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Infective endocarditis: the evaluation of 64 cases
(2024) Aydın, Selda; Şahin, Meyha; Yılmaz, Ezgi; Mert, Ali
Introduction: Infective endocarditis (IE) remains an important infectious disease with a high mortality rate despite advancements in diagnostic and therapeutic methods. Our study aimed to determine the demographic characteristics, clinical, microbiologic, and imaging findings, treatment modalities and clinical outcomes, and factors affecting mortality in IE cases. Materials and Methods: The study was retrospectively designed in a tertiary university hospital. Between January 2015 and December 2023, 64 cases of definite and probable IE in individuals over the age of 18, defined according to the 2023 Duke IE criteria by The International Society for Cardiovascular Infectious Diseases, were included in the study. Results: The median age was 61.5 years (interquartile range= 48-74 years) and 69% (n= 44) were male. The most common symptoms and signs were fever (84.3%), murmur (62.5%), and embolic events (25%). Definite IE was diagnosed in 91% (n= 58) and probable IE in 9% (n= 6) of the patients. Natural valve IE was identified in 51.6% of cases, prosthetic valve IE in 34.4%, and pacemaker IE in 14%. The most commonly affected valves were mitral (35.6%) and aortic (33.3%) valves. Microbiological diagnostic methods identified the causative agent in 89.1% of cases. The most frequently isolated microorganisms were staphylococci (43.8%) and enterococci (21.9%). Surgery was performed in 50% of the patients. The mortality rate during hospitalization was 22%. Higher mortality rates were observed in the presence of advanced age, coronary artery disease, chronic kidney disease, and pacemaker endocarditis. Conclusion: It is noteworthy that the average age of patients with IE is increasing, staphylococci are the predominant microbiological agent, and patients with endocarditis associated with advanced age, chronic kidney disease, and the presence of a pacemaker have a more severe prognosis. These findings emphasize the critical importance of IE management being conducted by an IE team, as recommended in the European Society of Cardiology 2023 endocarditis guidelines.
Achieving high accuracy in meniscus tear detection using advanced deep learning models with a relatively small data set
(2025) Güngör, Erdal; Vehbi, Husam; Cansın, Ahmetcan; Ertan, Mehmet Batu
Purpose: This study aims to evaluate the effectiveness of advanced deep learning models, specifically YOLOv8 and EfficientNetV2, in detecting meniscal tears on magnetic resonance imaging (MRI) using a relatively small data set. Method: Our data set consisted of MRI studies from 642 knees—two orthopaedic surgeons labelled and annotated the MR images. The training pipeline included MRI scans of these knees. It was divided into two stages: initially, a deep learning algorithm called YOLO was employed to identify the meniscus location, and subsequently, the EfficientNetV2 deep learning architecture was utilized to detect meniscal tears. A concise report indicating the location and detection of a torn meniscus is provided at the end. Result: The YOLOv8 model achieved mean average precision at 50% threshold (mAP@50) scores of 0.98 in the sagittal view and 0.985 in the coronal view. Similarly, the EfficientNetV2 model obtained area under the curve scores of 0.97 and 0.98 in the sagittal and coronal views, respectively. These outstanding results demonstrate exceptional performance in meniscus localization and tear detection. Conclusion: Despite a relatively small data set, state-of-the-art models like YOLOv8 and EfficientNetV2 yielded promising results. This artificial intelligence system enhances meniscal injury diagnosis by generating instant structured reports, facilitating faster image interpretation and reducing physician workload. Level of Evidence: Level III.
