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Predicting risk of lymph node metastasis in papillary thyroid cancer using miRNAs and clinicopathological features
(Springer Nature Link, 2025) Ergün, Penbe Gül; Aydoğan, Çağatay; Ceviz, Ayşe Begüm; Candan, Gonca; Batur, Şebnem; Yılmaz Aydoğan, Hülya; Öztürk, Oğuz; Öztürk, Tülin
This study investigates potential prognostic values in models created with clinico pathological features and expression profles of miRNAs known for their critical roles in papillary thyroid carcinoma (PTC) for lymph node metastasis (LNM) in PTC cases. Forty-seven lymph node-metastatic PTC patients and 46 non-metastatic patients were included. Using RT-PCR, miR-21, miR-146b, miR-221, and miR-222 expression was analyzed in carcinoma tissues and metastatic lymph nodes of the same PTC patients and carcinoma tissues of non-metastatic PTC patients. MiR 146b (p<0.001) and miR-221 (p=0.009) were overexpressed in metastatic PTCs compared to non-metastatic PTCs. The miRNA expression profles were similar in the lymph nodes and primary cancer of metastatic PTCs. In the presence of larger tumors (>1 cm) in metastatic PTCs, miR-146b and miR221 were overexpressed in the tumor tissue (p=0.036), while miR-222 was overexpressed in metastatic lymph nodes (p=0.035). miR-146b was also upregulated in lack of peritumoral lympho cyte infltration (p=0.006). In conclusion, our fndings suggest that the overexpres sion of miR-146b and miR-221 in PTC tissues may be associated with lymph node metastasis and a poorer prognosis. Furthermore, the presence of larger tumors and increased levels of intratumoral fbrosis in non-metastatic PTC patients could indi cate a poor prognosis.
Antihypertensive treatment of a patient with normal blood pressure: Case report and call for paying attention
(Wolters Kluwer, 2025) Atmaca, Hasan; Erol, Mustafa Kemal; Yetkin, Ertan
The current 2024 European Society of Cardiology (ESC) guideline for the management of elevated blood pressure and hypertension defines blood pressure less than 115/65 mmHg by ambulatory blood pressure monitoring (ABPM) as nonelevated, blood pressures in-between 115–129 and 65–79 mmHg as elevated blood pressure, and hypertension as ≥130/80 mmHg. There, might be patients seeking medical attention for the symptoms, apparently nonspecific but suggestive of hypertension with optimal, or not elevated, or elevated blood pressure values. A female patient with complaints of headache and dizziness lasting for 2 months has been evaluated in cardiology outpatient clinic and assessed by ABPM. It has been told that she had previously blood pressure of 90–100/50–60 mmHg and was suffering from headache when systolic blood pressure exceeds 110 mmHg. Her 24-h ABPM revealed systolic and diastolic blood pressure as 106/63 mmHg showing nighttime decrease compared with daytime pressures (98/59 mmHg and 108/68 mmHg, respectively). Thereafter, she was instructed to keep continuing the life-style modification and given to beta-blocker (bisoprolol 5 mg) as an antihypertensive treatment. At the end of the 2 weeks of follow-up period, she was headache-free and was feeling comfortable and well with a mean home blood pressure of 98/56 mmHg. We have presented prosperous antihypertensive treatment of a female patient suffering from headache and dizziness with a numerically normal or nonelevated blood pressure. In the presence of symptoms and having not elevated or elevated blood pressure levels, patients’ history on previous measure of blood pressure might facilitate our decision-making process.
