The European Research Journal (EuRJ) is an international, independent, double-blind peer-reviewed, Open Access and online publishing journal, which aims to publish papers on all the related areas of basic and clinical medicine.
Meeting Abstracts of the 6th Uludag Cardiology Summit, March 26-29, 2026, Bursa, Türkiye
OP-1. Prognostic Value of the HALP Score for Predicting Left Ventricular Remodeling in STEMI Patients Undergoing Primary PCI OP-2. Short Term Clinical Outcomes and Predictors of Selective Left Bundle Branch Pacing OP-3. Association Between Delayed QRS Transition Zone and Diabetes Mellitus OP-4. Vasospastic Angina: A Case of Coronary Spasm Confirmed by Ergonovine OP-5. Cardiac Effects of Chronic Pyrethroid Exposure OP-6. Effect of SGLT-2 Inhibitors on MPV in Heart Failure Patients OP-7. Evaluation of Subclinical Myocardial Dysfunction in Cirrhosis Using 4D Strain Analysis OP-8. The Role of the Intermountain Risk Score in Predicting Coronary Artery EctasiaOP-9. Association Between Uric Acid to Albumin Ratio and No-Reflow Phenomenon in Patients with NSTEMI OP-9. Association Between Uric Acid to Albumin Ratio and No-Reflow Phenomenon in Patients with NSTEMI OP-10. Coronary Vasospasm Presenting as ST-Elevation Myocardial Infarction: A Case Report OP-11. Management of a Stripped Stent within a Dissected Coronary Lesion OP-12. Prognostic Utility of the Pan-Immune-Inflammation Value (PIV) in Predicting No-Reflow Among Patients Undergoing Primary PCI for STEMI OP-13. VARC-3 Outcomes of Myval, Portico, and Evolut-R in TAVI OP-14. Colchicine Aiding Recurrent Pacemaker Pocket Inflammation Management: A Case Report OP-15. Colchicine Use After Coronary Artery Stenting: One-Year Follow-Up Results OP-16. Drug-Coated Balloon-Only Strategy for Chronic Total Occlusion: A Prospective, Two-Center Study of 48 Patients OP-17. The Role of Pharmacological Cocktails in Preventing Radial Spasm and Complications During Percutaneous Coronary Intervention (PCI): A Clinical Study OP-18. Drug-Coated Balloon-Only Strategy in a True LCx–OM Bifurcation Lesion (Medina 1.1.1): Case Report with 12-Month Follow-Up OP-19. The Utility of Atherogenic Index of Plasma in Predicting in-Hospital Ischemic Stroke in Patients Undergoing Carotid Artery Stenting OP-20. A Case of Long QT Syndrome Presenting with Ventricular Arrhythmia OP-21. Can We Predict Reperfusion in ST-Elevated Myocard Infaction? OP-22. The Effect of Volume Overload on Ventriculo-Arterial Coupling in Hemodialysis Patients OP-23. Minimal Symptoms, Maximum Risk: Hidden Type A Dissection Accompanying an 81 mm Ascending Aortic Aneurysm OP-24. Comparative Efficacy of Single- and Dual-Defibrillator Orthogonal Electrical Cardioversion in Persistent Atrial Fibrillation OP-25. Complete Atrioventricular Block and Postpartum Cardiomyopathy in a Patient With c-TGA: A Case of Right-Sided Cardiac Resynchronization Therapy OP-26. Predictive Value of Systemic Immune-Inflammation Index for INOCA OP-27. Transcatheter Closure of Mitral Paravalvular Leak Developing After Mechanical Mitral Valve Replacement: A Case Report OP-28. Acute Coronary Syndrome After Anaphylaxis: Kounis Syndrome Case OP-29. Cardiac Lymphoma: A Rare Case Report OP-30. The Clinical Significance of the Plasma Atherogenic Index in Predicting Total Occlusion in Patients with Non-ST Elevation Myocardial Infarction OP-31. Prognostic Nutritional Index and Frailty After Ischemic Stroke: Mid-Term Follow-Up Results OP-32. Diagnostic Challenge in Cardiac AL Amyloidosis: When Imaging Speaks Louder Than Serum Biomarkers OP-33. Nightmare in the Cath Lab: LMCA Dissection OP-34. Association of Preoperative Serum Magnesium Levels and Acute Kidney Injury Following Thromboembolectomy in Acute Limb Ischemia OP-35. Could the Systemic Coagulation Inflammation Index Be a Predictor of Worse Outcomes After Carotid Endarterectomy? OP-36. The Role of Exocrine Pancreatic Insufficiency in Predicting Concomitant Carotid Artery Disease in Diabetic Patients Scheduled to Undergo Coronary Artery Bypass Grafting OP-37. Relationship Between TASC II Lesion Severity and Carotid Artery Stenosis: A Cross-Sectional Analysis OP-38. Hyponatremic Seizure in a Middle-Aged Woman on Spironolactone–Hydrochlorothiazide OP-39. An Unexpected Cause of Angina: Successful Percutaneous Closure of an Internal Mammary Artery–Left Atrium Fistula OP-40. Predictors of Isolated Nocturnal Hypertension in Non-obese Non-diabetic Individuals OP-41. The Impact of Guideline-based Treatment on In-hospital Outcomes in Infective Endocarditis OP-42. The Effect of Unfractionated Heparin Administration Timing on Radial Artery Spasm and Occlusion in Radial Coronary Angiography OP-43. The Mediating Role of Heart Rate in the Relationship Between Smoking and Myocardial Performance Op-44. Avoiding Emergency Surgery with Imaging-Guided Thrombolysis in Mechanical Valve Thrombosis OP-45. Predictive Value of the Frontal QRS-T Angle for Coronary Thrombus Burden in Patients Presenting with Acute Myocardial Infarction OP-46. STEMI Caused by Thrombotic Subclavian Occlusion in LIMA Grafted Patient OP-47. Hemoptysis During Cardioverter-Defibrillator Implantation: A Rare Complication OP-48. Intra-Arterial Lidocaine for Resistant Radial Artery Spasm OP-49. Routine Clinical and Lipid Parameters Predict High-Grade Atrioventricular Block After Transcatheter Aortic Valve Implantation: A Pragmatic Single-Center Study OP-50. CONUT Score and Length of Hospital Stay in Acute Decompensated Heart Failure OP-51. Distinction Between Type 2 Myocardial Infarction and Myocardial Injury in Troponin Positivity: Retrospective Clinical Classification and 30-Day Prognosis OP-52. Myocardial Contraction Fraction as an Independent Predictor of Cardiovascular Mortality in Patients with Chronic Renal Failure OP-53. Surgical Stentectomy and Bypass in Coronary Full Metal Jacket OP-54. AF-Ablation Performed via Transeptal Passage Through Septal Occuder Device: A Case Report. OP-55. Acute Axillary Artery Occlusion Following Transradial Intervention: A Case Report OP-56. A Multidomain Risk Cluster for Predicting Contrast-Induced Nephropathy After Carotid Artery Stenting OP-57. An Overlooked Phenotype: Widespread Non-calcified Atherosclerosis Presenting with Vision Loss OP-58. Safety and Efficacy of Carotid Artery Stenting Without Routine Anticholinergic Pretreatment OP-59. The Dark Path of Infective Endocarditis: Prosthetic Valve Endocarditis Unveiled by Multimodality Imaging OP-60. The Cost of Pregnancy? Peripartum Cardiomyopathy Following IVF OP-61. Malignant RCA in the Shadow of Perimyocarditis Op-62. One Implantation, Two Challenges: Anatomical Difficulty and Post-Cardiac Injury Syndrome OP-63. Ozaki Procedure OP-64. Diagnostic Performance of Coronary CT Angiography Compared with Invasive Coronary Angiography and the Impact of Coronary Calcium Score: A Single-Center Real-World Study
Copyright (c) 2026 The European Research Journal https://creativecommons.org/licenses/by-nc-nd/4.0
Three Decades of SSRI/SNRI Withdrawal Research: A Bibliometric and Science-Mapping Study
