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https://hdl.handle.net/20.500.13055/58

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The use of bispectral index for monitorization of the depth of sedation in procedural sedoanalgesia in the emergency department
(Bayrakol Medical Publisher, 2026) Gökdağ, Eren; Sarı Doğan, Fatma; Yılmaz, Sarper
Aim: To determine the effectiveness of the Bispectral Index (BIS) measurement as an objective criterion for measuring the depth of sedation in the emergency department (ED) by comparing it with the Modified Ramsey Sedation Scale (MRSS), which is a clinical scale for measuring sedation depth. Methods: In this study, the compatibility of BIS values and MRSS values at the moment when the patients reached clinically appropriate sedation depth for intervention in those requiring sedation-analgesia in the ED due to extremity trauma were compared. Results: No statistically significant correlation was found between patients’ initial MRSS scores at the time of intervention and either their initial or minimum BIS values (p>0.05). A moderate negative correlation (r=-0.432, p=0.022) was observed between the MRSS values and the minimum BIS readings. No statistically significant difference was observed in minimum BIS values based on the sedative agent administered (p>0.05). Conclusion: In this study, a moderate correlation was found between the lowest BIS values and the MRSS scores corresponding to those BIS values. Although further comprehensive and detailed studies are necessary to establish the limitations and optimal use of BIS monitoring during procedural sedation-analgesia in the ED—especially considering both existing literature and the limitations of this study—BIS appears to be a promising alternative to clinical sedation scales for monitoring sedation depth.
Evaluation of the psychosocial aspects of the patients applying to the university cosmetology unit
(Unico's Medicine, 2026) Oraloğlu, Göktürk; Kuman Tunçel, Özlem; Elbi, Hayriye; Sağduyu, Ahmet Afşin; Ertam Sağduyu, İlgen
Objective: It is important to evaluate cosmetic patients psychologically and thus minimize potential adverse psychological outcomes that may occur after the procedure. This study aimed to investigate the psychosocial parameters in cosmetic patients. Materials and methods: Female patients (≥18 years old) who applied to the Ege University Dermatology and Venereal Diseases Department Cosmetology Unit were selected. ''Hospital Anxiety and Depression Scale'', ''Body Image Coping Strategies Inventory'', ''Temperament and Character Inventory'', ''Dermatology Quality of Life Index'' and ''Life Events' Checklist-5 '' forms were applied to the patients. The obtained data were analyzed statistically. Results: There were 36 people in the case group and 34 participants in the control group. A statistically significant difference was not found regarding life quality, anxiety, body image disturbance, and personally experienced life events between the two groups. Reward dependence, empathy, and purposefulness were significantly higher in the cosmetic group. Conclusion: The life quality was not negatively affected, the incidence of anxiety and depression was low, traumatic events were rare, and positive rational acceptance was mostly chosen as the main method of coping with body image negativities in cosmetic patients. Compared with controls, cosmetic patients demonstrated higher reward dependence, empathy, and purposefulness scores, without evidence of increased psychopathology.
A mixture of potent polyphenolic anticarcinogens: Microarray analysis of their efficacy in MCF-7 and MCF-10A cell lines
(ACG Publications, 2026) Seyhan, Mehmet Fatih; Eronat, Allison Pınar; Diren, Ayça; Tüzüner, Mete Bora; Ceviz, Ayşe Begüm; Yılmaz Aydoğan, Hülya; Öztürk, Tülin; Öztürk, Oğuz
Polyphenols are abundantly available through diet and show great promise with their safe use against cancer. In our previous studies, we have shown cytotoxic effects of more than 30 polyphenols in breast cancer. In this study, we have aimed to investigate the effects of various polyphenols upon MCF-7 breast cancer and MCF-10A normal epithelial cells. To this end, we have designed a polyphenolic mixture based on the most effective concentrations of seven compounds, which is a first according to literature in terms of polyphenolic combi nation studies. Cell proliferation experiments were executed utilizing WST-1 and apoptotic status by Annexin V-PI. After determining most effective concentrations, we operated whole genome microarray analysis. Based on microarray data, the best effective concentration for both cell lines is 75% of polyphenolic mixture. In MCF-7 cell line, this dosage induced in down regulation of cell cycle, cell division, DNA repair and some genes linked to breast cancer. In contrast, no remarkable effect was observed in MCF-10A cell line. The designed polyphenolic mixture was demonstrated to inhibit breast cell division in multiple pathways. Our findings on cell division in MCF-7 cell line were found similarly with the study based on polyphenol rich propolis which inhibited cell division remarkably in SK-BR-3 cells. This mixture, which is shown to have highly effective anticarcinogenic effects, can be considered as a prototype of natural prescription design for our future research.
