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In this work, we developed a wearable, head-mounted device that automatically calculates the precise Relative Afferent Pupillary Defect (RAPD) value of a patient. The device consists of two RGB LEDs, two infrared cameras, and one microcontroller. In the RAPD test, the parameters like LED on-off durations, brightness level, and color of the light can be controlled by the user. Upon data acquisition, a computational unit processes the data, calculates the RAPD score and visualizes the test results with a user-friendly interface. Multiprocessing methods used on GUI to optimize the processing pipeline. We have shown that our head-worn instrument is easy to use, fast, and suitable for early-diagnostics and screening purposes for various neurological conditions such as RAPD, glaucoma, asymmetric glaucoma, and anisocoria., Scientific and Technological Research Council of Turkey (TÜBİTAK); 2247-A National Lead Researchers Program; European Union (EU); European Innovation Council (EIC) Horizon

BACKGROUND: While prosthetic rings are commonly used for mitral valve repairs, autologous pericardium is an alternative ring material that can be used in these procedures. In this report, we aim to present a comparison of two types of rings used for mitral repair. METHODS: Between January 2005 and January 2009, 107 patients who underwent mitral valve repair surgery were analyzed. Patients were divided into two groups, according to the type of ring that was used for mitral annular stabilization. Glutaraldehyde-treated pericardial rings were used for 31 patients (group 1), whereas prosthetic rings were used for 76 patients (group 2). Survival, freedom from reoperation, recurrent mitral regurgitation, and the effects of rheumatic mitral disease on these parameters were evaluated and compared for both groups. RESULTS: Follow-up time for our cohort was 4.24±0.4 years. There were four and seven late mortalities in groups 1 and 2, respectively, and five reoperations in each group. There was no significant difference between the groups, in terms of survival, freedom from reoperation, and recurrent mitral regurgitation (log-rank analyses for both groups were P = 0.777, P = 0.346, and P = 0.781, respectively). There was no significant difference in freedom from reoperation and recurrent mitral regurgitation for both groups, in terms of underlying rheumatic valvular disease and other types of pathology. CONCLUSION: Pericardial ring annuloplasty shows to be a considerable alternative technique for mitral valve repair procedures in the mid- to long-term follow up. Rheumatic mitral valves had poor outcomes, when compared with other types of structural valvular pathologies in cases where pericardial rings were used in the repair procedure., NA

We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p=0.835). Univariate analysis revealed the association of mechanical ventilation (p=0.002) and bacterial growth in tracheal aspirate (p=0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak., The consumables of this study were funded by Koc University IsBank Center for Infectious Diseases (KUISCID).

Introduction: due to medical improvements leading to increased life expectancy after renal transplantation and widened eligibility criteria allowing older patients to be transplanted, incidence of (low-risk) prostate cancer (PCa) is increasing among renal transplant recipients (RTR). It remains to be established whether active surveillance (AS) for PCa represents a safe treatment option in this setting. Therefore, we aim to compare AS discontinuation and oncological outcomes of AS for PCa of RTR vs. non-transplant patients. Methods: multicentre study including RTR diagnosed with PCa between 2008 and 2018 in whom AS was initiated. A subgroup of non-RTR from the St. Antonius hospital AS cohort was used as a control group. Comparison of RTR vs. non-RTR was performed by 2:1 propensity score matched survival analysis. Outcome measures included tumour progression-free survival, treatment-free survival, metastasis rates, biochemical recurrence rates and overall survival. Patients were matched based on age, year of diagnosis, PSA, biopsy ISUP grade group, relative number of positive biopsy cores and clinical stage. Results: a total of 628 patients under AS were evaluated, including 17 RTRs and 611 non-RTRs. A total of 13 RTR cases were matched with 24 non-RTR cases. Median overall follow-up for the RTR and non-RTR matched cases was, respectively, 5.1 (IQR 3.2-8.7) years and 5.7 (IQR 4.8-8.1) years. There were no events of metastasis and biochemical recurrence among matched cases. The matched-pair analysis results in a 1-year and 5-year survival of the RTR and non-RTR patients were, respectively, 100 vs. 92%, and 39 vs. 76% for tumour progression, 100 vs. 91% and 59 vs. 76% for treatment-free survival and, respectively, 100 vs. 100% and 88 vs. 100% for overall survival. No significant differences in tumour progression-free survival (p = 0.07) and treatment-free survival were observed (p = 0.3). However, there was a significant difference in overall survival comparing both gr, NA

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Aim: To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow-up. Methods: This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean +/- SD follow-up was 86 +/- 78 months. Results: The Kaplan-Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan-Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (>= 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan-Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan-Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow-up period. Causes of death were end-stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. Conclusions: Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL., NA

Objective: Roberts syndrome is a rare autosomal recessive disease characterized by limb defects, prenatal onset growth retardation, and craniofacial anomalies. We aimed to compare the clinical and molecular findings of six cases with Roberts syndrome with the previously reported patients from Turkiye and to emphasize that a definitive diagnosis can be made in the intrauterine period with cytogenetic tests in the early period without the need to wait for molecular test results. Materials and Methods: Six cases, diagnosed with Roberts syndrome, in our outpatient clinic of Istanbul University, Istanbul Faculty of Medicine, Medical Genetics Department between 2015-2021, were included in the study. The family history, clinical information, and cytogenetic and molecular findings of the patients were retrospectively reviewed and compared with the cases reported from Turkiye in the literature. G and C-banding techniques and Sanger sequencing of the ESCO2 gene were performed. Results: Pathogenic variants in homozygous in four and compound heterozygous in two patients in the ESCO2 gene were identified. Compound heterozygous c.[417dup];[1131+1G>A] (p.[(Pro140Thrfs(star)8)];[(?)]) in case 1, and c.[1111dup];[760del] (p.[(Thr371Asnfs(star)32)];[(Thr254Leufs(star)13)]) in case 6, homozygous c.1131+1G>A (p.(?)) in case 2, case 3 and case 5, and homozygous c.1111dup (p.(Thr371Asnfs(star)32)) in case 4 were detected. The variants reported in our case series were previously associated with the disease. The first demonstration of the c.760del in a Turkish case contributed to the genetic association of this pathogenic variants with Roberts syndrome Although all the previously reported patients were homozygous, we have detected two patients with compound heterozygous pathogenic alterations from Turkiye indicating that the disease should also be considered in families with no consanguinity., NA