Objectives: Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are widely prescribed, and growing evidence highlights the clinical and methodological challenges of withdrawal during discontinuation. This study aimed to provide a comprehensive bibliometric map of SSRI/SNRI withdrawal research to clarify production patterns, citation structures, thematic evolution, and global collaboration. Methods: A comprehensive search of the Web of Science Core Collection (1995–2025) identified 652 original articles on SSRI/SNRI withdrawal, discontinuation, or tapering. Records were analyzed using the bibliometrix package in R for performance metrics, co-citation and keyword networks, and country–institution collaboration structures. Results: The corpus comprised 652 documents published in 308 journals, citing 18,957 references, with an annual growth rate of 7.79%. Articles received a mean of 41.6 citations. The Journal of Clinical Psychiatry (22 articles; h=20) and Journal of Clinical Psychopharmacology (18; h=14) were the most influential sources. Highly cited documents ranged from 270 to 730 citations, predominantly from Lancet, Pediatrics, The New England Journal of Medicine, and American Journal of Psychiatry. Keyword frequency was led by “depression” (n=172), “fluoxetine” (n=153), and “antidepressants” (n=152). The United States produced 240 articles (36.8%; 12,904 citations), forming the central hub of the collaboration network. Conclusions: SSRI/SNRI withdrawal research shows concentrated authorship, journal anchoring, and geographically centralized knowledge production, with emerging themes in tapering, pregnancy outcomes, and pharmacogenetics.
Selective Serotonin Reuptake Inhibitor (SSRI)
Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)
Analysis of Early Reoperation and Mortality Following Intertrochanteric Fracture Fixation in Elderly Patients: A Focus on Frailty, Bone Quality, and Technical Factors
Objectives: Intertrochanteric femur fractures in older adults carry high risks of early complications and mortality. This study aimed to identify independent predictors of early fixation failure and postoperative mortality by integrating patient-, fracture-, and technique-related factors. Methods: This single-center retrospective cohort included 150 patients aged ≥65 years who underwent surgical fixation with a Dynamic Hip Screw (DHS) or Proximal Femoral Nail Antirotation (PFN-A) for the AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A intertrochanteric fractures. Evaluated variables included comorbidity burden assessed using the Charlson Comorbidity Index, bone quality assessed using the Singh Index, pre-fracture mobility assessed using the Functional Ambulation Scale, fracture pattern, and reduction–fixation quality. Results: Early reoperation occurred in 12.6% of patients, and 6-month mortality was 24%. Independent predictors of early reoperation included fracture instability (AO/OTA 31-A3; adjusted odds ratio [aOR]=1.41) and higher Charlson Comorbidity Index score (aOR=2.47). In contrast, better bone quality (higher Singh Index; aOR=0.16), superior reduction–fixation quality (aOR=0.12), and higher pre-fracture mobility (aOR=0.75) were protective against reoperation. Early mortality was independently associated with a higher Charlson Comorbidity Index score (aOR=1.74), poorer bone quality (aOR=0.42), and lower pre-fracture mobility (aOR=0.24). Implant type did not significantly influence either outcome. Conclusions: Early fixation failure is primarily influenced by fracture instability, osteoporosis severity, and fixation quality, whereas early mortality reflects comorbidity burden and frailty. Incorporating comorbidity burden, bone quality, and pre-fracture mobility into preoperative assessment may improve risk stratification and guide personalized perioperative management in elderly patients with intertrochanteric femur fractures.
Craniofacial Morphological Features in Childhood Age with Autism Spectrum Disorder
Objectives: Autism spectrum disorder often exhibits unusual craniofacial morphology, which may indicate underlying neurodevelopmental abnormalities in childhood. This study aimed to investigate the relationship between craniofacial anthropometric measurements, the severity of autism, and language development in children with autism spectrum disorder. Methods: This study included 66 children (50 boys, 16 girls) aged 6–10 years who were diagnosed with autism spectrum disorder. Three-dimensional facial scanning was performed after the removal of glasses, and anthropometric measurements were analyzed in relation to scores on the Gilliam Autism Rating Scale and the Turkish Communication Development Inventory. Results: A significant association was found between increased head circumference and higher autism severity (P=0.035), with larger head size correlating with decreased forehead height, may suggest greater symptom severity in boys. No significant associations were observed in girls. Craniofacial metrics showed no association with language development in either gender. Conclusions: Head circumference and forehead height have been identified as potential craniofacial indicators of autism severity in boys with autism spectrum disorder. These findings highlight the effectiveness of craniofacial phenotyping in clarifying the neurodevelopmental characteristics associated with autism. Future research, utilizing larger and more sex-balanced cohorts, is imperative to clarify these relationships and their potential diagnostic relevance.
Febrile Seizures: Clinical Factors Influencing the Length of Hospital Stay
Objectives: This study aimed to identify the clinical factors influencing the length of hospital stay (LOS) in children aged 0–60 months hospitalized with febrile seizures (FS), and to explore potential immunological and psychosocial modulators that may affect hospitalization decisions. Methods: A retrospective observational study was conducted at a tertiary hospital in Karabük, Türkiye, between September 2023 and September 2025. Medical records of patients diagnosed with FS (ICD-10 R56.0) were reviewed using the FONET and e-Nabız systems. Demographic and clinical variables - including age, sex, fever, seizure duration, type (simple/complex), recurrence, infection focus, and presence of seasonal allergic rhinitis (SAR) - were analyzed. Factors associated with LOS were evaluated using multivariable linear regression (P<0.05). Results: A total of 93 children (53.3% male, mean age: 24.6±13.7 months) were included. The mean LOS was 48.2±44.7 hours. Regression analysis showed that recurrence and SAR were associated with shorter LOS (P=0.062 and P=0.065, respectively), while seizure duration and prematurity had no significant effect. Bronchitis, otitis, and tonsillitis were linked to longer stays, whereas acute gastroenteritis and mild upper respiratory infections were linked to shorter ones. Family history was strongly associated with recurrence but not with LOS. Conclusions: Hospital stay in FS is influenced more by immunological and psychosocial dynamics than by traditional demographic factors. The presence of SAR may act as a modulatory condition reducing LOS, possibly through pre-activated immune regulation. Family experience appears to facilitate earlier discharge. Integrating these factors into clinical decision-making may improve resource use and standardize hospitalization criteria.
Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience
Objectives: Clinicians widely utilize local anesthetic (LA) agents in pain management and surgical interventions. Nevertheless, drug hypersensitivity reaction (HR) to their use continue to raise considerable concern among both clinicians and patients. The present study aims to investigate the relationship between local anesthetic hypersensitivity reactions (LA-HRs) and comorbid conditions in patients referred to our clinic. Methods: Clinical data and test results of patients who were referred to our allergy clinic for evaluation of suspected LA-HR were retrospectively reviewed. Skin tests (ST) and subcutaneous provocation tests (SPT) were performed. Results: A total of 200 patients were included in the study. The most common reason for referral was a suspected LA-HR (80%), followed by a history of HR to other drugs with a need for LA use during upcoming procedures (20%). Among 160 patients with suspected LA- HR, only 5.6% demonstrated confirmed hypersensitivity by positive ST and SPT. Of the 40 patients with a history of HR to other drugs, only 2.5% tested positive for LA-HR. A history of comorbidity was present in 70% patients. Patients with suspected LA-HR had a significantly higher prevalence of comorbidities compared to those with HR to other drugs. However, none of the patients who tested positive had a history of comorbidity. Conclusions: Confirmed hypersensitivity risk among patients reporting LA-HR is very low. Although comorbidities were more common among patients reporting LA-HR, none of the patients with confirmed allergy had any comorbidities, underscoring the low confirmed hypersensitivity rate in this population.
Biologic Therapies for Type 2 Inflammatory Diseases: A Bibliometric Analysis of Publication Trends and Intellectual Structure
Objectives: To comprehensively analyze the scientific literature (2005–2025) on biologic agents for Type 2 inflammatory diseases, including Severe Asthma (SA), Atopic Dermatitis (AD), and chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to identify publication trends, thematic clusters, collaboration networks, and the field's intellectual foundation. Methods: A bibliometric analysis was performed using data from the Web of Science (WoS) Core Collection (retrieved October 27, 2025). VOSviewer software was used to analyze co-occurrence networks (based on Author Keywords) and map collaborations. Results: A total of 7,339 publications were analyzed. A significant acceleration in publishing occurred after 2017. The most productive countries were the USA (n=2,346), Italy (n=1,149), and the UK (n=936). Thematic analysis identified three distinct clusters: AD, SA, and CRSwNP. The intellectual foundation of the field is built upon highly cited phase 3 clinical trials (e.g., mepolizumab, dupilumab, benralizumab) published in top-tier journals (NEJM, The Lancet). Conclusions: The research landscape for Type 2 biologics has grown rapidly since 2017, driven by clinical validation in landmark trials. The field's focus is evolving from demonstrating clinical efficacy toward mechanism-based personalized medicine and biomarker identification.
Effects of Localized Arm Fatigue, General Fatigue, and Elbow Bracing on Shooting Accuracy and Shoulder Proprioception: A Randomized Crossover Study
Objectives: This study aimed to comparatively investigate the effects of localized arm fatigue, general fatigue, and elbow brace use on proprioceptive accuracy and shooting accuracy in amateur female basketball players. Methods: Fifty-two amateur female basketball players (mean age: 23.08±2.02 years) participated in a randomized crossover study. Participants underwent three experimental conditions: localized arm fatigue, general fatigue, and brace application, each tested on separate days with a 48-hour washout period between sessions. Proprioceptive accuracy was assessed using the Joint Position Sense Error (in degrees), and shooting accuracy was evaluated based on shot success percentage. Fatigue perception was measured using the Borg Rating of Perceived Exertion Scale. Statistical analyses included Friedman and Wilcoxon signed-rank tests with Bonferroni correction for multiple comparisons. Results: Localized arm fatigue significantly decreased shooting accuracy (from 53.16% to 38.83%, P=0.014) and increased proprioceptive error (from 5.40° to 8.65°, P=0.003). General fatigue resulted in a moderate increase in proprioceptive error (from 4.05° to 5.35°, P=0.049) but did not significantly affect shooting accuracy (P=0.090). The use of an elbow brace improved proprioceptive accuracy (error reduction from 5.30° to 3.00°, P=0.035) and marginally enhanced shooting performance (increase from 48.33% to 54.83%, P=0.027). Strong negative correlations were found between proprioceptive degradation and shooting accuracy after localized fatigue (r= –0.787, P<0.001). Conclusions: Localized arm fatigue impairs proprioception and shooting accuracy more severely than general fatigue. Elbow bracing mitigates these impairments, suggesting its use as an intervention to maintain technical performance under fatigue in basketball athletes.
Chronobiology and Chronotherapy-Related Effects in Non-Traumatic Pain Presentations in the Emergency Department: A Retrospective Study
Objectives: Pain is one of the most frequent reasons for emergency department (ED) admissions, yet the chronobiological patterns of pain-related presentations remain insufficiently explored. This study aimed to retrospectively analyze the temporal and seasonal characteristics of non-traumatic pain-related ED visits, with a focus on daily and seasonal variations influenced by circadian rhythms. Methods: This retrospective, descriptive, cross-sectional study included adult patients (≥18 years) who presented to the Afyonkarahisar Health Sciences University Adult ED with non-traumatic pain between January 1, 2023, and December 31, 2023. Cases were identified based on ICD-10 codes for headache (R51, G43, G44), chest pain (R07.1–R07.4), abdominal pain (R10.0–R10.4), and musculoskeletal pain (M54, M79, M25). Demographic data, admission times, diagnostic procedures, treatment initiation, and hospitalization rates were analyzed. Statistical analyses utilized appropriate parametric and non-parametric tests, with significance set at P<0.05. Results: A total of 4524 patients were included (53.9% female; mean age 47.3±21.4 years). Chest pain was the most frequent diagnosis (40%), followed by headache (35.6%), musculoskeletal pain (19.6%), and abdominal pain (4.8%). ED visits peaked in the evening (mode: 21:09) and were least frequent after midnight. Headache admissions were significantly higher in autumn (30.7%), while chest pain was most common in winter (32%). Women more frequently presented with headache and abdominal pain, while men predominantly reported chest and musculoskeletal pain. Conclusions: Non-traumatic pain-related ED visits appeared to follow certain chronobiological patterns with observable sex-related differences. These preliminary findings may contribute to understanding temporal trends in pain-related ED utilization and could serve as a basis for future studies exploring the potential role of chronotherapy in pain management. Validation through larger, multicenter, and prospective studies is needed to strengthen and generalize these findings.