Suicide risk in psychiatric patients: An analysis of demographic and psychosocial factors
(SOCIAL SCIENCES STUDIES JOURNAL, 2025) Er, Filiz; Duyan, Veli; Özkan, Cengiz; Taymur, İbrahim
The aim of this study is to assess the likelihood of suicide in patients diagnosed with psychiatric disorders and currently receiving treatment, and to examine the relationship between this likelihood and demographic data, as well as psychosocial factors. Using a descriptive and cross sectional model, the data from 165 participants were collected and evaluated through a personal information form and the Suicide Probability Scale (SPS). The study revealed significant relationships between suicide risk and variables such as age, education level, marital status, place of residence, and types of social support. It was also highlighted that the participants generally had a negative perception of their psychological health, and individuals lacking emotional social support showed higher levels of hopelessness and negative self-concept. Furthermore, individuals receiving low social support were found to have a higher suicide risk. The findings indicate that social work professionals can play a significant role in identifying individuals at risk for suicide and developing preventive measures. These results point to the necessity of strengthening social support systems and improving psychological health services.
GWAS analysis of sudden cardiac death cases in a Turkish population
(İstanbul University Press, 2025) Özel Cavlak, Gülay; Cavlak, Mehmet; Kınoğlu, Kubilay; Ceviz, Ayşe Begüm; Eronat, Allison Pınar; Kobak, Işıl; Şam, Bülent; Yıldız, Mustafa; Bayraktar, Bülent; Yılmaz Aydoğan, Hülya; Öztürk, Oğuz
Objective: Sudden death is defined as death occurring within one hour of the onset of symptoms, with cardiovascular diseases being one of the leading causes. The most common genetic factors leading to sudden cardiac death are hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomy6 opathy. In some cases, autopsies may reveal no evidence of long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, or Brugada Syndrome. Materials and Methods: We collected samples from sudden cardiac death cases aged 5–40 years (arrhythmia as Group 1, hypertrophy as Group 2, and ischemic heart disease as Group 3), as well as from healthy athletes (control group as Group 4), and analyzed them using genome6wide association study (GWAS) with a DNA microchip containing 196,725 single nucleotide polymorphism (SNP) markers thought to be associated with sudden cardiac death or other cardiovascular diseases. Results: We detected any possible genetic variations or patterns that could elucidate the mechanisms underlying sudden cardiac death in a Turkish population. In our study group, two polymorphisms; rs2971851 and rs9609516, stood out as prominent variants compared with healthy elite athletes. Conclusion: We aimed to identify potential genetic variations or patterns that could shed light on the mechanisms underlying sudden cardiac death in the Turkish population. In our study group, two poly6 morphisms, rs2971851 and rs9609516, emerged as prominent variants when compared to healthy athletes.
Dual etiology vs. MetALD: how MAFLD and MASLD address liver diseases coexistence
(OAE Publishing, 2025) Zerehpooshnesfchi, Shadi; Lonardo, Amedeo; Fan, Jian-Gao; Elwakil, Reda; Tanwandee, Tawesak; Altarrah, Munira; Örmeci, Necati; Eslam, Mohammed
Fatty liver disease associated with metabolic dysfunction has emerged as a significant global health challenge. This condition often coexists with other liver diseases, such as alcohol-related liver disease and viral hepatitis, complicating both diagnosis and management. To address the limitations of the non-alcoholic fatty liver disease (NAFLD) classification, two alternative frameworks have been proposed: metabolic dysfunction-associated fatty liver disease (MAFLD) in 2020 and metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. A key difference between these definitions is how they consider fatty liver disease in relation to the coexistence of other liver conditions. MAFLD adopts a dual etiology concept, creating a unified classification system that aligns with contemporary clinical and epidemiological needs. In contrast, MASLD introduces a new term, MetALD (metabolic and alcohol-related/associated liver disease), to describe patients who have both metabolic dysfunction and excessive alcohol intake. This review critically examines the clinical, research, and epidemiological implications of the differing approaches of MAFLD and MASLD, offering insights into their potential to enhance the understanding and management of multi-etiology liver diseases.
Early stage effectiveness of the automated insulin delivery system—is artificial intelligence really effective?
