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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.
Women’s experiences of breastfeeding during pregnancy: A Turkish descriptive study
(Springer Nature Link, 2025) Bayraktar, Sema; İnce, Zeynep; Yıldız, Nevin; Eski, Nuray; Çoban, Emine Asuman
Background Breastfeeding is generally terminated when the mother becomes pregnant again within two years because there is no clear consensus on how to manage breastfeeding during pregnancy. Additionally, health professionals may not have accurate information about this issue. This study aimed to determine women’s attitudes towards breastfeeding during pregnancy and why they stopped breastfeeding when they became pregnant. Methods This study is a descriptive one, involving pregnant mothers with a breastfeeding infant under 2 years old (n=101). The participants were followed up regarding those who had given birth to a new child and chosen the BDP. The researchers surveyed them after birth. The data were collected using a survey form that included a total of 26 questions created by the researchers, which aligned with the existing literature. Data were collected using a questionnaire that included information about maternal, neonatal, and obstetrical data, as well as breastfeeding experience and problems encountered during pregnancy. Data were handled and analyzed using IBM SPSS Statistics v22.0 (SPSS Inc., Chicago, IL, USA). Results The mean age of the mothers was 29.3 years (SD±4.9), gravidity was 3.2 (SD±1.7), and parity was 2.5 (SD±1.1). The mean age of the breastfed children was 12.6 months (SD±5.3) when the mothers became pregnant again. The reasons for stopping breastfeeding were professional advice (35%, n=34), their own decision (30%, n=30), believing that breastfeeding could have adverse effects on the unborn baby, and social pressure (16%). Only 5% (n=5) of mothers continued breastfeeding between 7 and 9 months after pregnancy. Conclusions Our results indicate that when a mother wishes to breastfeed during pregnancy, providing breastfeeding counseling by healthcare professionals with accurate information is essential to sustain lactation and maintain the well-being of the breastfeeding child without harm to the unborn baby.
Impact of lightness differences in digitally simulated composite resin restorations on perceived smile attractiveness
(Wiley, 2025) Ntovas, Panagiotis; Ünal, Tuna; Korkut, Bora; Ferraris, Federico; Fehmer, Vincent; Sailer, Irena
Objectives: To investigate the effect of lightness differences between digitally simulated composite restorations and anterior maxillary teeth, in combination with restoration type, and clinical experience on perceived smile attractiveness. Materials and Methods: An imaging software program (Adobe Photoshop CC 2023) was used to digitally manipulate a frontal full-face portrait of a smiling female model, to create five types of moderate-sized composite resin restorations of moderate size. For each restoration 14 lightness differences were simulated. The image was digitally modified to simulate five different types of composite resin restorations (Class III, Class IV, Class V, diastema closure (bilateral and unilateral approach)). Each restoration was adjusted through 7 incremental increases and 7 incremental decreases of 1 unit in lightness (L* value), yielding a total of 70 images. The smile attractiveness of each picture was rated by 80 dentists and 80 laypersons, ranged from 21 to 77years using a visual analog scale. The Wilcoxon signed-rank test was employed to assess whether the mean of a sample significantly differed from the control (p<0.05). Results: Among the different restoration types, crown fracture repairs (Class IV) had the greatest negative impact, followed by proximal restorations (Class III), diastema closures (Bilateral approach), diastema closures (Unilateral approach), and, lastly, cervical restorations (Class V), which had the least impact on perceived smile attractiveness (p≤0.05). The influence of lightness differences, whether toward a darker or lighter restoration, was dependent on both the type of restoration and the observer's experience. Conclusions: The effect of lightness difference on perceived smile attractiveness was significantly influenced by both the type of composite resin restoration and the observer's experience. Dental professionals perceived lightness discrepancies as less attrac tive compared to laypersons, suggesting that experience plays a key role in the perception of esthetic outcomes. Clinical Significance: The repositioning of an esthetic direct dental restoration is highly influenced by the dentist's chromatic perception which is more sensitive than that of a layperson who evaluates its matching with the natural tooth. The findings of the present study can support evidence-based clinical decision-making.