Different cortex activation between young and middle-aged people during different type problem-solving: an EEG&fNIRS study
(2025) Sarıcaoğlu, Mevhibe; Yücel, Meryem Ayşe; Budak, Miray; Omurtag, Ahmet; Hanoğlu, Lütfü
Problem-solving strategies vary depending on the type of problem and aging. This study investigated the hemodynamic response measured by the changes in the oxyhemoglobin concentration (HbO), alpha frequency power, and their interrelation during problem-solving in healthy young and middle-aged individuals, employing combined electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) recordings. The study included 39 young and 30 middle-aged subjects. The brain activation that occurred while answering different questions was recorded using combined EEG and fNIRS. During the EEG & fNIRS recording, four questions (arithmetic, general knowledge, insight, and basic operation) were used for problem-solving. Alpha power (8–13 Hz) and HbO changes were analyzed. The behavioral results indicated significant differences between age groups in various question types. While the middle-aged group performed better on the general knowledge questions, the older group performed better on the insight and four-process questions. The fNIRS results reveal significant differences in brain activation during problem-solving tasks, particularly in regions like DLPFC/TA, STG, pSSC/Wernicke, and STG/angular gyrus Wernicke's area. The young group with the highest HbO was recorded during arithmetic questions, general knowledge questions, and basic operation questions. In contrast, there was no significant highest HbO during insight questions. Similar findings were observed in the middle-aged group, with the highest HbO recorded during general knowledge questions. However, there was no significant HbO in other channels during the solving of other question types in this group. The alpha power varied across different electrodes for various question types in both young and middle-aged groups. The highest alpha frequency band power for different electrodes was recorded while solving general knowledge questions in the young group and insight questions in the middle-aged group. Finally, the EEG and fNIRS correlation results showed positive correlations between HbO and alpha frequency band power in specific brain regions while solving general knowledge questions, particularly in the middle-aged group. The study reveals age-related differences in behavioral performance, brain activation patterns, and neural correlates during various cognitive tasks, showcasing distinct strengths between middle-aged and young individuals in specific question types.
Williams-Beuren syndrome case series with thinner fovea centralis and central corneal thicknesses
(2025) Yılmaz, Göksu; Demirci, Göktuğ; Karaman, Sevil; Sargolzaeimoghaddam, Maral; Uluçam, Enes Sedat; Sarg, Arya
Background/aims: To characterize the ocular signs of Williams-Beuren syndrome (WBS) in 3 cases examined at Istanbul Medipol University Ophthalmology Clinic. Methods: Three patients with a diagnosis of WBS underwent comprehensive ophthalmic evaluation at the Istanbul Medipol University Ophthalmology, including best-corrected visual acuity, slit-lamp biomicroscopy, dilated fundus examination, optical coherence tomography, corneal topography and colour fundus imaging. Results: All 3 cases had decreased best corrected visual acuity, decreased ILM-RNFL thicknesses with a persistence of inner retinal layers on the SD-OCT examinations, decreased central corneal thickness yet normal epithelial thickness measurements and retinal arteriolar tortuosity in fundus examination. Conclusion: WBS is a complex multisystem genetic disorder. The ocular findings observed in these cases which are decreased corneal thickness with normal epithelial thickness, decreased ILM-RPE thicknesses, and retinal arteriolar tortuosity may provide future insight into systemic vascular findings affected by a microdeletion of chromosome 7q11.23 which also contains elastin gene in WBS.
Evaluation of the clinical and genetic characteristics of primary ciliary dyskinesia patients with situs inversus totalis
(2025) Ustabaş Kahraman, Feyza; Jafarov, Üzeyir; Yazan, Hakan; Yurtsever, İsmail; Çakır, Erkan; Yeşil Sayın, Gözde
Background: Situs inversus totalis (SIT) is present in approximately 40%–50% of patients with primary ciliary dyskinesia (PCD). We evaluated the relationships between novel genetic results and the clinical and radiological characteristics of PCD patients with SIT. Methods: The study included 48 patients diagnosed with PCD and SIT. Demographic and clinical features, disease-related scores (Bhalla, Primary Ciliary Dyskinesia Rule [PICADAR], and American Thoracic Society [ATS]), and genetic analyses were retrospectively assessed. Results: The median age of patients was 13 (6.5–16) years, and parental consanguinity was observed in 43 (89.58%) patients. Bhalla score was available in 31 patients and “moderate and severe” score was observed in 19 (61.29%) patients. The median PICADAR score was 10 (8–11), and 34 (70.83%) patients had a high (≥ 10) PICADAR score. The ATS score was found to be 4 in 24 (50%) patients and 3 in 20 (43.75%) patients. Genetic data were available in 40 patients and mutations were found in 27 (67.5%) patients. The most common pathogenic variants were DNAH5 in 8 (20%), CCDC103 in 4 (10%), and CCDC39 in 3 (7.5%) patients. Subjects with any genetic variants may be older, have a greater frequency of parental consanguinity, higher Bhalla score, and higher ATS score (p < 0.05). DNAH5 mutation was associated with a lower likelihood of neonatal ICU stay and neonatal respiratory distress-related symptoms (p = 0.036 and 0.015, respectively). Conclusions: Situs abnormalities may be a warning sign for the early diagnosis of PCD. Early diagnosis of PCD through genetic analysis is important for preventing chronic lung pathologies and predicting prognosis and may improve the quality of life.