(AVES, 2025) Çetin, Ferhat; Göncüoğlu, Enver Şükrü; Abalı, Saygın; Arslanoğlu, İlknur; Deyneli, Oğuzhan; Telci Çaklılı, Özge; Yalın Turna, Hülya; Şahiner, Elif; Güzel, Dila; Yılmaz, Mehmet Temel
Objective: This study aimed to evaluate the effectiveness of the self-learning capabilities of artificial intelligence (AI) algorithms. The hypothesis was that if the success of closed-loop insulin delivery is mainly attributed to AI algorithms, then the improvement in glycemic control would be more signifi cant just after the “learning” phase. Methods: The Medtrum A8 TouchCare® Nano system was used on 15 patients with type 1 diabetes. Daily continuous glucose monitoring (CGM) data pre-automated insulin delivery (AID) was statisti cally compared with the post-AID period. Results: Patients (median age 32 (6-54) years, 40% female) had a median HbA1c of 8.4% (5.3-10.7) before initiation of AID and a median GMI of 6.6% (5.8-8.3) after 2 weeks. The shifts in glycemia and glycemic variability between the 5-day period pre-AID vs. the first day and the 3 5-day periods post-AID were significant (pre-AID vs. 1-5-10-15 days; time in range (TIR, %): 55.9 vs. 76.6-81.7-83.8- 81.5 (P=.001); Q1 (mg/dL): 123 vs. 112-108-106-110 (P=.009); Q3 (mg/dL): 204 vs. 176-173-168-169 (P=.004); inter-quarter range (IQR, mg/dL): 78 vs. 57.2-56.6-53-55 (P=.002)). The biggest shift in TIR was achieved in the first day (10.1%). Comparative analysis of the 5-day intervals post-AID was insig nificant by means of the improvement in glycemia (P > .05). No significant change in glycemic param eters between 15, 30, and 90 days were noted (P > .05). Conclusion: Artificial intelligence-augmented AID becomes effective at the very early stages of initia tion. There is a need for further research into glycemic changes in the early days of AID initiation to better define the principles of initiating AID systems.
Cytotoxic and anti-migratory effects of polyphenolic compounds on breast cancer cells by altering Jam-A, LFA-1, and VLA-4 gene expression
(Taylor & Francis, 2025) Özkara, Gülçin; Ceviz, Ayşe Begüm; Eronat, Allison Pinar; Pehlevan Karabıyık, Funda; Candan, Gonca; Özturk, Oğuz; Yılmaz Aydoğan, Hülya
This study represents the initial research of the effects of a com bination of the largest number (13) of different polyphenic sub stances (PFK5120), formulated based on the propolis content on cell viability, migration and expression of lymphocyte function-associated antigen-1 (LFA-1), very late antigen-4 (VLA-4) and junction adhesion molecule A (Jam-A) in breast cancer (BC) cells. PFK5120 negatively affected cell viability at a 5% concentra tion as compared with unexposed ones (p<0.001). Treatment with 20% PFK5120 for 48h down-regulated Jam-A in MCF-7 and MCF-10A, up-regulated LFA-1 in MCF-10A and MDA-MB-231, and down-regulated VLA-4 in MCF-10A and MDA-MB-231 (p<0.001). Furthermore, migration was found to be inhibited by PFK5120 at varying doses and times. Migration was completely inhibited by 35% PFK5120 treatment in MDA-MB-231, while even lower concen trations (10%) were effective in MCF-7. Current findings indicate that PFK5120 represents a valuable natural component of BC ther apy through its cytotoxic and anti-migratory effects.