Biomechanical Determinants of Shooting Performance: The Role of Wrist and Elbow Joint Range of Motion in Male Basketball Players
Objectives: The aim of this study is to examine the relationship between wrist and elbow joint range of motion and shooting performance in young male basketball players. Methods: The research was conducted as a cross-sectional correlational study. The study sample consisted of 23 male basketball players residing in Diyarbakır, selected through purposive sampling. The wrist and elbow joint range of motion values, along with shooting performance scores of the athletes, were measured. Frequency analyses were performed, and after confirming the normality of the data distribution, Pearson correlation and multiple regression analyses were conducted. Results: According to the results, strong and significant positive correlations were observed between elbow flexion and pronation and shooting performance. In addition, elbow supination, as well as wrist flexion and extension, also showed statistically significant positive relationships with shooting performance. However, no significant relationship was found between shooting performance and radial deviation, ulnar deviation, or elbow extension. Conclusions: In conclusion, elbow joint range of motion appears to have a significant and determining effect on shooting performance in young male basketball players. In contrast, wrist mobility contributes to shooting performance to a more limited extent and therefore cannot be considered a direct determining parameter.
The Effects of Nateglinide and Octreotide on the Uterus in Rats with Experimentally Developed Polycystic Ovary Syndrome: A Histopathological Study
Objectives: It was aimed to investigate the histopathological effects of Nateglinide (NG) and Octreotide (OC) on uterine morphology in rats with experimentally induced polycystic ovary syndrome (PCOS). Methods: Forty-two female Sprague-Dawley rats (10-12 weeks old, 340-360 g) were divided into six groups (n=7 per group) as Control, PCOS, PCOS+NG, NG only, PCOS+OC, OC only. PCOS was induced via daily oral administration of Letrozole (1 mg/kg) for 21 days. Treatment groups received NG (oral, 30 days) or OC (intraperitoneal, 0.1 mg/kg/day for 30 days). After the experiment, the uterus tissues of all rats were dissected and subjected to histopathological examinations after histological procedures. Results: Histopathological analysis revealed significant uterine damage in the PCOS group compared to other groups (P<0.01). In contrast, the Control, NG-only, and OC-only groups showed normal uterine architecture with intact epithelium, organized glands, and normal stromal structure and there were no significant differences between related groups (P>0.05). Treatment with NG or OC in PCOS rats led to improved epithelial and glandular morphology and reduced Mast cell density, no evidence of edema, and inflammation was found in the connective tissue of these treated groups, suggesting partial improvement of PCOS-induced uterine pathology (P<0.01). Conclusions: NG and OC treatments ameliorated PCOS-induced uterine histopathological changes, suggesting their potential to improve endometrial morphology. These findings may have implications for therapeutic strategies aimed at enhancing endometrial receptivity and highlighting the importance of addressing endometrial health in therapeutic strategies beyond ovarian treatment in PCOS patients.
Cardio-Hematology Crossroads: A Diffuse Large B-Cell Lymphoma Case Presenting with a Cardiac Mass
Cardiac involvement by diffuse large B-cell lymphoma (DLBCL) is a rare clinical entity that often presents with nonspecific symptoms, making early diagnosis particularly challenging. In this context, we report a case that highlights the diagnostic obstacles and the importance of early evaluation. A 58-year-old male presented with dyspnea, malaise, fingertip numbness, weight loss, and shoulder pain. Transthoracic echocardiography revealed a right atrial mass, prompting further assessment. Positron Emission Tomography-Computed Tomography demonstrated increased 18F-FDG (18F-fluorodeoxyglucose) uptake in multiple regions, including the cardiac musculature, raising suspicion for disseminated lymphoproliferative disease. The biopsy of the left superior cervical lymph node confirmed diffuse large B-cell lymphoma. The patient underwent six cycles of chemoimmunotherapy and achieved complete metabolic remission. This case underscores the need to consider lymphoid malignancies in the differential diagnosis of intracardiac masses and persistent cardiac symptoms without an obvious cause. Early use of multimodal imaging and prompt histopathological confirmation are critical for accurate diagnosis and appropriate treatment planning. Rapid initiation of immunochemotherapy may improve clinical outcomes and reduce the risk of severe cardiac complications.
Evaluation of Cardiac Functions and Rhythm in Pediatric Patients Diagnosed with Chronic Kidney Failure
Objectives: Chronic renal failure (CRF) represents a progressive and irreversible decline in renal function. Among individuals with end-stage renal disease (ESRD), cardiovascular disorders are recognized as the leading contributors to morbidity and mortality. The present study aimed to assess cardiac function in pediatric patients diagnosed with CRF. Methods: This cross-sectional study included 30 pediatric patients with CRF who were under follow-up between October 2018 and August 2019, along with 30 age- and sex-matched healthy controls. The CRF group was further divided into two subgroups according to dialysis status. For all participants, conventional 12-lead electrocardiography was performed, and indices associated with atrial (P-wave dispersion, Pd) and ventricular (QT dispersion, corrected QT dispersion, Tp–e, Tp–e/QT, Tp–e/QTc) arrhythmia risk were recorded. Each subject also underwent a detailed echocardiographic evaluation, including both conventional and tissue Doppler measurements. Results: Anthropometric characteristics and blood pressure values did not significantly differ between the patient and control groups. Apart from an increased mean corrected QT dispersion (QTcd), other electrocardiographic parameters were comparable between groups. Ejection fraction (EF) and fractional shortening (FS) values were lower in CRF patients compared with controls. LV mass index (LVMI) was significantly higher in the dialysis subgroup relative to the control group. Additionally, the myocardial performance index (Tei index) was markedly elevated in CRF patients (P<0.001). Conclusions: These findings underscore the need for comprehensive cardiac evaluation in children with CRF. Nonetheless, larger-scale studies are warranted to confirm and expand upon these observations.
Therapeutic Effects of Alpha-Lipoic Acid on High-Dose Ibuprofen-Induced Renal Damage in Rats
Objectives: Nonsteroidal anti-inflammatory drugs, particularly ibuprofen, are commonly used worldwide and can cause nephrotoxicity through prostaglandin inhibition, oxidative stress, and inflammatory activation. This study aimed to investigate the histopathological, fibrotic, and oxidative effects of high-dose ibuprofen administration and to evaluate the therapeutic potential of alpha-lipoic acid) in reversing these changes. Methods: Twenty-eight male Wistar albino rats were randomly divided into four groups (n=7): Control, Alpha-lipoic acid (100 mg/kg), Ibuprofen (250 mg/kg), and Ibuprofen+Alpha-lipoic acid. Ibuprofen was administered orally for 21 days, while alpha-lipoic acid was given during the last 7 days. Histopathological changes were evaluated using Hematoxylin & Eosin, Masson’s Trichrome, and Periodic Acid–Schiff staining. Fibrotic and inflammatory markers (TGF-β1, α-SMA, TLR-4) were assessed immunohistochemically. Oxidative stress was evaluated by measuring malondialdehyde levels and superoxide dismutase activity. Results: Ibuprofen administration resulted in significant tubular degeneration, hydropic changes, necrosis, tubular dilatation, and hyperemia. Masson’s Trichrome staining showed a significant increase in collagen deposition, while Periodic Acid-Schiff staining revealed glomerular and tubular basement membrane thickening. Immunohistochemistry demonstrated marked upregulation of TGF-β1, α-SMA, and TLR-4 (P<0.001). Biochemically, malondialdehyde levels were significantly increased (P<0.01) and superoxide dismutase activity was markedly decreased (P<0.001) compared to controls. Alpha-lipoic acid treatment significantly ameliorated these changes, reducing fibrosis and inflammatory marker expression and restoring malondialdehyde and superoxide dismutase levels toward normal (P<0.05). Conclusions: Alpha-lipoic acid exerts renoprotective effects against ibuprofen-induced nephrotoxicity by reducing oxidative stress, modulating fibrotic pathways, and improving renal histoarchitecture, suggesting its potential as a therapeutic agent in drug-induced kidney injury.