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Introduction: Primary glioblastoma (GBM) cell cultures have become a very important tool for future research due to the patient-specific genetic makeup of GBM cells and different treatment response variations. In sodium fluorescein-guided surgeries, regions sampled for primary cell culture are also stained with FL. However, the effects of FL on GBM cell cultures are unknown. In our study, the effect of FL on GBM cell cultures after a possible contamination was investigated. Resarch Question: Does sodium fluorescein have an effect on glioblastoma cell cultures? If there is, should sodium fluorescein be used after primary cell culture sampling when performing sodium fluorescein-guided glioblastoma surgery? Methods: Standard cell culture techniques were used to generate GBM cell lines, which were then split into control and FL treated groups. Cell counts, cell viability, cellular aging, and beta-galactosidase analyses were compared between these groups. Cells' microscopic pictures were also assessed. Results: Our study reveals that FL-applied cultures had fewer cells overall and more s beta-galactosidase activity than control groups. The notion that FL may have an impact on the environment of GBM cell cultures is thus raised by our main findings regarding the use of FL and its effects on cell cultures. Conclusion: To prevent adverse effects on the growth of primary GBM cell cultures, neurosurgeons might think about using FL after sampling the tumor tissue during operations., NA

Context: Tumoral (grossly visible) intraductal neoplasms of the bile ducts are still being characterized. Objective: To investigate their morphologic, immunohistochemical, and molecular features. Design:Forty-one cases were classified as gastric-, intestinal-, pancreatobiliary-type intraductal papillary neoplasm (IPN), intraductal oncocytic papillary neoplasm (IOPN), or intraductal tubulopapillary neoplasm (ITPN) on the basis of histology. All neoplasms were subjected to targeted next-generation sequencing. Results: The mean age at diagnosis was 69 years (42–81 years); male to female ratio was 1.3. Most neoplasms (n = 23, 56%) were extrahepatic/large (mean size, 4.6 cm). The majority (n = 32, 78%) contained high-grade dysplasia, and 68% (n = 28) revealed invasion. All gastric-type IPNs (n = 9) and most ITPNs/IOPNs showed consistent colabeling for CK7/MUC6, which was less common among others (P = .004). Intestinal-type IPNs (n = 5) showed higher rates of CK20 expression than others (P < .001). Overall, the most commonly mutated genes included TP53 and APC, while copy number variants affected ELF3 and CDKN2A/B. All gastric-type IPNs contained an alteration affecting the Wnt signaling pathway; 7 of 9 (78%) showed aberrations in the MAPK pathway. Mutations in APC and KRAS were common in gastric-type IPNs as compared with others (P = .01 for both). SMAD4 was more frequently mutated in intestinal-type IPNs (P = .02). Pancreatobiliary-type IPNs (n = 14) exhibited frequent alterations in tumor suppressor genes including TP53, CDKN2A/B, and ARID2 (P = .04, P = .01 and P = .002, respectively). Of 6 IOPNs analyzed, 3 (50%) revealed ATP1B1-PRKACB fusion. ITPNs (n = 6) showed relatively few recurrent genetic aberrations. Follow-up information was available for 38 patients (median, 58.5 months). The ratio of disease-related deaths was higher for the cases with invasion (56% versus 10%). Conclusions: Tumoral intraductal neoplasms of the bile ducts, similar to their counterparts in, This work has been supported by a gift from the Melamed Family Foundation, and by the Marie-Josee and Henry R. Kravis Center for Molecular Oncology, the Cancer Center Support Grant of the National Institutes of Health/National Cancer Institute under award number P30CA008748.

The triglyceride glucose (TyG) index is an indicator of insulin resistance and associated with increased risk of diabetes mellitus and cardiovascular events. Our study investigates the correlation between TyG index and contrast induced nephropathy (CIN) in non-diabetic patients with non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). 350 non-diabetic NSTEMI patients (183, 52.3% male) undergoing PCI were retrospectively enrolled. The enrolled cohort was divided into 2 groups based on the calculated TyG index, namely values < 8.65 or higher. CIN was defined as an increase in serum creatinine > 25% or 0.5 mg/dL from baseline in the first 48 to 72 hours after PCI. A total of 56 (16%) cases of CIN were diagnosed. In contrast to patients with lower TyG indexes, patients with higher TyG indexes (>= 8.65) had a higher frequency of CIN, 9.5%. versus 20.8% respectively (P .004). Patients with CIN also had higher TyG indexes (8.74 +/- 0.12 vs 8.67 +/- 0.11, P < .001). In addition, TyG index, age, and glomerular filtration rate were identified as independent risk factors for CIN in logistic regression model (OR: 2.5 CI: 1.3-4.6, P .006, OR: 1.0 CI: 1.0-1.1, P < .001, OR: 1.0 KI: 1.03-1.06, P .025). In the ROC analysis, the area under the curve predictive of CIN was 0.666 (P < .001, 95% [CI] 0.58-0.75) with a cutoff value of 8.69 (sensitivity 71,4%, specificity 55.1%) TyG index. Higher TyG indexes are associated with an increased risk of CIN in non-diabetic patients with NSTEMI., NA

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Objective: atrial mechanical dysfunction may be an alternative mechanism underlying the increased risk of systemic embolism in patients with atrial septal aneurysm (ASA). This study aimed to evaluate left atrial (LA) and right atrial (RA) function using two-dimensional speckle tracking echocardiography (2D STE) in patients with isolated ASA. Methods: fifty-four patients with ASA (mean age 50.3 ± 12.48, 37% male) and 48 healthy individuals of similar age and gender (mean age 48.3 ± 10.84, 39.6% male) were included in the study. To assess atrial mechanical function, measurements of left and right atrial reservoir strain (RS), peak contraction strain (PCS), and conduit strain (CS) were conducted using 2D STE, in addition to conventional evaluation with transthoracic echocardiography. Results: LA RS and PCS values were significantly lower in the ASA group than in the controls (37.52 ± 2.89 vs. 40.16 ± 2.68%, P < 0.001 and 17.29 ± 2.5 vs. 19.18 ± 2.23%, P < 0.001, respectively). Similarly, RA RS and RA PCS were significantly lower in patients with ASA (36.97 ± 2.19 vs. 39.77 ± 2.36%, P < 0.001 and 16.78 ± 2.10 vs. 18.54 ± 2.43%, P < 0.001, respectively). A multivariate regression analysis revealed a strong independent association between ASA and the measures LA RS, LA PCS, RA RS, and RA PCS. Conclusion: our findings indicate that bi-atrial function are diminished in patients with isolated ASA. This may be a possible cause for the increased risk of arterial embolism in this patient group, aside from atrial arrhythmias and patent foramen ovale. Validating these results with larger studies may influence the treatment and follow-up strategies for patients with isolated ASA. / Amaç: atriyal mekanik disfonksiyon, atriyal septal anevrizmalı (ASA) hastalarda artmış sistemik emboli riskini açıklayabilecek sebeplerden birisi olabilir. Bu çalışmanın amacı izole ASA’lı hastalarda iki boyutlu ‘‘speckle tracking’’ ekokardiyografi (2B STE) kullanarak sol atriyum (LA) ve sağ atriyum (RA, NA