Evaluation of demographic, clinical, laboratory findings and treatments of our cases with febrile convulsions: A descriptive research
(Turkiye Klinikleri Yayınevi, 2025) Özdil Yılmaz, İlkiz Özge; Karal, Yasemin
Objective: In this study, we aimed to determine the sociodemographic, clinical and laboratory characteristics, responses to treatment options, and risk factors for the development of epilepsy in cases who presented to our clinic with febrile convulsions (FC) and were diagnosed with FC. Material and Methods: 200 patients who applied to Trakya University Faculty of Medicine, Department of Pediatrics Outpatient Clinic and Child Neurology Polyclinic between January 2014-December 2018 and were diagnosed with febrile convulsion were evaluated retrospectively. In recurrent simple febrile convulsions and in all complicated febrile convulsions, electroencephalography (EEG) was performed. In case of abnormal EEG findings, appropriate treatment was started. Results: The male/female ratio was 1.22/1, 78% were term births. The average age at diagnosis was 21.82±12.69 months. 52.5% were complicated. The common source of fever was upper respiratory tract infection (83%). 10% had a family history of epilepsy and 25% had a history of febrile convulsions. The recurrence rate was 22.5%. Abnormal EEG was detected in 8% of the patients. Patients with recurrence had higher platelet counts and patients with epilepsy had higher C-reactive protein levels. Conclusion: Epilepsy was observed in %13 of febrile convulsions. The rate of epilepsy diagnosis was high in those with abnormal EEG (81%). As a result; monitoring of febrile convulsions is important due to the increased risk of epilepsy and frequent recurrence compared to the general population. Although we found no significant difference between treatment options in preventing recurrence, rectal diazepamand antipyretics may be preferred since it is easy to apply and has few side effects.
Neural therapy in migraine: Clinical evidence for a holistic therapeutic approach - analysis of 464 cases
(Salient Visionary Publications LLC, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin; Bilgin, Mehmet Dinçer; Acarkan, Tijen; Özkan, Neslihan; Tamam, Yusuf
Background: Migraine is one of the most common neurological disorders and significantly impairs quality of life. While conventional therapies may alleviate symptoms, they often fail to address the underlying causes. Neural therapy is a therapeutic approach in which local anesthetics such as procaine or lidocaine are not primarily used for analgesia but rather to modulate the autonomic nervous system, particularly its sympathetic branch. This method aims to restore functional balance and stabilize dysregulated networks through segmental and systemic reflex pathways, thereby supporting a holistic regulatory effect. Objective: This retrospective study aims to evaluate the effectiveness of neural therapy in 464 migraine patients using a holistic, regulatory medical approach. Methods: Patient history forms were analyzed for hormonal dysregulation, intestinal dysbiosis, temporomandibular dysfunction, C2 vertebral blockage, hydration status, and interference fields. Additionally, clinical treatment progressions were statistically assessed. Results: Over 91% of patients demonstrated clinical improvement, and 60% became symptom-free. The most frequently observed contributing factors were intestinal dysbiosis (89%), hormonal imbalance (71%), and temporomandibular/C2 dysfunctions (43% each). Conclusion: Neural therapy is an effective and regulatory therapeutic option for migraines, particularly in chronic, multifactorial cases. Its integration into a holistic treatment strategy may yield substantial clinical benefits.
Staphylococcus aureus as a signature species of skin microbiome in actinic keratosis and squamous cell carcinoma: A narrative review
(Wolters Kluwer, 2025) Duman, Nilay; Oraloğlu, Göktürk; Ece, Deniz; Caner, Ayşe
Cutaneous squamous cell carcinoma (cSCC) is a common type of skin cancer and the second most common type of nonmelanoma skin cancer. Actinic keratosis (AK) is a premalignant lesion that can progress to cSCC over time. AK and cSCC are associated with microbial dysbiosis and an increased abundance of the bacterium Staphylococcus aureus. Although AK and cSCC are highly colonized with S. aureus, a bacterium of the skin microbiota, it is not yet known whether this bacterium is associated with cancer development. Here, we analyze the studies on the relationship between S. aureus and keratinocytic skin neoplasia, evaluating the contribution of S. aureus to the development and prognosis of cSCC and AK lesions. The overabundance of S. aureus and the compounds secreted by this bacterium can induce cancer‑promoting changes in skin cells. The presence of high amounts of certain S. aureus strains in premalignant skin lesions may constitute a protumorigenic stimulus by inducing oxidative stress and DNA damage and downregulating DNA repair mechanisms. S. aureus associated with AK and cSCC can trigger keratinocytes to produce inflammatory cytokines typically upregulated in cSCC. These circumstances also suggest a potential specific involvement of S. aureus in the progression from AK to cSCC.