Complementary and integrative medicine for the treatment of tourette’s syndrome
(Wiley, 2025) Pringsheim, Tamara; Deans, Catherine; Anis, Saar; Bhatia, Poonam; Black, Kevin; Değirmenci, Yıldız; Gilbert, Donald; Hartmann, Andreas; Hull, Mariam; Malaty, Irene
Background: There is widespread interest in complementary and integrative medicine (CIM) among people with Tourette's syndrome (TS). Objective: To perform a systematic review of evidence on the use of CIM to reduce tics and improve tic-related quality of life. Methods: We included clinical studies of CIM in children, adolescents and adults with TS and chronic tic disorders, and assessed the change in tic severity and/or tic-related quality of life using validated scales. Risk of bias of randomized controlled trials was assessed using the risk of bias tool of the American Academy of Neurology, which classifies studies into Class I, II, III or IV based on quality criteria. Results: 49 clinical studies and three systematic reviews were included. Most studies were rated Class IV and therefore at high risk of bias. Class I studies demonstrated efficacy of functional MRI neurofeedback, 5-Ling granule, Jingxin Zhidong formula, and Ningdong granule in reducing tic severity. Class II studies suggest efficacy of mindfulness-based intervention for tics, acupuncture combined with atlantoaxial joint bone setting therapy, and art therapy. Systematic reviews summarizing the Chinese literature on acupuncture, acupuncture with herbal medicine and massage therapy suggest greater reduction in tics compared to conventional treatments but there is low confidence in the evidence due to poor methodological quality of included studies. Conclusions: Evidence to support the use of complementary and integrative medicine for TS is limited in methodological quality and widespread applicability. These limitations prohibit evidence-based recommendations for general use among individuals with TS.
Decoding surgical proficiency and complexity: A machine learning framework for robotic herniorrhaphy
(Springer Nature Link, 2025) Shin, Thomas H.; Fanta, Abeselom; Gökçal, Fahri; Shields, Mallory; Benlice, Çiğdem; Kudsi, Omar Yusef
Objective To evaluate the predictive value of objective performance indicators (OPIs) for case complexity assessment and explore their role in quantifying skill acquisition during robotic ventral herniorrhaphy. Summary background data Despite advances in herniorrhaphy techniques, unclear metrics of case complexity have signifi cant implications for operative planning, resource allocation, and patient outcomes. While existing complexity definitions rely primarily on clinical factors external to operator behavior, the expanding adoption of robotic platforms in ventral her nia repair provides unprecedented access to quantifiable surgical performance metrics. However, the relationship between these objective performance indicators and both case complexity and skill development remains incompletely understood, representing a gap that machine learning approaches may help address. Methods OPI and clinical data from 561 consecutive robotic ventral hernia repairs over eight years were analyzed using iterative ensemble machine learning models to predict case complexity. Dimensional reduction analyses using t-distributed stochastic neighbor embedding tracked skill evolution, with Euclidean distances calculated between successive cases to quantify skill acquisition over time. Results Gradient boosting models integrating clinical and OPI variables achieved F1 score of 0.87, while OPIs alone scored 0.58. Longitudinal analysis revealed high OPI variability during early cases, stabilizing within 10 months despite increas ing case complexity, indicating skill acquisition may compensate for procedural difficulty. Dimensional reduction analyses captured this evolution through weighted Euclidean distances. Conclusions Objective performance indicators poorly predict case complexity independently, yet their temporal evolution reveals surgical skill acquisition. The concurrent stabilization of OPI stochasticity and progression to more complex cases demonstrates that surgical proficiency and complexity assessment are interdependent phenomena, establishing digital metrics as tools for understanding the dynamic relationship between surgeon learning and case difficulty.
