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Purpose: The aim of this study was to examine the structural-neurochemical abnormalities of the frontal white matter (FWM), deep gray matter nuclei, and pons in patients with Wilson's disease (WD) using proton magnetic resonance spectroscopy (MRS) and diffusion-weighted imaging (DWI).Materials and Methods: Nine patients with WD and 14 age-matched controls were examined with MRS. N-Acetylaspartate (NAA), choline (Cho), and creatine (Cr) peaks were calculated. DWI scans from six WD patients and six controls were also obtained. The relative metabolite ratios and apparent diffusion coefficient (ADC) values of the WD patients were compared to those of the control subjects by using statistical measures.Results: Measurements in the thalamus and pons showed significantly lower NAA/Cho and NAA/Cr ratios in the WD group than in the control group (P < 0.05). Thalamic and pontine Cho/Cr ratios in the patient group were significantly higher than those of the control group (P < 0.05). No statistically significant relation was found between the patient and control groups as a result of the MRS examinations of FWM and all ADC measurements (P > 0.05).Conclusion: MRS is a noninvasive, valuable modality for detecting structural-neurochemical changes of the brain stem and deep gray matter in patients with WD. The contribution of DWI in these patients is limited. [ABSTRACT FROM AUTHOR]

Background/Objective: In this study, our purpose was to evaluate the thalamic magnetic resonance (MR) spectroscopic changes in multiple sclerosis (MS) patients. Patients and Methods: Forty-three relapsing-remitting MS (RRMS) patients and 23 control subjects were included in this study. Routine brain MR and MR spectroscopy (MRS) using single voxel technique were carried out in all the patients and the controls. The N-Acetylaspartate (NAA), choline (Cho) and creatine (Cr) peaks were calculated. The thalamic relative metabolite ratios of the RRMS patients were compared to those of the control subjects by using the statistical measures (Mann-Whitney U test). The level of statistical significance was set at 0.05. Results: The thalamic NAA/Cr and NAA/Cho ratios were lower while the thalamic Cho/Cr ratio was higher in the MS patients than those of the control subjects. But these differences in the spectroscopic relative metabolite ratios were not statistically significant between the groups (p=0.34, p=0.22 and p=0.1, respectively). Conclusion: The spectroscopic relative metabolite ratios were of limited value in determining the presence of metabolic changes in the deep grey matter of MS patients. New studies about the presence of the deep grey matter damage in MS patients are necessary. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to evaluate the efficacy of stereotactic body radiotherapy (SBRT) using the CyberKnife-M6 (CK-M6) with lung optimized treatment (LOT) module in patients with primary lung cancer and lung metastases., Methods: Forty-two lesions from 35 patients were treated between 2019 and 2022. Four-dimensional computed tomography images were obtained when the patients were in a free breathing modality. Tracking modality was selected prospectively according to the visibility of the target. The median prescribed dose was 48 Gy in four fractions (fx) (28 - 55 Gy/1- 7 fx). The median age was 68 years (47 - 82 years), and 43% of cases were adenocarcinoma. The median lesion size was 15 mm (6 - 36 mm)., Results: Complete, partial and stable responses were obtained as 26%, 62%, and 9.5% at a median of 2 months (1 - 6 months), and 35.5%, 47.5% and 5% at the 12th month evaluation, respectively. Grade 3 and higher toxicity was not observed in any case. The mean and 2-year overall survival (OS) was 31.5 months and 54%, and the local recurrence-free survival (LRFS) was 29.6 months and 51%, respectively. In univariate analysis, target lesion type, complete response (CR), and higher esophagus maximum dose were favorable factors for OS and LRFS (P < 0.05). The CR at 12th month evaluation remained significant in multivariate analysis in terms of OS (hazard ratio = 8.602, 95% confidence interval: 1.05 - 70.01; P = 0.044)., Conclusions: A mean LRFS of 29.6 months and OS of 31.5 months were obtained in patients with primary and metastatic lung cancer. With a median treatment time of 25 min, motion-managed strategy with CK-M6-LOT-based SBRT is an effective, safe, and comfortable treatment method for lung cancer., Competing Interests: The preliminary results of the study were presented as a poster presentation at the IASLC 2022 World Conference on Lung Cancer, August 6 - 9, 2022, Vienna, Austria. The authors declare no conflict of interest., (Copyright 2024, Sureyya et al.)