Comparative Outcomes of Surgery and Chemoradiotherapy After Neoadjuvant Chemotherapy in Stage II–III Bladder Cancer
Objectives: Radical cystectomy following neoadjuvant chemotherapy is the standard treatment for Muscle-Invasive Bladder Cancer (MIBC). However, definitive chemoradiotherapy may represent a viable alternative in patients who are medically inoperable or decline surgery. This study aimed to compare the clinical outcomes of patients with stage II–III MIBC treated with neoadjuvant chemotherapy followed by either Radical cystectomy or CRT, the latter performed without maximal transurethral resection of bladder tumor (TURBT). Methods: This retrospective study included 63 patients with stage II–III MIBC treated between December 2014 and March 2025 at two tertiary referral centers in Türkiye. All patients received neoadjuvant chemotherapy (NAC) prior to either surgery (n=39) or Chemoradiotherapy (CRT) (n=24). Clinicopathological, laboratory, and survival data were analyzed. Overall Survival (OS) and Event-Free Survival (EFS) were assessed using the Kaplan–Meier method and compared with the log-rank test. Cox regression was used to identify independent prognostic factors. Results: The median age was 64 years, and 88.9% of patients were male. Comorbidities were more frequent in the CRT group (79.2% vs. 59%), though the difference was not statistically significant (P=0.099). Median OS was 46.5 months in the surgery group and 31.6 months in the CRT group (P=0.407), while median EFS was 30.1 and 21.0 months, respectively (P=0.375). Distant metastasis was the most common recurrence pattern (36.5%). Multivariate analysis identified comorbidity (Hazard ratio [HR] = 0.37, 95% CI: 0.17–0.80, P=0.012) and hemoglobin <12 g/dL (HR =0.53, 95% CI: 0.25–0.94, P=0.048) as independent predictors of poor survival. Conclusions: NAC followed by either surgery or CRT provides comparable long-term disease control in patients with stage II–III MIBC. Although RC remains the gold standard for operable patients, CRT offers an effective curative-intent option for those unfit for surgery—even in the absence of maximal TURBT. Comorbidity and anemia were significant adverse prognostic factors, emphasizing the importance of individualized treatment selection in this patient population.
Cancer Therapy (Excl. Chemotherapy and Radiation Therapy)
Early On-Treatment Nutritional Change and Baseline Inflammation Stratify Outcomes in Patients Receiving Immune Checkpoint Inhibitors
Objectives: In patients receiving immune checkpoint inhibitors (ICIs), baseline nutritional status is frequently recorded, but what happens during treatment may be at least as informative. We examined whether the 3-month change in Mini Nutritional Assessment (ΔMNA)–Short Form (SF) is associated with survival, and how this relates to baseline systemic inflammation measured by modified Glasgow Prognostic Score (mGPS). Methods: We retrospectively screened institutional records and included 54 adults with advanced/metastatic solid tumors treated with ICIs who had MNA-SF documented at treatment start and again at approximately 3 months. ΔMNA was defined as MNA-SF (~3 months) minus baseline MNA-SF (higher values indicate improvement) and was categorized for Kaplan–Meier analyses as worsened (≤ −1), stable (= 0), or improved (≥ +1). Baseline mGPS was derived using CRP >5 mg/L and albumin <35 g/L. Overall survival (OS) and progression-free survival (PFS) were measured from ICI initiation. Cox regression assessed ΔMNA as a continuous variable, with prespecified adjustment for baseline mGPS, age, and sex. Results: Median follow-up was 317 days (IQR 170.5–457.3). Death occurred in 16/54 patients and a PFS event in 27/54. Median OS was 706 days (1-year OS 71.3%; 2-year OS 49.4%), and median PFS was 337 days (1-year PFS 48.5%; 2-year PFS 15.1%). Nutritional categories shifted toward better status at 3 months (baseline normal/risk/malnutrition 29/23/2 vs 35/17/2 at follow-up). In univariable Cox models, higher ΔMNA was associated with longer survival (PFS: HR 0.72, 95% CI 0.56–0.94; P=0.016; OS: HR 0.56, 95% CI 0.38–0.82; P=0.003). In prespecified multivariable models, baseline mGPS was independently associated with OS (HR 1.86, 95% CI 1.00–3.45; P=0.048). After adjustment, the association between ΔMNA and outcomes remained in the protective direction but did not meet conventional statistical significance (OS: HR 0.67, 95% CI 0.42–1.06; P=0.086; PFS: HR 0.72, 95% CI 0.56–1.05; P=0.094). In an exploratory lung cancer subgroup (n=36), ΔMNA was associated with improved PFS (HR 0.62; P=0.008) and OS (HR 0.59; P=0.018). These subgroup findings should be interpreted as hypothesis-generating. Conclusions: Baseline mGPS captured inflammatory risk at ICI start, while ΔMNA captured what happened to nutritional status over the first 3 months. In this cohort, nutritional improvement showed a consistent protective direction for OS and PFS even after accounting for baseline inflammation, and mGPS retained an independent association with OS. These findings support prospective studies that reassess nutrition during immunotherapy rather than relying on a single baseline measurement.
Health Practices of Turkish Expectant Mothers
Objectives: Health practices during pregnancy are important to support mother - child health and the safety of the delivery. Defining these health practices can help to support vulnerable groups at risk. This study aims to determine the health practices of Turkish expectant mothers and analyze related factors. Methods: A total of 350 pregnant women were reached in this cross-sectional study from a state hospital in Istanbul during their prenatal visits. Data were collected with a Personal Information Form and Health Practices in Pregnancy Questionnaire-II (HPQ-II). Results: Most (65.1%, n=228) were between 18-31 years, mean age 29.69±6.61 (18-45) years, with junior high school degree (55.7%, n=195), and housewives (90.3%, n=316). Nearly all (98.6%, n=345) followed routine examinations, were in the second trimester (51.7%, n=181), had planned pregnancy (86.6%, n=303), but had no pregnancy school attendance (96.6%, n=338). For most expectant women (55.7%, n=195), doctors were information resources. The average HPQ-II score was 108.76±5.36 (93-123). Analysis results emphasize a significant difference between education level, smoking behavior, stillbirth, and the HPQ-II score. Especially, elementary school graduate women, smokers, and those with stillbirth experience had a lower HPQ-ll score (P<0.05). Conclusions: Study results indicate the importance of improving the education level of women in mother and child health care and community health. Communities with higher levels of education will also contribute to better health practices. However, indicators like smoking behavior and previous history of stillbirth can also be considered important risk factors for lower health practices in pregnancy.