Objective: we evaluated if admissiontriglyceride-glucose index (TyG index) correlated with the anatomical synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score 2 in non-ST elevation myocardial infarction (NSTEMI), nondiabetic patients. Methods: SYNTAX score 2 (SSII) was retrospectively evaluated in 260 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2]. We stratified patients according to tertiles of SSII (<= 21.5, 21.5-30.6, and >= 30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. Results: the average age of the patients was 57.2 +/- 10.9 years; 135 patients (52.2%) were males. The average TyG index was 8.68 +/- 0.12, and SSII was 18.9 +/- 9.9. A moderate correlation was found between TyG index and SSII (r = 0.347; P < 0.001) and TyG index was independent risk factors for SSII high [odds ratio (OR), 6.0; 95% CI, 2.7-17.0; P < 0.001]. Conclusion: in nondiabetic patients with NSTEMI, TyG index correlated with the SSII. Cardiovasc Endocrinol Metab 12: 1-5, NA

Background and objectives: there is a lack of information regarding the effective duration of treatment necessary to prevent the development of acquired resistance when fluoroquinolones (FQ), and/or pyrazinamide (Z) resistance has occurred in patients with polydrug-resistant tuberculosis and isoniazid resistance. The management of these kinds of patients should be carried out in experienced centers according to drug susceptibility test results, clinical status of the patient and the extensity of the disease. Materials and methods: we evaluated treatment regimens, treatment outcomes, and drug adverse effects in seven patients with polydrug-resistant tuberculosis, including those with Z and/or FQ resistance in a retrospective analysis Results: regarding the patients with polydrug-resistant tuberculosis in addition to isoniazid (H) resistance, three had Z, two had FQ, and the remaining two had both Z and FQ resistance. In the intensive phase of the treatment, the patients were given at least four drugs according to drug susceptibility tests, and at least three drugs in the continuation phase. The duration of treatment was 9–12 months. Two of the patients were foreign nationals, and could not be followed up with due to returning to their home countries. Regarding the remaining five patients, three of them were terminated as they completed treatment, and two as cured. No recurrence was observed in the first year of the treatment. The most common, and serious drug side effect was seen for amikacin. Conclusions: in patients with polydrug-resistant TB, if Z and/or FQ resistance is detected in addition to H resistance, the treatment of these patients should be conducted on a case-by-case basis, taking into account the patient’s resistance pattern, clinical condition, and disease prognosis. Close monitoring of the side effects will increase the success rate of the treatment., NA

Necrotizing fasciitis (NF) is an uncommon, severe, life-threatening soft tissue infection involving the subcutaneous tissue. Immunocompromised and patients with diabetes are at a higher risk of developing NF. One of the pathophysiologic mechanisms of NF is subcutaneous arterie thrombosis and tissue ischemia. Bevacizumab, a agent used in cancer treatment, blocks the activity of the vascular endothelial growth factor receptor. Recently, it is used along with paclitaxel and carboplatin due to an increased survival rate. The frequent use of this combination caused patients to applied to the emergency department (ED) with some side effects. NF is one of the rare side effects of this combination. Here, we present a patient with ovarian cancer who was admitted to the ED with severe leg pain, whose initial examination and tests were normal, and then NF developed within hours and then arrested., NA

Introduction: Autoimmune hepatitis (AIH) is a chronic liver disease caused by a perturbed immune system. The scarcity of short- and long-term immune monitoring of AIH hampered us to comprehend the interaction between immunosuppressive medication and immune homeostasis. Methods and patients: We recruited children with AIH at the time of diagnosis and at the 1st, 3rd, 6th, 12th, 18th, and 24th months of immunosuppression (IS). We also enrolled children with AIH being on IS for >2 years. Children with drug-induced liver injury (DILI), and those receiving tacrolimus after liver transplantation (LT), were enrolled as disease/IS control subjects. Healthy children (HC) were also recruited. Peripheral blood mononuclear cells (PBMCs) were isolated from all participants. Healthy liver tissue from adult donors and from livers without inflammation were obtained from children with hepatoblastoma. By using flow cytometry, we performed multi-parametric immune profiling of PBMCs and intrahepatic lymphocytes. Additionally, after IS with prednisolone, tacrolimus, rapamycin, or 6-mercaptopurine, we carried out an in vitro cytokine stimulation assay. Finally, a Lifecodes SSO typing kit was used to type HLA-DRB1 and Luminex was used to analyze the results. Results: Untreated AIH patients had lower total CD8 T-cell frequencies than HC, but these cells were more naive. While the percentage of naive regulatory T cells (Tregs) (CD4(+)FOXP3(low)CD45RA(+)) and regulatory B cells (Bregs, CD20(+)CD24(+)CD38(+)) was similar, AIH patients had fewer activated Tregs (CD4(+)FOXP3(high)CD45RA(-)) compared to HC. Mucosal-associated-invariant-T-cells (MAIT) were also lower in these patients. Following the initiation of IS, the immune profiles demonstrated fluctuations. Bregs frequency decreased substantially at 1 month and did not recover anymore. Additionally, the frequency of intrahepatic Bregs in treated AIH patients was lower, compared to control livers, DILI, and LT patients. Following in vitro IS, This project was funded by the Turkish Association for the Study of the Liver (TASL) charity, and seed funded by Koc University.

Background and Objectives: The impact of pure histological subtypes in testicular non-seminoma germ cell tumors on survival, specifically regarding pure embryonal carcinoma, is not well established. Therefore, this study aimed to test for differences between pure embryonal carcinoma and mixed germ cell tumor patients within stages I, II and III in a large population-based database. Materials and Methods: We relied on the Surveillance, Epidemiology and End Results (SEER) database (2004-2019) to identify testicular pure embryonal carcinoma vs. mixed germ cell tumor patients. Cumulative incidence plots depicted cancer-specific mortality that represented the main endpoint of interest. Multivariable competing risks regression models tested for differences between pure embryonal carcinoma and mixed germ cell tumor patients in analyses addressing cancer-specific mortality and adjusted for other-cause mortality. Results: Of 11,223 patients, 2473 (22%) had pure embryonal carcinoma. Pure embryonal carcinoma patients exhibited lower cancer-specific mortality relative to their mixed germ cell tumor counterparts for both stage III (13.9 vs. 19.4%; p < 0.01) and stage II (0.5 vs. 3.4%, p < 0.01), but not in stage I (0.9 vs. 1.6%, p = 0.1). In multivariable competing risks regression models, pure embryonal carcinoma exhibited more favorable cancer-specific mortality than mixed germ cell tumor in stage III (hazard ratio 0.71, p = 0.01) and stage II (hazard ratio 0.11, p < 0.01). Conclusions: Pure embryonal carcinoma exhibits a more favorable cancer-specific mortality profile relative to mixed germ cell tumor in stage II and III testicular cancers. Consequently, the presence of mixed germ cell tumor elements may be interpreted as a risk factor for cancer-specific survival., The APC was funded by Open Access Publication Fund of Goethe University Frankfurt am Main and German Research Foundation.