We aimed to assess Large Language Models (LLMs)-ChatGPT 3.5-4, BARD, and Bing-in their accuracy and completeness when answering Methotrexate (MTX) related questions for treating rheumatoid arthritis. We employed 23 questions from an earlier study related to MTX concerns. These questions were entered into the LLMs, and the responses generated by each model were evaluated by two reviewers using Likert scales to assess accuracy and completeness. The GPT models achieved a 100% correct answer rate, while BARD and Bing scored 73.91%. In terms of accuracy of the outputs (completely correct responses), GPT-4 achieved a score of 100%, GPT 3.5 secured 86.96%, and BARD and Bing each scored 60.87%. BARD produced 17.39% incorrect responses and 8.7% non-responses, while Bing recorded 13.04% incorrect and 13.04% non-responses. The ChatGPT models produced significantly more accurate responses than Bing for the "mechanism of action" category, and GPT-4 model showed significantly higher accuracy than BARD in the "side effects" category. There were no statistically significant differences among the models for the "lifestyle" category. GPT-4 achieved a comprehensive output of 100%, followed by GPT-3.5 at 86.96%, BARD at 60.86%, and Bing at 0%. In the "mechanism of action" category, both ChatGPT models and BARD produced significantly more comprehensive outputs than Bing. For the "side effects" and "lifestyle" categories, the ChatGPT models showed significantly higher completeness than Bing. The GPT models, particularly GPT 4, demonstrated superior performance in providing accurate and comprehensive patient information about MTX use. However, the study also identified inaccuracies and shortcomings in the generated responses., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Thrombocytopenia is a characteristic adverse event of trastuzumab emtansine (T-DM1), one of the essential treatment options for human epithelial growth factor receptor 2 (HER2)-positive breast cancer. The present study investigated the predictive value of thrombocytopenia for time-to-treatment discontinuation (TTD) in patients receiving T-DM1 for advanced-stage HER2-positive breast cancer. The present observational study enrolled 138 patients who received T-DM1 at six oncology centers from January 2016 to December 2021. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting TTD. The median age of patients was 50 years (range, 26-83). The median number of T-DM1 cycles was 9 (range, 2-58), the overall response rate was 50.0% and the disease control rate was 69.6%. At a median follow-up time of 19.3 months, the median TTD was 9.5 months [95% confidence interval (CI), 7.3-11.7], and the median overall survival was 28.2 months (95% CI, 19.2-37.2). Thrombocytopenia during treatment was observed in 39% of all patients, and 66.7% of these patients experienced early thrombocytopenia (in the first four treatment cycles). Multivariate analysis revealed that the independent factors for TTD were hormone receptor status [hazard ratio (HR), 1.837; 95% CI, 1.249-2.701; P=0.002], Eastern Cooperative Oncology Group performance status score (HR, 3.269; 95% CI, 1.788-5.976; P<0.001) and thrombocytopenia during treatment (HR, 0.297; 95% CI, 0.198-0.446; P<0.001). Patients with early thrombocytopenia had a significantly longer TTD of 17.3 months (95% CI, 11.8-22.8) compared with 7.6 months (95% CI, 5.8-9.4) for patients without early thrombocytopenia (P<0.001). The results of the present study indicated that patients with early thrombocytopenia had improved survival outcomes compared with those without. Thus, maximum benefit from T-DM1 treatment may be achieved by confirming the predictive role of thrombocytopenia in T-DM1 treatment in prospective studies and large-scale cohorts., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023, Spandidos Publications.)

Objective: To evaluate the performance of ChatGPT, an artificial intelligence (AI) language model, in providing patient information on prostate cancer, and to compare the accuracy, similarity, and quality of the information to a reference source., Methods: Patient information material on prostate cancer was used as a reference source from the website of the European Association of Urology Patient Information. This was used to generate 59 queries. The accuracy of the model's content was determined with F1, precision, and recall scores. The similarity was assessed with cosine similarity, and the quality was evaluated using a 5-point Likert scale named General Quality Score (GQS)., Results: ChatGPT was able to respond to all prostate cancer-related queries. The average F1 score was 0.426 (range: 0-1), precision score was 0.349 (range: 0-1), recall score was 0.549 (range: 0-1), and cosine similarity was 0.609 (range: 0-1). The average GQS was 3.62 ± 0.49 (range: 1-5), with no answers achieving the maximum GQS of 5. While ChatGPT produced a larger amount of information compared to the reference, the accuracy and quality of the content were not optimal, with all scores indicating need for improvement in the model's performance., Conclusion: Caution should be exercised when using ChatGPT as a patient information source for prostate cancer due to limitations in its performance, which may lead to inaccuracies and potential misunderstandings. Further studies, using different topics and language models, are needed to fully understand the capabilities and limitations of AI-generated patient information., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of Competing Interest None Declared.

Purpose: To investigate the prevalence of overactive bladder (OAB) in patients with obstructive sleep apnea syndrome (OSAS) and the factors affecting it., Materials and Methods: A total of 255 patients were included in this prospectively designed study. Among all patients, 166 were male, 89 were female; 213 patients were married and 42 were single. All patients underwent polysomnography. All patients completed the OAB-V8 form. OSAS was diagnosed via polysomnography. OAB was diagnosed via OABV8. The participants were evaluated as patients with and without OAB and those with and without OSAS. SPSS for Windows version 18.0 software was used for the statistical analysis and the level of significance was set at α  = 0.05., Results: The prevalence of OAB was high among the OSAS patients (66.3%, n  = 136). Age, body mass index, waist circumference, marital status, oxygen desaturation index (ODI4) ⩾4%, apneahypopnea index (AHI), the number and duration of decreases in O 2 saturation below 90%, wake after sleep onset (WASO) duration, and groups, and OSAS severity were different in the OAB group ( p  < 0.05). Duration and number of O 2 saturation <90%, and ODI4 are higher in the OSAS group and OAB group ( p  < 0.05). In multivariate logistic regression analysis, AHI, WASO, age, and marital status were the factors influencing OAB., Conclusion: OAB is seen at a high rate in OSAS patients. Hypoxia is the main basis for both diseases and probably it is the common pathway. AHI, WASO, age, and marital status can provide valuable information to physicians for predicting OAB.

Aim: To understand the changing trends in pediatric head injury in a university hospital comparing two decades., Material and Methods: The medical records of pediatric patients hospitalized for head injuries were evaluated retrospectively between 2000 and 2020 to investigate the epidemiological differences between decades. The patient files were evaluated in terms of age, sex, mechanism of trauma, whether there was additional trauma, radiological findings, Glasgow coma score (GCS), and Rankin scores., Results: A difference was found between the ages of the patients who were hospitalized for head trauma in 2000-2010 (first decade) and 2011-2020 (second decade) (p < 0.001). The admission rate of children in the preschool age group was higher in the second decade (p < 0.05), whereas the admission rate of school-age children and adolescents was higher in the first decade (p < 0.05). The admission rate of patients who had head trauma due to traffic accidents was higher in the first decade (p < 0.05). The rate of linear fracture was higher in the second decade (29.90% vs. 55.60%, p < 0.05). The incidence of epidural hemorrhage was higher in patients admitted in the first decade (18.50% vs. 7.90%, p < 0.05)., Conclusion: Some classical information has changed over the years. Multicenter studies with a higher number of patients will correct the changing knowledge about pediatric head trauma.

