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Abstract Background Fatty acid uptake can be measured using PET and 14-(R,S)‐[18F]fluoro‐6‐thia‐heptadecanoic acid ([18F]FTHA). However, the relatively rapid rate of [18F]FTHA metabolism significantly affects kinetic modeling of tissue uptake. Thus, there is a need for accurate chromatographic methods to analyze the unmetabolized [18F]FTHA (parent fraction). Here we present a new radiometabolite analysis (RMA) method, with comparison to a previous method for parent fraction analysis, and its use in a test-retest clinical study under fasting and postprandial conditions. We developed a new thin-layer chromatography (TLC) RMA method for analysis of [18F]FTHA parent fraction and its radiometabolites from plasma, by testing stationary phases and eluent combinations. Next, we analyzed [18F]FTHA, its radiometabolites, and plasma radioactivity from subjects participating in a clinical study. A total of 17 obese or overweight participants were dosed with [18F]FTHA twice under fasting, and twice under postprandial conditions and plasma samples were obtained between 14 min (mean of first sample) and 72 min (mean of last sample) post-injection. Aliquots of 70 plasma samples were analyzed using both methods, enabling head-to-head comparisons. We performed test-retest and group comparisons of the parent fraction and plasma radioactivity. Results The new TLC method separated seven [18F]FTHA radiometabolite peaks, while the previous method separated three. The new method revealed at least one radiometabolite that was not previously separable from [18F]FTHA. From the plasma samples, the mean parent fraction value was on average 7.2 percentage points lower with the new method, compared to the previous method. Repeated [18F]FTHA investigations on the same subject revealed reproducible plasma SUV and parent fractions, with different kinetics between the fasted and postprandial conditions. Conclusions The newly developed improved radio-TLC method for [18F]FTHA RMA enables accurate parent fraction correction, which is required to obtain quantitative data for modelling [18F]FTHA PET data. Our test-retest study of fasted and postprandial conditions showed robust reproducibility, and revealed clear differences in the [18F]FTHA metabolic rate under different study settings. Trial registration EudraCT No: 2020-005211-48, 04Feb2021; and Clinical Trials registry NCT05132335, 29Oct2021, URL: https://classic.clinicaltrials.gov/ct2/show/NCT05132335 .

Background: Many surgical treatment methods have been presented for Kienböck's disease. The most current treatment method is the surgical procedure with 4+5 extensor compartmental artery (ECA) bone graft. However, the graft harvest site is very close to the radioulnar and radiocarpal joints.Objectives: This study aimed at determining the efficacy of intraoperative fluoroscopy evaluation of 4+5 ECA.Methods: Intraoperative fluoroscopic visualization of the 4+5 ECA may facilitate the surgical procedure. Patients with lunate avascular necrosis at stage II-IIIA according to Lichtman classification who underwent 4+5 ECA bone graft were included in the study. A total of 13 patients (3 females, 10 males) participated in the study.Results: The mean follow-up period of the patients was 15 months. In all patients, 4+5 ECA localizations were determined fluoroscopically. None of the patients experienced complications related to graft harvest.Conclusion: Locating the intraoperative fluoroscopic 4+5 ECA may make the surgical procedure safer.

Flexibility is an important component of athleticism in gymnasts' training, as its insufficient development can significantly complicate the process of formation of specific skills and movement coordination and limit the possibility of manifesting and increasing strength and speed abilities (Дейнеко & Біленька, 2021). The aim of this study was to analyse the impact of the severity of FPP on balance performance in different planes (frontal, sagittal and overall balance) in the Turkish national youth team. This study is a prospective and double-blinded cohort study conducted in the Department of Physiotherapy and Rehabilitation of Bolu Abant Izzet Baysal University. The evaluation protocol consists of two main phases: first, the measurement of joint positions or angles (subtalar joint position, subtalar joint angle, first metatarsophalangeal (MTP) extension angle and tibia-femoral angle measurement), second, the measurement of balance. 20 participants aged 13-18 years, male and female, from the Turkish national youth gymnastics team were included in this study. Linear regression analysis was performed to determine whether there is an effect of severity of FPP on balance performance. There is no clear effect of FPP severity on balance performance in youth gymnastics at the national level. However, some evaluations show significant associations in the frontal plane in relation to the mediolateral stability index. None of the assessments showed a significant association with the anteroposterior stability index.

