causing pathogens. Co-incubation with postbiotics at 5 mg/mL and above concentrations reduced the biofilm formation of ruminant mastitis-causing pathogens by more than 70%. Lactic acid was found to be the highest organic acid in postbiotics.

It is commonly well-known that biofilms are the predominant mode of bacterial growth, reflected in the clinic observations, where approximately 80% of all bacterial infections are related to biofilms. Bacteria in biofilms are well protected against environmental stresses, antibiotics, disinfectants and the host’s immune system and are usually extremely difficult to eradicate. Due to common problems caused by biofilms, alternative anti-biofilm strategies must be developed. Enterococcus strains are able to form complex surface-associated communities (biofilms), which contribute to its resistance and persistence in both host and non-host environments, and are especially important in food processing and clinical environments. Enterococcus biofilms showed increased antimicrobial resistance to the most of antibiotics as compared to the planktonic bacteria, which make them difficult to combat. There is an increasing evidence that biofilms are often associated with infectious diseases. Novel anti-biofilm strategies must be designed to include natural bio products instead of common antibiotics. Mushrooms are a nutritionally functional foods and a source of pharmaceuticals having functions such as antitumor, immunomodulating, antioxidant, cardiovascular, anti-hypercholesterolemia, antiviral, antibacterial, anti-parasitic, antifungal, detoxification, hepatoprotective, and antidiabetic. In addition, they have a notable activity against biofilms. In this study, the antimicrobial and anti-biofilm activities of some medicinal and edible mushrooms, namely Morchella angusticeps Peck, Ganoderma lucidum (Curtis) P. Karst., Cerioporus squamosus (Huds.) Quél., Trametes versicolor (L.) Lloyd and Lentinula edodes (Berk.) Singer were screened against multi drug resistant Enterococcus strains. As a result, it was observed that these mushrooms have notable potency to develop alternative medicines to struggle infectious diseases and biofilms.

Previous studies have indicated that the exopolysaccharides of lactic acid bacteria exhibit antibiofilm activity against non-oral bacteria by preventing their initial adhesion to surfaces and by downregulating the expression of genes responsible for their biofilm formation. The aims of this study were to (1) characterize the exopolysaccharides (EPSs) of Lactobacillus plantarum EIR/IF-1 postbiotics, (2) test their antibiofilm effect on dual biofilms, and (3) evaluate their bacterial auto-aggregation, co-aggregation, and hydrocarbon-binding inhibitory activity. The EPSs were characterized by FTIR, HPLC, and thermogravimetric analysis. Bacterial auto- and co-aggregation were tested by Kolenbrander’s method and hydrocarbon binding was tested by Rosenberg’s method. Dual biofilms were formed by culturing Fusobacterium nucleatum ATCC 25586 with one of the following bacteria: Prevotella denticola ATCC 33185, P. denticola AHN 33266, Porphyromonas gingivalis ATCC 33277, P. gingivalis AHN 24155, and Filifactor alocis ATCC 35896. The EPSs contained fractions with different molecular weights (51 and 841 kDa) and monosaccharides of glucose, galactose, and fructose. The EPSs showed antibiofilm activity in all the biofilm models tested. The EPSs may have inhibited bacterial aggregation and binding to hydrocarbons by reducing bacterial hydrophobicity. In conclusion, the EPSs of L. plantarum EIR/IF-1, which consists of two major fractions, exhibited antibiofilm activity against oral bacteria, which can be explained by the inhibitory effect of EPSs on the auto-aggregation and co-aggregation of bacteria and their binding to hydrocarbons.