Comparison of Hemiarthroplasty, total hip arthroplasty, and internal fixation for hip fractures in patients over eighty years of age: factors affecting mortality: a nationwide cohort study of fifty three thousand, four hundred and ninety five patients from Türkiye
(2025) Uzel, Kadir; Birinci, Murat; Hakyemez, Ömer Serdar; Bostancı, Bilal; Bingöl, İzzet; Öktem, Umut; Azboy, İbrahim
Purpose: Hip fractures are a common cause of mortality in elderly patients. This study aimed to determine the predictive factors affecting mortality among patients over the age of 80 who underwent surgical treatment for hip fractures. Methods: We searched the Turkish Ministry of Health’s e-health database to identify patients over 80 years old who had undergone surgery for proximal femoral fractures from 2016 to 2022. This process yielded 53,495 patients. Demographic data as well as comorbidities, blood transfusions, postoperative 90 days medical complications, and mortality was investigated. Multivariate logistic regression analysis was performed to identify risk factors for one year mortality in patients undergoing surgical treatment for proximal hip fractures. Results: The mortality rate was 37.2% in the first year. The mean Charlson comorbidity index(CCI) was 6.8 (range: 4–22). In the postoperative period, 68.6% of the patients received blood transfusions. Logistic regression analysis identified significant predictors of one-year mortality in surgical patients, including male gender, increased age, higher CCI scores, AKI, PE, pneumonia, electrolyte imbalance, gastrointestinal bleeding, blood transfusion, and increased mortality risks with hemiarthroplasty and internal fixation compared to total hip arthroplasty. (p < 0.001 for all). Conclusions: This large cohort study demonstrated that the mortality rate is high and that the type of surgery, male gender, older age, blood transfusion requirements, and high CCI score are associated with mortality in patients over 80 years of age who have undergone surgery for hip fractures. Preoperative optimization and postoperative care are critical for these vulnerable elderly patients.
The impact of circadian rhythm disruption on oxaliplatin tolerability and pharmacokinetics in Cry1-/-Cry2-/- mice under constant darkness
(2025) Akyel, Yasemin Kübra; Öztürk Seyhan, Narin; Gül, Şeref; Çelik, Melis; Taşkın, Ali Cihan; Selby, Christopher; Okyar, Alper
Circadian rhythms, the 24-h oscillations of biological activities guided by the molecular clock, play a pivotal role in regulating various physiological processes in organisms. The intricate relationship between the loss of circadian rhythm and its influence on the tolerability and pharmacokinetic properties of anticancer drugs is poorly understood. In our study, we investigated the effects of oxaliplatin, a commonly used anticancer drug, on Cry1-/- and Cry2-/- mice (Cry DKO mice) under darkness conditions, where they exhibit free-running phenotype. We administered oxaliplatin at a dosage of 12 mg/kg/day at two distinct circadian times, CT8 and CT16, under constant darkness conditions to Cry DKO mice and their wild type littermates. Our results revealed a striking disparity in oxaliplatin tolerance between Cry DKO mice and their wild-type counterparts. Oxaliplatin exhibited severe toxicity in Cry DKO mice at both CT8 and CT16, in contrast to the wild type mice. Pharmacokinetic analyses suggested that such toxicity was a result of high concentrations of oxaliplatin in the serum and liver of Cry DKO mice after repeated dose injections. To understand the molecular basis of such intolerance, we performed RNA-seq studies using mouse livers. Our findings from the RNA-seq analysis highlighted the substantial impact of circadian rhythm disruption on gene expression, particularly affecting genes involved in detoxification and xenobiotic metabolism, such as the Gstm gene family. This dysregulation in detoxification pathways in Cry DKO mice likely contributes to the increased toxicity of oxaliplatin. In conclusion, our study highlights the crucial role of an intact molecular clock in dictating the tolerability of oxaliplatin. These findings emphasize the necessity of considering circadian rhythms in the administration of anticancer drugs, providing valuable insights into optimizing treatment strategies for cancer patients.