Abstract Background: In ingrown toenail, classifications and the treatment approaches according to staging has been clearly reported in the literature. However, there are not enough data about the selection of the appropriate surgical technique according to the stage. In this study, we compared two different surgical techniques in patients with Heifetz stage 2 and 3 in means of surgical results, recovery time, patient comfort and cosmetics. Methods: Between January 2019 and January 21, patients who applied with the complaint of ingrown toenails who were treated with two mentioned surgical techniques in two centers with at least 1 year follow-up were included. The patients were evaluated preoperatively in means of the Heifetz classification. In group 1 (n:54) matrix excising Winograd and in group 2 (n:51) matrix preserving Vandenbos techniques were used. Postoperative recovery time, complication rates, functional and cosmetic patient satisfaction were evaluated in tall cases. Results: 105 cases of ingrown toenails treated surgically were included in the study. 62 (59%) cases were Heifetz stage 2, 43 (41%) cases were Heifetz stage 3. No statistically significant difference was found between Heifetz stage 2 and stage 3, regardless of surgical technique, in complication, recurrence, patient functional/cosmetic satisfaction rates, and recovery time. In overall analysis regardless of Heifetz staging, recovery time was shorter with Winograd method (p:0.0001), complication and recurrence rates were lower with Vandenbos method (p:0.0001), and VAS cosmetic satisfaction was higher in Vandenbos (p:0.002). Conclusion: Winograd and Vandenbos in Heifitz stages 2 and 3 have low complication rates and high patient satisfaction. Earlier healing could be achieved with the Winograd technique, while low complication/recurrence rates and high cosmetic satisfaction could be achieved with the Vandenbos technique. Early recovery/high cosmetic expectation should be considered instead of Heifetz staging in determining the surgical technique.

Abstract Background: In this study, we examined whether carpal bones (lunate, hamate, capitate) morphologies and fourth metecarp-capitate articulation have an effect on the distal radius fracture pattern. Methods: 206 patients who applied to the emergency department with distal radius fracture between 2016-2020 were included in the study. Preoperative and pre-reduction x-ray films of the patients were examined. Lunate, hamate, capitate morphologies and 4.metacarp articulation analyzed and classified. Distal radius fracture types were classified according to AO and Fernandez. The relationship between carpal bone morphology and distal radius fracture type was analyzed. Results: This study consisted of 101 men and 103 women. AO fracture types and carpal bone morphologies (lunate joint type according to Viegas, lunate type according to Zapico, capitate morphology, hamate morphology and capitate-4 metacarpal joint morphology) did not differ significantly (p > 0.05). Fernandez fracture types and carpal bone morphologies (lunate joint type according to Viegas, lunate type according to Zapico, capitate morphology, hamatum morphology and capitate-4.metacarp joint morphology) were compared, there was no significant difference (p > 0.05). Conclusion: As a result, no clear relationship could be demonstrated between carpal bone morphology and distal radius fracture pattern.

Summary: Background: Combined glucose-dependent insulinotropic polypeptide receptor (GIPR) and glucagon-like peptide-1 receptor (GLP1R) agonism is superior to single GLP1R agonism with respect to glycemic control and weight loss in obese patients with or without type 2 diabetes. As insulin resistance and obesity are strong risk factors for nonalcoholic fatty liver disease (NAFLD), in the current study we investigated the effects of combined GIPR/GLP1R agonism on NAFLD development. Methods: Male APOE∗3-Leiden.CETP mice, a humanized model for diabetic dyslipidemia and NAFLD when fed a high-fat high-cholesterol diet, received subcutaneous injections with either vehicle, a GIPR agonist, a GLP1R agonist, or both agonists combined every other day. Findings: GIPR and GLP1R agonism reduced body weight and additively lowered fasting plasma levels of glucose, triglycerides and total cholesterol. Strikingly, we report an additive reduction in hepatic steatosis as evidenced by lower hepatic lipid content and NAFLD scores. Underlying the lipid-lowering effects were a reduced food intake and intestinal lipid absorption and an increased uptake of glucose and triglyceride-derived fatty acids by energy-combusting brown adipose tissue. Combined GIPR/GLP1R agonism also attenuated hepatic inflammation as evidenced by a decreased number of monocyte-derived Kupffer cells and a reduced expression of inflammatory markers. Together, the reduced hepatic steatosis and inflammation coincided with lowered markers of liver injury. Interpretation: We interpretate that GIPR and GLP1R agonism additively attenuate hepatic steatosis, lower hepatic inflammation, ameliorate liver injury, together preventing NAFLD development in humanized APOE∗3-Leiden.CETP mice. We anticipate that combined GIPR/GLP1R agonism is a promising strategy to attenuate NAFLD progression in humans. Funding: This work was supported by a grant from the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation, Dutch Federation of University Medical Centers, the Netherlands Organization for Health Research and Development, and the Royal Netherlands Academy of Sciences [CVON-GENIUS-II] to P.C.N.R., a Lilly Research Award Program [LRAP] Award to P.C.N.R. and S.K., a Dutch Heart Foundation [2017T016] grant to S.K., and an NWO-VENI grant [09150161910073] to M.R.B.; J.F.D.B. is supported by the Nutrition and Health initiative of the University of Groningen; Z.Y. is supported by a full-time PhD scholarship from the China Scholarship Council (201806850094 to Z.Y.).