Background: It is known that regular physical activity reduces anxiety. Low anxiety levels affect mood, emotions, and empathy. Oxytocin is a powerful hormone that regulates social interaction, sexual reproduction, maternal–infant bonding, milk release, empathy, and anxiety. Empathy is an important behavior in the living community; and also important for sportsmen during sportive competition and daily living life, because sportsmen are also role model of people. Aims: To investigate the effects of voluntary physical activity on oxytocin, anxiety, and empathy levels as well as the relationship between them. Study Design: Animal experiment. Methods: Male and female mice were made to exercise in running wheel cages for 6 weeks. Their empathy and anxiety levels were evaluated by using Helping Behavior test and elevated plus maze and open field test, respectively. And then the brain and blood oxytocin levels were measured. Results: Empathy-like behavior was improved in both genders of the exercise groups (door-opening time decreased in both genders of exercise groups, p for both=0.0001). As a response to exercise, both the brain and serum oxytocin levels increased in female mice (both of p=0.0001); however, in males, oxytocin levels increased in only the brain (p

Periodontitis is a destructive disease of the tooth-surrounding tissues. Infection is the etiological cause of the disease, but its extent and severity depend on the immune–inflammatory response of the host. Immune cells use reactive oxygen species to suppress infections, and there is homeostasis between oxidative and antioxidant mechanisms during periodontal health. During periodontitis, however, increased oxidative stress triggers tissue damage, either directly by activating apoptosis and DNA damage or indirectly by activating proteolytic cascades. Periodontal treatment aims to maintain an infection and inflammation-free zone and, in some cases, regenerate lost tissues. Although mechanical disruption of the oral biofilm is an indispensable part of periodontal treatment, adjunctive measures, such as antibiotics or anti-inflammatory medications, are also frequently used, especially in patients with suppressed immune responses. Recent studies have shown that probiotics activate antioxidant mechanisms and can suppress extensive oxidative stress via their ability to activate nuclear factor erythroid 2-related factor 2 (Nrf2). The aim of this narrative review is to describe the essential role of Nrf2 in the maintenance of periodontal health and to propose possible mechanisms to restore the impaired Nrf2 response in periodontitis, with the aid of probiotic and postbiotics.

Abstract Hypoxia occurs in the splanchnic region during exercise associated with sympathetic activity. In the elderly, vascular insufficiency and low vascular endothelial growth factor (VEGF) expression are observed. Compared to young people, sympathetic signals of older individuals are blunted and more resistant to splanchnic blood flow alterations during exercise. VEGF induces vasodilation responses and hence may retain blood in the splanchnic vascular bed. We hypothesized that regular mild-intensity exercise triggers weak VEGF expression in the digestive tract of the elderly. The effects of exercise on the levels of VEGF, superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA) and total antioxidant capacity (T-AOC) in the stomach, jejunum, ileum and colon tissues were evaluated. With exercise, the VEGF levels in the stomach and colon increased. Although the SOD, GPx, and MDA levels decreased in the stomach, they increased in the colon. T-AOC increased in the stomach and there was no change in the jejunum, ileum and colon. The hypoperfusion during exercise was not equal in all regions of the gastrointestinal tract in the aged subjects. Hypoxia and other exercise-related mechanisms could have led to this VEGF induction. The stomach, jejunum, and ileum might have developed resistance to ischemia. The induction of VEGF may be beneficial in aging-associated impaired gastrointestinal homeostasis and neovascularization.

Alkaline proteases have biotechnological importance due to their activity and stability at alkaline pH. 56 bacteria, capable of growing under alkaline conditions were isolated and their alkaline protease activities were carried out at different parameters to determine their optimum alkaline protease production conditions. Seven isolates were showed higher alkaline protease production capacity than the reference strains. The highest alkaline protease producing isolates (103125 U/g), E114 and C265, were identified as Bacillus licheniformis with 99.4% and Bacillus mojavensis 99.8% based on 16S rRNA gene sequence similarities, respectively. Interestingly, the isolates identified as Bacillus safensis were also found to be high alkaline protease producing strains. Genotypic characterizations of the isolates were also determined by using a wide range of molecular techniques (ARDRA, ITS-PCR, (GTG)5-PCR, BOX-PCR). These different techniques allowed us to differentiate the alkaliphilic isolates and the results were in concurrence with phylogenetic analyses of the 16S rRNA genes. While ITS-PCR provided the highest correlation with 16S rRNA groups, (GTG)5-PCR showed the highest differentiation at species and intra-species level. In this study, each of the biotechnologically valuable alkaline protease producing isolates was grouped into their taxonomic positions with multi-genotypic analyses.