Evaluation of zonulin levels in patients with migraine
(2025) Ülfer, Gözde; Polat, Burcu; Yabalak, Ahmet; Çakıcı, Çağrı
Background: Zonulin regulates permeability in blood–brain and intestinal barriers. The pathophysiology of migraine is based on the effect of neurogenic inflammation. The aim of the current investigation was to examine the serum zonulin level in individuals suffering from migraine. Methods: The sample comprised 40 individuals who had migraine and 40 controls. Disease duration, attack duration, attack frequency, Visual Analog Scale (VAS) scores, and comorbidities were available for the migraine group. Serum zonulin levels were evaluated by using the ELISA method. Results: There were no statistically significant differences between the two groups concerning age or gender (p > 0.05). The zonulin value of patients with migraine was higher when compared to the controls, indicating a significant difference (p = 0.037; p < 0.05). The zonulin level did not correlate with disease duration, attack duration, VAS score, or attack frequency (p > 0.05). The receiver operating characteristic curve analysis of zonulin revealed a cut-off value of 30.58 and above, at which it had 52.50% sensitivity, 77.5% specificity, 70% positive predictive value, and 62% a negative predictive value. The area under the curve was 63.6%, and the standard error value was 6.3%. The analysis also showed a statistically significant correlation between migraine diagnosis and a zonulin level of 30.58 (p = 0.006; p < 0.01). Conclusions: Elevated zonulin levels in patients with migraine support the disruption of the intestinal barrier and neuroinflammation in these patients. The zonulin level may be a predictive biomarker of migraine. Multicenter, randomized trials are needed to evaluate treatments for intestinal permeability and zonulin levels in migraine patients.
Frontocentral delta and theta oscillatory responses are sensitive to sleep deprivation during a working memory task
(2025) Yırıkoğulları, Harun; Dalmızrak, Esra; Güntekin, Bahar
Sleep deprivation has become a severe public health problem in modern societies. Negative consequences of prolonged wakefulness on cognitive abilities have been demonstrated and working memory is one of the main cognitive functions that can be affected by sleep deprivation. This study aims to investigate the effects of sleep deprivation on working memory through EEG event-related oscillations. Thirty healthy young adult university students and graduates were included in this study (15 rested control – 15 sleep-deprived). A 2-back task was used to evaluate working memory, and both groups performed the task during EEG recording. The sleep-deprived (SD) group was required to stay awake for 24 h, and then the EEG session was conducted. The rested control (RC) subjects participated in the morning after a regular night's sleep. Event-related power and phase-locking analyses were applied, and delta (1–3.5 Hz), theta (4–6.5 Hz) and alpha (8–13 Hz) frequencies were investigated in the time-frequency domain. In the 2-back task, significantly prolonged reaction times were observed in the SD group. However, the decrease in accuracy rate was not significant. The EEG analyses revealed that the SD group had decreased frontocentral event-related delta and theta power responses after the presentation of stimuli. Moreover, task accuracy was positively correlated with the left frontocentral delta power in the SD group, and theta power in the RCs. Thus, we propose that the adverse effects of sleep deprivation on working memory can be observed through low-frequency oscillatory responses in the brain.
Bioactivity of hexokinase II inhibitor ikarugamycin and relation with tissue factor in breast cancer cell lines
(2025) Akgül Obeidin, Vildan; Bayramoğlu, Feyza; Dişli, Sevgi; Emekli, Neslin
Despite the understanding gained from scientific studies regarding Hexoki-nase II (HK2)’s involvement in cancer cell metabolism, there are no reports of directly inhibiting HK-2 enzyme to affect tissue factor (TF) activity in cancer cells. This study primarily investigates the complex mechanisms triggering ne-oplastic cell formation by examining the in vitro bioactivation of the Ikaruga-mycin (IKA) molecule, commonly used as an antibiotic. The IC50 values for MDA-MB-231 (TNBC) and MCF-7 (TPBC) cell lines are 24.1 µM and 19.25 µM, respectively. Furthermore, TF activation in breast cancer cell lines was demon-strated through Prothrombin Time (PT) analysis, showing that IKA effectively prolongs TF activation compared to Sodium Oxamate and Paclitaxel (Ptx), commonly used as a chemotherapeutic agent. Additionally, it was observed to be more effective in hormone-dependent MCF-7 breast cancer cell lines. Future studies should focus on investigating the changes in protein, enzyme, and gene levels of TF following treatment with IKA.
Mortality associated with surgical site infections following cardiac surgery: insights from the international ID-IRI study
(2025) Erdem, Hakan; Ankaralı, Handan; Al Tawfiq, Jaffar; Angamuthu, Kumar; Piljic, Dragan; Karahangil, Kadriye; Giammanco, Anna
Objectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods: Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results: Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions: To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.
