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A quality by design study of the use of microfluidic nanoprecipitation for the generation of sub-100 nm drug nanocrystals
(Elsevier, 2026) Pirinçci Tok, Yağmur; Abukhamees, Shorooq; Fitaihi, Rawan; Demiralp, Burcu; Özsoy, Yıldız; Craig, Duncan
Although drug nanocrystals have attracted considerable interest within the pharmaceutical industry, there remain issues with the production of nanocrystals with a size below 100 nm. The aim of the present study is to develop a stable, reproducible Canagliflozin (CFZ) sub-100 nm nanosuspension system using microfluidic nanoprecipitation and Quality by Design (QbD) techniques. By means of the circumscribed central composite design (CCCD), critical parameters of the microfluidic nanoprecipitation process and nanosuspension formula tion components were optimised. Optimal CFZ nanosuspension with Z-average of 89.52 ± 3.30 nm, PDI of 0.12 ± 0.01 and drug content of 92.49 ± 0.03 % was successfully fabricated using Soluplus as a stabiliser. An increase in saturation solubility corresponding to approximately 250 times the value of the pure CFZ in water was noted. The optimised CFZ nanosuspension was solidified by freeze-drying and electrospraying. Overall, the study has demonstrated that by using a combination of microfluidics and QbD it is promising to generate stable sub-100 nm nanocrystals with high yield, and narrow size distribution and favourable stability.
Anatomic safety profile of a novel mini external fixator for proximal crescentic osteotomy in hallux valgus correction: A cadaveric study
(Springer Nature Link, 2026) Coşkun, Osman; Nteli Chatzioglou, Gkionoul; Gürses, İlke Ali; Ok, Fatma; Gayretli, Özcan; Erdil, Mehmet
Purpose The proximal crescentic osteotomy is an effective procedure for hallux valgus correction, but stable fixation remains challenging. Our previous biomechanical study suggested that the MEF may offer comparable or greater stability than a specific cannulated screw fixation construct in a cadaveric model. This study aims to evaluate the anatomical safety of the MEF by investigating its relationship with critical neurovascular structures and tendons. Methods An anatomical dissection study was performed on ten foot cadaveric specimens. The MEF was applied using five mini-Schanz pins inserted in predefined positions. Following fixation, a layer-by-layer dissection was conducted to expose the dorsalis pedis artery, superficial cutanous branches of the foot, the superficial venous arch, and the extensor hallucis lon gus and brevis tendons. The distance from each pin to these structures and any iatrogenic injuries were recorded. Results The superficial venous arch was injured at low rates by the medial distal pin (20%), the medial proximal pin (10%), and the lateral distal pin (20%). Tendon injury was more frequent, with the extensor hallucis longus tendon being injured by 20–30% of pins, and the extensor hallucis brevis tendon by the lateral intermediate and distal pins (20% each). Conclusion The application of the MEF for first metatarsal fixation appears anatomically safe with respect to major arteries and nerves. The consistent avoidance of the dorsalis pedis artery and key sensory nerves is a significant advantage over some established techniques. However, surgeons should be aware of the potential risk to the superficial venous arch and extensor tendons during pin placement. These findings support further investigation of the MEF for proximal crescentic osteotomy f ixation.
Anatomical study of the superficial and deep circumflex iliac arteries: Morphology, variability, and surgical relevance
(Springer Nature Link, 2026) Ok, Fatma; Nteli Chatzioglou, Gkionoul; Karip, Burak; Önal, Vildan; Yıldız, Nilay; Tatar, Burak Ergün; Gayretli, Özcan
Purpose The vascular anatomy of the groin region plays an important role in reconstructive surgery and regional anesthesia, yet data on the precise morphology and topography of the superficial and deep circumflex iliac arteries remain limited. Methods 28 lower extremities of fourteen formalin-fixed male cadavers were dissected to examine the superficial and deep circumflex iliac arteries. Their origins, branching patterns, diameters, and spatial relationships to the inguinal ligament and femoral triangle were recorded. Morphometric distances were measured with a digital caliper, and correlations between parameters were analyzed statistically. Results The superficial circumflex iliac artery arose exclusively from the femoral artery in all cases and was consistently located within the femoral triangle. Its mean origin diameter was 1.83±0.46 mm. The deep circumflex iliac artery showed greater variability, originating from the external iliac artery in half of the cases and from the femoral artery in the other half. Its mean origin diameter was 2.25±0.40 mm, and it was located outside the femoral triangle in 71.4% of cases. Multiple significant correlations were identified between vessel diameters, bifurcation points, and their spatial relationships with the inguinal ligament. Conclusion The superficial circumflex iliac artery displays consistent anatomy, whereas the deep circumflex iliac artery demonstrates notable variability in origin and topography, though with stable vessel caliber. These findings provide detailed morphometric insights that may support safer flap design and improve surgical and anesthetic planning in the groin region.