Design study of 200 MWth Gas Cooled Fast Reactor with UN-PuN fuel long life without refueling has been done. GFR is one type reactor in Generation IV reactor system. It uses helium coolant and fast neutron spectrum. Helium is chemical inert, single phase and low neutron moderation. In this study the calculations are performed by using SRAC code with PIJ calculation for the fuel pin cell calculation and CITATION calculation for core calculation. The data libraries use JENDL 3.2. The variation fuel fractions are 50% until 60%. The diameter active core is 150 cm and the height active core is 100 cm. The reflector radial-axial width is 50 cm. The variation of the powers are 100 MWth up to 500 MWth. The high power causes the high k-eff value. The optimum design is reached when the power is 200 MWth, variation percentage Plutonium for fuel F1:F2:F3=9%:11%:13%. The comparation of fuel:cladding:coolant fraction = 55%:10%:35%. The cooling down time of Plutonium is nine months. The optimum k-eff value is 1.0142 with excess reactivity value 1.403%. The decay of Plutonium decrease k-eff value in the beginning of burn up.

In order to display high-bit resolution images on low-bit resolution displays, bit resolution needs to be reduced. This problem is vital especially for low-cost or small (mobile) devices. To untangle the bit reduction problem, special color quantization algorithms, called dithering, are employed on high-bit resolution images. The dithering process helps to remedy the problem, but it does not help much in terms of storage and transmission of images. To reduce storage needs and lower data transmission, numerous special compression techniques have been proposed in the last several decades. While the well-known compression algorithms, such as gzip, help lower image file sizes, usually, they are not adequate. To improve the compression gain, special compression techniques that take into account structure of image data must be developed. In this paper, we show that, when the pseudo-distance technique (PDT) is used for dithered images, it yields better compression results than GIF and PNG.