Restless legs syndrome in children with celiac disease: Associations with vitamin D and iron deficiency and the role of gluten-free diet adherence
(BioMed Central, 2026) Cebe Tok, Ayşegül; Köle, Mehmet Tolga; Güven, Deniz; Tehçi̇, Ali Kansu; Kandemi̇r, İbrahim
Background Celiac disease (CD) is a systemic autoimmune disorder frequently associated with micronutrient deficiencies and extraintestinal manifestations, including neurological complications. Restless Legs Syndrome (RLS) is a sensorimotor disorder linked to dopaminergic dysfunction and iron and vitamin D deficiency, both of which are common in pediatric CD. Objective To evaluate the prevalence and severity of RLS in children with CD and to investigate the associations between RLS symptoms and serum vitamin D and iron parameters, as well as the potential effect of gluten-free diet (GFD) adherence. Methods This prospective cross-sectional study included 67 children with CD (aged 10–18 years) and 68 age- and sex-matched healthy controls. RLS was assessed using the International Restless Legs Syndrome Study Group rating scale. Demographic, anthropometric, clinical, and biochemical data—including serum iron, ferritin, folate, vitamin B12, and 25-hydroxyvitamin D—were recorded. Group comparisons were performed using appropriate parametric or non-parametric tests. Associations were evaluated using Spearman correlation and Bayesian correlation analyses. Results RLS scores were significantly higher in the CD group compared with controls (median 6 [0–13] vs. 0 [0–0]; p < 0.001), and RLS duration was also longer in children with CD (p < 0.001). Serum vitamin D levels showed a significant negative correlation with RLS scores (r = −0.251, p < 0.05). RLS duration demonstrated a strong positive correlation with RLS severity (r = 0.838, p < 0.001). Transglutaminase IgA levels were inversely correlated with ferritin (r = −0.417, p < 0.001) and folate levels (r = −0.332, p < 0.05), while transglutaminase IgG levels were negatively correlated with ferritin (r = −0.285, p < 0.05) and vitamin D (r = −0.304, p < 0.05). Bayesian correlation analysis revealed no strong associations between Marsh classification and most clinical or biochemical variables, except for a strong association between RLS duration and severity (BF₁₀ > 100). Adherence to a gluten-free diet was not significantly associated with RLS severity (p > 0.05). Conclusions Children with celiac disease exhibit significantly higher RLS symptom severity than healthy peers. Lower serum vitamin D levels and reduced iron stores appear to be associated with increased RLS severity, regardless of Marsh stage or dietary adherence. These findings highlight the potential value of screening for RLS and monitoring vitamin D and ferritin levels in pediatric patients with celiac disease.