Clinical characteristics and development of complications differ between adult-onset and child–adolescent-onset type 1 diabetes: A report from a tertiary medical center in Türkiye
(Wiley, 2025) Çakmak, Ramazan; Telci Çaklılı, Özge; Ok, Ayşe Merve; Mutlu, Ümmü; Sarıbeyliler, Göktuğ; Seferova Nasifova, Vefa; Bilgin, Ersel; Çoşkun, Aylin; Güzey, Damla Yenersu; Satman, İlhan
Background and Aims: The age-at-onset is of great importance in the heterogeneity of Type 1 diabetes mellitus (T1DM). This study was designed to define clinical and laboratory differences between child–adolescent-onset and adult-onset T1DM at presentation and during follow-up and determine the predicting factors for developing microvascular and macrovascular complications. Material and Methods: This retrospective observational study evaluated T1DM patients who were followed in the diabetes outpatient clinic between January 1, 2000, and December 31, 2019. Results: The study cohort included 490 individuals with T1DM (54.3% female, 58.8% adult-onset, and median follow-up: 5 years). In the adult-onset group, baseline C-peptide and GADA prevalence were higher, whereas presentation with ketoacidosis was 2.3-fold lower compared to the child–adolescent-onset group (p < 0.001). During follow-up, the adult-onset group had a 2.4-fold higher overweight/obesity (p < 0.001) and 1.7-fold higher dyslipidemia/hyperlipidemia (p = 0.002) than the child–adolescent-onset group. In multivariate analysis, fasting glucose (p = 0.024) in adult-onset, dyslipidemia/hyperlipidemia (p = 0.037) in child–adolescent-onset, and diabetes duration (p = 0.008 and p = 0.007) and hypertension (p = 0.001 and p = 0.01) in both groups were associated with increased risk of microvascular complications, whereas age-at-onset (p = 0.024), dyslipidemia/hyperlipidemia (p = 0.03), nephropathy (p = 0.003), and neuropathy (p = 0.001) in adult-onset and age (p = 0.002) and triglycerides (p = 0.013) in child–adolescent-onset groups were associated with increased risk of macrovascular complications. The cutoff C-peptide levels at baseline predicted microvascular complications in the whole cohort and adult-onset group were defined as 0.383 ng/mL (p < 0.001) and 0.41 ng/mL (p = 0.001), respectively. In the Kaplan–Meier analysis, C-peptide (< 0.383 ng/mL) but not age-at-onset predicted future development of microvascular and macrovascular complications (p = 0.003 and p = 0.032). Conclusion: Clinical presentation and prognosis differ in adult-onset and child–adolescent-onset T1DM. Low initial C-peptide may predict the development of microvascular and macrovascular complications.
Neural therapy as a key modulator in non-specific low back pain
(Salient Visionary Publications LLC, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin; Özkan, Neslihan; Tamam, Yusuf; Acarkan, Tijen; Elmacıoğlu, Mehmet Ali; Bilgin, Mehmet Dinçer
Background: Non-specific low back pain (NSLBP) is a widespread musculoskeletal disorder with multifactorial origins, including postural dysfunctions, myofascial imbalances, autonomic dysregulation, and psychosocial influences. Differentiating between functional and degenerative causes is crucial for treatment planning. Conventional therapies often fall short, particularly in chronic cases. This study evaluate the efficacy of neural therapy as a regulatory, minimally invasive treatment option for NSLBP. Methods: This retrospective analysis includes 1,242 patients treated at the Natural Health Clinic between 2017 and 2024. Patients underwent neural therapy targeting modulation of the autonomic nervous system (ANS), resolving interference fields, and treating myofascial trigger points. Treatment duration, symptom severity (VAS, ODI), and functional improvement were assessed, with stratification by age and chronicity. Results: Neural therapy led to complete symptom resolution in 29% of cases and marked improvement in 35%, with only 2% reporting worsening symptoms. Most patients required between 2 and 4 sessions; fewer than 10% needed over 12 sessions. Age and symptom duration correlated with treatment intensity—older and long-term chronic patients often needed more sessions. Combined with manual medicine, neural therapy enhanced outcomes by addressing vegetative dysfunctions, neurogenic inflammation, and segmental restrictions. Conclusion: Neural therapy offers a compelling integrative approach for both functional and degenerative NSLBP. Its ability to regulate autonomic dysfunctions, reduce chronic inflammation, and address underlying interference fields positions it as a practical component of multimodal pain management. The retrospective data from over 1,200 patients underscores its clinical relevance, especially for middle-aged and older adults with chronic symptoms.