Comparison of quadro‑iliac plane block and erector spinae plane block for postoperative analgesia management after single level lumbar discectomy surgery: A randomized, double‑blind, controlled, prospective, multicenter study
(Springer Nature Link, 2025) Turan, Engin İhsan; Otlu Bıyıkoğlu, Büşra; Özen, Volkan; Alver, Selçuk; Umutoğlu, Tarık; Cücü, Oğuzhan; Çevik, Serdar; Çiftçi, Bahadır; Şahin, Ayça Sultan
Purpose Effective postoperative analgesia management is critical for optimizing recovery and patient satisfaction following lumbar discectomy. Erector Spinae Plane Block (ESPB) is an established regional anesthesia technique with proven efficacy, while the novel Quadro-Iliac Plane Block (QIPB) has shown promise as an alternative approach. This study compares the analgesic efficacy, opioid-sparing potential, and safety of ESPB and QIPB in single-level lumbar discectomies. Method This multicenter, prospective, randomized, double-blind study included 60 patients aged 18–65 years undergoing single-level lumbar discectomy. Patients were randomized into ESPB (n=30) and QIPB (n=30) groups. Both blocks were performed at the end of surgery, before the extubation under ultrasound guidance using 40 ml (0.25%) bupivacaine bilater ally. The primary outcome was postoperative pain assessed by the Numeric Rating Scale (NRS) at 12 h. Secondary outcomes included tramadol consumption, rescue analgesia requirements, hemodynamic parameters, and adverse events. Results The primary outcome, 12-h NRS scores, did not differ significantly between groups (p>0.05), indicating similar anal gesic efficacy. Secondary outcomes—including total tramadol consumption (54.00±49.03 mg for ESPB vs. 44.67±44.16 mg for QIPB, p=0.476), need for rescue analgesia, and incidence of nausea and vomiting—were also comparable. No motor block was observed in either group. Conclusion Although QIPB did not demonstrate superiority over ESPB, it was found to be not inferior in analgesic effect and safety outcomes. These findings suggest that QIPB may be a reliable alternative to ESPB in lumbar discectomy procedures.
Association of health-promoting behaviors with oral health status among Turkish dental students: A cross-sectional study
(Springer Nature Link, 2026) Ballı Akgöl, Beyza; Bayram, Merve; Üstün, Nilüfer; Aksaka, Nurcan
Background: Oral health is an essential component of overall well-being, and dentistry students are expected to model healthy behaviors. However, their lifestyle habits may not always reflect this role. This study explores the relationship between oral health status and health-promoting behaviors among fourth-year dental students. While the Health-Promoting Lifestyle Profile II (HPLP II) has been widely applied, its use alongside objective oral health indices in this population remains limited. Methods: This cross-sectional study assessed health-promoting behaviors using the Health-Promoting Lifestyle Profile II (HPLP II) and evaluated oral health status using clinical indices, including Decayed, Missing, and Filled Teeth (DMFT) index, Gingival Index (GI), and Plaque Index (PI), among fourth-year dental students. Results: Students with better gingival health exhibited higher overall health-promoting lifestyle scores, particularly in the domains of nutrition and health responsibility. Similarly, participants with better plaque control demonstrated more favorable stress management behaviors. In addition, weak inverse associations were observed between dental caries experience and spiritual growth, as well as between plaque accumulation and overall health-promoting lifestyle behaviors. Conclusion: This study revealed significant links between key health promoting lifestyle domains—nutrition, stress management, and health responsibility—and oral health indicators. These findings underscore the need to integrate structured health promotion modules into dental curricula to improve students’ well-being and clinical competence.