Purpose: There is a scarcity of information regarding the health consequences of chest binding and its effects on pulmonary functions (PFs). This study aimed to evaluate binding practices, physical outcomes, and effects on PFs of trans or gender diverse (TGD) youth who bind., Methods: The TGD and control groups underwent pulmonary function tests (PFTs), with the TGD group undergoing testing both with their binder and after removal. We additionally evaluated binding practices and its physical outcomes., Results: 33 TGD participants with a mean age of 20.15 ± 2.76 and 31 controls with a mean age of 20.74 ± 2.95 years were included. A large majority reported physical side effects, back pain being the most common. The comparison of PFTs of the TGD group with and without binder showed that vital capacity , forced vital capacity, and forced expiratory volume in 1 second values were significantly lower in the presence of a binder (both % predicted and L) (p < .005). Binding duration (both lifetime and weekly) did not correlate with PFTs, however, the ratio of change in forced expiratory volume -1/ forced vital capacity induced by binding correlated with weekly binding duration. When we separately compared the PFTs of the TGD group with and without binder to the control group, we found no significant difference., Discussion: Despite the abundance of physical side effects, comparison with the control group does not support long-lasting effects of binding on PF; however, it indicates acute restrictive impairment without a significant effect on airflow obstruction in youth who bind. These findings hold significance in facilitating well-informed decision-making processes pertaining to binding practices., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to explore the strength and direction of the relationship between spectral cepstral-based, time-based acoustic measures and the self-perception of voice in trans women., Methods: Forty-eight trans women were included in the study. Analysis of the sustained vowel phonation was performed using Multidimensional Voice Profile Analysis (MDVP), and spectral-cepstral analyses of the sustained vowel phonation, all-voiced weighted sentence, and spontaneous speech were made via Analysis of Dysphonia in Speech and Voice (ADSV) software. For self-perceptual evaluations, the Trans Woman Voice Questionnaire (TWVQ) and the Self-perception of Voice Femininity Scale (SPVF) were used. The correlation between MDVP, spectral-cepstral parameters, and TWVQ and SPVF scores was calculated., Results: The present study found a positive relationship between F0, SPVF, and TWVQ. Among the perturbation parameters, the jitter was the only one found to correlate with SPVF and TWVQ. The CPPF0 parameter was found to be associated with a more feminine voice perception and a higher voice-related quality of life in all speech samples in the present study. In addition, higher CPP values achieved from vowel phonation were associated with less feminine voice perception and lower voice-related quality of life. The present study also suggests a weak correlation with the SPVF and Cepstral Peak Prominence Standard Deviation (CPPF0 SD) of the spontaneous speech sample in a negative direction., Conclusions: This study found weak and moderate levels of correlations between F0, jitter (%), CPP, CPPF0, CPPF0 SD parameters, and self-perceptual measures. These findings suggested that such a level of relationship is attributable to the fact that these tools evaluate different aspects of voice in accordance with the International Classification of Functioning System. According to this pioneering study, it would be beneficial to incorporate spectral-cepstral measures into the objective assessment protocol for trans women's voices., 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 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Fibroblast growth factor-2 (FGF2) is involved in the regulation of affective behaviour and shows antidepressant effects through the Akt and extracellular signal regulated kinase (ERK) 1/2 pathways. Nudix hydrolase 6 (NUDT6) protein is encoded from FGF2 gene's antisense strand and its role in the regulation of affective behaviour is unknown. Here, we overexpressed NUDT6 in the hippocampus and investigated its behavioural effects and the underlying molecular mechanisms affecting the behaviour. We showed that increasing hippocampal NUDT6 results in depression-like behaviour in rats without changing FGF2 levels or activating its downstream effectors, Akt and ERK1/2. Instead, NUDT6 acted by inducing inflammatory signalling, specifically by increasing S100 calcium binding protein A9 (S100A9) levels, activating nuclear factor-kappa B-p65 (NF-κB-p65), and elevating microglia numbers along with a reduction in neurogenesis. Our results suggest that NUDT6 could play a role in major depression by inducing a proinflammatory state. This is the first report of an antisense protein acting through a different mechanism of action than regulation of its sense protein. The opposite effects of NUDT6 and FGF2 on depression-like behaviour may serve as a mechanism to fine-tune affective behaviour. Our findings open up new venues for studying the differential regulation and functional interactions of sense and antisense proteins in neural function and behaviour, as well as in neuropsychiatric disorders. KEY POINTS: Hippocampal overexpression of nudix hydrolase 6 (NUDT6), the antisense protein of fibroblast growth factor-2 (FGF2), increases depression-like behaviour in rats. Hippocampal NUDT6 overexpression triggers a neuroinflammatory cascade by increasing S100 calcium binding proteinA9 (S100A9) expression and nuclear NF-κB-p65 translocation in neurons, in addition to microglial recruitment and activation. Hippocampal NUDT6 overexpression suppresses neurogenesis. NUDT6 exerts its actions without altering the levels or downstream signalling pathways of FGF2., (© 2024 The Authors. The Journal of Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Background: Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD)., Methods: The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) ( n = 279), Southern Europe (SE) ( n = 92), Northern Europe (NE) ( n = 92), and Western Europe (WE) ( N = 148)., Results: About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 ( N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 ( N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 ( N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 ( N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines., Conclusions: Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.