Aim: To investigate the preoperative and postoperative differences in the upper-body and spinal shapes of patients with scoliosis., Material and Methods: Digitized two-dimensional X-ray images were used to obtain the shapes of the upper-body and spine. The preoperative and postoperative mean shapes were compared by using a Generalized Procrustes analysis. The thin plate spline (TPS) method was used to evaluate the spinal shape deformation between the preoperative and postoperative periods., Results: The pre- and postoperative upper-body and spinal shape differences were significant. The TPS graphics showed highlevel deformations between the pre- and postoperative periods. The left superior border of the L4 spinous process showed the highest deformation., Conclusion: The preoperative and postoperative upper-body and spinal shape differences and structural deformations that correlated with scoliosis were shown to be significant.

Objective: Overactive bladder (OAB) is a common clinical problem with associated morbidities both in men and women. Although real-life management strategies have been examined among urologists (URO), treatment choices may differ between different specialties. In the present study, an online survey was conducted to determine and compare the management strategies and clinical preferences of UROs, obstetricians/gynecologists (OB/GYN), and geriatricians (GER) in the treatment of OAB in their daily practices., Methods: Between December 2020 and February 2021, an online questionnaire was sent to URO, OB/GYN, and GER specialists/residents. Current strategies and attitudes toward treatment of OAB in patients &lt;65 years were compared between URO and OB/GYN, whereas the responses were compared between all three specialties in patients ≥65 years., Results: A total of 733 specialists/physicians (433 URO, 236 OB/GYN, and 64 GER) completed the online survey. Patients with OAB were more likely to present to URO compared to OB/GYN and GER (p = 0.001). A combination of behavioral modification and pharmacotherapy (antimuscarinics and/or beta-3 agonists) were chosen for the initial treatment of patients with OAB in both specialties with a significantly higher proportion by URO than by OB/GYN (51.9% vs. 38.1%; p = 0.001). Antimuscarinics were the most frequently prescribed medications by both the URO and OB/GYN specialties (81.8% vs. 78.4%; p = 0.27). Combination therapy with antimuscarinics was preferred more often by URO (91.5% vs. 77.1%; p = 0.001) when no or an inadequate response after initial treatment occurred. Multiple medication use, comorbidities, and risk of cognitive side effects affected medication preference by all specialists, especially by GER (p = 0.018)., Conclusions: Patients with OAB present to UROs, OB/GYN and GER more frequently compared to other specialities. Although antimuscarinics and beta-3 adrenoceptor agonists are equally recommended as first-line pharmacotherapy for OAB, antimuscarinics were preferred for most patients as the initial molecule by all specialties. Beta-3 agonists are increasingly preferred for elderly patients., (© 2022 Wiley Periodicals LLC.)

Introduction: The pharyngeal airway is important during diagnosis and treatment planning in orthodontics. This study aimed to compare the changes in the shape of the pharyngeal airway in patients with Class III malocclusion treated with a facemask (FM) with a removable maxillary appliance and modified tandem traction bow appliance (MTTBA)., Methods: This study consisted of pretreatment and posttreatment lateral cephalograms of 35 subjects with skeletal and dental Class III malocclusion. In the first group, 20 patients (12 males, 8 females; mean age, 10.2 years) were treated with MTTBA. The mean treatment time was 12 months. In the second group, 15 patients (10 males, 5 females; mean age, 10.3 years) were treated with FM. The mean treatment time was 11.7 months. Nineteen pharyngeal landmarks were considered from the image corresponding to the midsagittal plane and marked using tpsDig software (version 2.04; Stony Brook, NY). Pharyngeal airway shape difference between the groups was assessed by performing a Generalized Procrustes analysis. The shape deformation of the pharyngeal airway from the pre- to posttreatment periods was evaluated using the thin-plate spline method., Results: There were no differences between MTTBA and FM groups according to airway shape for pretreatment and posttreatment periods. However, there were some deformities using the enlargement of the nasopharyngeal area in the FM group and oropharyngeal area in the MTTBA group according to pretreatment periods., Conclusions: There were no differences between the groups according to the mean pharyngeal airway shapes when the posttreatment periods of the FM and MTTBA groups were examined., (Copyright © 2022. Published by Elsevier Inc.)