Change in the concentration of interleukin-10 and tumor necrosis factor-α in gingival crevicular fluid after probiotic use in patients undergoing treatment with fixed orthodontic appliances
(Springer Nature Link, 2025) Erdemir, Cihan; Alkumru, Pınar; Çıracı, Enver; Ekenoğlu Merdan, Yağmur; Gök Yurttaş, Asiye; Amasya, Hakan; Elgün, Tuğba
Purpose This study aimed to evaluate the effect of the use of chewable probiotic tablets on interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) levels in gingival crevicular fluid (GCF) in patients undergoing treatment with fixed orthodontic appliances. Methods This prospective case–control study involved 60 patients undergoing treatment with fixed orthodontic appliances. Participants were divided into two groups. The test group was administered probiotic chewable tablets (Motiflor AS, Abfen Farma, Ankara, Turkey) once daily for 15 days, and the control group received routine orthodontic treatment without probiotics. GCF samples were collected from each participant at two time points: at the beginning of the treatment (T0) and on the 21st day (T1). Samples were obtained separately from all four canines using collection strips. The levels of IL-10 and TNF-α in GCF were analyzed using the enzyme-linked immunosorbent assay (ELISA) method. Statistical tests were performed to assess the normality of the distribution of quantitative variables. All analyses were performed using GraphPad Prism (version 9.1.1, GraphPad Software, San Diego, CA, USA). Data normality was assessed using the Kolmogorov–Smirnov test. Friedman’s test for repeated measures was employed, followed by Dunn’s post hoc test. Results The variability that was observed for the IL-10 cytokine levels in the control group was significantly higher than that for the test group (p< 0.05). IL-10 levels in the test group increased while the TNF-α levels decreased. T1/T0 ratio for TNF-α was found to be lower in the test group compared to the control group (p= 0.002). Conclusion The results suggest that probiotic tablets may play a role in modulating IL-10 and TNF-α levels during orthodontic tooth movement. However, the current study was limited to the first 21 days of mechanical force application to the teeth, and it is recommended to investigate the long-term effects or other factors affecting cytokine changes in future studies.
NiO-SnO2 nanocomposite as an adsorbent for the preconcentration of manganese ions in chamomile tea extract
(Elsevier, 2026) Şaylan, Meltem; Gürsoy, Selim; Zaman, Buse Tuğba; Bakırdere, Sezgin
Matricaria chamomilla L., referred to as chamomile, is a well-known medicinal plant that is widely distributed throughout the world. In this study, a novel NiO-SnO2 nanocomposite- assisted preconcentration method was established for efficient extraction and separation of manganese ions from chamomile tea extract. This pre concentration method was coupled with flame atomic absorption spectroscopy (FAAS). NiO-SnO2 nano composites were synthesized using simple one-pot co-precipitation procedure and calcined at 650 ◦C to obtain nanoparticles with sizes below 100 nm. X-ray diffraction (XRD) analysis indicated that the crystallite size of NiO SnO2 nanocomposites was estimated to be 46.03 nm using the Monshi–Scherrer equation. The LOD (limit of detection) and linear working range were determined as 3.6 μg/L and 10–100 μg/L, respectively. The proposed method was successfully validated, and recoveries ranged from 87.2 %–117.0 %. NiO-SnO2 nanocomposites represent a promising low-cost adsorbent for the preconcentration and subsequent determination of other heavy metal ions in diverse herbal extracts.
Feeding the mind: Preliminary insights into the effects of anthocyanin-rich extract from black carrots on brain activity and gut microbiota in patients with cognitive impairments
(Nature Research, 2025) Müdüroğlu Kırmızıbekmez, Aynur; Önder, Alparslan; Özdemir, Mustafa Yasir; Gürerk, Gamze; Aydın, Sevcan; Eryiğit, Önder Yüksel; Güloğlu, Mehmet Oktar; Kara, İhsan
Anthocyanins, known for their antioxidant and anti-inflammatory properties, have been associated with cognitive benefits, potentially mediated by gut-brain axis interactions. This study investigates the effects of a 12-week Anthocyanin-Rich Extract (ARE) intervention on brain activity and gut microbiota composition in older adults with neurocognitive impairments. In this study, 50 participants underwent electroencephalography (EEG) recordings and gut microbiota analyses before and after the intervention. EEG data were analyzed using connectivity and entropy metrics across multiple frequency bands. Gut microbiota composition was assessed via 16S rRNA sequencing to evaluate taxonomic shifts. Results revealed increased EEG connectivity, particularly in alpha, beta, and gamma frequency bands, suggesting improved neural communication and complexity following ARE consumption. Significant changes in nonlinear EEG metrics were observed, consistent with previous findings in the literature. Microbiota analysis indicated non-significant alterations in overall diversity but revealed increases in Alistipes, Streptococcus thermophilus, and Flavonifractor, alongside a decrease in Hungatella, potentially implicating SCFA metabolism and inflammatory regulation. These findings suggest ARE may enhance cognitive health by modulating neural activity and gut microbiota composition. While these results provide preliminary evidence of neuroprotective effects, further research with larger, disorder-specific cohorts and placebo-controlled designs is necessary to validate outcomes and explore gut-brain axis mechanisms in cognitive decline.