Objective: Impulsivity is an important risk for suicidality, which is common in patients with major depressive disorder (MDD). The goal of this study was to examine multiple facets of impulsivity in depressed patients compared with healthy controls and to assess their relationship to suicidality., Method: Outpatients diagnosed with MDD using the Structured Clinical Interview for DSM-IV were recruited. Two groups were constituted as "MDD in remission" (n=32) and "MDD" (n=71). The "healthy control" group (n=30) consisted of individuals who had never been diagnosed with any psychiatric disorder. Impulsivity was assessed with the Barratt Impulsivity Scale (BIS), a self-rating measure, and with the following behavioral tasks: Go/No-go Task, Iowa Gambling Task, and Balloon Analogue Risk Task. The scores of the 3 groups (n=133) were compared to evaluate the effect of MDD. The scores were also analyzed and compared in the patients in the 2 MDD groups (n=103) with respect to their current and lifetime suicidality., Results: There was no difference in the 3 groups in task scores, but nonplanning BIS was correlated with the severity of depressive symptoms. Patients with suicidal ideation (SI) had higher BIS total and attention impulsivity scores and more commission errors on the Go/No-go Task, reflecting failure in response inhibition, compared with the patients without SI., Conclusions: Failure to show differences in impulsivity-related tasks suggests that there might be no relationship between the state of depression and impulsivity. However, these findings confirm that there is an association between SI and response inhibition and the attention facet of impulsivity in depression., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The study aimed to investigate the effectiveness of maintenance electroconvulsive therapy (mECT) with respect to the hospitalization duration, number of hospitalizations, and major and minor treatment changes with a mirror-image study design., Methods: Medical charts of patients who received at least a 3-month-long course of mECT were reviewed. The records of 36 patients (17 with psychotic disorders, 19 with affective disorders) were retrospectively examined for 2 periods with the same duration; during the mECT (post-mECT) and before the mECT (pre-mECT). The hospitalization duration, the number of hospitalizations, and major and minor treatment changes, which were assumed to provide information on the effectiveness of the interventions, were recorded and compared between these periods. Statistical analysis was performed using generalized estimating equation models conducted with age, diagnostic category, and observation time as covariates. In addition, the relapse and recurrence rates and time to relapse/recurrence were analyzed., Results: Comparison of pre-mECT and post-mECT periods revealed that mECT, applied in an individualized schedule combined with pharmacotherapy, was associated with a lower frequency ( P < 0.001; rate ratio [RR], 0.161; 95% confidence interval [CI], 0.087-0.297), shorter duration of hospitalization ( P < 0.001; RR, 0.123; 95% CI, 0.056-0.271), and lower number of major treatment changes ( P = 0.007; RR, 0.522; 95% CI, 0.324-0.840), irrespective of diagnoses. The relapse/recurrence rates were similar in the 2 diagnostic categories ( P = 1.000; 26.3% vs 29.4%)., Conclusions: Maintenance ECT should be increasingly considered an important treatment modality in patients with affective and psychotic disorders after an effective course of ECT., Competing Interests: The authors have no conflicts of interest or financial disclosures to report., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person., Competing Interests: Conflict of interests were reviewed as part of the selection process for committee members and at the end of the process before publication. No conflicts of interest were deemed significant or consequential., (© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.)

Rapid physical, psychological and sexual changes in adolescents due to the developmental process differentiate the approach to adolescents with gender dysphoria (GD) from the approach to adults. In this article, two adolescents who applied for GD and followed up for a long time are presented. The first case was assigned male at birth and defined herself as female. At the age of fifteen, a gonadotropin-releasing hormone analog was started for puberty suppression, and sex hormone was started in the follow-up. The second case's assigned sex was female and defined himself as male. At the age of sixteen years and six months, puberty suppressive treatment was started, followed by sex hormones. Both cases were able to continue their psychosocial development without any problems after the psychiatric and physical treatments they could reach on time. Although GD in adolescents cannot be resolved with puberty suppression alone, it creates time to resolve the acute problems and to search for appropriate treatment approaches in the future. Puberty suppression partially relieves and prevents the exacerbation of the dysphoria experienced by the youth diagnosed as GD, and creates time to search appropriate treatment approaches in the follow-up. Through these two cases, it is aimed to introduce the gender affirmation processes of adolescents with GD, to discuss the medical interventions in adolescence and the psychosocial effects of the process on individuals. Keywords: Gender dysphoria, gender incongruence, adolescence, gender affirmation process, puberty supression, puberty blockers.