The significance of thoracic blockages for the autonomic nervous system – neural therapy and its clinical relevance
(Sci Vision Publishers, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin; Tamam, Yusuf; Oettmeier, Ralf; Acarkan, Tijen; Reuter, Uwe Rudolf Max
Background: Thoracic blockages not only present as mechanical movement restrictions but also influence a wide range of physiological processes due to their close connection with the autonomic nervous system, particularly the sympathetic nervous system. Persistent sympathetic activation can lead to autonomic dysfunctions, organ disorders, hormonal imbalances, metabolic diseases, myofascial pain syndromes, and circulatory disturbances. Methods: This study analyzes the pathophysiological mechanisms of thoracic blockages and their impact on the spinal and autonomic nervous systems. The primary focus is on the interplay between sympathetic hyperactivity, impaired microcirculation, and the formation of myofascial trigger points. Results: Chronic thoracic blockages can induce reflexive hypertonia of the paravertebral musculature, leading to pain, organ dysfunction, and central nervous system sensitization. This exacerbates muscular imbalances and contributes to the chronicity of pain syndromes. Therapy: Combining neural therapy and manual medicine offers an integrative approach to restoring disrupted physiological balance. While neural therapy targets sympathetic dysregulation and modulates interference fields, manual medicine helps restore mobility and reduce muscular dysfunction. Conclusion: Effective treatment of thoracic blockages requires an interdisciplinary approach that addresses both neurovegetative and mechanical aspects. The combination of neural therapy and manual medicine is an effective method for sustainably regulating structural and functional imbalances while reducing healthcare costs.
Reply to the letter to the editor: 'Coronary atherosclerosis burden and coronary artery tortuosity'
(Kare Publishing, 2025) Özyaşar, Mehmet; Doğduş, Mustafa; Yılmaz, Ahmet; Altıntaş, Mehmet Sait; Yetkin, Ertan
To the Editor, First, we would like to thank the author1 and the editorial team for their attention to and interest in our work. We deeply value your constructive criticism and contributions, which we see as an opportunity for further improvement. Collateral circulation plays a significant role in the prognosis of coronary artery disease.2 We acknowledge the importance of considering the effect of collateral circulation when calculating Gensini scores.3 In our retrospective study, while evaluating cases of chronic coronary syndrome that underwent coronary angiography, the coronary collateral flow assessment (Rentrop) score (3) was 0 in all cases. However, we accept that this detail should have been clarified more explicitly in our article. Our study aimed to minimize confounding factors as much as possible to realistically examine the relationship between coronary artery tortuosity and coronary atherosclerosis. While we acknowledged in the limitations section of our study that this might introduce a potential bias in patient selection,4 we accept that it would have been beneficial to explicitly state that we sought to eliminate the effect of collateral circulation. One of the key strengths of our study is the large patient cohort, along with the meticulous exclusion of other confounding factors. In conclusion, while recognizing the importance of collateral circulation, we believe that our study provides important information about the relationship between coronary artery tortuosity and atherosclerotic plaque burden. We hope this research contributes to a deeper understanding of coronary artery disease and offers a new perspective for future studies.
The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease
(Springer, 2025) Eslam, Mohammed; Fan, Jian-Gao; Yu, Ming-Lung; Wong, Vincent Wai-Sun; Cua, Ian Homer; Liu, Chun-Jen; Tanwandee, Tawesak; Örmeci, Necati; K. Sarin, Shiv; George, Jacob
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.