Mechanical performance of nonabsorbable monofilament suture materials tied with different suturing techniques under various knot configurations: An in vitro study
(MDPI Publishing, 2025) Tayşi, Nuri Mert; Erten Tayşi, Ayşegül; Erçal, Pınar; Şişmanoğlu, Soner
This study compared widely used nonabsorbable and monofilament suture materials tied with three different configurations and two different suture techniques. Three su ture materials (polytetrafluoroethylene, polypropylene, and nylon) were tied with either Laurell–Gottlow or the horizontal mattress suturing techniques using three different knot configurations: A (2 = 1 = 1 = 1 = 1), B (2 × 1 = 1 = 1 = 1), and C (1 × 2 = 1 = 1 = 1) on an experimental platform manufactured using a three-dimensional printer. Specimens underwent microtensile testing to determine maximum load failure and elongation rates at baseline and after 7 days of artificial saliva immersion. The Laurell–Gottlow yielded significantly lower elongation rates and higher failure load than the horizontal mattress suturing technique using nylon and polypropylene sutures at both time points (p < 0.001). Nylon had a significantly higher failure load and elongation than polypropylene and polyte trafluoroethylene at baseline for both suturing techniques and all three knot configurations (p < 0.001). Configuration C had low failure load values following immersion for all suture materials when using horizontal mattress suturing. Configuration A demonstrated superior failure load following the immersion period for all materials using both techniques. The polytetrafluoroethylene suture remained more stable over time. These findings indicate that the Laurell–Gottlow suturing technique with Configuration A provides better mechanical resistance to external forces when using nonabsorbable monofilament suture materials.
The african middle east association of gastroenterology (AMAGE) clinical practice guidelines for the diagnosis and management of metabolic dysfunction associated fatty liver disease
(Elsevier, 2026) Fouad, Yasser; Elwakil, Reda; Sanai, Faisal M.; Ojo, Olusegun; Al Awadhi, Sameer; Ocama, Ponsiano; Abdelaty, Nadia; Al-Busafi, Said A.; Örmeci, Necati; Eslam, Mohammed
Over the past few decades, the profile of liver diseases in Africa and the Middle East has undergone significant changes. The incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the seriousness of the situation, there is a scarcity of local or regional guidelines established to address it. This document presents the clinical practice guidelines from the African Middle East Association of Gastroenterology (AMAGE) related to the screening, diagnosis, and management of MAFLD. It addresses multiple aspects of managing this condition while taking into account local circumstances and the healthcare system's management requirements. These guidelines are intended for routine clinical use, with a specific focus on particular groups when needed.
Surgical anatomy of the anterior choroidal artery: Complex morphometry and morphological analysis of its origin and relations
(Springer Nature Link, 2025) Kaçur, İdil; Nteli Chatzioglou, Gkionoul; Nas, Emine; Coşkun, Osman; Gayretli, Özcan
Background The anterior choroidal artery (AChA) and posterior communicating artery (PComA) are critical vessels with significant anatomical variations. Detailed knowledge of their morphometry and origin is essential for neurovascular surgery and understanding cerebrovascular pathology. Methods This study was conducted on 62 fresh cadavers (124 hemispheres). The external diameters of the internal carotid artery (ICA) and PComA were measured. The AChA was clas sified based on its origin: Type 1 (from the ICA), Type 2 (from the ICA bifurcation), or Type 3 (from the PComA). The distance from the AChA origin to the PComA origin was measured for each type. The circumferential origin of the AChA from the ICA was also documented. Results The mean external diameter of the ICA was 3.77±0.77 mm. The proximal, middle, and distal external diameters of the PComA were 1.01±0.49 mm, 0.97±0.48 mm, and 0.90±0.45 mm, respec tively, with a mean length of 14.82±4.74 mm. The AChA originated from the ICA (Type 1) in 76.9% of hemispheres, from the ICA bifurcation (Type 2) in 21.4%, and from the PComA (Type 3) in 1.7%. The distance between the AChA and PComA origins differed significantly between types, being greatest for Type 2 (4.73±1.16 mm) compared to Type 1 (3.98±1.23 mm) (p=0.001). The AChA most commonly arose from the posterior wall of the ICA (84.68%). Conclusion This study provides detailed morphometric data on the AChA and PComA in a Turkish/Caucasian population, revealing a notably high prevalence of the AChA originating from the ICA bifurcation. The significant difference in the AChA-PComA distance based on the origin type may have important implications for surgical planning and hemodynamic modeling, underscoring the clinical relevance of these anatomical variations.