Anxiety levels and associated sociodemographic factors in mothers of children with first febrile seizures: A case-control study
(Elsevier, 2026) Küçük, Elif; Köle, Mehmet Tolga; Erkin, Gökşen; Kandemir, İbrahim; Hüsrevoğlu Esen, Feyza; Güven, Deniz; Uysal, Feride; Akın, Yasemin
Objective: The prognosis of febrile seizures (FS) is generally favorable; however, a child's first febrile seizure can be distressing for parents. The aim of this study was to assess the anxiety levels of mothers whose children present to the pediatric emergency department with FS for the first time and to examine the relationship between these anxiety levels and the sociodemographic characteristics of the mothers. Methods: This case-control study included mothers presenting for the first time to the pediatric emergency department of our hospital with children aged 6 months to 6 years, either for simple FS or for fever without seizures. Maternal anxiety levels were assessed using the State–Trait Anxiety Inventory (STAI) approximately 12 h after the initial seizure. Sociodemographic characteristics were also collected, and the relationship between these characteristics and anxiety levels was analyzed. Results: A total of 103 participants (52 in the FS group, 51 controls) were included. Higher maternal education and family income were associated with lower STAI-S and STAI-T scores. The FS group had significantly higher mean STAI-S (p < 0.001) and STAI-T (p = 0.007) scores, by 14.6 and 3.6 points, respectively. Multivariate analyses revealed that income was a significant confounder for both STAI-T and STAI-S. Conclusion: Mothers of children with FS report higher levels of anxiety. Sociodemographic factors, such as income and maternal education level, play a significant role in maternal anxiety levels. Targeted educational and support programs addressing income inequalities in healthcare could help reduce maternal anxiety and improve the management of FS.
The effect of covid 19 pandemic on childhood obesity in Turkey
(BioMed Central, 2026) Akalın, Hilal; Kılıç, Ayşe; Özçetin, Mustafa; Yıldız, İsmail; Kandemir, İbrahim; Varkal, Muhammet Ali; Yıldız, Melek
Aim: We aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on the prevalence of obesity in childhood, laboratory parameters associated with obesity and children's lifestyle changes. Patients and Method: We included exogenous children with obesity and overweight between the ages of 6 and 17 who applied to the General Pediatric Polyclinic of Istanbul Faculty of Medicine between 2018 and 2021. We allocated the participants to two groups: those who applied before and after April 2020 (when the first patient was diagnosed with COVID-19 in Türkiye) and compared anthropometric measurements, biochemical values, and imaging results. We also subjected a survey regarding the demographic characteristics of the cases, nutritional behaviors, and physical activities. Results: Sex distribution did not alter during the pandemic. However, the prevalence of exogenous obesity doubled, morbidly obese people rate increased, fasting insulin, insulin resistance, and low-density lipoprotein cholesterol (LDL-C) levels increased, and triglyceride levels decreased during the COVID-19 pandemic. There was no significant difference between the two periods regarding Hemoglobin A1c, alanine aminotransferase, aspartate aminotransferase, total cholesterol, high density lipoprotein levels, blood pressures, and hepatosteatosis. Consumption of pastries, packaged foods, and desserts increased during the pandemic. Also, children's physical activity decreased whereas screen time and sleep time increased. Adolescents' Food Habits Checklist scores did not alter significantly. Conclusion: There were significant increase in consuming unhealthy foods, becoming physically inactive, and screen time during pandemic with insulin resistance, obesity and increased LDL-C.
Is LCP1 rs7324845gene variant related to obesity or NAFLD in adolescents
(Springer Nature, 2025) Yetim Şahin, Aylin; Sayın, Sevde Hasanoğlu; Kandemir, İbrahim; Oyacı, Yasemin; Kılıç, Ayşe; Pehlivan, Sacide
European Journal of Human Genetics
Synergistic cytotoxicity of bentonite–zeolite 4A nanocomposite in human melanoma cells
(Taylor & Francis, 2026) Duman, Nilay; Evcin, Atilla; Çelik, Sefa; Oraloğlu, Göktürk; Caner, Ayşe
The cytotoxic effects of bentonite and zeolite 4A nanoparticles (NPs), as well as their nanocomposite (NC), were investigated in human melanoma (G361) cells. Although both materials have demonstrated anticancer potential, their effects on melanoma remain insufficiently explored. This study aimed to evaluate the cellular responses induced by bentonite and zeolite 4A NPs, individually and in combination, in G361 cells. Methods: Physicochemical characterization was performed using X-ray diffraction (XRD), X-ray fluorescence (XRF), and scanning electron microscopy (SEM). IC₅₀ values were determined for bentonite NPs, zeolite 4A NPs, and the NC. Cell viability was assessed using the MTT assay, while apoptosis was evaluated through caspase-3 activity measured by ELISA. Results: All treatments exhibited dose-dependent cytotoxicity in melanoma cells. Notably, the NC demonstrated a strong synergistic interaction, enhancing cytotoxic effects and enabling reduced effective concentrations. Despite the pronounced cytotoxicity observed in the NC group, no significant increase in caspase-3 activity was detected compared to control. These findings suggest the involvement of caspase-independent cell death mechanisms, particularly necrotic or non-classical apoptotic processes. Conclusion: The bentonite/zeolite 4A nanocomposite exerts synergistic cytotoxic effects in melanoma cells. While the results highlight its therapeutic potential, further mechanistic studies are required to clarify the underlying pathways prior to clinical translation.