Objective: Anhedonia, which is defined as diminished capacity of having pleasure, is a common symptom in many mental disorders. It has been aimed in this study to adapt to the Turkish language the Snaith- Hamilton Pleasure Scale Clinician Administered Form (SHAPS-C) and examining reliability and validity of Snaith-Hamilton Pleasure Scale Clinician Administered Turkish Form (SHAPS-C-TR) which measures anhedonia in clinical and healthy samples., Method: Two groups consisting of 63 participants consulting the psychiatry clinic and 67 non-clinical participants were included in the study. Data were collected with the Turkish version of the SHAPS-C (the SHAPS-C-TR), the Beck Depression Inventory (BDI), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Positive Negative Affect Scale (PANAS)., Results: The Kuder-Richardson internal consistency coefficient for the entire participants, the clinical and the non-clinical group were, 0.765, 0.813 and 0.657 respectively. The intra-class coefficient for test-retest reliability was 0.732. The total score on the SHAPS-C-TR significantly correlated with the scores on the anhedonia items of the BDI and the MADRS but not the scores on anxiety items. The PANAS positive symptoms scores were negatively correlated with the SHAPSC- TR total score. In the clinical group, the participants followed up with depression had significantly higher SHAPS-C-TR score than the rest of the participants. A similar difference was not demonstrated by the scores of the clinical group participants followed up with anxiety disorder. Scores on the SHAPS-C-TR did not vary with respect to the demographic characteristics of the participants., Conclusion: The SHAPS-C-TR is a valid and reliable measurement tool to assess anhedonia in both clinical and non-clinical individuals irrespective of differences in demographic features.

Objective: The problems faced by trans women with regard to their voice may affect their quality of life. For the evaluation of trans women's voice, tools assessing their self-perception are very important, with the Transsexual Voice Questionnaire (TVQ MtF ) being one of the most frequently used. The purpose of this study was to investigate the validity and reliability of the Turkish version of the TVQ MtF (TVQ MtF -TR), which was previously translated into 12 languages., Study Design: Cross-sectional study., Method: A total of 41 trans women participated in this study. The participants filled out the TVQ MtF -TR, the self-perceptions of voice femininity questionnaire, and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF-TR). Additionally, 58.5% of the participants filled out the TVQ MtF -TR again two weeks after the first interview., Results: The total Cronbach's-α value of the TVQ MtF -TR was 0.972, and the item-total correlation values were found to be between 0.323 and 0.876. The intraclass correlation coefficient value was 0.931. There was a strong negative correlation between TVQ MtF -TR and self-perceptions of voice femininity. There was a significant negative correlation between TVQ MtF -TR and the psychological and environmental domains of WHOQOL-BREF-TR. However, there was no significant relationship found between the social and physical domains., Conclusion: According to the results of the study, the Turkish version of TVQ MtF -TR was considered a valid and reliable tool., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Gender-affirming and supportive relations for transgender youth are considered protective in terms of mental health., Aim: To describe how transgender youth perceived changes in their gender expression, in the course of the gender-affirming path, and the effect of social connectedness and social support on depression and anxiety during the pandemic., Methods: In this cross-sectional study, transgender youth completed an online survey developed to evaluate the perceived changes in gender expression and affirmation path that occurred during COVID-19 and the age-stratified lockdown. Furthermore, we aimed to investigate the effect of social connectedness and social support on depression and anxiety in this population during