Acute-on-chronic liver failure (ACLF): The ‘Kyoto consensus’-steps from Asia
(Springer, 2025) Choudhury, Ashok; Kulkarni, Anand V.; Arora, Vinod; Sood, Ajit; Dökmeci, Abdul Kadir; Chowdhury, Abhijeet; Koshy, Abraham; Duseja, Ajay; Örmeci, Necati; Mishra, Ajay Kumar
Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplanta tion. There have been various defnitions proposed worldwide. The frst consensus report of the working party of the Asian Pacifc Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the “APASL ACLF Research Consortium (AARC)” was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia–Pacifc region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the ‘Golden Therapeutic Window’, the ‘transplant window’, and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these defnitions to be equally efective in their respective cohorts in identifying patients with high mortality. To overcome the diferences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the feld of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The ‘Kyoto APASL Consensus’ presented below carries the fnal recommendations along with the relevant background information and areas requiring future studies.
Fibromyalgia syndrome (FMS): Neural therapy as a key to pain reduction and quality of life
(Salient Visionary Publications LLC, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin
Fibromyalgia syndrome (FMS) is a complex chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairments. Its global prevalence is estimated at 2–3%, with women between the ages of 30 and 60 being most commonly affected. The pathophysiology of FMS is multifactorial, involving central sensitization processes, dysfunctions of pain inhibition mechanisms, and chronic inflammatory and neuroendocrine disturbances. Pathophysiological Mechanisms: Central sensitization: Increased pain processing in the central nervous system. Neuroendocrine dysfunction: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol and serotonin levels. Lymphatic dysfunction: Edema, inflammation, and accumulation of toxins. Silent inflammation: Chronic inflammatory processes with elevated cytokine activity (e.g., TNF-α, IL-6). Neural Therapy as a Treatment Approach Neural therapy addresses autonomic dysregulation and restores the balance between the sympathetic and parasympathetic nervous systems. Key therapeutic strategies include: Local infiltrations: Procaine or lidocaine injections to reduce pain sensitivity. Segmental therapy: Treatment of spinal reflex zones to regulate the autonomic nervous system. Interference field therapy: Identification and treatment of chronic irritative foci. Adjunctive measures, such as manual lymphatic drainage, anti-inflammatory nutrition, and micronutrient therapy, can enhance treatment efficacy. The combination of neural therapy and regulatory medicine shows promising results in reducing pain, improving sleep quality, and restoring quality of life.
The effect of patient education in treatment of fibromyalgia: A randomized controlled trial
(Kare Publishing, 2025) Aşık, Hatice Kübra; Demir, Saliha Eroğlu; Özaras, Nihal; Rezvani, Aylin; Aydın, Teoman; Güler, Mustafa; Poşul, Sevde; Poyraz, Emine
Objective: Fibromyalgia syndrome (FMS) can be treated with a variety of pharmaceutical and non-pharmacological approaches. The purpose of this study was to evaluate the effects of patient education and a home exercise program on FMS patients' pain, fatigue, functioning, and quality of life. Materials and Methods: The study included patients who satisfied the American College of Rheumatology's FMS criteria. They were split up into two groups at random. A schedule of at-home exercise was given to both groups. Furthermore, Group 2 patients participated in patient education sessions. At baseline and eight weeks later, both groups underwent examinations. Evaluation criteria included the Nottingham Health Profile (NHP) for quality of life, the Beck Depression Inventory (BDI) for psychological status, the Visual Analogue Scale for pain severity (VASp) and exhaustion (VASf), and the Fibromyalgia Impact Questionnaire (FIQ) for functional status. Results: The primary clinical and demographic characteristics of the two groups were comparable at baseline. Although the values of VASp (p=0.014), VASf (p=0.011), BDI (p=0.043), NHP subscales (p<0.05), FIQ (p=0.012) showed statistically significant improvements in Group 2, only Group 1's FIQ score significantly improved (p=0.027). There were substantial differences in VASp (p=0.026), VASf (p<0.001), BDI (p<0.001), and all NHP subscales except sleep problems, FIQ scores (p=0.036) between the two groups in favor of Group 2 at the end of eight weeks. Conclusion: Patients with FMS should receive patient education in addition to home-based exercise, which is an effective treatment for reducing symptoms, enhancing psychological well-being, and improving quality of life.