Examination of infant mortality risk in Turkey with spatio-temporal Bayesian models
(PAGEPress, 2025) Kılıç Yıldırım, Sade; Alpar, Celal Reha
The infant mortality rate in Turkey declined from 13.9 deaths per 1,000 live births in 2009 to 9.3 deaths per 1,000 live births in 2017. This study explored the role of spatio-temporal Bayesian models in explaining this decline. Parametric, nonparametric spatio- temporal Bayesian models, and a Bayesian generalized linear model without space, time, and space-time interaction were applied using the Integrated Nested Laplace Approximation (INLA) method. Exceedance probabilities were used for detecting significant risk clusters. The unstructured spatial and structured temporal interaction random effect of the best-fitting spatio-temporal Bayesian model contributed more to explaining variation in the relative risk of infant mortality than the other random effects. From 2009 to 2017, in each year, significant risk clusters were consistently detected in the eastern and south-eastern Anatolia regions. An increase of 1,000 USD in the Gross Domestic Product (GDP) per capita reduced the relative risk of infant mortality by 2.8%. When determining the factors that may affect infant mortality in Turkey, it is also essential to consider the effects of space, time, and space-time interaction. In addition, decision-makers should consider the increase in GDP per capita as a factor in reducing infant mortality in Turkey by focusing on these significant risk clusters in the eastern and south-eastern Anatolia regions.
Logistical requirements for high-resolution anoscopy: Pre-procedure preparation and materials – A video vignette
(Wiley, 2025) Arslan, Çiğdem
High-resolution anoscopy (HRA) is a diagnostic procedure that in-volves examining the anus, anal canal and perianal region with amicroscope, utilizing 5% acetic acid and Lugol's solution to detectabnormal epithelial changes and early precursors of anal cancer.Vital stains cause epithelial and vascular changes that distinguishnormal tissue from lesions, aiding in clinical decision-making forbiopsy.
Gender differences in the distribution of IDL, LDL, and HDL lipoprotein subfractions in MODY compared to type 2 diabetes: Data from the MODY-Ist study
(Elsevier, 2025) Yılmaz Aydoğan, Hülya; Kanca Demirci, Deniz; Gül, Nurdan; Yanar, Fatih; Poyrazoğlu, Şükran; Güleç Yılmaz, Seda; Tüzüner, Mete Bora; İsbir, Turgay; Öztürk, Oğuz; Satman, İlhan
Background: The distribution of intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL) and high density lipoprotein (HDL) subfractions specific to diabetes types and changes under dyslipidemia conditions have been well characterised. Research into the distribution of lipoprotein subfractions in Maturity-Onset Diabetes of the Young (MODY) has hitherto been confined to certain subtypes, with gender-based differences remaining to be elucidated. The objective of this study was to comparatively evaluate the distribution of lipoprotein subfractions according to gender in MODY, T2DM patients, and control groups. Methods: Lipoprotein subfractions in 119 serum samples of the study groups were analyzed using the Lipoprint System. Results: The midbands of IDL (MID-A to C) in female MODY cases, and the HDL-small fraction in male MODY cases, were found to be lower compared to female and male T2DM cases, respectively. In the T2DM group, age was positively correlated with MID-C and MID-B in both genders, while it was negatively correlated with MID-A in female cases. ROC analysis demonstrated that the decrease in the MID-C fraction in female MODY subjects (AUC:0.809, p = 0.0001) and the decrease in the HDL-small fraction in male MODY subjects (AUC:0.818, p = 0.002) were significantly associated with the likelihood of MODY. Conclusion: Given that a considerable proportion of MODY patients are frequently misdiagnosed as T2DM, low levels of MID-C and HDL-small fractions, both of which are triglyceride-rich, may have potential as a diagnostic value for female and male MODY patients, respectively.