The Relationship Between Forward Head Posture with Hand Grip Strength and Thoracic Kyphosis Among Young Adults
Objectives: Forward head posture (FHP) is a common postural abnormality where the external auditory canal is positioned ahead of the shoulder joint’s plumb line. This study aimed to evaluate FHP’s impact on thoracic kyphosis, hand grip strength, and pinch grip strength in healthy adults. Methods: Ninety-three healthy adults (18–25 years) participated, divided into two groups based on craniovertebral angle (CVA): the FHP group (CVA <45°, n=38) and the control group (CVA >45°, n=55). CVA was measured via photogrammetry. The thoracic kyphosis angle was assessed using the Goniometer Pro app. Hand grip strength was measured with a Jamar dynamometer, and pinch grip strength with a Baseline hydraulic pinch gauge. Results: No significant differences were found between groups in thoracic kyphosis angle, hand grip, or pinch grip strength (P>0.05). CVA showed no significant correlation with these parameters in either group (P>0.05). However, in the FHP group, the thoracic kyphosis angle was significantly correlated with non-dominant hand grip strength (r= -0.324, P=0.047), dominant pinch grip strength (r= -0.350, P=0.031), and non-dominant pinch grip strength (r= -0.394, P=0.014). Conclusions: Hand grip and pinch grip strength were not affected by FHP in asymptomatic young adults. No relationship was found between CVA and thoracic kyphosis. However, individuals with FHP and thoracic kyphosis angles above 40° may experience altered non-dominant hand function, potentially due to kyphotic changes.
Is Seronegative Rheumatoid Arthritis Far From Being a Benign Subtype of Rheumatoid Arthritis? A Retrospective Comparative Study of Seronegative Rheumatoid Arthritis and Seropositive Rheumatoid Arthritis
Objectives: Our study aimed to compare patients with seronegative rheumatoid arthritis (SNRA) and seropositive rheumatoid arthritis (SPRA) to determine whether they represent favourable and unfavourable subtypes of the same disease, or whether SNRA patients follow an aggressive course similar to SPRA patients. Methods: Patients diagnosed with rheumatoid arthritis (RA) according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria (n=334) were evaluated retrospectively. Patients were classified into SNRA (n=108) and SPRA (n=226) groups based on their seropositivity status. The SNRA and SPRA groups were compared regarding clinical, laboratory, imaging, and medical treatment characteristics. Results: Gender, age at diagnosis, comorbidities, acute phase reactants, medical therapies (excluding leflunomide), anaemia, cancer, and mortality did not differ significantly between the two groups (P>0.05). There was also no significant difference between the groups in the total number of joints where erosion was detected (SNRA: n=9 (8.3%), SPRA: n=25 (11.1%), P=0.563). Interstitial lung disease (ILD) was the most common extra-articular involvement and was detected only in the SPRA group (n=9 (4.0%), P=0.034). Conclusions: It should be noted that SNRA patients, like SPRA patients, may experience an aggressive disease course and develop erosive joint damage. Seropositivity is important regarding ILD, and necessary follow-up and treatment plans should be implemented without delay for both SNRA and SPRA patients.
Factors Affecting Mortality in COVID-19 Pneumonia Patients Treated with Tocilizumab
Objectives: Severe COVID-19 pneumonia is often complicated by hyperinflammation and multiorgan failure. Tocilizumab, an interleukin-6 receptor antagonist, has been used to mitigate cytokine storm; however, it’s prognostic impact remains uncertain. Methods: This retrospective cohort study included 43 adult patients with PCR-confirmed COVID-19 pneumonia who received tocilizumab at a tertiary hospital in Turkiye between April and September 2020. Patients were categorized as survivors or non-survivors. Demographic data and laboratory markers were analyzed at baseline, 24 hours, and 7 days post-treatment. Statistical analyses included Mann–Whitney U, Wilcoxon signed-rank, and chi-square tests. Results: Non-survivors were significantly older (mean age: 72.4 vs. 64.9 years, P=0.046) and had higher levels of C-reactive protein (P=0.002), D-dimer (P=0.004), procalcitonin (P= 0.001), troponin (P=0.004), BUN (P<0.001) and creatinine (P=0.02). Survivors showed higher albumin and prognostic nutritional index (PNI) values (P=0.009 and P<0.001, respectively). On day 7, survivors exhibited increased lymphocyte, eosinophil, and platelet counts, while non-survivors had persistent neutrophilia, leukocytosis, and elevated neutrophil-to-lymphocyte ratios (P<0.05). Dynamic biomarker trends suggested ongoing inflammation and prothrombotic states among non-survivors. Conclusions: Tocilizumab therapy may be more effective when administered early and in patients with preserved nutritional and immune function. Advanced age, renal dysfunction, elevated inflammatory markers, and poor nutritional status were significant predictors of mortality. Further prospective studies are warranted to validate these findings.
Not All That Masses Are Cancer: Pilomatrixoma Presenting as Breast Cancer
Pilomatrixoma is a rare benign skin neoplasm originating from the hair follicle matrix and is exceptionally uncommon in breast tissue, particularly in male patients. Due to overlapping clinical and ultrasonographic features, it is frequently misdiagnosed as breast cancer. This study aims to highlight pilomatrixoma as an important differential diagnosis of breast masses and to emphasize the role of histopathological confirmation. We report two male patients with breast lesions. A 40-year-old male presented with an infected breast lesion, and a 70-year-old male presented with a palpable breast mass. Both patients underwent clinical evaluation, ultrasonography, and tru-cut biopsy. Following histopathological confirmation of pilomatrixoma, elective surgical excision was performed. Tru-cut biopsy findings in both cases were consistent with pilomatrixoma. Ultrasonographic evaluation suggested suspicious features, leading to BI-RADS 4–5 categorization and initial concern for malignancy. Complete surgical excision with clear margins was achieved in both patients, and no complications or recurrences were observed. Pilomatrixoma is a rare benign tumor of the skin that can closely mimic breast cancer, especially on imaging. Despite its typical occurrence in the head, neck, and upper extremities and predominance in young females, it should be considered in the differential diagnosis of male breast masses. Histopathological confirmation via tru-cut biopsy is essential for accurate diagnosis, and surgical excision with clear margins is curative.