STAT3 plays an important role in various complex and sometimes contradictory pathways such as proliferation, differentiation, migration, inflammation, and apoptosis. The transcriptional activity of the STAT3 gene is controlled by a transcription factor called ZNF341. There is insufficient data on radiation sensitivity and post-radiation DNA repair in STAT3- loss-of-function (LOF) patients. We aimed to investigate the radiosensitivity in patients with STAT3-LOF and ZNF341 deficiency. Twelve patients with STAT3-LOF and four ZNF341-deficiency patients were recruited from three clinical immunology centers in Turkey and evaluated for radiosensitivity by the Comet assay, comparing to 14 age- and sex-matched healthy controls. The tail length (TL) (μm), percentage of DNA in the tail (TDNA%), and olive tail moment (OTM) (arbitrary units) were evaluated at the same time for baseline (spontaneous), initial (immediately after 2 Gy irradiation), and recovery (2 h after irradiation) periods by using a computerized image-analysis system, estimating DNA damage. Except for a patient with ZNF341 deficiency who developed nasal cell primitive neuroendocrine tumor and papillary thyroid cancer during the follow-up, there was no cancer in both groups. During the recovery period of irradiation, TL, TDNA%, and OTM values of healthy controls decreased rapidly toward the baseline, while these values of patients with STAT3-LOF and ZNF341 deficiency continued to increase, implying impaired DNA repair mechanisms. Increased radiosensitivity and impaired DNA repair were demonstrated in patients diagnosed with STAT3-LOF and ZNF341 deficiency, potentially explaining the susceptibility to malignant transformation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Immunology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Analyzing the association between hematologic parameters and abnormal cranial computerized tomography (CT) findings after head trauma., Material and Methods: A total of 287 children with isolated traumatic brain injury (TBI) were divided into the 'normal' (NG), 'linear fracture' (LFG) and 'intraparenchymal injury' groups (IPG) based on head CT findings. Demographical/clinical data and laboratory results were obtained from medical records., Results: The neutrophil-lymphocyte ratio was markedly higher in the LFG (p = 0.010 and p = 0.016, respectively) and IPG (p = 0.004 and p < 0.001, respectively) compared with NG. Lower lymphocyte-monocyte ratio (p = 0.044) and higher red cell distribution width-platelet ratio (RPR) (p = 0.030) were associated with intraparenchymal injuries. Patients requiring neurosurgical intervention had higher neutrophil-lymphocyte ratio (p = 0.026) and RPR values (p = 0.031) and lower platelet counts (p = 0.035). Lower levels of erythrocytes (p = 0.005), hemoglobin (p = 0.003) and hematocrit (p = 0.002) were associated with severe TBI and unfavorable outcome (p = 0.012, p = 0.004 and p = 0.006, respectively)., Conclusions: Hematologic parameters are useful in predicting the presence of abnormal cranial CT findings in children with TBI in association with injury severity; surgery need and clinical outcome.

Introduction: Our knowledge has gaps regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication levels and its association to severity of Coronavirus disease 2019 (COVID-19). The aim of this study was to investigate the association of SARS-CoV-2 viral load with disease severity and serum biomarkers in COVID-19 patients., Methodology: Viral load was determined via cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 214 adult patients. Ct values were compared with clinical severity, biochemical and hematological biomarkers., Results: Clinical course of the disease was mild (49.1%), moderate (40.2%), and severe (10.7%). Median Ct value was 28.2 (IQR: 22.2-33.8) during the first week of the disease. Ct values were lower within five days after symptom onset [lowest Ct value on the third day (median: 24, IQR: 20.6-32.3)], but they increased significantly during the second and third weeks. No association was detected between admission Ct values and disease severity. Gender, age, co-morbidity, and mortality did not differ significantly in patients with low (≤ 25) and high (> 25) Ct values. White blood cell, neutrophil, platelet, and especially lymphocyte counts, were significantly lower in patients with low Ct values., Conclusions: No definitive/clear correlation between SARS-CoV-2 viral load and severity and mortality was found in the studied COVID-19 patients. However, neutrophil, platelet, and especially lymphocyte count were significantly lower in patients with a high viral load., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Imran Saglik, Beyza Ener, Halis Akalin, Buşra Ozdemir, Gokhan Ocakoglu, Baris Yalcin, Ugur Onal, Ozge Aydin Guçlu, Nilufer Aylin Acet Ozturk, Ulku Tuzemen, Ezgi Demirdogen, Asli Gorek Dilektasli, Harun Agca, Esra Kazak, Funda Coskun, Yasemin Heper, Melda Payaslioglu, Dane Ediger, Ahmet Ursavas, Emel Yilmaz, Cuneyt Ozakin, Esra Uzaslan, Mehmet Karadag.)

The novel coronavirus disease was declared as a pandemic and CKD is an important risk factor for morbidity and mortality. Dialysis has additional contributions on transmission risk so prompt preventive strategies were implemented for dialysis patients. We aimed to evaluate pandemic-related perceptions and concerns of dialysis patients and differences between dialysis modalities. An anonymous survey for assessing concerns, knowledge, and attitudes about the pandemic was sent online to a total of 339 patients on maintenance dialysis at four tertiary dialysis centers in Turkey. A total of 309 patients (54.9 ± 15.1 years, 51.6% females, 55.7% in-center HD, 44.3% peritoneal dialysis) enrolled. The anonymous online survey was conducted at the end of April 2020. HD patients were more concerned about transmission risk (p = 0.002) and risks associated with the dialysis treatment environment and the transport methods (p < 0.001). The total concern score was significantly higher in the HD group (2.60 ± 0.93 vs. 1.65 ± 0.54, p < 0.001). The knowledge about the pandemic and prevention methods and the attitudes of prevention were similar between the groups (p = 0.161 and 0.418, respectively). The compliance rate of personal preventive strategies was 98.1%. Considering changing the current dialysis modality due to the pandemic was higher in the HD group (p < 0.001). Although the preventive strategies were performed properly in the HD centers, HD patients were more concerned about the Covid-19 outbreak compared with PD. Our results support home dialysis treatments for modality decisions with patients' positive perspective of PD over HD during the pandemic., (© 2021 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)

Introduction: In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG)., Methods: This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined., Results: There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups (P<0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group (P=0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance (P>0.05)., Conclusions: Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.