Addressing spirituality in counseling: Turkish mental health professionals’ views on a training program for professional competencies
(Springer Nature Link, 2026) Ekşi, Halil; Turgut, Ebru Talibe; Karalı, Fatma Betül; Şen, Hale; Akyol, Havvanur; Aydın, Neslihan; Koç, Yusuf Ziya
The integration of spirituality into counseling has gained increased attention due to its significant impact on psychological well-being. However, mental health profes sionals often face challenges with incorporating spiritual dimensions into therapy, primarily due to inadequate training, conceptual ambiguity, and ethical concerns. This qualitative phenomenological study aims to explore mental health profession als’ perspectives on addressing spirituality in counseling and to assess the necessity of a specialized training program to enhance competencies in this area. We used cri terion sampling to select 11 experienced psychologists, counselors, and academics to, conduct semi-structured interviews, and analyze the data using descriptive analy sis to identify the key themes related to integrating spirituality into counseling. The findings reveal that the current training curricula does not adequately cover spir ituality, which has led to a lack of confidence among mental health professionals. The participants highlighted several barriers, including professional hesitancy, ethi cal concerns, clients’ misunderstandings, and the dominance of secular educational models. Additionally, the study identified the specific competencies needed for inte grating spirituality into counseling and categorized them into knowledge, skills, and attitudes. The professionals emphasized the need for a structured training program that includes conceptual knowledge about spirituality, evidence-based intervention techniques, ethical considerations, and culturally sensitive approaches. Furthermore, recommendations were made regarding the content, format, and evaluation methods for such a training module. The study underscores the urgent need for standardized training to equip mental health professionals with the skills required to address spir ituality in an ethical and culturally competent manner.
Complex ventral hernia repair using botulinum toxin with combination of Fasciotens® after colorectal surgery: A video vignette
(Wiley, 2026) Demirli Atıcı, Semra; Yıldırım, Yasemin; Canda, Aras Emre; Terzi, Mustafa Cem; Arslan, Çigdem; Erenler Bayraktar, İlknur; Bayraktar, Onur; Bisgin, Tayfun
Complex ventral hernia repair using botulinum toxin with combination of Fasciotens® after colorectal surgery: A video vignette
Interfacial bond strength of CAD/CAM resin composites on dentin vs. composite substrates: Influence of dual-cure and self-adhesive resin cements
(MDPI Publishing, 2026) Batgerel, Oyun Erdene; Yazıcıoğlu, Oktay; Kıtın, Emine; Gençel, Burç İhsan; Yamak, Fatih; Ergün Bozdağ, Süreyya; Sasany, Rafat
This in vitro study evaluated the shear bond strength (SBS) of four CAD/CAM (Computer aided design/Computer aided manufacturing) polymer-based indirect composites bonded to dentin and microhybrid composite substrates using two resin cements. Gradia Plus (GP), Ceramage (Ce), Tescera ATL (TA), and Lava Ultimate (LA) were fabricated into cylindrical specimens (3 × 3 mm). Dentin substrates were obtained from extracted molars, while composite substrates were prepared from Filtek Z250 (4 mm × 2 mm). Bonding was performed using either a self-adhesive resin cement (RelyX U200; RU200) or a dual-cure adhesive resin cement (RelyX Ultimate; RU), resulting in 16 experimental groups (n = 12 per group). SBS was measured using a universal testing machine (1 mm/min), and failure modes were assessed under stereomicroscopy. Bond strength was significantly higher on composite substrates than on dentin (p < 0.001), primarily due to favorable polymer– polymer compatibility and matrix interdiffusion, which improved stress accommodation at the adhesive interface. TA and Ce showed superior adhesion when combined with RU, while LA exhibited the lowest values, particularly on dentin bonded with RU200. Overall, the dual-cure adhesive system provided stronger bonding than the self-adhesive system (p < 0.05). These findings highlight the influence of substrate type, composite architecture, and cement chemistry on interfacial performance in indirect polymer-based restorations.