The Effect of Digital Breast Tomosynthesis on BI-RADS Categorization in Different Breast Densities: A Retrospective Evaluation
Objectives: This study aimed to evaluate the impact of digital breast tomosynthesis (DBT) on BI-RADS categorization compared to conventional mammography (MMG), across different mammographic breast density types. Methods: In this retrospective study, 520 female patients aged 35–85 years who underwent both MMG and DBT between 2023 and 2025 were included. Standard craniocaudal (CC) views were acquired for MMG and mediolateral oblique (MLO) views for DBT. Synthetic MLO (sMLO) images were automatically generated by the device from DBT data. Patients were categorized according to the breast density (Type A–D), and all images were reviewed in consensus by two experienced radiologists. Breast Imaging Reporting and Data System (BI-RADS) categories, lesion types, were recorded. BI-RADS categorizations from MMG and DBT were compared overall and within density subgroups. Results: The mean age was 53.0 ± 9.9 years. Breast density distribution was: Type A (3.8%, n=20), B (28.5%, n= 148), C (43.5%, n=226), and D (24.2%, n=126). BI-RADS classifications differed significantly between MMG and DBT, especially in dense breasts. Of the BI-RADS 2 cases on MMG, 21.6% (n=64) were reclassified as BI-RADS 3 or 4 with DBT, while 6.3% (n=7) of BI-RADS 3 cases were downgraded. BI-RADS 5 categorization showed complete agreement between modalities, though 33% (n=5) of BI-RADS 4 cases were downgraded. At least one pathological finding was observed in 91.3% (n=475) of patients, most commonly nodular opacities (57.1%, n=297), vascular wall calcifications (13.3%, n=69), and coarse calcifications (5.4%, n=28). McNemar analysis revealed significant reclassification between BI-RADS 2 and 3 in Types C and D (P<0.001). Conclusions: DBT significantly alters BI-RADS categorization in dense breasts. These findings support the potential role of DBT as a complementary tool in screening protocols, particularly for patients with heterogeneously dense or extremely dense breast tissue.
Breast Imaging Reporting and Data System
Association of Maternal Creatinine-to-Body Weight and Urea-to-Creatinine Ratios with Gestational Diabetes Mellitus
Objectives: Gestational diabetes mellitus (GDM) is a multifactorial metabolic disorder associated with altered glucose metabolism and systemic physiological adaptations during pregnancy. Subtle changes in renal-related biochemical parameters may reflect underlying metabolic alterations accompanying GDM. This study aimed to evaluate the association between maternal creatinine-to-body weight (Cre/BW) and urea-to-creatinine (Urea/Cre) ratios and GDM, with a particular focus on their potential role as renal–metabolic indicators during pregnancy. Methods: This retrospective case–control study included 1,064 pregnant women (532 with GDM and 532 matched controls) who underwent a 75 g oral glucose tolerance test between 24 and 28 weeks of gestation. Propensity score matching was applied to reduce baseline differences between groups. Maternal serum creatinine, urea, and body weight were recorded in the first and second trimesters, and Cre/BW and Urea/Cre ratios were calculated. Group comparisons, receiver operating characteristic (ROC) analyses, and multivariate logistic regression were performed. Results: In the second trimester, the Cre/BW ratio was significantly lower, and the Urea/Cre ratio was significantly higher in women with GDM compared with controls (both P<0.001). The Cre/BW ratio demonstrated moderate discriminatory ability for distinguishing GDM status (Area under the curve [AUC]=0.774), whereas the Ure/Cre ratio showed modest performance (AUC=0.614). In multivariate analysis, second-trimester Cre/BW and Urea/Cre ratios remained independently associated with GDM after adjustment for clinically relevant covariates. These results suggest a potential association; however, the discriminatory performance of the Cre/BW and Urea/Cre ratios should be regarded as exploratory rather than diagnostically definitive. Conclusions: Lower Cre/BW and higher Urea/Cre ratios were associated with GDM in this retrospective cohort. These findings suggest that simple renal-related biochemical ratios may reflect metabolic–renal adaptations in pregnancies complicated by GDM. However, given the modest diagnostic performance and retrospective design, these parameters should be considered exploratory indicators rather than standalone clinical tools. Further prospective studies are required to clarify their clinical relevance.
Association Between Cardiopulmonary Bypass–Induced Sirtuin-1 Suppression and Apoptosis
Objectives: The aim of this study is to investigate, at the molecular level, the effect of cardiopulmonary bypass (CPB) on Sirtuin-1 levels, an epigenetic-metabolic regulatory protein, and the relationship between this change and Caspase-3, one of the key executor molecules of cellular apoptosis. Methods: Patients undergoing open heart surgery under CPB were included in the study. Sirtuin-1 and Caspase-3 levels were measured in venous blood samples taken from patients during the preoperative, intraoperative, and postoperative periods. The Wilcoxon Signed Ranks test was used to analyze differences between time points. Results: Sirtuin-1 levels decreased significantly during the intraoperative period compared to preoperative values (Z= -6.212, P<0.001). Similarly, postoperative Sirtuin-1 levels were significantly lower compared to both the preoperative (Z= -6.229, P<0.001) and intraoperative periods (Z= -6.186, P<0.001). Caspase-3 levels showed a significant increase in the intraoperative period compared to the preoperative period (Z= −6.262, P<0.001). Postoperative Caspase-3 levels were significantly higher than both the preoperative (Z= -6.196, P<0.001) and intraoperative periods (Z= -6.203, P<0.001). Conclusions: These findings indicate that CPB suppresses circulating Sirtuin-1 levels and that this suppression is associated with increased apoptosis. CPB-induced Sirtuin-1 inhibition may be one of the molecular mechanisms of surgical-related cellular damage. Sirtuin-1 may be considered a potential molecular target for preventing CPB-related myocardial and systemic damage.
Outcomes of Teletherapy and Face-to-Face Voice Therapy for Vocal Fold Nodules: A First-Line Treatment Comparison
Objectives: This study aimed to compare the effectiveness of teletherapy and face-to-face voice therapy in patients diagnosed with vocal fold nodules by evaluating acoustic, aerodynamic, perceptual, and patient-reported voice outcomes. Methods: A total of 40 patients with vocal fold nodules received either teletherapy or face-to-face voice therapy for a period of six to eight weeks. Voice assessments were performed before and after therapy and included videolaryngoscopic examination, acoustic voice analysis, aerodynamic voice measurements, auditory-perceptual voice evaluation, and patient-reported outcome measures related to voice handicap, voice-related quality of life, and reflux-related symptoms. Results: Both therapy groups demonstrated significant improvements in acoustic voice stability, perceptual voice quality, and patient-reported voice outcomes after treatment. No significant differences were observed between teletherapy and face-to-face therapy for most outcome measures. Patients receiving face-to-face therapy showed a greater change in fundamental frequency compared with those receiving teletherapy. Both therapy modalities were associated with significant reductions in voice-related handicap, improvements in voice-related quality of life, and decreased reflux-related symptoms. Conclusions: Teletherapy appears to be an effective and accessible alternative to face-to-face voice therapy for patients with vocal fold nodules. Further studies are warranted to investigate long-term outcomes and to explore integrated and hybrid treatment models in voice rehabilitation.