Diaphragmatic dysfunctions and their treatment: Neural therapy and manual medicine as effective approaches
(Salient Visionary Publications, 2025) Ural Nazlıkul, Fatma Gülçin; Nazlıkul, Hüseyin
Diaphragmatic dysfunctions are a medical issue whose relevance is often underestimated. They manifest in respiratory and systemic symptoms such as dyspnea, sleep disturbances, chronic fatigue, gastroesophageal reflux, and even heart failure. As the primary respiratory muscle, the diaphragm is pivotal in maintaining trunk stability and regulating intra-abdominal pressure, making its dysfunction capable of exerting profound impacts on overall health. Causes and Pathophysiology of Diaphragmatic Dysfunctions: Diaphragmatic dysfunctions can arise from a variety of factors, including: Chronic stress, which increases tension in the diaphragm and surrounding fascia, Myofascial trigger points, which impair muscle contraction and mobility, Scar tissue, which limits fascial mobility, Trauma, surgeries, or mechanical stress, which may irritate or impair the function of the phrenic nerve. The phrenic nerve, which innervates the diaphragm, plays a crucial role in the functionality of this muscle. Irritation or damage to the phrenic nerve can significantly impair diaphragmatic movement, leading not only to breathing difficulties but also to dysregulation of the autonomic nervous system and organ functions. Treatment Approaches: The combination of neural therapy and manual medicine has proven to be particularly effective in treating diaphragmatic dysfunctions. Injections targeting myofascial trigger points and segmental therapy can support diaphragmatic function. Manual diagnostics play a critical role in identifying segmental dysfunctions and fascial adhesions.
Ergenlik öncesi bir kızda vajinada yabancı cisim
(Türkiye Klinikleri Yayınevi, 2025) Uğur Baysal, Serpil; Totur, Gülberat; Yavuz, Onur
Kız çocuklarında tekrarlayan vajinal akıntı ya da kanama yakınması, özellikle standart tedaviye dirençli ise vajinada yabancı cisim varlığını düşündürmelidir. En sık tuvalet kâğıdı saptanırken, madeni para, boncuk, küçük oyuncaklar ve çengelli iğne gibi farklı objeler de bildirilmiştir. Bu nedenle, benzer semptomlarla başvuran hastalarda ayrıntılı değerlendirme kritik öneme sahiptir. Sekiz yaşında bir kız çocuğu, 4 aydır aralıklı âdet kanaması olduğu ileri sürülerek polikliniğe getirildi. Ağrı, ateş ve travma öyküsü yoktu. Dış merkezde yapılan tetkiklerde erken puberte ve koagülasyon bozukluğu dışlanmış, pelvik görüntüleme normal bulunmuştu. Cinsel istismar açısından çocuk ve aile ile ayrı ayrı görüşüldü, cinsel istismar dışlandı. Fizik muayenede vulvada ciltte hiperemi dışında patoloji saptanmadı. Külotunda kahverengi akıntı görüldü. Laboratuvar incelemelerinde anormallik yoktu. Kadın hastalıkları ve doğum ana bilim dalından konsültasyon istendi, vajinada yabancı cisim görülerek çok küçük bir parça tuvalet kâğıdı çıkarıldı. Vajinadan kanama olgularında ayırıcı tanıda vulvovajinit, yabancı cisim, cinsel istismar, travma, puberte prekoks ve tümörler yer almalıdır. Puberte öncesi ortaya çıkan vajinal kanamalarda öncelikle yabancı cisim düşünülmelidir.

Güncel Gönderiler