Clinical characteristics of peripheral joint disease in axial and peripheral spondyloarthritis: Findings from a multicentre cross sectional study
(2025) Sarıyıldız, Emine; Duruöz, Mehmet Tuncay; Gezer, Halise Hande; Aktaş, İlknur; Akar, Servet; Hizmetli, Sami; Şahin, Nilay; Akgül, Özgür; Alkan Melikoğlu, Meltem; Sezer, İlhan; Ataman, Şebnem; Ural Nazlıkul, Fatma Gülçin; Çapkın, Erhan; Yılmaz, Figen; Kalyoncu, Umut
Peripheral joint disease (PJD) is the most common peripheral manifestation in spondyloarthritis (SpA) patients. This study aimed to determine PJD characteristics and associated factors in patients with axial SpA (AxSpA) and peripheral SpA (pSpA). This cross-sectional and multicenter study involved 13 different rheumatology and physical medicine & reha bilitation clinics, and patients diagnosed with axSpA or pSpA were included in the study. PJD was defined as the ‘ever’ related to SpA according to the physician. Multivariable analyses were conducted to identify factors associated with PJD. A total of 394 patients were enrolled in the study (57.6% male, mean age 40.8 years), of whom 359 (91.1%) were clas sified as AxSpA and 35 (8.9%) as pSpA. Peripheral arthritis was reported in 118 patients (29.9%), comprising 85 (72%) with AxSpA and 33 (28%) with pSpA. Among the whole population with PJD, the main joint involvement pattern was monoarticular (33.9%, n=40) and oligoarticular (49.2%, n=58). The rate of predominantly lower limb and large joint involvement was approximately 60% (n=68) and the major course of PJD was transient (42.4%, n=50) and intermit tent (40.7%, n=48). pSpA patients had a higher rate of persistent (33.3% vs. 14.3%, p=0.021) and progressive arthritis (15.2% vs. 1.2%, p=0.007). The coexistence of PJD with other peripheral involvement and extra-articular manifestations excluding psoriasis was widespread. Dactylitis, enthesitis, and high CRP level were positively associated with PJD; on the contrary, ever alcohol intake, presence of sacroiliitis on MRI, and family history for SpA were negatively associated. PJD was accompanied by both other peripheral involvements and extra-articular manifestations, excluding psoriasis and the course of PJD was more persistent in pSpA patients. This undoubtedly contributes to an increased disease burden.
Insufficient impact of the aldose reductase inhibitor cemtirestat on the skeletal system in type 2 diabetic rat model
(Public Library of Science, 2025) Martiniakova, Monika; Prnova, Marta Soltesova; Kovacova, Veronika; Mondockova, Vladimira; Svik, Karol; Londzin, Piotr; Folwarczna, Joanna; Omelka, Radoslav; Dikmen, Tayfun
Cemtirestat, a multi-target drug combining aldose reductase inhibition with antiox idant properties, is considered a promising therapeutic agent for chronic diabetic complications. Current evidence suggests that long-standing diabetes adversely affects skeletal health, leading to diabetic bone disease. As the impact of cemtirestat on the skeletal system in an animal model of type 2 diabetes mellitus (T2DM) is still unknown, our study first investigated its effect on impaired bone health in Zucker dia betic fatty (ZDF) rats. Adult rats were divided into four groups: L (untreated lean ZDF rats), D (untreated obese ZDF rats), DT2.5 (obese ZDF rats treated with 2.5mg/kg/ day cemtirestat), and DT7.5 (obese ZDF rats treated with 7.5mg/kg/day cemtirestat), with cemtirestat treatment lasting 2 months. Group D had increased levels of plasma glucose, insulin, triglycerides, glycated hemoglobin, total cholesterol, alkaline phos phatase, alanine aminotransferase, C-terminal telopeptide of type 1 collagen, greater body weight, femoral weight, structure model index, reduced cortical bone volume fraction, cortical bone thickness, trabecular bone volume fraction, and trabecular thickness compared to group L. Cemtirestat supplementation only elevated plasma phosphate levels in group DT2.5, trabecular bone volume fraction and trabecu lar thickness in group DT7.5, but the treatment had no effect on other parameters demonstrated in ZDF rats by macroscopic analysis, micro-CT cortical bone analysis, and mechanical testing. These findings indicate that the efficacy of cemtirestat in restoring deteriorated bone health caused by T2DM is not substantiated due to its insufficient effect on the skeletal system in the ZDF rat model.

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