Gymnastics is an aesthetic olympic branch where systematic and rhythmic movements are performed at high levels in harmony with the body (19). It is a popular sport requires a combination of physical fitness components such as speed, agility, strength, balance and flexibility. Especially, lower extremity alignment can affect successful performance in gymnasts (6). Pes planus is generally defined as a postural disorder caused by lowering or absence of the medial longitudinal arch height of the foot (17). Although there are many studies that try to explain the cause of pes planus; a clear etiological cause, which is accepted and agreed upon today cannot be presented (9,11,23,27). For the diagnosis of pes planus; clinical measurement and examination, radiological and ultrasonographic methods are used. In addition, it was evaluated with methods such as ink footprint methods, digital pressure measurements and podoscope (22,24). Calculations such as Clark angle, Chippaux-Smirak Index and Shateli Index are used in the evaluation of pes planus (22). The muscle function of the lower extremity is affected by the structure of the foot. In a foot with pes planus, the load on the foot cannot be evenly distributed. Therefore, muscles and other structures provide compensation to meet this irregularity. In the studies on pes planus, EMG method was used to investigate the structural deformity of the foot and the changes in the activities of the lower extremity muscles during walking or jumping (10,12,15,16). Electromyography (EMG) is the science of recording and interpreting the electrical activity of muscles. In recent years, EMG studies have provided an important perspective in understanding muscle functions and have been accepted as the golden key in recording muscle activity (25). Surface electromyography (sEMG) is used to examine the neuromuscular activation of the muscles that function in functional movement, balance-related situations and in the training of athletes (4,13). Jumping is a movement that an individual has made against his or her own body weight. Jumping performance depends on features such as muscle strength, explosive speed, flexibility, body anthropometry and motor coordination (8,18). Jumping is an important motor skill in all gymnastics disciplines and has a decisive role in performance (18). This study aims to determine the effect of the presence of pes planus on vertical jump height and muscle activation in gymnasts.

Giriş: Günlük yaşam sırasında ağırlık kaldırmak sıklıkla kullanılmakta olup, omuz eklemi de üst ekstremitenin hareket serbestliğinin çoğundan sorumludur. Amaç: Bu çalışmada, sağlıklı bireylerde omuz ekleminin fleksiyon ve abdüksiyon hareketleri sırasında ağırlık kaldırmanın kas aktivasyonlarına farklı açı değerlerindeki etkisinin belirlenmesi amaçlanmıştır. Yöntem: Çalışma, yaş ortalaması 22.60 ± 0.44 olan 28 sağlıklı erkek bireyin katılımı ile gerçekleştirilmiştir. Bireyler ağırlıksız ve 3 kilogramlık bir ağırlık ile omuz fleksiyon ve abdüksiyon hareketi yaptığı sırada kas aktivasyonları trapezius kası üst orta ve alt parçaları ile deltoid kasının ön ve orta parçalarından yüzeyel elektromiyografi cihazı ile kaydedilmiştir. Hareketler 0-30, 0-60, 0-90, 0-120, 0-150 ve 0-180 dereceler arasında ve metronom eşliğinde yapılmıştır. Bulgular: Ağırlıksız olarak gerçekleştirilen fleksiyon ölçümlerinde tüm hareket açıklıklarında aktivitesi en fazla olan kas ön deltoid kası iken ağırlık ile gerçekleştirilen fleksiyon ölçümlerinde ise hareketin erken açılarında en aktif kasın üst trapezius, diğer açılarda ise ön deltoid kası olduğu görülmüştür. Ağırlıksız olarak gerçekleştirilen abdüksiyon ölçümlerinde ise yine erken derecelerde en aktif kas ön deltoid iken ağırlık ile gerçekleştirilen ölçümlerde ise üst trapezius kasının aktif olduğu belirlenmiştir. Sonuç ve Öneriler: Ağırlık ile veya ağırlıksız yapılan fleksiyon ve abdüksiyon hareketlerinde çalışma grubumuzda yer alan bireylerde en fazla aktivasyon gösteren kaslar, üst trapezius ve ön deltoid kasları olmaktadır. Bu kasların aktivasyonunu düzenlemeyi hedefleyen tedavilerde omuzun dirençli fleksiyon veya abdüksiyon hareketlerinin kullanımı göz önünde bulundurulabilir.