Beyond organ-specific therapies: A unified approach to multi-organ fibrosis
(Dove Medical Press Ltd, 2026) Pan, Ziyan; Zerehpoosh, Shadi; Wang, Shu-Chi; Örmeci, Necati; Kim, Won; Eslam, Mohammed
Organ fibrosis, characterized by excessive scarring of tissues in the liver, kidney, lung, and heart, poses a significant and growing global health challenge, resulting in considerable morbidity and mortality, with a lack of effective treatment options. Most research and drug development efforts have traditionally focused on individual organs in isolation. This review aims to provide a comprehensive perspective on multi-organ fibrosis, highlighting recent advances that clarify the complex cellular and molecular mechanisms involved in the liver, kidney, lung, and heart. It examines both common and organ-specific factors that drive fibrogenesis. Additionally, the review discusses the current and future landscape of antifibrotic therapies, including innovative approaches to developing pan-organ antifibrotic drugs. Challenges and future directions in the design of clinical trials are also addressed.
APASL clinical practice guidelines on the management of chronic hepatitis b infection: A 2026 update
(Asian Pacific Association for the Study of the Liver (APASL), 2026) You, Hong; Maiwall, Rakhi; Chen, Jing; Ahn, Sang Hoon; Dökmeci, Abdul Kadir; Dou, Xiaoguang; El-Sayed, Manal; Fan, Jian-Gao; Örmeci, Necati; Gao, Zhiliang
Globally, especially in the Asia-Pacific region, chronic hepatitis B infection has led to an undesirable escalating morbidity and mortality with acute-on chronic liver failure, end-staged liver cirrhosis and hepatocellular carcinoma. This has happened despite the past four-decades of major scientific advances made in screening methods, vaccination strategies, highly effective low-cost anti-viral therapies and surveillance strategies for early detection of hepatocellular carcinoma. To address this health threat, APASL has formed a Viral Elimination Taskforce to unite key opinion leaders from its member countries and regions. The ongoing shifts in hepatitis B epidemiology, socioeconomic changes, and advancements in technology are taken into consideration. With the conjoint efforts of all the members of the APASL Viral Elimination Taskforce, this clinical practice guidelines have been formulated aiming to facilitate healthcare professionals, policy makers and patients in making practical and cost-effective management decisions for chronic hepatitis B infection. Altogether, it provides recommendations in thirteen major areas related to screening, vaccination, treatment and HCC surveillance. The implementation of this clinical practice guidelines represents major APASL effort toward elimination of the disease burden due to chronic hepatitis B infection in Asia-Pacific region.