Aim: To ascertain whether the brain stem?s shape differs in patients with syrinx and without syrinx in cases with Chiari malformation Type I (CM-1), relative to healthy controls., Material and Methods: Data on marked brainstem regions were obtained from 2D digital image files. Generalized Procrustes analysis was used to evaluate shape differences among patients with syrinx, patients without syrinx, and healthy controls. Shape deformations among groups were examined by Thin Plate Spline (TPS) analysis., Results: According to the brain stem shape, there were differences between patients with syrinx and controls, and between patients without syrinx and controls. High-level deformations were also observed among the groups., Conclusion: In the present study, the presence of shape deformations in Chiari patients? brainstem was demonstrated. This is the first study using a landmark-based geometrical morphometric method to demonstrate the shape difference in Chiari patients? brainstem.

Study Objective: To describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes., Design: A prospective cohort study., Setting: Minimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey., Patients: Women who were diagnosed with ≥ stage 2 uterine prolapse., Interventions: A laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh., Measurements and Main Results: The primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period., Conclusion: Laparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative., (Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

Purpose: We aimed to assess the accuracy of home titration in estimating apnea hypopnea index (AHI) and optimal pressure values and to compare improvements in subjective daytime sleepiness, sleep quality and quality of life, along with 3-months treatment adherence of patients that received at-home versus in-laboratory auto-titrating positive airway pressure (APAP) titration., Materials and Methods: In patients with a diagnosis of obstructive sleep apnea syndrome (OSAS), a study arm of laboratory attended APAP titration was compared with a study arm of home titration using an APAP device for three days. Subjective questionnaires were evaluated before and after 3 months of treatment., Results: Fifty-three patients with newly diagnosed OSAS were enrolled. There was a significant positive correlation between PSG AHI and APAP AHI (r s  = 0.43, P = 0.003) and the fixed pressure for the APAP arm was positively correlated with the APAP PSG arm of the study (r s  = 0.71, P < 0.001). When the Bland-Altman graphs were compared, it was seen that the measurements obtained by the APAP AHI method were 0.3 units higher than the PSG AHI measurements, and that the mean of the measurement differences between the two methods was not different than 0 (P [H 0 : Mean = 0] = 0.551). After 3 months of treatment, average nightly use was slightly higher in the APAP arm (P = 0.387)., Conclusions: The results indicate that both titration methods were not clinically inferior in terms of a fixed optimal pressure, residual events, 3-months treatment adherence and change in subjective sleepiness, sleep quality and quality of life after treatment., (© 2020 John Wiley & Sons Ltd.)

Introduction and Hypothesis: There has been a great deal of discussion about mesh complications in urogynecology in recent years. However, awareness of other doctors who are not urogynecologists is unknown. This study was aimed at determining the level of awareness of mesh discussions among medical doctors whose specialty is not urology or gynecology., Methods: A survey study was administered, and all medical doctors, except gynecologists and urologists, were invited. Respondent doctors were classified into four groups: King's College Hospital (KCH), UK; Uludag University Hospital (UUH), Turkey; the United States (USA); and the world (WORLD). The primary outcome was the awareness of mesh discussion in urogynecology, and the secondary outcome was the social media awareness of the mesh discussion., Results: 1231 doctors responded to the survey. The awareness of the current mesh problems among the respondent doctors was 15.8% in KCH, 15.4% in UUH, 26.9% in the USA, and 16.2% in WORLD. The social media awareness about mesh problems was 20.8% in KCH, 20.3% in UUH, 32.8% in the USA, and 20.6% in WORLD. Although there were no differences among three of the groups with regard to primary and secondary outcomes, the USA group score was statistically significantly higher than the others., Conclusions: Social media can influence doctors' thinking on controversial academic issues. In this survey study, non-urogynecologist doctors in the USA cohort have higher awareness levels and a higher social media awareness level than other groups.

Aim: To investigate the differences in the head shapes of scaphocephaly patients during the pre- and postoperative phases., Material and Methods: Cranium shape data were collected from the two-dimensional digital images. The generalised Procrustes analysis was used to obtain mean shapes in the pre- and postoperative phases. The shape deformation of the cranium from the pre- to postoperative phases was evaluated using the thin plate spline method., Results: There was no significant cranial shape difference in the pre and postoperative phases. The high-level deformations from the pre- to postoperative phase were seen in thin plate spline graphs. The highest deformation was observed at the biparietal dimension., Conclusion: In this study, we showed that the structural deformation of the cranium was correlated with sagittal craniosynostosis. The present study also shows that pre- and postoperative head shapes of patients with scaphocephaly can be compared using head shape with the landmark-based geometric morphometric method by taking into consideration the topographic distribution.