Awareness, Knowledge and Consumption of Postbiotics Among Students at Two Different Universities in Türkiye: A Cross-Sectional Survey
Objectives: Postbiotics, defined as non-viable microbial cells or their components that provide health benefits, are emerging as an important topic in functional food research. However, awareness and consumption among young adults remain limited. This study aimed to evaluate the awareness and knowledge levels of postbiotics among university students. Methods: The study population included 346 students who completed a questionnaire consisting of 17 demographic and lifestyle questions and a 20-item postbiotic knowledge scale adapted from a validated tool. Descriptive statistics were used to analyze the data. Results: It was revealed that 86.1% (n=298) of the students included in this study had never heard of postbiotics and 96.2% (n=333) had never used postbiotic supplements. Overall, 48.8% (n=169) of participants had a poor, 39.0% (n=135) a moderate, and 11.8% (n=41) a good knowledge level. Female students demonstrated significantly higher knowledge scores than males (P<0.05). Conclusions: The findings indicate that university students have limited awareness and consumption of postbiotics. Contributing factors may include insufficient promotion, inadequate understanding of health benefits, and limited market availability of postbiotic products. To improve awareness, it is recommended that educational activities be organized in universities to enhance students’ understanding of postbiotics and encourage their inclusion in health-promoting dietary habits.
Investigation of Changes in Liver Fibrosis Scores and Kidney Function in Patients with Diabetic Hepatosteatosis
Objectives: Hepatosteatosis, diabetes, and chronic kidney disease are significant risk factors for mortality and morbidity. The objective of this study was to examine the relationship between non-invasive liver fibrosis scores and kidney function tests in patients with diabetic hepatosteatosis. Methods: This present study was conducted through a retrospective analysis of two consecutive data sets of 72 diabetic patients aged 18–80 years of both sexes who were investigated for at our hospital between 2018 and 2024. The relationships between hepatosteatosis, diabetes mellitus parameters, kidney function tests, liver function tests, and fibrosis scores (BARD, BAAT, NFS, FIB4, APRI) were examined. Results: Among the patients included in the study, 54.2% (n=39) were female, and the mean age was 60.99±12.46 years. A moderate negative correlation was found between the initial GFR and both initial FIB4 (P<0.001) and NFS values (P=0.001), while a weak negative correlation was observed between the final GFR and both final FIB4 (P=0.016) and NFS values (P=0.001). A weak negative association was observed between the differences in the initial and final GFR values and both the differences in BARD scores and BARD ratios (P=0.039). Linear regression analysis revealed that a one-unit increase in the BARD ratio led to a 4.34-unit decrease in GFR. Conclusions: The study revealed a correlation between fibrosis progression, as measured by repeated measurements, and an increased risk of developing new-onset chronic kidney disease. The findings of this study indicated that liver fibrosis in patients with diabetic hepatosteatosis might contribute to the development of chronic kidney disease, thereby underscoring the necessity for enhanced monitoring of kidney function.
Examining the Food and Nutrition Literacy Levels of Middle School-Aged Children
Objectives: This cross-sectional study was conducted to examine the food and nutrition literacy levels of middle school children. Methods: Data required for the study were collected online between January 22, 2025, and April 20, 2025. The study group consisted of middle school-aged children. Data were collected using an online survey method using the Socio-Demographic Data Collection Form and the Food and Nutrition Literacy Scale for Children (FNLSC) from 374 middle school-aged children who volunteered for parental consent and were selected using a non-probability sampling method. The statistical analysis of the data obtained in the study was carried out using SPSS 27.0 data analysis software, which employed the following methods: T-test, Oneway Anova, and Kolmogorov-Smirnov test. Results: Of the middle school students participating in the study, 60.2% (n=225) were males and 39.8% (n=149) were female students, with a higher proportion of male students participating. The reliability coefficient of the food and nutrition literacy scale for children was found to be 0.55, while the harmful consumption subscale was 0.45, the packaging reading subscale was 0.50, the beneficial consumption subscale was 0.45, and the interaction subscale was 0.50. In examining food and nutrition literacy levels, significant differences were found within the subscale based on age, gender, grade, family, and nutritional status, but these differences were not statistically significant (P>0.05). Conclusions: In the study examining the food and nutrition literacy levels of middle school children, no differences were found based on some variables. It is recommended that research be conducted to examine children's food and nutrition literacy levels by considering different factors.
Comparative Analysis of Large Language Models in Hemodialysis Vascular Access: ChatGPT-5, Gemini-2.5, and DeepSeek-V3
Objectives: Vascular access is a key component of effective hemodialysis treatment. Patient education regarding selection, complications, and daily care remains challenging. Recently, large language models (LLMs) have been explored as supportive tools in this field. This study compared three widely used LLMs (ChatGPT-5, Gemini-2.5, and DeepSeek-V3) in addressing patient-centered questions on hemodialysis vascular access. Methods: Twenty-five frequently asked patient questions were compiled from literature, educational materials, and expert input. Each question was submitted to the three LLMs in standardized sessions, and answers were anonymized. Four cardiovascular surgeons independently evaluated responses in a blinded manner using 5-point Likert scales for accuracy, clarity, and scientificity. Statistical analyses compared model performances. Results: DeepSeek-V3 provided significantly responses with a higher word count and achieved higher scientific depth scores compared to ChatGPT-5 and Gemini-2.5 (P<0.01). Accuracy scores showed ChatGPT-5 demonstrated significantly lower than both Gemini-2.5 and DeepSeek-V3 (P<0.001). No significant differences were observed among models regarding clarity. Overall, DeepSeek achieved the highest mean scores across all criteria. Conclusions: DeepSeek-V3 demonstrated superior scientific depth and overall reliability, whereas ChatGPT-5 showed relative weaknesses in accuracy. The comparable clarity across models highlights LLMs’ potential as supportive tools for patient education. Future studies should further validate these tools in real-world clinical settings and define appropriate safeguards for their use.
Impact of Radial Bowing Alteration on Functional Outcomes Following Locked Intramedullary Nailing of Adult Both-Bone Forearm Fractures
Objectives: Plate osteosynthesis is the standard treatment for adult both-bone forearm fractures, but locked intramedullary nailing (IMN) offers a minimally invasive alternative. Its impact on restoring radial bow and functional outcomes is unclear. This study assessed changes in radial bow magnitude and location after IMN and their relationship with functional outcomes. Methods: Twenty-six adult patients who underwent locked IMN for diaphyseal both-bone forearm fractures between 2015 and 2024 were retrospectively analyzed. Demographic data, radiographic measurements, union time, functional scores, and range of motion were recorded. Radial bow magnitude and bow apex location were measured on standardized radiographs and compared between the operated and contralateral forearms. Correlation analyses were performed to evaluate associations between bow changes and functional outcomes. Results: All fractures achieved union, with no cases of nonunion or radioulnar synostosis. The mean time of union was 10.7±1.8 weeks. Extensor pollicis longus (EPL) rupture occurred in two (7.7%) patients. Postoperative radiographs showed reduced bow magnitude (Δ=0.61±1.13 mm; P=0.010) and a distal shift in bow location (Δ = –5.38±5.39%; P=0.001) on the operated side. A significant negative correlation was found between distal bow displacement and supination (r = –0.561; P=0.003). No correlation was observed with pronation, VAS, or QuickDASH scores. Conclusions: Locked IMN ensures reliable union and excellent function. While IMN changes radial bowing, only excessive distal displacement impairs supination.