Simple Summary Previous analyses from referral centers of testicular cancer investigated the prognostic impact of presence of teratoma components in advanced testicular primary tumor specimens and observed conflicting results. However, data investigating pure teratoma in primary tumor specimens is limited and the prognostic impact is uncertain. To address this void, we tested for overall survival differences and subsequently, differences in cancer-specific and other-cause mortality in pure teratoma vs. mixed germ cell tumor patients. We aimed to test for survival differences between testicular pure teratoma vs. mixed germ cell tumor (GCT) patients in a stage-specific fashion. Pure teratoma and mixed GCT in primary tumor specimens were identified within the Surveillance, Epidemiology, and End Results database (2004-2019). Kaplan-Meier curves depicted five-year overall survival (OS) and subsequently, cumulative incidence plots depicted cancer-specific mortality (CSM) and other-cause mortality (OCM) in a stage-specific fashion. Multivariable competing risks regression (CRR) models were used. Of 9049 patients, 299 (3%) had pure teratoma. In stage I, II and III, five-year OS rates differed between pure teratoma and mixed GCT (stage I: 91.6 vs. 97.2%, p < 0.001; stage II: 100 vs. 95.9%, p < 0.001; stage III: 66.8 vs. 77.8%, p = 0.021). In stage I, survival differences originated from higher OCM (6.4 vs. 1.2%; p < 0.001). Conversely in stage III, survival differences originated from higher CSM (29.4 vs. 19.0%; p = 0.03). In multivariable CRR models, pure teratoma was associated with higher OCM in stage I (Hazard Ratio (HR): 4.83; p < 0.01). Conversely, in stage III, in multivariable CRR models, pure teratoma was associated with higher CSM (HR: 1.92; p = 0.04). In pure teratoma, survival disadvantage in stage I patients relates to OCM. Survival disadvantage in stage III pure teratoma originates from higher CSM., Cristina Cano Garcia was awarded a scholarship by the STIFTUNG GIERSCH.

Purpose: this study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results. Methods: the treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches. Results: the mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents. Conclusion: MCA aneurysms tend to be complex, with integrated branches and potentially wide ne, NA

Purpose: it is known that early retirement has been increasing for patients with Parkinson's disease. The data on the factors that cause early retirement in this patient population is limited. The objective of this study is to analyze the effects of Parkinson's disease that cause early retirement. Methods: seventy-five patients with Parkinson's disease (mean age: 59.10 +/- 9.20 years) participated in this study. Data were collected through face-to-face interviews with patients within the framework of 29 questions determined by the researchers by examining the literature and similar studies. Results: participants have been analyzed into groups: Retirement types and reasons for retirement. Patients that quit their jobs because of Parkinson's disease stated that bradykinesia in motor symptoms, somnipathy, and depression in non-motor symptoms came first in their reasons for retirement. It has been determined that 90% of participants that quit their jobs because of Parkinson's disease were not supported by the institutions they worked for, 77.55% couldn't receive physiotherapy treatment and 61.22% couldn't receive psychological therapy. In addition, it has been determined that 55.1% of the participants would like to work if they find a suitable job. Conclusion: for patients to stay in the workforce longer, patients with Parkinson's disease, their caregivers, and employers should be informed about the health problems associated with Parkinson's disease, their possible consequences, as well as strategies and treatment techniques developed for motor and non-motor symptoms. / Amaç: Parkinson hastalarındaki erken emeklilik oranının giderek arttığı bilinmektedir. Bu hasta popülasyonunda erken emekliliğe neden olan faktörler arasında kısıtlı sayıda veri vardır. Çalışmadaki amacımız Parkinson hastalığının erken emekliliğe neden olan etkilerini incelemektir. Yöntem: çalışmaya 75 Parkinson hastası (ortalama yaş: 59,10±9,20 yıl) dâhil edildi. Literatür ve benzer çalışmalar incelene, NA

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S', or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis., NA

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Purpose: this study evaluated single-center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy, and retreatment rates. MEthods: a retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome, and complications were recorded. Patients were divided into 2 groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the 2 groups in terms of tumor size reduction, retreatment, and complication rates. Results: in this study, 42 patients (37 (88.1%) females and 5 (11.9%) males) harboring 48 AMLs were included. The mean age was 43.46 (range, 20-78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94 +/- 1 cm (P < .001) after treatments; however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (P = .21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48 +/- 25.71 (range, 2-102) months. Conclusion: in this study, no clear supplementary benefit was observed in terms of safety and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs., NA

Objective: post-operative adhesion is a common problem in abdominal surgery. Especially, foreign materials are strong stimulus for the development of adhesions. The aim of this study was to investigate whether drug release material coated prosthetic mesh decreases intra-abdominal adhesion formation or not. Methods: 5-Fluorouracil (5-FU) releasing ""chitosan gels"" were loaded to polypropylene and polyglactin-910 grafts. Polypropylene, polyglactin-910 grafts, chitosan gel, and 5-FU-loaded polyglactin 910, polypropylene grafts were used to cover abdominal defects of rats which were created under sterile conditions (n=84). Each group was divided into two subgroups (n=6). Subgroups were sacrificed on the 7(th) and 30(th) days. Results: the 7(th) day macroscopic examinations were similar. Polypropylene group was most adhesive group on the 30(th) day. There were less adhesions in chitosan gel and 5-FU-loaded groups. Capsule and capsule margins showed no difference on both the 7(th) and 30(th) days. Polypropylene-5-FU group and polypropylene-chitosan gel group showed significantly less macroscopic adhesions than polypropylene control group. Furthermore, polyglactin-910-chitosan gel group was less adhesive than polypropylene control group. Conclusion: this study showed that 5-FU decreases the adhesions but the dosage and release kinetics need further investigations., This work was partially supported by Hacettepe University Research Fund (project no: 05D07101005).