Impulsivity in parkinson’s disease
(Wolters Kluwer, 2026) Değirmenci, Yıldız; Altınbaş, Kürşat; Keçeci, Hulusi; Bougea, Anastasia; İsmayılov, Rashad; Gourzis, Philippos
Introduction/Aims: Parkinson’s disease (PD) is a neurodegenerative disease characterized by cardinal motor and nonmotor symptoms. Impulse control disorders are common neuropsychiatric manifestations in patients with PD (pwPD) under dopaminergic therapy. However, impulsivity is an underestimated symptom. Hence, the present study aimed to evaluate the impulsivity in pwPD. Methods: Forty‑seven adults who were diagnosed with having PD according to the Queen Square Brain Bank criteria for PD diagnosis and 30 age‑matched healthy controls were enrolled in the study. The sociodemographic data of the study participants and disease characteristics of the patients were recorded. All participants completed the Barratt impulsiveness scale (BIS). BIS scores were statistically analyzed between the groups. Results: The results revealed no significant differences between the patients and controls in terms of age (P > 0.05) or sex (P > 0.05). The total BIS scores were higher in the PD group than in the healthy controls (t = 2.1, P = 0.038). The items of BIS and attentional impulsivity scores were higher in the pwPD than in the controls (t = 2.8, P = 0.005), but there were no statistically significant differences between the groups in terms of motor and nonplanning impulsivity (z = 1.8, P = 0.07; and t = 1.1, P = 0.31, respectively). Discussion: Our results indicate that attentional impulsivity is an important clinical characteristic of pwPD, even in the absence of impulse control disorders. Conclusion: Further studies are required to confirm these findings in view of personalized PD treatment.
Dil ağının anatomik ve fonksiyonel görüntülemesi
(Başkent Üniversitesi, 2025) Seçkin, Mustafa
Dil, insan beyninde yaygın ve dinamik bir sinir ağı aracılığıyla yürütülen, karmaşık bir bilişsel işlevdir. Geleneksel modeller, dili ağırlıklı Broca ve Wernicke alanları ile sınırlı bir şekilde konumlandırsa da güncel nörogörüntüleme çalışmaları, dilin kortikal ve subkortikal yapılar arasında organize olmuş çok merkezli bir ağ tarafından işlendiğini göstermektedir. Ayrıca bu çalışmalar klasik Broca ve Wernicke alanlarının linguistik işlemlemedeki rolünü de sorgulamaktadır. Bu kapsamda, özellikle çift akışlı model, dilin bilişsel süreçlerini açıklamada güçlü bir kuramsal çerçeve sunmaktadır. Bu modele göre, dorsal akış ağırlıklı olarak fonolojik ve gramatik işlemleme ile birlikte motor üretimle, ventral akış ise ağırlıklı olarak anlamsal çözümleme ve kavramsal eşleştirme süreçleriyle ilişkilidir. Bu sinirsel mimarinin anlaşılmasında multimodal nörogörüntüleme yaklaşımları temel bir rol oynamaktadır. Fonksiyonel manyetik rezonans görüntüleme (fMRI), dilsel görevler sırasında özellikle sol hemisferde, frontal, temporal ve inferior paryetal bölgelerde belirgin aktivasyonlar göstermektedir. Diffüzyon tensör görüntüleme (DTG), ak maddedeki nöral yolakların bütünlüğünü ve bağlantısallığını ortaya koymaktadır. Elektroensefalografi (EEG) ve manyetoensefalografi (MEG) ise yüksek zamansal çözünürlükleri sayesinde dilsel süreçlerin zamanlamasını anlamada önemli katkılar sağlamıştır. Bu sunumda, dil ağının deneyime duyarlı (plastik) bir sistem olarak yeniden kavramsallaştırılmasına olanak sağlayan nörogörüntüleme teknikleri ele alınacak, bu tekniklerin hem temel sinirbilim araştırmaları hem de klinik uygulamalar bağlamında sunduğu kuramsal ve metodolojik açılımlar tartışılacaktır.