Long-Term endocrine outcomes with special emphasis on the gonadal impact of acute lymphoblastic leukemia treatment in females
(Springer Nature Link, 2026) Karakaş, Hasan; Tarçın, Gürkan; Bayramoğlu, Elvan; Turan, Hande; Ocak, Süheyla; Turan, Volkan; Evliyaoğlu, Olcay; Tiraje, Tiraje; Apak, Hilmi; Ercan, Oya
This study aims to explore the long-term endocrine and gonadal effects of chemotherapy and radiotherapy in female acute lymphoblastic leukemia (ALL) patients. A cohort study included girls diagnosed with ALL and treated between 2000 and 2020. Patients with at least 2 years elapsed since treatment completion were included. Endocrinological evalua tions included anthropometric measures and pubertal status, as well as fasting insulin, glucose, lipid levels, and hormone assessments for adrenal, and thyroid functions. Reproductive functions were evaluated based on gonadotropin, estradiol, and anti-Müllerian hormone (AMH) levels. A total of 51 female patients were included. At the time of study participa tion, the mean age was 14.7 years, and the mean time since treatment completion was 9.4 years. At least one endocrine disorder was present in 39.2% of participants, with dyslipidemia, insulin resistance, and obesity being the most common. Low AMH levels (<1.1 ng/dL) were found in 41.6%, particularly in those who underwent bone marrow transplantation. A significant positive correlation was found between the time elapsed since treatment and AMH levels (p<0.001, r=0.612), while age at diagnosis, risk group (standard, intermediate or high risk), and cranial radiotherapy showed no significant associations. A substantial proportion of ALL survivors developed endocrine complications, with ovarian reserve compro mised in over 40% of cases. Notably, this is the first cohort study to demonstrate a significant positive correlation between AMH levels and the time elapsed since treatment, suggesting a potential for gonadal recovery except in those exposed to intensive chemotherapy or transplantation.
Evaluation of seropositivity developed against specific antigens of helicobacter pylori in neurodegenerative diseases
(Turkish Neuropsychiatric Society, 2026) Akçin, Rüveyda; Tütüncü, Melih; Karagöz Sakallı, Nazan; Apaydın, Hülya; Bozluolçay, Melda; Can, Günay; Soysal, Aysun; Sirekbasan, Serhat; Dinç, Harika Öykü; Sarıbaş, Suat; Kocazeybek, Bekir
Introduction: It is suggested that Helicobacter pylori (Hp) can reach the brain via the oral-nasal-olfactory route, through Hp-infected monocytes in the disrupted blood-brain barrier (BBB), or through a rapid retrograde neural network leading to neurodegeneration from the gastrointestinal tract (GIS) and may lead to neurodegenerative diseases such as Alzheimer’s (AD), Parkinson’s (PD) and Multiple sclerosis (MS). In this study, we aimed to evaluate the possible immunopathogenesis relationship between Hp-specific antigens and neurodegenerative diseases by determining the frequency of seropositivity against different specific antigens of Hp in diseases such as AD, PD and MS. Methods: In our cross-sectional, retrospective case-control study, the immunoreactivity frequencies of Hp-specific and non-specific CagA (p120), VacA (p95), p75, FSH (p67), UreB (p66), HSP homolog (p57), flagellin (p54), p50, p41, p33, OMP (p30), UreA (p29), p26, OMP (p19), p17 antigens were determined by Western Blot method in 36 AD, 35 PD, 91 MS cases with Hp-IgG reactivity, and 55 controls without a neurodegenerative/demyelinating by ELISA method. Results: No significant difference was found between the immunoreactivity frequencies of Hp antigens between AD and control groups (p>0.05). In the multivariate logistic analysis performed for PD cases, age ≥ 50 and immunoreactivity frequency of p19 were found to be independent risk factors (OR: 36.752, p<0.05) (OR: 5.570, p<0.05). In MS cases, immunoreactivity frequency of p17 antigen was found to be a risk factor (OR: 2.646, p<0.05). In addition, the mean level of Hp-IgG reactivity was found to be negatively associated with MS development (indicating an inverse correlation) in the control group compared to the MS group (OR: 0.585, p < 0.05). Furthermore, logistic regression analysis in the total study group revealed that the immunoreactivity frequency of the p17 antigen was identified as a risk factor for MS (OR: 2.438, p<0.05). Conclusion: Our data on AD cases are insufficient. In PD cases, the significantly higher frequency of immunoreactivity to the Hp-p19 antigen in individuals aged ≥50 years (OR=5.570) is noteworthy. In the MS group, the significantly high detection of Hp p17 antigen and its presence as a risk factor (OR=2.646), and the significantly high detection of p26 antigen suggest the relationship between these antigens and the MS development process. However, it is a fact that new and many prospective cohort-based case-control studies are needed to reveal this more clearly.