Objective: To investigate the effect of challenging factors on laparoscopic hysterectomy trends within twenty-four years., Population and Method: This was a trend analysis study of 7558 women who underwent hysterectomy for benign indications between 1995-2018 in Bursa Uludag University Hospital, Turkey. A trend analysis of obesity, previous laparotomy (≥3) and uterine specimen weight (≥500g) was applied for abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (TLH) rates in this period. The primary outcome was laparoscopic hysterectomy trends throughout the years. We measured the effect of obesity, previous laparotomies and large uterus on TLH trends as secondary outcomes., Results: The ratio of TLHs to all hysterectomies was 2.4% in 1995 and 44.7% in 2018 which increased 33 times higher over 24 years. The percentage of obese patients in TLH cases increased from 1% to 37%, the rate of patients who had three or more previous laparotomy in TLH cases increased from 0% to 32.2%, and the percentage of patients who had more than 500g uterus specimen in laparoscopic hysterectomy cases increased from 0% to 32.8%., Conclusion: Laparoscopic hysterectomy trends are increasing in challenging cases. Obesity, previous surgeries, and large uteruses are no longer a limiting factor for laparoscopic hysterectomy., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Purpose: The present study aims to biochemically analyze the fluid samples containing stone dust taken during the perioperative period to determine the role of fluid in the prediction of stones in patients treated with ureterorenoscopic procedures. Our secondary aim is to investigate the role of both fluid analysis and stone analysis in predicting the results of the metabolic analysis., Methods: Comparative analyses were performed using fluid samples containing stone dust from 93 patients. Biochemical analysis of fluid containing stone dust was conducted; stone fragments were examined at a separate location using X-ray diffractometry(XRD). Metabolic analysis was performed to patients who provided stone-free status 1 month later. The results of chemical analysis were compared with the results of the XRD analysis., Results: Patients' stone type was determined with high accuracy using biochemical analysis. Differences were noted in ten patients following biochemical analysis and XRD analysis. Biochemical analysis predicted metabolic disorders in more patients than XRD analysis, particularly for those patients with multiple stone compositions. However, no significant differences between the results of biochemical and XRD analysis methods were found (κ = 0.27; p = 0.002). Moreover, biochemical analysis results revealed metabolic disorders in five patients; these findings were missed by XRD analysis., Conclusion: Biochemical analysis of fluid taken perioperatively during ureterorenoscopic laser lithotripsy to treat urinary system stone disease was found to determine stone composition with high accuracy. Biochemical analysis of fluid samples taken during the perioperative period is, thus, an easy, reliable and cost-effective test to assess stone composition in patients undergoing ureterorenoscopic procedures.

Introduction: Vaccines have been shown to prevent illness, disability and death from vaccine-preventable diseases. The purpose of our study was to analyze the influenza and pneumococcal vaccination status of patients, the factors that influence the uptake of influenza/pneumococcal vaccination and the effects of health literacy (HL) on vaccination., Materials and Methods: In this cross-sectional study, demographic characteristics, comorbid diseases and the pneumococcal and influenza vaccination status in previous years were recorded for each patient. The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to assess HL., Results: A total of 350 patients were enrolled in the study. A total of 6.3% of patients had received both vaccines. 20% of subjects were vaccinated with influenza vaccine and 11.1% of the subjects were vaccinated with pneumococcal vaccine. Overall HL was insufficient for 70.9%, problematic for 20.6%, sufficient for 7.1% and excellent for 14.2% of patients. Patients who had pneumococcal and influenza vaccination had higher disease prevention HL scores (p = 0.013, p = 0.001; respectively)., Discussion: An insufficient HL level was found to be much higher than previous studies. It was observed that an increase in disease prevention HL was associated with a rise in the rate of pneumococcal and influenza vaccination., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The surgical procedure is viewed as a typical treatment choice for patients with Chiari malformation (CM). Decompression is the preferred method for surgery, but it is not always possible to understand whether decompression has been successful especially in an early period. The present study focuses on investigating the shape differences in the cerebellums of Chiari patients compared with healthy controls, and to assess the clinical application of this situation whether if present. The MRI scans were reviewed retrospectively. Cerebellar data were obtained from the digital images and 9 anthropometric landmarks were marked on each image. Shape difference was assessed by performing Generalized Procrustes analysis. The cerebellar shape deformation from control to the patient was evaluated performing the Thin Plate Spline approach. There is a statistically significant cerebellar shape difference between groups. Highest deformation was determined at the cerebellar tonsillar inferior area, posterior of the uvula, and anterior of inferior medullary velum. The present study demonstrated cerebellar shape differences in CM I patients using a landmark-based geometric morphometric approach, considering the topographic distribution of cerebellum for the first time.

Aim: The aim of this study is to compare demographic characteristics, operative data, and complication rates of women who underwent total laparoscopic hysterectomy by the skeleton uterus technique (Skeleton-TLH) with those of women who underwent TLH by the standard technique (Standard-TLH) in a university teaching and research hospital., Materials and Methods: This retrospective study included 932 laparoscopic hysterectomies in a university teaching and research hospital between January 1, 2013 and December 31, 2017. Clinical characteristics, operative outcomes, and complications were recorded and compared for the two techniques., Results: In total, 932 laparoscopic hysterectomies were performed, 454 by Skeleton-TLH and 478 by Standard-TLH. The general demographic characteristics of the patients were similar; only gravida and parity were statistically significantly different between the groups ( P < 0.001). Based on the primary outcomes (the operative data), total anesthesia time and main operation time were similar in the two groups. Estimated blood loss was statistically significantly lower in the Skeleton-TLH group than in the Standard-TLH group. Hospital stay was longer for the Skeleton-TLH group, and specimen weight was heavier. The secondary outcome was the complication rate. There were no differences between the Skeleton-TLH and Standard-TLH groups in the rates of all minor and major complications., Conclusion: TLH with the skeleton uterus technique is feasible and safe, especially for advanced pelvic surgeons. This technique not only provides retroperitoneal access to the pelvic spaces and good anatomical visibility; but it also delivers a safer laparoscopic hysterectomy by clamping the uterine arteries and monitoring the ureter throughout the operation., Competing Interests: There are no conflicts of interest.