Hemimyelomeningocele: A systematic review and meta‑analysis of the literature
(Springer Nature Link, 2026) Adıyaman, Ali Ekrem; Karakaş, Furkan; Hamzaoğlu, Can; Saban, Şevval; Kılınç, Tunahan; Acar, Burak; Nabili, Tabriz; Ekşi, Murat Şakir
Hemimyelomeningocele (HMM) is a rare split cord malformation where only one hemicord forms a myelomeningocele-like sac, and the opposite hemicord undergoes normal neurulation. We aimed to compile all published HMM cases to concisely summarize embryology, presentation, imaging, associated anomalies, management, and outcomes of the disorder. Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (1968–Feb 2025) for studies with confirmed human HMM, extracting clinical, radiological, surgical, and follow-up data. Of 688 records screened, 25 articles met inclusion criteria, encompassing 67 patients. Most publications were single-patient case reports. Presentation occurred predominantly in newborns or early infancy. The dysraphic sac was lumbosacral in most cases, and type I split cord malformation with a bony spur outnumbered type II. Hemivertebrae and congenital scoliosis were the common vertebrae anomalies. Nearly all patients underwent surgery combining sac excision, detethering, and bony spur removal. Postopera tive neurological outcomes were favorable: the majority improved, and the other ones remained stable; no surgery-related mortality was reported. HMM can be recognized as a distinct clinic radiological entity within the split-cord spectrum. Early, ideally prenatal diagnosis, timely microsurgical repair, and coordinated multidisciplinary care yield favorable functional outcomes in most patients. This first systematic review compiles the available evidence and provides a practical basis for future diagnostic and treatment decisions.
Lumbar spine: Diagnosis and therapy with neural therapy
(Springer Nature Link, 2026) Ural Nazlıkul, Fatma Gülçin; Nazlıkul, Hüseyin
The lumbar spine, due to its topographical location and the significant load it bears, is frequently a center for chronic and acute conditions. Typical symptoms include pain and movement restrictions caused by various factors such as degeneration, postural imbalances, structural changes, or functional disorders. Neural therapy offers an effective method for both diagnosis and treatment by specifically targeting interference fields and influencing the body’s autonomic regulation. Notably, neural therapy has shown positive results in the treatment of lumbalgia, sciatica, and degenerative diseases of the lumbar spine. It supports tissue regeneration, improves circulation, and reduces pain perception by modulating the autonomic nervous system. These outcomes are achieved through precise injection techniques, such as facet joint injections and spinal nerve injections, allowing for direct and localized treatment. Neural therapy aims to activate the body’s self-healing powers and eliminate interference fields by targeted injections into the autonomic nervous system. By modulating the sympathetic and parasympathetic nervous systems, pain syndromes can be alleviated, and functional disorders corrected. The importance of comprehensive diagnosis, which considers both functional and autonomic factors, is essential to maximize the effectiveness of neural therapy and ensure holistic treatment.
The cervical spine
(Springer Nature Link, 2026) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin
The cervical spine (CSS) is the most mobile part of the spine, consisting of seven vertebrae that connect the head and trunk. Neural therapy and manual medicine offer effective approaches to treating CSS dysfunction through targeted injections and mobilization techniques. These therapies can reduce pain, improve mobility, and normalize autonomic functions. Case studies demonstrate the effectiveness of these combined approaches in treating cervical spine disorders.
The thoracic spine
(Springer Nature Link, 2026) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin
The thoracic spine (TSP) is the longest section of the spine, consisting of 12 vertebrae. It connects the cervical and lumbar spines and is responsible for the motor and sensory innervation of the trunk. Pathological stimuli can be reflexively relayed via the autonomic nervous system (ANS), leading to dysfunctions. Palpation plays an important role in diagnosing TSP dysfunctions. Injections into the spinous processes, facet joints, and intercostal nerves can be used to treat pain and movement disorders.
Rare but critical: Indomethacin-responsive headache with long-lasting autonomic symptoms
(Galenos Publishing House, 2026) Talibov, Tural; İnci, Meltem; Ekizoğlu, Esme; Baykan, Betül
Hemicrania with long-lasting autonomic symptoms (LASH), first described in by Rozen1 , is an extremely rare headache disorder thought to be part of the trigeminal autonomic cephalalgia (TAC) spectrum. However, it is not included in the current International Classification of Headache Disorders, 3rd Edition (ICHD-3).2 Notably, patients with LASH typically respond well to indomethacin.