Objective: The aim of this study was to identify the strategies used for the diagnosis and treatment of patients with temporomandibular disorders (TMDs) by general dental practitioners (GDPs) in the city of Istanbul.Methods: A total of 154 GDPs were assessed by a single examiner in this questionnaire-based study. Descriptive statistics were calculated for all variables, and the results were analyzed at a 95% CI and statistical power of 80% with the significance level set at P < .05.Results:The most frequently employed strategies for obtaining a diagnosis were patients’ medical history (33.1%), physical examination (37.7%), and a combination of diagnostic methods (29.2%). The most commonly referred specialties were prosthodontics (62.2%) and maxillofacial surgery (36.9%). All GDPs treated their TMD patients with occlusal splints, and the majority of the occlusal splints were hard occlusal splints (62.8%). Half of the GDPs considered the etiology of TMD to involve stress, whereas 49.4% believed that TMD is of a multifactorial etiology.Conclusion: The GDPs clarified that TMD patients were mostly treated with occlusal splints and this datum is consistent with the suggestions of previous consensus papers.

Introduction: This study aims to analyze the difference in muscle activation, posture and vertebral mobility values between healthy individuals and patients with lumbar spinal stenosis. Material and Methods: This study involved 48 lumbar spinal stenosis (LSS) patients of the average age of 55.19 ± 10.41 years and 48 healthy individuals with of the average age of 58.15 ± 8.44 years. Posture and spinal mobility of the participants were measured in the standing position, and the maximum flexion posture with spinal mouse. Muscle activation of rectus femoris, biceps femoris, tibialis anterior and medial head of the gastrocnemius muscle was measured during the maximum voluntary contraction and gait with a surface electromyography device (sEMG). Results: Maximum trunk flexion, standing segmental posture and mobility were similar in both groups (p > 0.05). On the other hand, a significant difference was found in general mobility scores (p < 0.05), and a statistically significant difference was found in muscle activation parameters (p < 0.05) in both groups. Conclusions: When the LSS and the healthy groups were compared, it was found that segmental posture and spinal mobility were similar in both groups; muscular activity was lower in the healthy group, and total vertebral mobility was lower in the LSS group.

Objectives: Tirzepatide, a dual GIP and GLP-1 receptor agonist, delivered superior glycemic control and weight loss compared to selective GLP-1 receptor (GLP-1R) agonism in patients with type 2 diabetes (T2D). These results have fueled mechanistic studies focused on understanding how tirzepatide achieves its therapeutic efficacy. Recently, we found that treatment with tirzepatide improves insulin sensitivity in humans with T2D and obese mice in concert with a reduction in circulating levels of branched-chain amino (BCAAs) and keto (BCKAs) acids, metabolites associated with development of systemic insulin resistance (IR) and T2D. Importantly, these systemic effects were found to be coupled to increased expression of BCAA catabolic genes in thermogenic brown adipose tissue (BAT) in mice. These findings led us to hypothesize that tirzepatide may lower circulating BCAAs/BCKAs by promoting their catabolism in BAT. Methods: To address this question, we utilized a murine model of diet-induced obesity and employed stable-isotope tracer studies in combination with metabolomic analyses in BAT and other tissues. Results: Treatment with tirzepatide stimulated catabolism of BCAAs/BCKAs in BAT, as demonstrated by increased labeling of BCKA-derived metabolites, and increases in levels of byproducts of BCAA breakdown, including glutamate, alanine, and 3-hydroxyisobutyric acid (3-HIB). Further, chronic administration of tirzepatide increased levels of multiple amino acids in BAT that have previously been shown to be elevated in response to cold exposure. Finally, chronic treatment with tirzepatide led to a substantial increase in several TCA cycle intermediates (α-ketoglutarate, fumarate, and malate) in BAT. Conclusions: These findings suggest that tirzepatide induces a thermogenic-like amino acid profile in BAT, an effect that may account for reduced systemic levels of BCAAs in obese IR mice.