Multi-omics characterization of improved cognitive functions in parkinson's disease patients after the combined metabolic activator treatment: a randomized, double-blinded, placebo-controlled phase II trial
(2025) Yuluğ, Burak; Altay, Özlem; Hanoğlu, Lütfü; Velioğlu, Halil Aziz; Coşkun, Ebru; Bayraktaroğlu, Zübeyir; Mardinoğlu, Adil
Parkinson’s disease is primarily marked by mitochondrial dysfunction and metabolic abnormalities. We recently reported that the combined metabolic activators improved the immunohistochemical parameters and behavioural functions in Parkinson’s disease and Alzheimer’s disease animal models and the cognitive functions in Alzheimer’s disease patients. These metabolic activators serve as the precursors of nicotinamide adenine dinucleotide and glutathione, and they can be used to activate mitochondrial metabolism and eventually treat mitochondrial dysfunction. Here, we designed a randomized, double-blinded, placebo-controlled phase II study in Parkinson’s disease patients with 84 days combined metabolic activator administration. A single dose of combined metabolic activator contains L-serine (12.35 g), N-acetyl-L-cysteine (2.55 g), nicotinamide riboside (1 g) and L-carnitine tartrate (3.73 g). Patients were administered either one dose of combined metabolic activator or a placebo daily for the initial 28 days, followed by twice-daily dosing for the next 56 days. The main goal of the study was to evaluate the clinical impact on motor functions using the Unified Parkinson’s Disease Rating Scale and to determine the safety and tolerability of combined metabolic activator. A secondary objective was to assess cognitive functions utilizing the Montreal Cognitive Assessment and to analyse brain activity through functional MRI. We also performed comprehensive plasma metabolomics and proteomics analysis for detailed characterization of Parkinson’s disease patients who participated in the study. Although no improvement in motor functions was observed, cognitive function was shown to be significantly improved (P < 0.0000) in Parkinson’s disease patients treated with the combined metabolic activator group over 84 days, whereas no such improvement was noted in the placebo group (P > 0.05). Moreover, a significant reduction (P = 0.001) in Montreal Cognitive Assessment scores was observed in the combined metabolic activator group, with no decline (P > 0.05) in the placebo group among severe Parkinson’s disease patients with lower baseline Montreal Cognitive Assessment scores. We showed that improvement in cognition was associated with critical brain network alterations based on functional MRI analysis, especially relevant to areas with cognitive functions in the brain. Finally, through a comprehensive multi-omics analysis, we elucidated the molecular mechanisms underlying cognitive improvements observed in Parkinson’s disease patients. Our results show that combined metabolic activator administration leads to enhanced cognitive function and improved metabolic health in Parkinson’s disease patients as recently shown in Alzheimer’s disease patients.
Migrant women's perception toward cervical and breast cancer screening in Türkiye: a qualitative analysis
(2025) Altaş, Zeynep Meva; Sezerol, Mehmet Akif
Introduction: This study aims to investigate the knowledge, attitudes, and behaviors of Syrian migrant women regarding breast and cervical cancer screenings in the Sultanbeyli district of Istanbul. Methods: The women were recruited from Extended Migrant Health Centre, which is a primary health care institution in Istanbul. In August 2024, face-to-face interviews were conducted using an open-ended, semi-structured question form administered by a nurse experienced in qualitative research. Sociodemographic information, their thoughts on cancer, information on the types of cancers screened and sources of information, their participation in cancer screenings, and their perspectives on cancer screenings were asked. Results: In depth interviews were conducted with 40 migrant women. Four main themes and thirteen sub-themes were identified. These themes include “Opinions about the cancers and information about the cancer screenings” “Attitudes about the cancer screening program” “Perspectives on preventive measures against cancers” and “Problems in access to health services”. Women mostly described cancer as a serious, incurable, and fatal disease. Despite this perception, almost half of the participants had not attended cancer screening programs. The majority said they did not undergo screening because they had no symptoms. The other main barriers for participation included lack of knowledge, fear of receiving a negative result, or fear of the procedures involved. Conclusions: Based on this study, migrant women have low level of attendance to breast and cervical cancer screening programs. Besides, they lack adequate information about breast cancer and cervical cancer, the screening protocols and preventive measuremets.