Introduction/Background: cervical cancer is the third most common gynecologic cancer in women worldwide and human papillomavirus (HPV) infection is the primary risk factor for cervical neoplasms. The recurrence rates of cervical cancer are 11% to 22% and 28% to 64% for those with Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA and IIB-IVA disease, respectively. Surgery is one of the treatment methods for oligometastatic recurrence. In this video we aimed to demonstrate a radical surgical treatment approach in a patient with sacral cervical cancer recurrence. Methodology: A 38-year-old patient with stage IIB underwent primary chemoradiotherapy in 2018. In 2019 a parametrial recurrence detected and she underwent radical hysterectomy followed by chemotherapy. She presented to our gynecologic oncology department with right leg pain in 2020. Magnetic resonance imaging and positron emission tomography revealed a 4 x 3.5 cm recurrent mass extending into the neural foramen in the right half of the sacrum and hypermetabolic residual mass adjacent to the right internal iliac artery and vein. The patient underwent surgery with these findings. Internal iliac artery and external iliac vein excision, sacral tumor resection and Boari flap ureteroneocystostomy was performed. The patient was discharged uneventfully. Results: she stayed at the intensive care unit for one day and discharged on the 11th postoperative day without any early complications. Conclusion: recurrent cervical cancer has a poor prognosis. Surgery, radiotherapy, chemotherapy, or various combinations may be used to treat recurrent disease. Removal of metastases or pelvic exenteration are surgical treatment options. Post recurrence surgery can improve progression-free survival (PFS) and overall survival (OS) in selected patients., NA

Purpose: both the performance characteristics of prostate-specific membrane antigen positron emission tomography and insurance approval improves with increasing prostate-specific antigen (PSA) level causing some physicians to delay post-radical prostatectomy salvage radiation therapy (sRT) after PSA failure. Yet, it is unknown for men with at most one high-risk factor (ie, pT3/4 or prostatectomy Gleason score 8-10) whether a PSA level exists above which initiating sRT is associated with increased all-cause mortality (ACM)-risk and was investigated. Methods: using a multinational database of 25,551 patients with pT2-4N0 or NXM0 prostate cancer, multivariable Cox regression analysis evaluated whether an association with a significant increase in ACM-risk existed when sRT was delivered above a prespecified PSA level beginning at 0.10 ng/mL and in 0.05 increments up to 0.50 ng/mL versus at or below that level. The model was adjusted for age at and year of radical prostatectomy, established prostate cancer prognostic factors, institution, and the time-dependent use of androgen deprivation therapy. Results: after a median follow-up of 6.00 years, patients who received sRT at a PSA level >0.25 ng/mL had a significantly higher ACM-risk (AHR, 1.49; 95% CI, 1.11 to 2.00; P = .008) compared with men who received sRT when the PSA was & LE;0.25 mg/mL. This elevated ACM-risk remained significant for all PSA cutpoints up to 0.50 ng/mL but was not significant at PSA cutpoint values below 0.25 ng/mL. Conclusion: among patients with at most one high-risk factor, initiating sRT above a PSA level of 0.25 ng/mL was associated with increased ACM-risk., Supported by UCSF Goldberg-Benioff Program in Translational Cancer Biology

Background: the concordance rates of transperineal (TP) versus transrectal (TR) prostate biopsies with radical prostatectomy (RP) specimen have been assessed poorly in men diagnosed with magnetic resonance imaging (MRI)-targeted biopsy (TBx). Objective: to evaluate International Society of Urological Pathology (ISUP) concordance rates between the final pathology at RP and MRI-TBx or MRI-TBx + random biopsy (RB) according to the biopsy approach. Design, setting, and participants: A multi-institutional database included patients diagnosed with TP or TR treated with RP. Intervention: TP-TBx or TR-TBx of the prostate. Outcome measurements and statistical analysis: The ISUP grade at biopsy was compared with the final pathology. A multivariable logistic regression analysis (MVA) was performed to assess the association between the biopsy approach (TP-TBx vs TR-TBx) and ISUP upgrading, downgrading, concordance, and clinically relevant increase (CRI). Results and limitations: Overall, 752 (59%) versus 530 (41%) patients underwent TR versus TP. At the MVA, TP-TBx was an independent predictor of upgrading (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4–0.9, p < 0.01) and improved concordance relative to the final pathology (OR 1.7, 95% CI 1.2–2.5, p < 0.01) after adjusting for age, cT stage, Prostate Imaging Reporting and Data System, number of targeted cores, prostate-specific antigen, and prostate volume. Moreover, TP-TBx was associated with a lower risk of CRI than TR-TBx (OR 0.7, p < 0.01). This held true when considering patients who underwent MRI-TBx + RB (OR 0.6, p < 0.01). The inclusion of men who had RP represents a potential selection bias. Conclusions: the adoption of TP-TBx compared with TR-TBx may reduce the risk of upgrading and improve the concordance of biopsy grade with the final pathology. The TP approach decreases the odds of CRI with improved patient selection for the correct active treatment. Patient summary: in this report, we evaluated whether tra, NA

Objective: platelet aggregation tests and the analysis of thromboxane A2 metabolites [serum thromboxane B2 (TXB2) and urine 11-dehydro TXB2] are used to evaluate the efficacy of aspirin. In myeloproliferative neoplasms (MPNs), the immature platelet fraction (IPF) rises due to enhanced platelet turnover, and this has been thought to reduce the efficacy of aspirin. This phenomenon is overcome by the recommendation of aspirin intake in divided doses. We aimed to evaluate aspirin efficacy in patients who were receiving aspirin treatment of 100 mg/day. Materials and Methods: thirty-eight MPN patients and 30 control patients (non-MPN patients who received a single daily dose of aspirin at 100 mg for nonhematological conditions) were enrolled. IPF, serum TXB2, and urine 11-dehydro TXB2 levels were measured and aggregation tests with arachidonic acid and adenosine diphosphate were performed by light transmission aggregometry (LTA). Results: mean IPF and TXB2 levels were higher in the MPN group (p=0.008 and p=0.003, respectively). IPF levels were lower in patients on cytoreductive therapy in the MPN group (p=0.001), but these values were similar between patients on hydroxyurea and the non-MPN group (p=0.72). TXB2 levels did not differ according to hydroxyurea treatment status but were higher in the MPN group compared to non-MPN patients (23.63 ng/mL and 19.78 ng/mL, respectively; p=0.04). TXB2 values were higher in patients with essential thrombocythemia and a history of thrombotic events (p=0.031). No difference was observed in LTA between the MPN and non-MPN patient groups (p=0.513). Conclusion: higher levels of IPF and TXB2 in the MPN patient group indicated platelets that could not be inhibited by aspirin. It was observed that patients under cytoreductive therapy had lower IPF values, but the expected decrease in TXB2 levels was not observed. These findings suggest that a lack of response to aspirin may be due to additional intrinsic factors rather than increased platele, The laboratory tests that were required to conduct this clinical study were funded by the Istanbul Medeniyet University Scientific Research Projects Coordination Unit (BAP, Project No. T-UZM-2019-1568, 18.10.2019).