Exterior claddings are used for architectural purposes primarily for practical and esthetic reasons. Panels are subjected to a variety of impacts, including chemical, and ultraviolet radiation, and are intended to survive them. In this study, the color, gloss, chemical and UV resistance, impact resistance, and surface tension of glass-ceramic (GC) coated steel panels and other products on the market, such as conventional ceramic wall tiles, glass, and aluminum panels, are compared. Three different types of GC powders were prepared: opaque, semi-transparent, and transparent. Each GC powder was applied to a pre-coated steel substrate. Chemical resistance was excellent in all samples, however, only the GC-coated steel panels and the aluminum panels satisfied the impact resistance criteria. A UV test was performed to ensure that surface characteristics such as gloss, color, and surface tension were stable in the presence of UV light. The aluminum gives alerts the most color shift (∆E ≈ 1.2), whereas the GC-coated steel panels showed just ∆E ≈ 0.2. The gloss values of the samples did not change significantly much. Furthermore, when compared to the other products, GC-coated samples had the lowest weight and the greatest performance.

A major challenge of obesity therapy is to sustain clinically relevant weight loss over time. Achieving this goal likely requires both reducing daily caloric intake and increasing caloric expenditure. Over the past decade, advances in pharmaceutical engineering of ligands targeting G protein-coupled receptors have led to the development of highly effective anorectic agents. These include mono-agonists of the GLP-1R and dual GIPR/GLP-1R co-agonists that have demonstrated substantial weight loss in experimental models and in humans. By contrast, currently, there are no medicines available that effectively augment metabolic rate to promote weight loss. Here, we present evidence indicating that activation of the GCGR may provide a solution to this unmet therapeutic need. In adult humans, GCGR agonism increases energy expenditure to a magnitude sufficient for inducing a negative energy balance. In preclinical studies, the glucagon-GCGR system affects key metabolically relevant organs (including the liver and white and brown adipose tissue) to boost whole-body thermogenic capacity and protect from obesity. Further, activation of the GCGR has been shown to augment both the magnitude and duration of weight loss that is achieved by either selective GLP-1R or dual GIPR/GLP-1R agonism in rodents. Based on the accumulation of such findings, we propose that the thermogenic activity of GCGR agonism will also complement other anti-obesity agents that lower body weight by suppressing appetite.

Objective: To investigate the etiologic, demographic, and clinical features of patients who were diagnosed as having acute stroke in the emergency department and thus, we aimed to contribute to the stroke data of our country, primarily to the data of our region. Materials and Methods: This study was retrospectively conducted on the data of 236 patients who were diagnosed as having acute stroke and admitted to the emergency department between January 1st, 2017, and December 31st, 2018. Results: Of the patients, 210 (88.9%) were diagnosed as having ischemic stroke and 26 were diagnosed as having hemorrhagic stroke (11.1%). One hundred six (44.9%) of the patients were admitted to the hospital within the first 4.5 hours, 130 (55.1%) - arrived to the hospital after 4.5 hours. Two hundred five (86.9%) patients were discharged from the hospital, and 31 (13.1%) patients died. Hypertension was found to be the most common risk factor among patients, followed by smoking. The highest number of patients was admitted during summer with a rate of 29.7%. Atrial fibrillation was found to be an independent risk factor of mortality in patients with acute stroke and increased the odds of mortality by 3.18 (p=0.008). Conclusion: Although our study reflects a large part of the stroke data of the Bolu province, it gives valuable results for the Western Black Sea region.