Sacroiliac joint or iliosacral joint
(Springer Nature Link, 2026) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin
The sacroiliac joint (SIJ) is often regarded as a controversial and enigmatic structure, serving as a source of explanation for various pain conditions and functional limitations that are otherwise difficult to categorize. This article provides a detailed examination of the SIJ’s anatomy, biomechanics, and the role of the pelvic ring. The SIJ is a synovial joint with limited mobility, crucial for weight transfer from the trunk to the hips. The article emphasizes the significance of ligamentous structures surrounding the SIJ and highlights the diagnostic and therapeutic approaches combining manual medicine and neural therapy, particularly focusing on the treatment of ligamentous structures. Techniques for the injection of ligaments in the SIJ region are discussed, offering effective conservative treatment options for sacroiliac dysfunction. The review also includes detailed examination procedures and identifies the common sources of pain associated with the SIJ.
Use of antidote in poisonings due to xenobiotics taken via inhalation route
(Türkiye Klinikleri Yayınevi, 2025) Gökdağ, Eren; Yılmaz Şahin, Nurdan; Yıldırım, Cuma; Sabak, Mustafa
Industrialization, pesticides, and widespread chemical use have increased the risk of inhalational poisonings. These exposures can cause severe respiratory and systemic effects, yet specific antidotes are not available for all agents. Where available, timely administration of antidotes can be lifesaving. The article reviews antidotes employed in poisonings resulting from inhaled toxic substances, with a focus on their pharmaceutical structures, clinical applications, and adverse effects. Atropine and pralidoxime are used for nerve agents and organophosphate/carbamate poisonings; hydroxocobalamin, sodium nitrite, and thiosulfate for cyanide exposure; naloxone for opioid aerosols; and chelating agents (DMSA, DMPS, BAL, CaNa₂EDTA) for mercury and lead vapors. Conversely, no specific antidote exists for agents such as ammonia, ozone, formaldehyde, methane, and anesthetic gases.
Temporal trends and regional variations in hepatocellular carcinoma etiology: A multinational study across Asia
(Springer Nature Link, 2026) Takeuchi, Yasuto; Tateishi, Ryosuke; Obi, Shuntaro; Otsuka, Motoyuki; Mochizuki, Hitoshi; Jazag, Amarsanaa; Yokosuka, Osamu; Ogasawara, Sadahisa; Örmeci, Necati; Sarin, Shiv Kumar; Omata, Masao
Background Hepatocellular carcinoma (HCC) remains a major health burden in Asia. Advances in antiviral therapies are reshaping the etiological landscape of HCC. This study evaluated temporal shifts in HCC etiology across Asian countries and their clinical implications. Methods This multinational study analyzed 6,261 newly diagnosed HCC patients registered in the APASL Hepatology/ Oncology Consortium (A-HOC) from 19 centers across seven Asian countries and regions between 2013 and 2023. Data on demographics, tumor characteristics, etiology, and treatment patterns were collected. Etiologies included hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic liver disease (ALD), metabolic dysfunction-associated fatty liver disease (MAFLD), MAFLD plus excess alcoholic intake (MAFLD +eAL), autoimmune liver disease, cryptogenic, and others. Temporal trends and regional variations were assessed. Results In many countries, HBV remained predominant (43.3%–69.5%) and relatively stable throughout the period, while HCV showed only modest reductions. In Japan, HCV was the leading cause of HCC (33.1%), with a significant decline over time, accompanied by a rise in MAFLD-related HCC. ALD-related HCC increased in South Korea, and MAFLD-related HCC rose in Turkey. Tumor size and stage at diagnosis varied by etiology and region, affecting treatment strategies. Early stage diagnosis was more frequent in Japan and Taiwan, whereas advanced-stage HCC was common in China and Indonesia. Conclusions Distinct regional patterns and temporal changes in HCC etiology across Asia highlight the need for tailored prevention and surveillance measures. The growing burden of MAFLD-related HCC emphasizes its emerging role in liver cancer development, particularly in regions with declining viral hepatitis.

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