Introduction and Hypothesis: Numerous studies have found that the short-term results of laparoscopic sacrocolpopexy for pelvic organ prolapse are safe and effective. This study evaluates the long-term results of the laparoscopic sacrocolpopexy operation between the urology and gynecology branches., Methods: A prospective study enrolling 206 patients was conducted to evaluate laparoscopic sacrocolpopexy as a surgical treatment for vaginal vault prolapse from 2011 to 2014. Two different surgical branches (urology and gynecology) applied laparoscopic sacrocolpopexy to their patients with their own techniques. The long-term results were assessed postoperatively after 4 years by pelvic examinations, including the Pelvic Organ Prolapse Quantification system (POP-Q) and quality-of-life assessments using validated questionnaires., Results: A total of 190 patients (94 urology and 96 gynecology patients) received a full clinical follow-up examination between April 2014-June 2018. Postoperative pelvic organ prolapse recurrence rates in each compartment were similar in both groups during the 4 years; 87.2% of the urology and 86.5% of the gynecology patients had no prolapse in any compartment according to the POP-Q system. The reoperation rate was 5.3% for the urology and 6.2% for the gynecology group. Mesh erosion was detected in two patients in both groups. Three patients responded to local estrogen therapy, and we removed the mesh vaginally in one patient. The subjective cure rate was 89.4% in the urology and 88.5% in the gynecology group after 4 years., Conclusions: Although different surgical branches perform laparoscopic sacrocolpopexy with their own techniques, long-term anatomical and functional results are similar between the branches. From a urogynecological point of view, laparoscopic sacrocolpopexy is a gold standard surgical procedure that can be performed by both urologists and gynecologists with similar long-term outcomes.

AimTo identify the reasons why patients with minor complaints choose emergency departments (EDs) as a first contact of care and whether dissatisfaction with primary care services influences their decisions., Methods: In this study, a self-completed survey called EUROPEP was given to 535 outpatients who were admitted to the Bursa Yuksek Ihtisas Training and Research Hospital in Bursa and examined in the green zone in July 2015. Patients were asked about their complaints and why they preferred EDs as a first contact of care., Results: EDs were the first contact of care in 87.8% of cases. In all, 9% of patients registered to family physicians who were working outside the city of Bursa. There was no relationship between patient satisfaction and the number of previous visits to EDs in last 12 months (P=0.09). The main reasons for admitting to the emergency services were feeling excessive pain (20.4%), perception of urgency (14.5%) and that the family doctor services were closed outside working hours (13.2%). The mean patient satisfaction with family practice offices was calculated to be 68.1%., Conclusions: The frequency of admission to EDs as a first contact of care was extremely high in the absence of a referral system. Patients who did not have family doctors in the settlement where they live put an extra burden on the EDs. Overall, patient satisfaction with their GPs did not influence the number of visits to EDs but accessibility remains a big challenge.

Background We have made a retrospective evaluation of the results of the cyanoacrylate ablation technique which has recently started to be used in the treatment of giant saphenous vein insufficiency today and in which tumescent anesthesia is not required. Methods Giant saphenous vein was treated in 50 patients between September 2015 and September 2016 by using endovenous cyanoacrylate ablation. In the procedure, tumescent anesthesia and varsity socks were not used. Control duplex ultrasound evaluation was performed in the post-procedural 1st, 6th and 12th months. Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores were evaluated. Results In the 50 patients who were treated, full closure was observed in giant saphenous vein in 47 (94%) patients in the 12th month control duplex ultrasound. The mean age of the patients was 46.4 (20-70) and 30 (60%) of them were female. The median Venous Clinical Severity Score scores in the 1st, 6th and 12th months were 3, 2 and 1, respectively ( p < 0.001); the median Aberdeen Varicose Vein Questionnaire scores in the 1st, 6th and 12th months were 7, 5 and 4, respectively ( p < 0.001). In the access site, two (4%) patients developed phlebitis and one (2%) developed ecchymosis. However, deep venous thrombosis, pulmonary embolism and paresthesia were not observed. Conclusion Considering the early period results in the treatment of giant saphenous vein insufficiency, cyanoacrylate ablation makes a more reliable alternative than endovenous thermal ablation methods in that it does not require tumescent anesthesia and it has a low incidence of adverse effects.

Aim: Preterm premature rupture of membranes (PPROM) is not only the most common distinguishable cause of preterm delivery, but is also associated with adverse neonatal outcomes. We determined the platelet indices in PPROM cases and evaluated their relationship to adverse neonatal outcomes., Methods: Fifty patients with PPROM and 50 patients who experienced spontaneous preterm labor at < 37 gestational weeks were evaluated. Complete blood counts, birth weights, Apgar scores, presence of sepsis and respiratory distress syndrome (RDS) and neonatal intensive care unit admission were recorded., Results: Patients with PPROM had increased mean platelet volumes (9.40 vs 10; P = 0.01), plateletcrit (0.19 vs 0.21; P = 0.03) and a higher frequency of neonatal sepsis (18% vs 38%; P = 0.02). Platelet indices in the patient group were compared according to the development of RDS. Plateletcrit values were higher in the RDS positive group (0.23 ± 0.05 vs. 0.21 ± 0.04; P = 0.04). The cut-off value for plateletcrit was determined as > 0.22, and the probability of RDS increased 5.86 times when plateletcrit values exceeded 0.22 (odds ratio 5.86, 95% confidence interval 1.01-32.01; P = 0.04). A one-unit increase in platelet distribution width resulted in a 1.33-fold increase in the risk of RDS (odds ratio 1.33, 95% confidence interval 1.01-1.77; P = 0.04)., Conclusion: Mean platelet volumes and plateletcrit significantly increased and plateletcrit had a predictive value for RDS in PPROM cases. Monitoring plateletcrit may be promising for predicting the development of RDS, one of the most common and serious complications of PPROM rupture., (© 2017 Japan Society of Obstetrics and Gynecology.)