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.
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.
ThermoMicrowave-sonication improves the stability and digestive bioaccessibility of phenolic compounds in parsley juice
(Elsevier, 2026) Yıkmış, Seydi; Tokatlı Demirok, Nazan; Duman Altan, Aylin; Paçal, İshak; Türkol, Melikenur; Tokatlı, Nazlı; Paçal, Nurettin; Abdi, Gholamreza; Aadil, Rana Muhammad
These are indications of the effects of ThermoMicrowave Sonication (TMS) on the bioactive compounds of parsley (Petroselinum crispum) juice and their bioaccessibility during in vitro digestion. Total phenolic content (TPC), iron-reducing antioxidant power (FRAP), chlorophyll, and ascorbic acid levels were measured in TMS treated and pasteurized samples. TMS minimized the loss of heat-sensitive proteins and significantly increased the phenolic content and antioxidant structure (p < 0.05). By following simulated oral, gastric, and intestinal digestion, TPC, chlorophyll, and FRAP levels were better in TMS samples than in controls or pasteurized samples. The highest recoverable levels were observed in the intestinal phase, highlighting the role of TMS in supporting functional quality after digestion. Prediction models using linear regression and LASSO showed strong accuracy (R2 > 0.99) for antioxidant capacity. Overall, TMS offers a promising, environmentally friendly, and industrially applicable tool for preserving and ensuring bioaccessibility of bioactive images in parsley juice and valuable information for functional electrical development. Chemical compounds: Gallic acid (PubChem CID:370); flovone (PubChem CID: 10680); vanillic acid (PubChem CID: 8468); rutin (PubChem CID: 5280805); naringin (PubChem CID: 442428); p- coumaric acid (PubChem CID: 637542); o- coumaric acid (PubChem CID: 637540); quercetin (PubChem CD: 5280459); alizarin (PubChem CD: 6293).
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.
Novel 1-benzyl-2-indolinone indole hybrids as tyrosine kinase inhibitors: Design, synthesis, and biological activity evaluation
(Elsevier, 2026) Cihan Üstündağ, Gökçe; Cinek, Tuğçe; Sancar, Serap; Yıldırım, Merve; Genç Akar, Öyküm; Özen Eroğlu, Güneş; Erol Bozkurt, Ayşe; Öztay, Füsun; Soylu Eter, Özge; Bolkent, Şehnaz; Kuruca, Serap; Karalı, Nilgün
In the present study, new 1-benzyl-2-indolinone indole hybrids (4a-s) were synthesized and their cytotoxic ef fects were determined against human breast (MCF-7 and MDA-MB 231), lung (A549), kidney (CAKI-1 and A498), colon (HT-29 and HCT-116), and pancreas (MIA PaCa-2) cancer cells by MTT assay. Some of the tested com pounds showed significantly better inhibitory effects and safety profiles than sunitinib malate against A498 and MIA PaCa-2 cells. Compound 4s showed a selective and significant cytotoxic effect on MIA PaCa-2 cells (IC50 = 0.15 μM; SI > 666.7). Compound 4b displayed significant cytotoxic effects on both A498 (IC50 = 0.87 μM; SI > 58.3) and MIA PaCa-2 (IC50 = 0.13 μM; SI = 390.0) cells. Compound 4b in A498 cells and compounds 4a-c, 4h, and 4s in MIA PaCa-2 cells significantly decreased general tyrosine kinase activity and induced apoptosis, accompanied by reduced ERK signalings. The inhibitory activities of compounds 4a–c, 4h, and 4s against SRC, PDGFR-β, and c-MET kinases were assessed in MIA PaCa-2 cells. Compounds 4a, 4b, 4h, and 4s inhibited PDGFR β, with 4h and 4s additionally targeting c-MET, while 4a, 4b, and 4h also demonstrated SRC inhibition. In this study, lead compounds 4b and 4s were identified as selective cytotoxic agents against human pancreatic car cinoma cells through induction of apoptosis and inhibition of SRC/PDGFR-β/c-MET signaling. Notably, com pounds 4b and 4s demonstrated a significantly better safety profile than sunitinib malate against noncancerous cells, underscoring their broader therapeutic potential. To understand their potential binding modes, molecular modeling studies were performed at the ATP-binding domains of SRC, PDGFR, and c-MET kinases.