The carotid artery is a valuable vascular access that can be used in patients who have undergone repetitive interventional and surgical procedures and premature babies. In the past, cut-down was used but nowadays, mostly the procedure is performed under ultrasonographic guidance. Complications such as bleeding, haematoma, and pseudoaneurysm may occur when the carotid artery is used as a vascular access for the procedures such as aortic balloon valvuloplasty, coarctation balloon angioplasty, or after interventional or surgical treatments to the carotid artery. Although pseudoaneurysm is very rare, prompt diagnosis and accurate treatment planning are life-saving. In this article, the diagnosis and treatment of pseudoaneurysm in the left common carotid after transcatheter coarctation balloon angioplasty in a 6-month-old infant will be presented., NA

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A significant contributing factor to the progression of late cyanosis in individuals undergoing Kawashima operation is pulmonary arteriovenous malformations. Following the Fontan procedure, arteriovenous malformations may regress. However, in cases with extensive malformations causing severe cyanosis, lobectomy can also be a possible treatment approach. Thereby, we present our two-step treatment strategy in a late Fontan completion complicated by arteriovenous malformations in a Kawashima patient., NA

Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk stratification after surgery, but less data exist for patients treated with definitive radiation therapy (RT) or RT in oligo-/metastatic disease stages. To guide future perspectives of GCs for RT, we conducted (1) a systematic review on the evidence of GCs for patients treated with RT and (2) a survey of experts using the Delphi method, addressing the role of GCs in personalized treatments to identify relevant fields of future clinical and translational research. We performed a systematic review and screened ongoing clinical trials on ClinicalTrials.gov. Based on these results, a multidisciplinary international team of experts received an adapted Delphi method survey. Thirty-one and 30 experts answered round 1 and round 2, respectively. Questions with ?75% agreement were considered relevant and included in the qualitative synthesis. Evidence for GCs as predictive biomarkers is mainly available to the postoperative RT setting. Validation of GCs as prognostic markers in the definitive RT setting is emerging. Experts used GCs in patients with PCa with extensive metastases (30%), in postoperative settings (27%), and in newly diagnosed PCa (23%). Forty-seven percent of experts do not currently use GCs in clinical practice. Expert consensus demonstrates that GCs are promising tools to improve risk-stratification in primary and oligo-/metastatic patients in addition to existing classifications. Experts were convinced that GCs might guide treatment decisions in terms of RT-field definition and intensification/deintensification in various disease stages. This work confirms the value of GCs and the promising evidence of GC utility in the setting of RT. Additional studies of GCs as prognostic biomarkers are anticipated and form the basis for future studies addressing predictive capabilities of GCs to optimize RT and, European Union (EU); Horizon 2020; Research and Innovation Programme; German Federal Ministry of Education and Research (BMBF); ERA PER Joint Funding Call 2019; A.T. acknowledges support from Cancer Research UK (C33589/A28284 and C7224/A28724 CRUK RadNet). This project represents independent research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. We thank Fotini Miltiadous for administrative support. ; Funding text 3: Disclosures: A.U.K. reports funding support from grant P50CA09213 from the Prostate Cancer National Institutes of Health Specialized Programs of Research Excellence and grant W81XWH-22-1-0044 from the Department of Defense, as well as grant RSD1836 from the Radiologic Society of North America, the STOP Cancer organization, the Jonsson Comprehensive Cancer Center, and the Prostate Cancer Foundation. C.Z. received funding from the Klaus Tschira foundation, Naslund Medical, and from the German Research Foundation. C.Z. received speaker fees from Johnson & Johnson and Novocure, all outside the submitted work. E.D. is an employee of Veracyte, manufacturer of Decipher. A.R. is a consultant and/or speaker for Astellas, Bayer, Pfizer, Blue Earth, Lantheus, Janssen, Tempus, and Veracyte. X.G. is on the consulting/advisory board for Bayer, Myovant, and Guardant Health.

Introduction: Spinal muscular atrophy (SMA) is a severe, inherited neuromuscular disorder characterized by progressive muscle weakness and atrophy. Cardiac pathology co-existence is reported more frequently in the severely affected patient groups. Structural heart anomalies, mainly septal, and outflow tract defects are commonly observed pathologies. Case presentation: We herein report the case of a 23 days-old female patient with the diagnosis of spinal muscular atrophy type 2 complicated with structural heart defects. Successful pulmonary banding, and at the age of 17 months, subsequent surgical atrial and ventricular septal defect closure were performed on our patient who was under treatment of Nusinersen Sodium. Post-operative recovery was uncomplicated. Cardiac assessments were normal, and the patient was neurologically improving in her recent follow-up. Conclusion: In the literature, there are no reported cases of successful surgical repair of heart defects in spinal muscular atrophy patients. These patients can be perceived as risky surgical candidates with suboptimal postoperative recovery given the unfavorable disease prognosis of SMA in untreated patients. We report our promising experience with a SMA type 2 patient undergoing a disease-modifying medical treatment. The SMA patients under treatment may be potential candidates for successful surgical cardiac correction given their overall improved prognosis., NA

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Objective: our study evaluated the effects of pregabalin (PR) on wrist function and chronic post-surgical pain (CPSP) following infraclavicular brachial plexus block for surgical repair of distal radius fractures. Methods: adult patients who underwent ultrasound-guided infraclavicular blockade (IB) plus surgical repair of a distal radius fracture between 2012 and 2017 were evaluated from hospital medical records retrospectively. Two different treatment protocols were used for postoperative analgesia. Group IB received standard analgesia protocol as 15 mg/kg IV paracetamol 4 times a day +/- 2 mg/kg IV tramadol and group PR received oral PR plus the standard protocol. The frequency of Tramadol use during hospital stay (TCHS) was also evaluated. The disability of the arm shoulder and hand (DASH) score and Mayo wrist score (MWS) were used to assess wrist function and a visual analog scale (VAS) was used for subjective pain severity assessment. CPSP and its neuropathic component were evaluated using the douleur neuropathique 4 (DN4) and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scales. Results: a total of 122 patients with a mean age 39.4 +/- 11.5 years were included in the study (group IB, n=62 and group PR, n=60). The TCHS of group PR was significantly lower than group IB (p=0.030). Better VAS, DASH and MWS scores were found in group PR at months 3, 6, and 12 (p=0.002, p=0.007, p=0.02 for VAS; p=0.01, p=0.01, p=0.01 for DASH; p<0.001, p<0.001, p=0.01 for MWS). The ratio of neuropathic pain according to DN4 and S-LANSS scores of group PR was also significantly lower than group IB at 6-and 12-month visits (p=0.21, p=0.023 for DN4; p=0.034, p=0.038 for S-LANSS). Conclusion: the administration of low dose PR for 2 weeks following distal radius fracture surgery is beneficial for wrist function, chronic pain, and opioid consumption., NA

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Background: the incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: a total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions, NA