Objectives: Spirometry is known to be a gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD). COPD Assessment Test (CAT) is an eight-item questionnaire currently in use to evaluate patients with COPD. In the present study, we aimed to evaluate if CAT is an adequate tool for screening COPD., Methods: In total, 600 persons aging ⩾40 years old were randomly selected from three different family practice units located in the city center. CAT was asked to the participants and a spirometry was used to assess pulmonary obstruction. Pulmonary obstruction was defined as forced expiratory volume in first second/forced vital capacity (FEV1/FVC)<70% and then COPD diagnosis was confirmed with the reversibility test. The relationship between CAT results and pulmonary function test values was evaluated., Results: In this sampling, the prevalence of COPD was 4.2%. Reliability of the CAT in the study group was acceptable (Cronbach's α: 0.84). The CAT scores was significantly higher in patients with COPD (P<0.001). There was a significant negative correlation between CAT score and FEV1, FVC and FEV1/FVC ratio (r=-0.31, P<0.001; r=-0.26, P<0.001; r=0.18, P=0.001). Among smokers, phlegm was the predominating symptom (P=0.01). Sensitivity of CAT was 66.67% and its specificity was 75.15% to determine COPD., Conclusions: CAT is a reliable questionnaire and there is an apparent relationship between the total CAT scores and COPD. However, CAT's ability to screen COPD is limited since it may miss the symptom-free cases.

Aim: Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis., Methods: A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results., Results: Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65±3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1-1.06, p=0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07-1.46, p=0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01-1.16, p=0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3±16 months., Conclusion: Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients with idiopathic amyloid A amyloidosis. Additionally, it was observed that patient survival was not affected by different etiological causes in amyloid A amyloidosis., (Copyright © 2017. Published by Elsevier Editora Ltda.)

Objective: We aimed to analyze the difference in 24-h blood pressure values during Ramadan of fasting and nonfasting individuals with no previous history of hypertension., Patients and Methods: This study was planned as a multicenter research study in the cities of Izmit, Zonguldak, Sivas, and Adana. The percentage changes in the blood pressure of the patients were calculated from their blood pressure measurements at 0 h while they were resting. A Food Frequency Questionnaire was filled out by all participants., Results: Forty patients were included in the fasting group and 55 patients were included in the nonfasting group in the study. There was a difference between the two groups in percent changes of systolic measurements performed at the 4th (5% difference and P=0.020), 13th (6% difference and P=0.015), 14th (10% difference and P=0.017), 18th (9% difference and P=0.027), 19th (9% difference and P=0.020), and 20th (6% difference and P=0.014) hours with respect to the baseline measurement at the 0 h. There was a difference between the fasting and nonfasting groups in the Fasting Food Questionnaire results. Meat consumption was significantly higher in the fasting group., Conclusion: A systolic blood pressure increase in fasting patients was observed in measurements at 18:00, 19:00, and 20:00 h. We believe that an increase of more than 10% in blood pressure at the time of iftar is an important result of our study in terms of the meal preferences of the individuals under risk.

Background No work has been reported on the use of video websites to learn about deep vein thrombosis and the value of education using them. We examined the characteristics and scientific accuracy of videos related to deep vein thrombosis on YouTube. Methods YouTube was surveyed using no filter and the key words 'deep vein thrombosis' and 'leg vein clot' in June 2016. The videos evaluated were divided into three groups in terms of their scientific content, accuracy, and currency: useful, partly useful, and useless. Results Of the 1200 videos watched, 715 (59.58%) were excluded with the exclusion criteria. Although most of the videos uploaded (22.9%, n = 111) were created by physicians, the number of views for website-based videos was significantly higher (p = 0.002). When the uploaded videos were assessed in terms of their usefulness, videos from physicians and hospitals were statistically more useful than other videos (p < 0.001). Conclusions For videos created by medical professionals to be of higher quality, we believe they should be more up-to-date and comprehensive, and contain animations about treatment modalities and early diagnosis in particular.

Purpose: To determine the effect of parathyroid autotransplantation (PA) on postoperative hypocalcemia in cases of total thyroidectomy., Materials and Methods: Cases undergoing total thyroidectomy and PA were compared with age and sex-matched controls who had not undergone PA. The postoperative percentage changes (PC) of parathyroid hormone (PTH) and calcium (Ca+2) in the first 12-24 hours (12-24hr→preop), between the 1st-3rd weeks (1-3wk→preop) and at the 6th month (6mo→preop), the rates of hypocalcemia (Ca+2< 8mg/dL) and low PTH level (PTH< 15 pg/mL), permanent hypocalcemia, inadvertent parathyroidectomy in both groups were compared., Results: The number of patients with PTH12-24hr<15 pg/mL was significantly higher (n:34,(55.7%)) than the number of patients in the control group (n:16(26.2%)), (p=0.001). The rate of decrease in the blood Ca+2 median PC (6mo→preop) was significantly higher in the PA group (4.2%) than the control group (1.1%), (p=0.008). There was no significant difference between the 2 groups in terms of the postoperative frequency of hypocalcemia (p>0.05). In the PA&age≤50 group, the rate of inadvertent parathyroidectomy was higher than that of cases over age 50 (p=0.029)., Conclusion: In spite of the presence of an increased postoperative hypocalcemia trend in cases requiring PA during total thyroidectomy, the rates of transient and permanent hypocalcemia were not different to the control cases. But the frequency of cases with low PTH level in cases undergoing PA was higher than that of the control cases. In cases of 50 years of age and under, who had undergone PA, the possibility of inadvertent parathyroidectomy increased.