the pandemic. The participants completed the following scales: Social Connectedness Scale Revised (SCS-R), Multidimensional Scale of Perceived Social Support (MSPSS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI). The effect of lockdown on life conditions, gender expression, social and medical gender-affirming path, social connectedness, social support, depression, and anxiety levels were examined. Linear regression analyses were performed to evaluate the relationships between BDI and STAI scores and other variables., Outcomes: The relationship between the levels of perceived social connectedness, and social support, the pandemic-related changes in living conditions and depression and anxiety scores were calculated., Results: A total of 49 transgender youth with a mean age of 20.53 ± 1.86 years were enrolled. Participants reporting discomfort at the place they live and who had difficulties concerning gender expression and affirmation had higher depression and anxiety scores and perceived lower social support from their family. Social connectedness score was a significant negative predictor of depression severity, whereas social connectedness and social support were both significant negative predictors of anxiety severity., Clinical Implications: Our results show increased adversity for transgender youth when connectedness with supportive people is diminished. During the COVID-19 pandemic, social connectedness and social support perceived by transgender youth are associated with better mental health., Strengths and Limitations: This is one of the first studies to evaluate the changes that occurred during the COVID-19 pandemic in transgender youth with relation to social support and connectedness, during an age-stratified lockdown. The main limitations were the small study size, skewed gender ratio and that the study sample came from a single gender clinic., Conclusion: As social connectedness and social support are significant predictors of depression and anxiety severity, special attention is needed to increase contact and support for transgender youth during the pandemic. Tüzün Z, Başar K, Akgül S. Social Connectedness Matters: Depression and Anxiety in Transgender Youth During the COVID-19 Pandemic. J Sex Med 2022;19:650-660., (Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: HIV-related stigma towards people living with HIV/AIDS (PLWHA) creates a barrier in access to quality health care, affects mental health and leads to poor treatment adherence. Assessment of different components of HIV-related stigma is needed to develop appropriate strategies for prevention and intervention. The aim of this study was to translate and adapt Berger HIV Stigma Scale to Turkish and assess its reliability and validity., Method: The Turkish version of the 40 item, 4-point Likert-type self-report HIV Stigma Scale, as well as Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES) and sociodemographic data form were administered to 95 PLWHA., Results: The items of the scale whose face validity was found to be sufficient, were loaded on four factors in the explanatory factor analysis: Internalised Stigmatization (16 items); Concerns with Public Attitudes (12 items); Negative Self Image (9 items); and Disclosure Concerns (8 items). This structure explained 46.71% of the variance after an item was removed based on the analysis. All subscales had acceptable internal consistency with Cronbach's alpha coefficients .802-.934. BDE scores had moderate positive correlations with Internalized Stigmatization; Concerns with Public Attitudes; Disclosure Concerns subscale scores (r s =0.214, p=0.047; r s =0.295, p=0.006; r s =0.353, p=0.001), and strong positive correlations with Negative Self Image score (r s =0.617, p<0.001). A moderate positive correlation was found between RSES and Negative Self Image subscale score (r s =0.434; p<0.001)., Conclusion: Our findings showed that the Turkish form of Berger HIV Stigma Scale is a reliable and valid tool for measuring HIV-related stigma in PLWHA., Competing Interests: Conflict of Interest: None, (Copyright: © 2021 Turkish Neuropsychiatric Society.)