Objective: Fibroblast growth factor 21 (FGF21) has been shown to rapidly lower body weight in the Siberian hamster, a preclinical model of adiposity. This induced negative energy balance mediated by FGF21 is associated with both lowered caloric intake and increased energy expenditure. Previous research demonstrated that adipose tissue (AT) is one of the primary sites of FGF21 action and may be responsible for its ability to increase the whole-body metabolic rate. The present study sought to determine the relative importance of white (subcutaneous AT [sWAT] and visceral AT [vWAT]), and brown (interscapular brown AT [iBAT]) in governing FGF21-mediated metabolic improvements using the tissue-specific uptake of glucose and lipids as a proxy for metabolic activity. Methods: We used positron emission tomography-computed tomography (PET-CT) imaging in combination with both glucose (18F-fluorodeoxyglucose) and lipid (18F-4-thiapalmitate) tracers to assess the effect of FGF21 on the tissue-specific uptake of these metabolites and compared responses to a control group pair-fed to match the food intake of the FGF21-treated group. In vivo imaging was combined with ex vivo tissue-specific functional, biochemical, and molecular analyses of the nutrient uptake and signaling pathways. Results: Consistent with previous findings, FGF21 reduced body weight via reduced caloric intake and increased energy expenditure in the Siberian hamster. PET-CT studies demonstrated that FGF21 increased the uptake of glucose in BAT and WAT independently of reduced food intake and body weight as demonstrated by imaging of the pair-fed group. Furthermore, FGF21 increased glucose uptake in the primary adipocytes, confirming that these in vivo effects may be due to a direct action of FGF21 at the level of the adipocytes. Mechanistically, the effects of FGF21 are associated with activation of the ERK signaling pathway and upregulation of GLUT4 protein content in all fat depots. In response to treatment with FGF21, we observed an increase in the markers of lipolysis and lipogenesis in both the subcutaneous and visceral WAT depots. In contrast, FGF21 was only able to directly increase the uptake of lipid into BAT. Conclusions: These data identify brown and white fat depots as primary peripheral sites of action of FGF21 in promoting glucose uptake and also indicate that FGF21 selectively stimulates lipid uptake in brown fat, which may fuel thermogenesis. Keywords: FGF21, β-klotho, White adipose tissue, Brown adipose tissue, Glucose uptake, Lipid uptake

Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective medications to reduce appetite and body weight. These actions are centrally mediated; however, the neuronal substrates involved are poorly understood. Methods: We employed a combination of neuroanatomical, genetic, and behavioral approaches in the mouse to investigate the involvement of caudal brainstem cholecystokinin-expressing neurons in the effect of the GLP-1RA exendin-4. We further confirmed key neuroanatomical findings in the non-human primate brain. Results: We found that cholecystokinin-expressing neurons in the caudal brainstem are required for the anorectic and body weight-lowering effects of GLP-1RAs and for the induction of GLP-1RA-induced conditioned taste avoidance. We further show that, while cholecystokinin-expressing neurons are not a direct target for glucose-dependent insulinotropic peptide (GIP), GIP receptor activation results in a reduced recruitment of these GLP-1RA-responsive neurons and a selective reduction of conditioned taste avoidance. Conclusions: In addition to disclosing a neuronal population required for the full appetite- and body weight-lowering effect of GLP-1RAs, our data also provide a novel framework for understanding and ameliorating GLP-1RA-induced nausea — a major factor for withdrawal from treatment.

Amaç: Bu çalışmada kalite yönetim aracı olan altı sigma protokolü kullanılarak klinik laboartuvar süreçlerindeki iyileştirici etki düzeylerinin belirlenip sağladığı pozitif katkıların ortaya konulması amaçlanmıştır.Gereç ve Yöntem: Bu çalışmada; Cukurova University Tıp Fakültesi Balcalı Sağlık Uygulama ve Araştırma Merkezi-Merkezi Laboratuvarı’nda oluşan hataların sınıflandırılması, nedenlerinin araştırılması ve yöntem performanslarının değerlendirilmesi için “Altı Sigma Protokolü” uygulanmıştır. Evrensel standartlarda çalışabilmek için hataların kaynağı ve sıklığının analizi yapılarak öncelikle mevcut durum tespit edilmiştir. Oluşan hataların saptanması ve sınıflandırılması sonucunda, en çok etkilenen süreçlerden başlanarak, düzeltici faaliyetler planlanmıştır. Bulgular: Preanalitik evre hata sayısı sigma düzeylerinin 4,250-4,357’den 4,500-4,625’e yükseldiği bulunmuştur. Analitik evrede en yüksek sigma düzeyinin amilaz testi için 10,5 olduğu görülmüştür. Postanalitik evrede ise; potasyum test istek sonuç süresi sigma düzeyinin süreç sonunda 2,250’den 2,500’e yükseldiği belirlenmiştir. Sonuç: Bu çalışma; hasta sağlığına olumsuz yansıyabilecek hataların giderilmesine, hasta memnuniyetine, uygun internal kalite kontrol kurallarının seçilmesine olanak sağlamıştır. Düzeltici faaliyetler ve alınan önlemler doğrultusunda kaliteli hizmetin bir maliyeti olmasına karşın kalitesizlik maliyetleri azaltılmıştır. Laboratuvar performansının evrensel ölçütlerde hesaplanarak, dünyadaki diğer klinik laboratuvarlar ile performans karşılaştırması da 4-5 üzerinde olması evrensel kalite standartlarında hizmet verdiğimizi teyit etmiştir.