Enhancing home-based exercise therapy with telerehabilitation in mild adolescent idiopathic scoliosis: A randomized controlled trial
(MDPI Publishing, 2025) Takinacı, Zuhal Didem; Çelik, Meltem; Yıldız, Şeyda; Talmaç, Mehmet Ali; Dut, Raziye
Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that affects postural alignment, function, and quality of life. Telere habilitation has emerged as a promising approach to enhance accessibility and conti nuity of exercise-based treatment in AIS. This study aimed to compare the effects of telerehabilitation-supported home exercise programs with standard home exercises on posture, pain, body image, and quality of life in adolescents with mild AIS. Materials and Methods: Forty adolescents aged 10–18 years with mild AIS (Cobb angle 10–25◦ , Risser 0–3) were randomly assigned to two groups: study (n = 20) and control (n = 20). Both groups performed an 8-week home-based exercise program. The study group addition ally received weekly online supervision by a physiotherapist. Outcomes included pain severity (VAS), posture (New York Posture Assessment Scale), body image (Walter Reed Visual Assessment Scale), and quality of life (SRS-22 questionnaire). Statistical analyses were performed using non-parametric tests, with a significance level of p < 0.05. Results: Twenty-nine participants completed the study (15 in the study group, 14 in the control group). Significant improvements were observed in the study group in SRS-22 total, pain, and function subscores, as well as posture scores (p < 0.05). In the control group, only the satisfaction subscore improved significantly (p < 0.05). No significant changes were detected in body image (WRVAS) in either group. Between-group comparisons showed greater overall clinical gains in the study group despite similar exercise adherence rates. Conclusions: Supervised telerehabilitation enhances the effectiveness of home-based exer cise programs in adolescents with mild AIS by improving postural alignment, reducing pain, and increasing functional capacity and quality of life. Telerehabilitation represents an accessible and efficient complementary strategy for managing AIS when in-person supervision is limited.
Radiographic medial posterior tibial slope ≥16° predicts multiple revisions after anterior cruciate ligament reconstruction
(Wiley, 2026) Kayaalp, Mahmut Enes; Inoue, Jumpei; Konstantinou, Efstathios; Kahraman, Hamit Çağlayan; Erden, Tunay; Musahl, Volker
Purpose: An increased posterior tibial slope (PTS) has been implicated as a risk factor for anterior cruciate ligament (ACL) graft failure. This matched case–control study aimed to compare radiographic and magnetic reso nance imaging (MRI)‐based PTS measurements between patients under going multiple revision anterior cruciate ligament reconstruction (ACLR) and those with successful primary ACLR and to identify thresholds predictive of high revision risk. Methods: In this matched case–control study, 156 patients were analysed: 78 patients undergoing multiple revision ACLR and 78 patients with suc cessful primary ACLR. Medial PTS was measured on radiographs, while medial, lateral and PTS difference (PTS asymmetry) were measured on MRI. Group differences were assessed using independent t tests and χ2 tests. Receiver operating characteristic (ROC) analysis identified optimal thresholds, and logistic regression quantified odds ratios (ORs) for multiple revisions per 1° increase in radiographic medial PTS, adjusting for body mass index (BMI), sex, side, height and weight. Results: Radiographic medial PTS was significantly higher in the multiple‐ revision group (12.5 ± 3.5° vs. 11.2 ± 3.0°, p = 0.016). ROC analysis identi fied an optimal medial PTS cutoff of 13° (area under the curve = 0.58, sensitivity = 0.49, specificity = 0.65), but only a PTS ≥ 16° was significantly associated with increased multiple revision risk (OR = 3.10, 95% confidence interval [CI]: 1.14–8.40; p = 0.037; specificity = 0.91; positive predictive value [PPV] = 0.70). MRI‐based medial and lateral PTSs, as well as PTS asymmetry, did not differ significantly between groups. Univariate logistic regression demonstrated a 10% increase in odds per 1° increase in radio graphic PTS (OR = 1.10, 95% CI: 1.00–1.22, p = 0.049), remaining signifi cant after adjustment for BMI, sex, side, height and weight (adjusted OR = 1.11, 95% CI: 1.01–1.23, p = 0.034). Radiographic medial PTS cor related moderately with MRI‐based medial PTS (r = 0.49, p < 0.001), but not with lateral PTS (p: n.s.). Conclusion: Radiographic medial PTS showed the strongest differentiation between successful primary ACLR and multiple‐revision ACLR. A PTS ≥ 16° identifies patients at significantly higher risk of multiple revisions, whereas MRI‐based medial PTS, lateral PTS and PTS asymmetry provide no addi tional discriminatory value. Radiographic medial PTS appears practical for preoperative risk stratification, whereas MRI‐based measures do not show similar utility. Level of Evidence: Level III.
PCOS phenotypes and hematological immune-inflammatory indices: A comparative evaluation
(Elsevier, 2025) Kından, Aykut; Kından, Goncagül; Soysal, Çağanay; Turan, Volkan
To evaluate hematological immune-inflammatory indices across different polycystic ovary syndrome (PCOS) phenotypes and assess their potential as diagnostic biomarkers. This retrospective cross-sectional study included 89 women aged 18–40 years diagnosed with PCOS according to the Rotterdam criteria, stratified into four phenotypes (A–D). Demographic, anthropometric, reproductive, biochemical, and hormonal data were extracted from clinical records. Hematological indices were calculated from complete blood counts. Group comparisons were performed using appropriate statistical tests, correlations with metabolic and hormonal parameters were assessed, and logistic regression analyses were conducted to identify independent predictors. Phenotype A demonstrated significantly higher body mass indeks (BMI), waist circumference, fasting glucose, insulin, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values compared with other phenotypes (all p < 0.01). Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), and Systemic Immune-Inflammation Index (SII) differed significantly across phenotypes, whereas Platelet-to-Lymphocyte Ratio (PLR) did not. ROC analysis revealed that SII had the highest discriminative ability (AUC=0.822, p < 0.001). NLR (AUC=0.663, p = 0.020) and MLR (AUC=0.642, p = 0.043) also showed moderate predictive value. Correlation analyses indicated positive associations of NLR and SII with total testosterone and Free Androgen Index (FAI), and negative correlations with Sex Hormone-Binding Globulin (SHBG) and High-Density Lipoprotein (HDL) cholesterol. Logistic regression identified BMI, SII, and LH/FSH ratio as independent pre dictors of specific phenotypes, further supporting their role as clinically relevant biomarkers. Hematological immune-inflammatory indices, particularly SII, may serve as cost-effective and accessible biomarkers for dis tinguishing PCOS phenotypes.