A complete response with daratumumab, venetoclax, azacitidine and dexamethasone in a heavily pre-treated, chemo-refractory early t-precursor acute lymphoblastic leukemia/lymphoma patient
(2025) Yiğit Kaya, Süreyya; Vatani, Mehrad; Akil, Rima; Çakır, Tansel; Maral, Senem; Kaynar, Leylagül; Sevindik, Ömür Gökmen
Early T-precursor acute lymphoblastic leukemia/lymphoma (ETP-ALL/LBL) is a rare and aggressive subtype of T-cell leukemia with poor prognosis and resistance to standard treatments. We report a 21-year-old male with ETP-ALL/LBL who, after an initial complete remission with the HOELZER protocol, experienced early relapse and was refractory to subsequent FLEND and BFM protocols. Following disease progression and complications, he was treated with a combination of daratumumab, venetoclax, azacitidine, and dexamethasone. This regimen achieved complete remission after one cycle. This case highlights the potential of this combination therapy as an effective treatment for refractory ETP-ALL/LBL, suggesting further research is warranted to validate its efficacy and safety.
Resting-state electroencephalographic rhythms depend on sex in patients with dementia due to parkinson's and lewy body diseases an exploratory study
(2025) Del Percio, Claudio; Lizio, Roberta; Lopez, Susanna; Güntekin, Bahar; Hanoğlu, Lütfü; Helvacı Yılmaz, Nesrin; Babiloni, Claudio
Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) are more prevalent in males than females. Furthermore, they typically showed abnormally high delta (< 4 Hz) and low alpha (8–10 Hz) rhythms from resting-state electroencephalographic (rsEEG) activity. Here, we hypothesized that those abnormalities may depend on the patient's sex. An international database provided clinical-demographic-rsEEG datasets for cognitively unimpaired older (Healthy; N = 49; 24 females), PDD (N = 39; 13 females), and DLB (N = 38; 15 females) participants. Each group was stratified into matched female and male subgroups. The rsEEG rhythms were investigated across the individual rsEEG delta, theta, and alpha frequency bands based on the individual alpha frequency peak. The eLORETA freeware was used to estimate cortical rsEEG sources. In the Healthy group, widespread rsEEG alpha source activities were greater in the females than in the males. In the PDD group, widespread rsEEG delta source activities were lower and widespread rsEEG alpha source activities were greater in the females than in the males. In the DLB group, central-parietal rsEEG delta source activities were lower, and posterior rsEEG alpha source activities were greater in the females than in the males. These results suggest sex-dependent hormonal modulation of neuroprotective-compensatory neurophysiological mechanisms in PDD and DLB patients underlying the generation of rsEEG delta and alpha rhythms, which should be considered in the treatment of vigilance dysregulation in those patients.
Epidemiology, treatment, and mortality of femoral neck fractures in patients over the age of 65 years: a nationwide retrospective cohort study of 83,789 cases in Turkey
(2025) Demirel, Mehmet; Birinci, Murat; Hakyemez, Ömer Serdar; Azboy, Nesrullah; Bingöl, İzzet; Azboy, İbrahim; Şen, Cengiz
Background: A population-based study delineating the epidemiologic, clinical, and treatment characteristics of femoral neck fractures (FNFs) in elderly patients has not yet been conducted in Turkey. In this nationwide study, the epidemiologic, clinical, and treatment characteristics of patients aged ⩾65 years with FNFs who underwent osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA) were examined. Methods: Patients aged ⩾65 years with FNFs were identified in this retrospective, nationwide study. Then, the patients who underwent osteosynthesis or total/hemiarthroplasty from 2016 to 2021 were included. All the outcome variables were collected from patient medical records stored in the e-health database of the Republic of Turkey Ministry of Health. Results: A total of 83,789 FNFs treated surgically were analysed. Osteosynthesis was performed on 21,130 FNFs (25.2%), HA on 56,378 FNFs (67.3%), and THA on 6281 FNFs (7.5%). From 2016 to 2021, the overall revision rates for THA and HA were 14.6% (914/5367 patients) and 5.9% (3301/53,077 patients), respectively. The rate of revision prosthetic surgery was significantly higher after THA than after HA (p < 0.001). Mortality rates at 1 year were 25% (n = 5293) for osteosynthesis, 14.7% (n = 924) for THA, and 71.1% (n = 40,109) for HA (p = 0.001). The multivariate model of 1-year postoperative mortality revealed 7 independent predictors: male sex (odds ratio [OR] 1.694; 95% confidence interval [CI], 1.640–1.751), use of a cemented femoral stem (OR 1.182; 95% CI, 1.117–1.250), acute myocardial infarction (AMI) (OR 1.317; 95% CI, 1.240–1.400), cerebrovascular accident (CVA) (OR 1.379; 95% CI, 1.333–1.425), chronic liver disease (CLD) (OR 2.188; 95% CI, 1.802–2.489), diabetes mellitus (DM) (OR, 1.160; 95% CI, 1.122–1.200), and age >81.50 years (OR 2.654; 95% CI, 2.569–2.742). Conclusions: Our study suggested that a hemiarthroplasty is the most common treatment modality for FNF followed by osteosynthesis (25.2%) and THA (7.5%) in Turkey. Revision rates after THA for FNF are concerning. The 1-year mortality rates are highest after HA, followed by osteosynthesis and THA. Male sex, cemented fixation, CVA, CLD, liver failure, DM, and age >81.50 are the independent predictive factors for postoperative 1-year mortality in this specific group of patients.