Background and Objectives: Robotic radical cystec-tomy (RARC) with intracorporeal urinary diversion is a technically complicated, time-consuming procedure. The aim of this study was to present the operative, pathologi-cal, oncological, and functional outcomes of patients who underwent endopelvic fascia sparing (EPFS) RARC with intracorporeal Studer pouch formation. To the best of our knowledge, this is first series in the literature that includes EPFS RARC.Methods: Between October 1, 2019 and April 30, 2022, 10 bladder cancer patients underwent EPFS RARC, bilat-eral extended pelvic lymph node dissection with intra-corporeal Studer pouch reconstruction with Balbay's technique. Patient demographics, operative, and post-operative parameters were recorded.Results: Among 10 patients, 8 were male and 2 were female. Mean operative time, median estimated blood loss, and median duration of hospital stay was 530 minutes, 316 ml, and 8 days, respectively. One month postoperatively, the mean maximum flow, average flow rate, mean voided, and post-voided urine volume were 20.2 ml/sec, 4.4 ml/sec, 273.6 ml, and 3.5 ml, respectively. All of the patients were fully continent during day-time, three had mild night-time incontinence requiring pad use (both patients 1 pad per night). During a mean 11.5 months of follow up, zero patients died. One patient with a pathological, stage 4 tumor, had nodal recurrence at six months postoperatively. No distant metastasis were detected. Conclusion: Endopelvic fascia sparing RARC has very promising early functional results with safe oncological outcomes and low complication rates., NA

Objective: to evaluate the impact of patellofemoral joint anatomical measurements of patients with anterior knee pain who were diagnosed with suprapatellar fat pad (SPFP) impingement syndrome (SP-FPIS) by magnetic resonance imaging (MRI). Study design: a prospective, descriptive study. Place and duration of study: Goztepe Education and Research Hospital, between March 2015 and June 2019. Methodology: The study included 34 patients (Group 1) and 34 healthy volunteers (Group 2) who were referred to the radiology clinic with anterior knee pain; they underwent MRI and diagnosed with SP-FPIS. Twenty-three anatomical measurements such as SPFP cranio caudal length (CC), anteroposterior length (AP), oblique length (OBL), patellar length (PL), patellar tendon length (PTL), Insall Salvati Index (ISI), patellar cartilage distal-tibial tubercle (TT), patellar cartilage length (PCL), Modified Insall Salvati Index (MISI), patellotrochlear cartilage length (TCL), lateral trochlear inclination angle (LTI), etc. related to the morphological structure of SPFP and patellofemoral joint were evaluated and compared in both groups. Results: The mean age of groups 1 and 2 was 45.62±10.87 and 41.47±11.98 years, respectively. There was a statistically significant difference in patients with SP-FPIS in PL, PT, TT, PC, MISI, TC, PTI, MF, PHY, PPI, MT, LTI, CC, AP, and OBL measurements compared with the control group (p<0.05). In the logistic regression analysis performed to evaluate the effect of statistically significant parameters on anterior knee pain, the probability of SP-FPIS increases 1.5 times as PTL increases among the groups, while the risk of SP-FPIS decreases 0.78 times as LTI decreases (p<0.05). Conclusion: there is a predisposing effect of PTL increase in SP-FPIS development, while LTI decrease has a protective effect. These results will guide future studies for the development and/or modification of treatment methods., NA

Cystic echinococcosis, a zoonotic parasitic disease, is endemic to many countries worldwide. This slowly progressing disease is seen rarely in the paediatric age group. In terms of cyst localization, cardiac involvement is infrequent. We report the case of a successful surgical and medical management of a paediatric hydatid disease patient with involvement of the heart., NA

Purpose: since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods: we used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman's correlation coefficient and reliability is measured using Cronbach's alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results: we reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion: through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly., NA

We hypothesized that myocardial septal scarring, assessed by cardiac magnetic resonance (CMR) using late gadolinium enhancement (LGE), at the site of cardiac contractility modulation (CCM) lead placement may predict treatment response. Eligible heart failure (HF) patients underwent LGE CMR imaging before CCM device implantation. The response to CCM therapy at follow-up was determined by a change in NYHA class and echocardiographic left ventricular ejection fraction (LVEF) assessment. Patients were classified as responders, if they showed an improvement in either NYHA class or improvement of LVEF by >= 5%. 58 patients were included. 67% of patients were classified as responders according to improved NYHA; 55% according to LVEF improvement. 74% of patients were responders if either NYHA class or LVEF improvement was observed. 90% of responders (according to NYHA class) showed septal LGE < 25% at septal position of the leads, while 44% of non-responders showed septal LGE > 25% (p < 0.01). In patients treated with CCM, an improvement of NYHA class was observed when leads were placed at myocardial segments with a CMR- LGE burden less than 25%., Open Access funding enabled and organized by Projekt DEAL

Background: the aim of the forensic nursing (FN) education is to provide nursing students with the basic knowledge of FN that they can use in the clinical area. Objective: the study evaluated the effect of integrating forensic nursing into the undergraduate nursing curriculum on 2nd- and 4th-year students' knowledge level of FN. Participants: The target population of this study was composed of 2nd- and 4th-year students in the nursing department at a foundation university in Istanbul. The study was conducted with 95 nursing students who agreed to participate in the study. Methods: the research was planned as cross-sectional and descriptive. The questionnaire form was developed with the help of literature by experts in the field. Each correct answer was scored as 4 points, and the total score could range from 0 to 100. Results: The average age was 21.64 +/- 1.16, and 66.3% (n = 63) was female. Out of the 95 students, 50.5% (n = 48) were in 2nd year, and 49.5% (n = 47) were in 4th year. A total of 47.4% (n = 45) of the students took a FN course, and 52.6% (n = 50) did not take FN course. The average level of knowledge for those who took FN course was 52.09 +/- 12.31 and for those who did not take FN course was 46.16 +/- 12.18. According to the status of taking FN course, a significant difference was found between the average level of knowledge (p < 0.05). Conclusions: these results emphasize the importance of integration of FN into the undergraduate nursing curriculum., NA