Comparative gastric microbiota profiles in non-ulcer dyspepsia and peptic ulcer patients
(Springer Nature Link, 2025) Polat Sarı, Silva; Soylu, Aliye; Peker, Kıvanç Derya; Adaş, Gökhan; Akgül, Özer; Sapmaz, Burcu; Öner, Yaşar Ali; Yüksel Mayda, Pelin; Çalışkan, Reyhan
Background Recent evidence suggests that the human stomach hosts a diverse microbiota beyond Helicobacter pylori, and that shifts in microbial composition may influence gastric health. In particular, oral-origin bacteria may dominate the gastric niche in the absence of H. pylori, yet their specific roles in different gastroduodenal disorders remain unclear. This study aimed to profile and compare the gastric microbiota composition in Turkish patients with non-ulcer dyspepsia (NUD) and peptic ulcer disease (PUD), in order to better understand microbial profiles potentially associated with gastroduodenal disease. Methods Ninety-eight patients underwent endoscopic evaluation and were divided into two groups according to the presence or absence of ulcers. Group 1 (n=52) included individuals with NUD, while Group 2 (n=46) comprised patients with PUD. Gastric biopsy samples from both groups were analyzed for the relative abundance of H. pylori using quantitative real-time PCR (qPCR), and next-generation sequencing was employed for a comprehensive analysis of the gastric microbiota. Results In total, H. pylori DNA was detected in 71.4% (70/98) of the samples, with a significantly higher prevalence in PUD patients (82.6%) compared to NUD patients (61.5%) (p=0.02). Distinct microbial profiles were observed based on H. pylori status. In NUD patients, Alloprevotella showed significantly higher relative abundance in H. pylori negative samples (p<0.05). Among PUD patients, the absence of H. pylori was associated with increased levels of Porphyromonas and Neisseria compared to NUD patients without H. pylori (p<0.05). These genera, typically associated with the oral cavity, appeared to expand opportunistically when H. pylori was absent. Conclusions The absence of H. pylori in gastric disorders was linked to a notable shift in microbiota composition, with increased representation of oral-origin bacteria such as Alloprevotella, Porphyromonas, and Neisseria. These findings, observed in a Turkish patient cohort, may reflect a potentially compensatory or opportunistic microbial shift in H. pylori-negative gastroduodenal disease. As exploratory findings, this study represents the first analysis from Türkiye comparing gastric microbiota profiles in NUD and PUD patients and provides novel regional insight into gastric microbial ecology.
Does combined pulmonary fibrosis and emphysema syndrome affect response to antifibrotic therapy and survival? A single-center retrospective cohort study
(Mattioli 1885, 2025) Teke, Nazlı Hüma; Ağca, Meltem; Türkar, Ayla; Sevim, Tülin; Tuncay, Eylem; Güngör, Sinem; Yıldırım, Elif; Özbaki, Fatma; Gündoğuş, Baran; Arınç, Sibel; Berk Takır, Huriye; Özmen, İpek
Objective: Combined pulmonary fibrosis and emphysema (CPFE) is a clinicoradiological syndrome characterized by upper lobe emphysema and lower lobe fibrosis, most commonly associated with idiopathic pulmonary fibrosis (IPF). This study compared the clinical characteristics, functional parameters, and mortality of patients with CPFE and IPF who received antifibrotic therapy. Methods: Between October 2015 and Au gust 2022, patients with IPF treated with antifibrotics for at least 6 months were retrospectively evaluated and divided into two groups: CPFE (emphysema present) and IPF (emphysema absent). Demographic data, antifi brotic therapy, functional parameters before and after treatment (FEV1%, FVC%, DLco %), clinical outcomes (hospital admissions, mortality) were compared. Results: Of the 204 patients with IPF, 90 (44%) had CPFE. CPFE patients were more often male, had greater smoking history, higher pack-years, and more lung cancer than IPF patients (p < 0.001 for all). Post-treatment FEV1% and FVC% did not significantly differ between the groups, whereas DLco% declined significantly in both (p < 0.001 and p = 0.002). DLco% decreased more in IPF than CPFE, but the difference was not statistically significant [−3 (−11–3) vs. −0.43 (−1.1–0.2), p = 0.36]. The hospital admission rates were similar. Independent risk factors for mortality included CPFE diagnosis (HR: 1.73, 95% CI: 1.06–2.83, p = 0.029), low FVC% (HR: 0.970, 95% CI: 0.96–0.98, p < 0.001), and device use (long-term oxygen therapy [LTOT] or home non-invasive mechanical ventilation [NIMV]) (HR: 2.48, 95% CI: 1.50–4.09, p < 0.001). Mean survival was shorter in patients with emphysema than in those without em physema (5.08 vs. 5.68 years, p = 0.08). Conclusions: Despite a decline in DLco%, changes remained below the futility threshold. Clinical outcomes and mortality were comparable. CPFE diagnosis, low FVC%, and LTOT/ NIMV use independently predicted higher mortality.

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