3',4'-dihydroxy flavonol (diohf) exerting a positive effect on neurogenesis and retinal damage in experimental brain ischemia-reperfusion of rats
(2025) Çetin, Osman; Aladağ, Tuğçe; Acar, Gözde; Önal, Ümmügülsüm; Baltacı, Saltuk Buğra; Moğulkoç, Rasim; Baltacı, Abdülkerim Kasım
Introduction: Brain ischemia-reperfusion can cause serious and irreversible health problems. Recent studies have suggested that certain flavonoids may help stabilize the correctly folded structure of the visual photoreceptor protein rhodopsin and offset the deleterious effect of retinitis pigmentosa mutations. Objective: The current study aimed to determine the effect of 3',4'-Dihydroxyflavonol (DiOHF) supplementation for 1 week on lipid peroxidation in the retina tissue following focal brain ischemia-reperfusion in rats. Methods: This study was carried out on male Wistar-albino rats. A total of 28 rats were used in the research, and four groups were formed: Control group: no anesthesia or surgical procedure was applied to the animals in this group, Sham group: after general anesthesia was established in the animals in this group, the carotid artery areas were opened and closed, and the 1 ml vehicle was applied for 1 week, Ischemia-Reperfusion (IR) group: after the carotid arteries were isolated in rats under general anesthesia, ischemia was performed by ligating them for 30 minutes, and then reperfusion was applied for 1 week, and Ischemia-Reperfusion + DiOHF group: under general anesthesia, ischemia was developed in the carotid arteries of the rats by ligation for 30 minutes, and then DiOHF was applied along with reperfusion for 1 week. At the end of the study, retinal tissue taken from animals sacrificed under general anesthesia was analyzed for MDA and GSH. Retinal tissue was also examined for histology and neurogenesis. Results: The highest MDA value was determined in the ischemia group, and the lowest value in the control and sham groups. In group 4, this parameter was found to be significantly lower than in the IR group. Retinal GSH was very low in the IR group. However, 1-week DiOHF treatment increased the GSH values. Deteriorations also occurred in the histological structure of the retinal tissue, and neurogenesis was inhibited. However, treatment improved retinal damage and neurogenesis. Conclusion: The results of the current study showed that focal brain ischemia in rats caused significant retinal lipid peroxidation. However, 1-week DiOHF treatment suppressed the increased lipid peroxidation by increasing GSH levels. Moreover, treatment improved retinal damage and neurogenesis.
Antibiotic-derived approaches in cancer therapy: effectiveness of ikarugamycin in hexokinase-2 inhibition, tissue factor modulation, and metabolic regulation in breast cancer
(2025) Akgül Obeidin, Serra Vildan; Şenol, Maşite Şehadet; Doğru Köseoğlu, Zeynep; Bayramoğlu, Feyza; Dişli, Sevgi; Yiğitbaşı, Türkan; Emekli, Neslin
We aimed to explore the role of ikarugamycin (IKA) in breast cancer, its connection with hexokinase-2 (HK-2) repression, and tissue factor (TF). This study sought to extend the role of HK-2 as a TF activator in a comprehensive analysis of these interactions from the enzyme, gene, and protein levels. The investigation was performed with MDA-MB-231 and MCF-7 breast cancer lines. The oxidative stress index (OSI), lactate production, and HK activity were assessed using colorimetric assays. Western blot and quantitative PCR analyses were performed to determine HK-2 and TF expressions. Prothrombin time Tests additionally assessed the effect of IKA therapy on TF activation. Three over four significantly downregulated genes were identified after a specific analysis of the IKA’s effect on HK-2 and TF in breast cancer cell lines. In the IKA treatment group, lactate production was markedly reduced (P < 0.05) and hexokinase activity was found to be reduced in all groups (P < 0.05, <0.01). Paclitaxel cytotoxicity independently causes lower OSI in all IKA-treated groups as compared to controls even though OSI is elevated in IKA groups compared to control. Molecular analysis results demonstrated significantly downregulated HK-2 and TF expressions at the protein level (P < 0.05, P < 0.01). Partial thromboplastin time results also showed that IKA-treated cells had longer TF activation duration. A potential indirect association of HK-2 inhibition and TF regulation in breast cancer cells is put forward in this study by presenting IKA’s bioactivation of breast cancer in all gene, protein, and enzyme levels.