Background: In people diagnosed with Gender Dysphoria (GD), low perceived social support from their families and society has been suggested to be associated with poor quality of life and mental well-being., Aim: To compare the perceived social support in individuals with GD with that in individuals without GD matched for age and gender., Methods: The study group (n = 50) consisted of individuals diagnosed with GD via psychiatric evaluation. A control group (n = 50) was created by matching volunteers without GD by age and gender. Sociodemographic data form, Structured Clinical Interview Form for DSM-IV TR Axis I Disorders (SCID-I), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to gather data from participants., Outcomes: comparing the perceived social support, the total and subscale MSPSS scores of groups were calculated., Results: The presence of at least 1 psychiatric disorder was significantly higher in the GD group than in the control group, either lifetime or during evaluation (P < .001 and P = .025, respectively). The total MSPSS and family support subscale scores were found to be significantly lower in the GD group than in the control group (P = .001 and P ≤ .001, respectively). When the groups formed on the basis of gender identity (32 trans men vs 32 cis men and 18 trans women vs 18 cis women) were compared, only the family support subscale score was found to be lower in trans men than cis men (P = .005). In addition, comparisons within the groups formed based on sex assigned-at-birth revealed lower total, friend, and family support in those assigned female-at-birth and lower total and family support in those assigned male-at-birth in the GD group. A multiple linear regression analysis revealed that the presence of GD was significantly associated with total and family support MSPSS subscale scores., Clinical Implications: The findings show that perceived social support in people diagnosed with GD is lower, even when the presence of psychiatric disorders is included in the analysis., Strengths and Limitations: The matched case-control design was the major study strength, whereas the sample size was the major limitation., Conclusion: Clinical care of people diagnosed with GD should include the evaluation of diverse sources of social support, efforts to strengthen family and friend support, maintenance of interpersonal relationships, and support of mental well-being. Kaptan S, Cesur E, Başar K, et al. Gender Dysphoria and Perceived Social Support: A Matched Case-Control Study. J Sex Med 2021;18:812-820., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: Although electroconvulsive therapy (ECT) has been extensively used for depressive episodes in bipolar disorder (BDD), it has received less interest in research compared with major depressive disorder (MDD). Studies comparing the efficacy of ECT in BDD and MDD have been contradictory. This study aimed to compare the effectiveness of ECT in BDD and MDD, analyzing the influence of clinical features on outcome., Methods: The medical charts and electronic records of 107 patients (MDDn = 75 [70.1 %], BDD n = 32 [29.9 %]) receiving bi-temporal ECT were investigated retrospectively. Features of the index episode, such as the time elapsed until ECT and the effect of diagnosis on efficacy evaluated by the Hamilton Depression Rating Scale (HAM-D), were analyzed., Results: The diagnostic groups were alike concerning clinical features of the index episode, such as the presence of psychotic symptoms and suicidality. Patient age and the number of previous affective episodes were significantly different between the groups. The time elapsed until ECT in the examined episode was significantly longer in the MDD group. Compared with the MDD group, the BDD group had a significantly higher remission rate with ECT. Regression analysis revealed that BDD diagnosis, older age, and shorter time until ECT were significantly associated with remission., Conclusion: The significant relationship observed between greater time elapsed until ECT and worse outcome is noteworthy in terms of clinical practice. This finding further challenges the widely accepted place of ECT as the "last resort" for the treatment of depression in bipolar and unipolar affective disorders., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Gender dysphoria refers to the experienced discomfort related to the incongruence between gender identity and the sex assigned at birth. Current treatment approach for this clinical condition is gender affirmation procedures. International guidelines about gender affirmation do not recommend routine genetic evaluation. In Turkey, provision of health insurance for medical expenses incurred by these procedures requires genetic consultation which frequently involves chromosome analysis (karyotyping). However, the contribution of routine chromosome analysis to the assessment and management of gender dysphoria is not established. This study aims to assess the results of chromosome analysis and its effect on the management of gender dysphoria., Method: The completed chromosome analysis results and observational records of 217 individuals among a total of 281 evaluated for gender affirmation in the psychiatry polyclinic were investigated retrospectively., Results: The chromosome analysis results of 213 (98.2 %) of the 217 individuals investigated were congruent with the sex assigned at birth. Variations were found in the karyotypes of 4 individuals with female sex assigned at birth, only 1 of whom had been diagnosed with a disorder of sex development. In the other cases, however, chromosome analysis did not affect the diagnosis or the clinical intervention., Conclusion: Finding that routine chromosome analysis during the assessment for gender affirmation process rarely affected the clinical diagnosis and the treatment was consistent with the reports of previous studies and supported the recommendation that chromosome analysis should be carried out only in cases where history, physical examination and the required imaging investigations suggested a disorder sex development.

Whereas the amplitude of the startle reflex varies with stimulus valence in the normal population, a lack of this affective modulation has been reported in patients with major depressive disorder. The present study sought to clarify blunted startle modulation as a feature of depression by comparing 16 patients diagnosed with major depression prior to and after 2 weeks of SSRI treatment, and 16 healthy controls. The affect-modulated startle reflex paradigm and the Self-Assessment Manikin were used to probe affective reactivity. In addition, a preliminary analysis of change in affective reactivity pattern was performed with depressed patients who could be assessed in the eighth week of treatment (n = 13). The control group showed a linear trend in response across valence categories, which was stable over sessions. Blunted affective reactivity was observed only in the patients and persisted after 2 weeks of treatment. Nevertheless, a linear trend could be detected in the eighth week of treatment. These findings confirm that the affective reactivity is blunted in depression and provide initial evidence for the lack of change in the early phase of SSRI antidepressant treatment. Nevertheless, in a small group, the emergence of a linear trend in response was evident later with treatment. Large-scale studies are required to assess the relation between the treatment response and the change in affective modulation of the startle reflex, as a potential biomarker., (© 2018 Society for Psychophysiological Research.)