Background and aim: liver biopsy is the gold standard method for the diagnosis and treatment of liver diseases. In this study, we aimed to evaluate the results of liver biopsies performed in a year in our clinic. In addition, we also aimed if these liver biopsies could reveal the etiology of liver disease in patients with elevations of transaminases or/and alkaline phosphatase levels or liver masses. Materials and methods: patients who had liver biopsies for persistently elevated transaminases or/and alkaline phosphatase levels, protocol biopsies after liver transplantation, or liver masses in our hepatology clinic between 2011 and 2012 were included in the study. Liver biopsy decisions were made by experts during the hepatology council. Liver biopsies were previously performed using classical percutaneous liver biopsy or ultrasonography-guided Sonocan (R) liver biopsy sets. The pathology results of liver biopsies and clinical data of the matching patients were obtained from the liver biopsy record archives and patient files, respectively. Results: totally, 479 liver biopsy results (male=252, 52.6%, mean age 49 +/- 14.5 years) were evaluated in the study. Of these patients, 432 (male=228) underwent percutaneous liver biopsy and 47 (male=24) underwent Sonocan (R) needle biopsy. The most common histopathologic diagnoses in the percutaneous liver biopsy group were chronic hepatitis B (n=127, 29.4%), normal histopathological findings (n=50, 11.6% and 32 of them were protocol biopsies after liver transplantation), and nonalcoholic steatohepatitis (NASH, n=41, 9.5%). The most common histopathologic diagnoses in the Sonocan (R) group were 25 liver metastasis out of 29 liver tumors (n=25, 53.2% of all) chronic hepatitis B (n=5, 10.6%), and NASH (n=3, 6.4%). Conclusion: in this study, diversity in liver biopsy results indicates the importance of histopathological evaluation. The most prevalent pathology in the liver biopsies was chronic hepatitis B, which is the most common, NA

Objective: to compare the radiological parameters of the normal population with the patients with Haglund's syndrome (HS) and to seek a correlation between pain scores and radiological parameters in patients with HS.Methods: thirty-one patients surgically treated for HS (Haglund group) and 36 healthy subjects free of hindfoot pathology seen in consultation for any other foot pathologies (control group) were included in the study. Demographic data of the patients were acquired, and radiological measurements such as; Fowler Philip Angle (FPA), lateral talus-first metatarsal angle (LTFMA), and Calcaneal pitch angle (CPA) were recorded. The visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) scores of the patients in the Haglund group were assessed.Results: mean CPA, FPA, and LTFMA in the Haglund group were 23.88 +/- 4.6, 58.16 +/- 5.7, and 4.92 +/- 1.88, respectively, and the same recordings in the control group were 21.16 +/- 4.81, 59.1 +/- 4.3, and 4.25 +/- 2.57, respectively. CPA differences between Haglund and control groups were statistically significant (p=0.021). The average values of the VAS and AOFAS scores of the patients in the Haglund group were 8.45 +/- 1.06 and 47.4 +/- 7.58, respectively. There was no correlation between the scores and the radiological measurements of patients in the Haglund group.Conclusion: radiological assessments are widely debated. Many studies support our results that measurements defined for the morphology of calcaneus are not associated with the Haglund's disease severity. Increase in the CPA is found to be related to HS. This may be explained by the extension of the calcaneus to irritate the Achilles tendon and cause heel pain. / Amaç: bu araştırmadaki amacımız normal popülasyonun radyolojik ölçümlerini, Haglund sendromlu (HS) hastalarla karşılaştırmak ve HS hastalarda ölçümsel değişimlerin ağrı ve fonksiyonel skorlar üzerindeki etkisini incelemektir. Yöntemler: HS nedeniyle cerrahi tedavi uygulan, NA

Objectives: to evaluate the effect of anterior segment depth (ASD; sum of anterior chamber depth and lens thickness) on the accuracy of 7 intraocular lens formulas calculated in patients with axial length (AL) between 22.5 and 24.5 mm.Materials and Methods: in this retrospective study, patients who underwent cataract surgery were divided into three groups based on their ASD measurements (Group I: ASD <7.30 mm, Group II: ASD between 7.30-7.90 mm, Group III: ASD >7.90 mm). The mean predictive error (MPE), mean absolute error (MAE), and median absolute error (MedAE) values of each group were compared. The effect of ASD on the predictive error (PE) of each lens formula was additionally tested in subgroups based on mean keratometry (K) values (Subgroup I: K <42.0 D, Subgroup II: K between 42.0-44.5 D, Subgroup III: K >44.5 D). Results: the study included 184 eyes of 184 patients. In Group I, all formulas except Olsen OLCR and Barrett II had clinically myopic MPEs. In Group II, the MPEs of all lens formulas except Barrett II were statistically non-different from zero (p>0.05). In Group III, the MPEs of all lens formulas were found to be statistically hyperopic. In Group III, all formulas except Olsen OLCR were significantly shifted to more hyperopic results when compared with Groups I and II (p<0.05). ASD was positively correlated with the PEs of the SRK/T, Holladay I, Hoffer Q, Barrett II, Hill-RBF, and Haigis formulas. In cases with mean K greater than 42.0 D, ASD was similarly correlated with PE for all formulas except Olsen OLCR.Conclusion: in eyes with AL between 22.5 and 24.5 mm, the predictions of lens formulas were significantly hyperopic in cases with greater ASD. / Amaç: ön segment derinliğinin (ÖSD; ön kamara derinliği ve lens kalınlığının toplamı), aksiyel uzunlukları (AU) 22,5 ve 24,5 mm arasında olan hastalarda 7 farklı göz içi lens formülü ile hesaplanan değerlerin doğrulukları üzerindeki etkisinin değerlendirilmesi. Gereç ve yöntem: bu retrospektif çalışma, NA

Background: irritable bowel syndrome (IBS) is the most frequent functional gastrointestinal (GI) disorder. In this study, we aimed to evaluate the different aspects of IBS among Middle Eastern residents. Methods: during the study period, patients attending gastroenterology clinics of nine tertiary referral centers in four Middle Eastern couturiers (Iran, Egypt, Kuwait, and Turkey) were evaluated by Rome IV diagnostic criteria, and those who fulfilled the diagnostic criteria of IBS were asked to fill in a questionnaire covering different demographics and clinical aspects. Results: overall, during a 6-month period, 509 patients with IBS were included. 41.3% of the participants were male (210 patients), and 37.4% of them had academic education. 50% of the participants were Caucasian, and 34% were Arab, and originally, they were citizens of 18 countries. 77.4% of the participants were residents of subtropical areas, while 22.2% were living in temperate regions. The average age of the participants during the first presentation in subtropical and temperate areas were 38.4 ± 12.19 and 38.06 ± 12.18 years, respectively (P = 0.726). The most common subtypes of IBS in subtropical areas were unclassified (IBS-U, 44.4%), constipation dominant (IBS-C, 27.6%), mixed pattern (IBS-M, 21%), and diarrhea dominant (IBS-D, 6.8%) in descending order while in temperate areas the most common subtypes were IBS-U (43.3%), and IBS-D (22.1%), respectively (P < 0.001). Besides abdominal pain, the most common symptom of patients in each region was bloating (62.2% and 68.1%, respectively, P = 0.246). The rate of depression and anxiety were significantly higher among the residents of temperate areas in comparison with subtropical regions (41.6% vs. 16.5% and 80.5% vs. 58.4%, respectively, P < 0.001). Conclusion: although the average age of IBS presentation is the same in subtropical and temperate areas, it seems that in temperate areas, the rate of IBS-D is more prevalent than in subtropical regi, NA