Three-dimensional semi-autotamatic segmentation of nasolacrimal duct morphometry on computed tomography images
(2025) Pençe, Kadriye Betül; Nalçacı Bozkurt, Nureda; Tekin, Bahar; Şen, Selva; Ansen, Gamze; Örmeci, Tuğrul; Yüzbaşıoğlu, Neslihan
Purpose: Given the potential role of nasolacrimal duct (NLD) morphometry in the aetiology of primary acquired obstructions, it is imperative that clinicians have access to detailed anatomical information. The aim of this study was to determine normative data on nasolacrimal duct morphometry in the Turkish population sample and to provide guidelines for clinicians. Methods: The study included retrospectively computed tomography images of a healthy Turkish population sample of 151 individuals, 79 of whom were female and 72 of whom were male. Images were modeled and analyzed using 3D Slicer version 5.2.2. Results: The total volume and area of the NLD were smaller in females than in males. The right- and left-sided volume of the NLD were smaller in females than in males (In male, right side 219.28 ± 77.53 mm3 and left side 213.14 ± 73.82 mm3; in female, right side 193.82 ± 75.71 mm3, left side, 190.34 ± 82.54 mm3). Although the anteroposterior and transverse diameters of the right-sided NLD were not statistically different between the genders, the anteroposterior and transverse diameters of the left-sided NLD and distance between right and left NLD were smaller in female than in males. The volume and surface area of the right-sided NLD and the distance between the right and left NLD were larger with increasing age. The anteroposterior diameter was observed to be larger on the right side than on the left in both sexes, whereas the transverse diameter was larger on the right side than on the left side exclusively in females. Conclusion: The results of this study may assist clinicians in the surgical approaches.
Enhancing treatment decisions for advanced non-small cell lung cancer with epidermal growth factor receptor mutations a reinforcement learning approach
(2025) Bozcuk, Hakan Şat; Sert, Leyla; Kaplan, Muhammet Ali; Tatlı, Ali Murat; Muğlu, Harun; Bilici, Ahmet; Alemdar, Mustafa Serkan
Background: Although higher-generation TKIs are associated with improved progression-free survival in advanced NSCLC patients with EGFR mutations, the optimal selection of TKI treatment remains uncertain. To address this gap, we developed a web application powered by a reinforcement learning (RL) algorithm to assist in guiding initial TKI treatment decisions. Methods: Clinical and mutational data from advanced NSCLC patients were retrospectively collected from 14 medical centers. Only patients with complete data and sufficient follow-up were included. Multiple supervised machine learning models were tested, with the Extra Trees Classifier (ETC) identified as the most effective for predicting progression-free survival. Feature importance scores were calculated by the ETC, and features were then integrated into a Deep Q-Network (DQN) RL algorithm. The RL model was designed to select optimal TKI generation and a treatment line for each patient and was embedded into an open-source web application for experimental clinical use. Results: In total, 318 cases of EGFR-mutant advanced NSCLC were analyzed, with a median patient age of 63. A total of 52.2% of patients were female, and 83.3% had ECOG scores of 0 or 1. The top three most influential features identified were neutrophil-to-lymphocyte ratio (log-transformed), age (log-transformed), and the treatment line of TKI administration, as tested by the ETC algorithm, with an area under curve (AUC) value of 0.73, whereas the DQN RL algorithm achieved a higher AUC value of 0.80, assigning distinct Q-values across four TKI treatment categories. This supports the decision-making process in the web-based ‘EGFR Mutant NSCLC Treatment Advisory System’, where clinicians can input patient-specific data to receive tailored recommendations. Conclusions: The RL-based web application shows promise in assisting TKI treatment selection for EGFR-mutant advanced NSCLC patients, underscoring the potential for reinforcement learning to enhance decision-making in oncology care.

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