Objective: Fibroblast growth factor 19 (FGF19) is a postprandial hormone which plays diverse roles in the regulation of bile acid, glucose, and lipid metabolism. Administration of FGF19 to obese/diabetic mice lowers body weight, improves insulin sensitivity, and enhances glycemic control. The primary target organ of FGF19 is the liver, where it regulates bile acid homeostasis in response to nutrient absorption. In contrast, the broader pharmacologic actions of FGF19 are proposed to be driven, in part, by the recruitment of the thermogenic protein uncoupling protein 1 (UCP1) in white and brown adipose tissue. However, the precise contribution of UCP1-dependent thermogenesis to the therapeutic actions of FGF19 has not been critically evaluated. Methods: Using WT and germline UCP1 knockout mice, the primary objective of the current investigation was to determine the in vivo pharmacology of FGF19, focusing on its thermogenic and anti-obesity activity. Results: We report that FGF19 induced mRNA expression of UCP1 in adipose tissue and show that this effect is required for FGF19 to increase caloric expenditure. However, we demonstrate that neither UCP1 induction nor an elevation in caloric expenditure are necessary for FGF19 to induce weight loss in obese mice. In contrast, the anti-obesity action of FGF19 appeared to be associated with its known physiological role. In mice treated with FGF19, there was a significant reduction in the mRNA expression of genes associated with hepatic bile acid synthesis enzymes, lowered levels of hepatic bile acid species, and a significant increase in fecal energy content, all indicative of reduced lipid absorption in animals treated with FGF19. Conclusion: Taken together, we report that the anti-obesity effect of FGF19 occurs in the absence of UCP1. Our data suggest that the primary way in which exogenous FGF19 lowers body weight in mice may be through the inhibition of bile acid synthesis and subsequently a reduction of dietary lipid absorption. Keywords: FGF19, Thermogenesis, UCP1, Metabolic, BAT, CYP7A1

Abstract Background Giant cell tumor of the tendon sheath is the most common form of giant cell tumors and is the second most common soft tissue tumor of the hand region after ganglion cyst. Magnetic resonance imaging is the diagnostic tool of choice for both diagnosis and treatment planning. The current standard treatment of choice is simple excision. The main concern about the treatment is related to the high recurrence rates. Besides incomplete excision, there is no consensus concerning the effect of other risk factors on recurrence. The literature lacks detailed reports on surgical excision of these tumors with a standardized surgical treatment and an appropriate patient follow up. The aim of this study was to investigate the recurrence rate and the associated recurrence risk factors for giant cell tumor of tendon sheath of the hand following a standardized treatment. Methods The records of patients treated for giant cell tumor of tendon sheath of the hand treated by the same hand surgeon were evaluated retrospectively. The features obtained from preoperative magnetic resonance imaging, final physical examination, patients’ age and sex, anatomical site of the tumor, relationship of the tumor with bone, joint or neurovascular structures, bone invasion, recurrence after surgery and complications like skin necrosis, digital neuropathy or limitation in range of motion were documented. Chi-square test was used to compare categorical variables. Results Fifty patient were included in the study. The average follow-up time was 84 months. Three recurrences (6%) were recorded. The only significant risk factor for the recurrence was tumor adjacency to the interphalangeal joints of the fingers other than thumb. No major or minor complications were encountered in the postoperative period. Conclusion With adequate surgical exposure and meticulous dissection provided by the magnification loupes, we were able demonstrate one of the lowest recurrence rates in the literature. Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence.