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Impression precision after hydrogen peroxide sterilization of scanner sleeves
(Springer Nature Link, 2026) Yılmaz, Berza; Arslan, Meriç; Kayasaroğlu, Damla Nur; Arslan, Elif Dilara; Sunal Aktürk, Ezgi
Introduction The iTero Element (Align Technologies, San Jose, CA, USA) is a widely used intraoral scanning device, and its protective sleeves for the scanning head are provided for single use. This condition puts the clinical management budget under financial strain and creates a disadvantage for managing environmental waste. The objective of our research was to assess how repeated sterilization of disposable scan head covers with hydrogen peroxide affected the precision of digital impressions. Methods Intraoral scans were carried out using the iTero Element 5D scanner on 26 patients. Hydrogen peroxide was used to sterilize the sleeves for 45min at 45 °C. The sterilization procedure was repeated between the second, third, and fourth intraoral scans. Each tooth was given a score based on the color change between the first and fourth scans, which were superimposed using the iTero TimeLapse technology. The OrthoCAD® software (Align Technologies) was also used to measure the intercanine, interpremolar, and intermolar distances, as well as the mesiodistal dimensions of all the teeth between the first molars. Results No statistically significant difference was found between the mesiodistal dimensions of the teeth and the interca nine, interpremolar, and intermolar distances between the 1st and 4th scans. There was no correlation between the mean differences of the mesiodistal dimensions of the teeth obtained with the 1st and 4th scans and TimeLapse scores. Conclusion After sterilization with hydrogen peroxide, the repeatability of digital measurements of the protective sleeves of the intraoral scanner was not adversely affected, and their clinical performance was maintained.
Sustainable synthesis of ZnO nanoparticles from melon (cucumis melo l.) by-products: RSM optimization, structural characterization, antioxidant activity, and photocatalytic performance
(Wiley, 2026) Bozkurt, Rabia Nur; Kaba, İbrahim; Kahraman, Yusuf Sezai; Altınkeser, Tuğçe
This study explores the eco-friendly synthesis of zinc oxide nanoparticles (ZnO-NPs) using polyphenol-rich extracts from melon (Cucumis melo L.) peel and seeds as naturalreducing and stabilizing agents. Optimization via response surface methodology (RSM) determined the ideal synthesis conditions at a 0.078 mol/L metal concentration, 14.73 mL extract, and pH 10.77. Characterization through XRD confirmed a hexagonal wurtzite crystal structure with an average size of 21.7 nm, while SEM and TEM imaging revealed predominantly spherical morphologies. UV–visible DRS analysis showed a 368 nm absorption edge with a calculated band gap of 3.21 eV. DLS measurements indicated a hydrodynamic diameter of 135.6 nm with a PDI of 0.206 and a zeta potential of −20.5 mV, confirming good colloidal stability. The resulting NPs exhibited strong antioxidant activity (IC50 = 40.7 µg/mL) and acted as effective heterogeneous photocatalysts for the degradation of organic dyes. Specifically, ZnO-NPs enabled the photodegradation of methyl orange (MO) and methylene blue (MB), achieving 63.56% degradation for 5 mg L−1 MO. These findings demonstrate that melon-waste-derived ZnO-NPs are sustainable and promising candidates for wastewater treatment and environmental remediation.
The impact of home-based telerehabilitation pranayama on sleep quality and wellbeing in mild to moderate obstructive sleep apnea syndrome. A randomized controlled trial
(BioMed Central, 2026) Kaçar Akkoç, Zeynep; Demir, Rengin; Mustafaoğlu, Rüstem; Önder, Ömer Önder; Naci, Baha; Atahan, Ersan
Background Obstructive sleep apnea syndrome (OSAS) is a common disorder that causes repeated airway obstruction, disrupted breathing, and fragmented sleep. This study aimed to investigate the effects of Pranayama on sleep quality, daytime sleepiness, quality of life, fatigue, depression, and anxiety in patients with OSAS. Methods This study was designed as an open-label, prospective, randomized controlled trial. OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group or a Control group. Pranayama training was applied to the Intervention group for 8 weeks, 7 days a week, and 3 times a day for 15 min. In addition, a single 15-minute session, 3 days a week, was conducted online under the supervision of a physiotherapist. The control group did not receive any intervention. Primary outcome was sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes included daytime sleepiness (Epworth Sleepiness Scale, ESS), Fatigue Severity Scale (FSS), Functional Outcomes of Sleep Questionnaire (FOSQ), Nottingham Health Profile (NHP), and Hospital Anxiety and Depression Scale (HADS). All outcome measures were assessed at baseline and reassessed after the 8-week intervention period. Results Thirty-eight OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group (n = 19) or a Control group (n = 19). Four participants (two in each group) were lost to follow-up, leaving the data of 34 participants (17 per group) available for inclusion in the final analysis. In the intervention group, PSQI scores decreased from 9.12 ± 4.71 to 6.88 ± 4.45 (p < 0.001), whereas no improvement was observed in the control group. Regarding the primary outcome, the reduction in PSQI scores was significantly greater in the intervention group than in the control group (p < 0.001). The ESS scores also decreased significantly in the intervention group, from 9.41 ± 6.15 to 7.41 ± 6.18 (p = 0.006, with a significant between-group difference (p < 0.001). Fatigue severity decreased in the intervention group (FSS change: 0.53 ± 0.70; p = 0.006), with a significant between-group difference (p = 0.037). The FOSQ score improved markedly, with significant gains in FOSQ total score (− 0.38 ± 0.25 vs. 0.14 ± 0.22 in controls; p < 0.001) and in activity level and vigilance subdomains (both p < 0.001). The HADS-anxiety scores decreased by 1.94 ± 3.94 (p = 0.059) and depression scores by 3.06 ± 2.05 (p < 0.001) in the intervention group, with significant between-group differences for both anxiety (p = 0.008) and depression (p < 0.001). Conclusion Pranayama was an effective adjunct therapy for these OSAS patients, and incorporating it into treatment strategies may enhance patient outcomes. Clinical trial registration number/date NCT04632147/22.10.2020.
Protective roles of gallic acid and lycopene against 4-nonylphenol induced testicular damage in SD rats
(SAGE Publications, 2026) Güleş, Özay; Kum, Şadiye; Naseer, Zahid; Boyacıoğlu, Murat; Özel Armutoğlu, Emine; Yıldız, Mustafa; Kırıkkulak, Murat; Doğan, Göksel; Bilici, Esra; Türkmen, Aybike; Tuna, Bilginer; Eren, Ülker
4-Nonylphenol (4-NP), an endocrine disruptor, is known to induce mutagenic, toxic, or carcinogenic effects, including testicular toxicity via inducing oxidative stress and apoptosis. The objective of this work was to determine the capacity of lycopene (LC) and gallic acid (GA) to protect testicular histological structure, biochemical responses, and semen parameters in rats exposed to 4-NP. In this 28-day dietary trial, six groups (n= 6 per group) received treatment via oral gavage: a control (corn oil, 2 mL/kg/day), LC (10 mg/kg body weight (BW)/day), GA (50 mg/kg BW/day), 4-NP (125 mg/kg BW/day), LC + 4-NP (LC followed by 4-NP), and GA + 4-NP (GA followed by 4-NP) groups. The results indicated that 4-NP administration adversely affects the final body weight, testicular histology, seminiferous epithelium heights (SEHs) (4-NP: 57.95 ± 0.49, p: 0.000), follicle-stimulating hormone (FSH) level, testis antioxidant capacity, testis malondialdehyde (MDA) level, and sperm viability and morphology. LC and GA supplementation significantly improved SEHs, activities of testis superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH), and sperm viability compared to the 4-NP group. Moreover, LC and GA exposures decreased histopathological lesions, including germinal epithelial degeneration, vacuolization, immature germ cells in the tubular lumen, and congestion in the interstitial area. Furthermore, they lowered TUNEL-positive cell counts and tubule percentages, testicular MDA levels, and abnormal sperm percentages. To our knowledge, this study provides one of the first systematic comparisons of lycopene and gallic acid in protecting against 4-NP-induced testicular toxicity under identical experimental conditions. The findings suggest that both compounds preserve testicular structure and function through their antioxidant and anti-apoptotic properties.
Efficacy-oriented approach for medium-sized follicles: A perspective on stimulation, expectation, and triggering strategy in IVF cycles
(Wiley, 2026) Aydın, Gerçek; Ergin, Elif; Araç, Merve; Bülbül, Mehmet; Çalışkan, Eray; Hatırnaz, Şafak; Dahan, Michael; Malvasi, Antonio; Tinelli, Andrea
Objective: To assess the therapeutic significance of routinely aspirating mid-sized fol licles (14.0–16.9 mm) during oocyte pick-up (OPU) by looking at procedural efficiency and embryo usage in cycles with varied follicular cohorts. Methods: In vitro fertilization (IVF) cycles with follicles classified as large (≥17 mm) or mid-sized (14.0–16.9 mm) at the time of OPU were included in this prospective cohort. Each group's oocytes were extracted and treated independently while main taining rigorous traceability. Analysis was performed on embryologic results, opera tive time factors, and embryo transfer utilization across successive transfer attempts. Pregnancy outcomes and the length of the operation were investigated. Laboratory results pertaining to trigger strategies were assessed descriptively. Results: When measured per mature oocyte, oocytes from mid-sized follicles showed comparable fertilization and blastocyst development rates. However, only a small percentage of embryo transfers included embryos from mid-sized follicles, especially in the initial two transfer attempts. Large follicles had a longer total OPU duration, and cycles that resulted in miscarriage had significantly longer operative times among large-follicle-derived embryo transfers. For mid-sized follicles, there were no differ ences in the length of the procedure based on the pregnancy outcome. Conclusion: The contribution of mid-sized follicle-derived oocytes to embryo trans fer selection seems to be restricted in everyday practice, despite their reassuring laboratory competence. Procedural efficiency is a potentially significant factor in customized IVF care, as evidenced by the correlation between longer operating times and worse clinical outcomes. In certain clinical situations, a focused stimula tion and aspiration approach might be suitable without obviously jeopardizing cu mulative results.
Tannic acid and copper-modified ZIF-8 metal organic framework as a cefotaxime delivery system for antimicrobial activity
(Galenos Publishing House, 2026) Pirinççi Tok, Yağmur; Özsoy, Münteha; Damar Çelik, Damla
Objectives: Antibiotic resistance has become a global public health threat. Cefotaxime (CTX), a third-generation cephalosporin, is approved for use in infants, children, and adults with various microbial infections, particularly those affecting the central nervous system. This study aimed to synthesize and characterize zeolitic imidazolate framework (ZIF)-8-based drug delivery systems (DDSs) to enhance antimicrobial activity and control CTX release. Materials and Methods: ZIF-8 was synthesized via the coordination network of Zn ions and 2-methylimidazole and subsequently modified with tannic acid (TA) and copper ions (Cu2+). ZIF-8 MOF and its derivatives were characterized by Fourier Transform Infrared, zeta potential, in vitro dissolution rate, and in vitro antimicrobial activity. Results: The drug loading capacity and encapsulation efficiency were found to be 39.50 ± 1.19% and 98.75 ± 2.96%, respectively, for ZIF-8@TA@CTX, and 40.75 ± 1.22% and 97.75 ± 2.93%, respectively, for ZIF-8@TA@Cu@CTX. Following 48 hours, the drug released from ZIF-8@TA@Cu@CTX was detected at 62.83 ± 1.89% at pH 5.0 and 83.19 ± 2.50% at pH 7.4 after 48 h, with dissolution profiles best fitting the Korsmeyer–Peppas model. The synthesized DDSs demonstrated a higher antibacterial activity against gram-positive bacteria than against gram-negative bacteria. Conclusion: ZIF-8 MOF DDs may serve as an alternative for delivering drugs to infected areas due to their controlled release under low pH conditions.
Three-dimensional automatic segmentation of root canals with focus on the second mesiobuccal canal using nnU-Netv2 on CBCT images: Deep learning approach
(BioMed Central, 2026) Güllü, Deniz Meltem; Orhan, Kaan; Kartal, Nevin
Background Artificial intelligence (AI) has the potential to reduce interpretation errors and save time during the evaluation of cone beam computed tomography (CBCT) images. This study aimed to assess the performance of AI in identifying and segmenting the second mesiobuccal canal (MB2), with concurrent segmentation of the main root canals, in the maxillary first molar prior to endodontic treatment. Methods In this study, 202 CBCT images that met the inclusion criteria were obtained from an anonymized database provided by Craniocatch (Eskişehir, Türkiye), with no associated personal data. The nnU-Netv2 model implemented with the PyTorch library was used for the detection and three-dimensional (3D) automatic segmentation of root canals. Owing to the narrow structure of the MB2 canal, labels were preprocessed via binary dilation with SciPy (v1.10.1), and training was conducted in two stages by applying different dilation levels. The performance of the artificial intelligence model was evaluated via the confusion matrix and further assessed with additional metrics, including the Dice score (DC), Jaccard index (JI), 95% Hausdorff distance (HD), and area under the curve (AUC). Results In this study, the nnU-Netv2 model achieved a sensitivity of 0.538, a precision of 0.719, a DC of 0.616, a JI of 0.445, a 95% HD of 0.874, and an AUC of 0.8 for 3D automatic segmentation of MB2. Conclusions This study is the first to apply the nnU-Netv2 model for 3D automatic segmentation of the MB2 canal in untreated teeth and highlights its potential utility in endodontic imaging. Further refinements in these systems may enable rapid and reliable 3D automatic segmentation of MB2 and enhance endodontic treatment quality and patient outcomes.
Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: Systematic review and meta-analysis
(BMJ Publishing Group, 2026) Vilela Filho, Osvaldo; Bannach, Matheus A.; Martins Lino Filho, Adriano; Hamani, Clement; Nuttin, Bart; Hariz, Marwan; Schulder, Michael; David Greenberg, Benjamin; Yılmaz, Atilla; Gonçalves Ferreira, António
Background Psychiatric disorders are increasingly contributing to global disability. Despite advances in conservative management, the prevalence of treatment-resistant cases remains high. Meanwhile, neurosurgery for psychiatric disorders (NPD) remains underused, largely due to strict regulations and historical concerns, particularly those related to neuropsychological side effects (NPSE). Objective To address this issue, we conducted a systematic review with meta-analysis to compare NPSE associated with radiofrequency ablative NPD to those observed in neuro-oncological, neurovascular and epilepsy surgeries. Methods PubMed, Embase and LILACS databases were searched in April 2024 for articles published in English/Spanish from 1990 to 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results A total of 48 articles with 2678 participants were included. The frequency of transient and permanent NPSE in the NPD group ranged from 0.94% to 11.50% and 0.94% to 2.03%, respectively, comparable to the other surgical groups (epilepsy: 0.31–11.70%; vascular: 0.52–22.90%; oncology: 0.94–17.60% for transient NPSE; epilepsy: 0.31–12%; vascular: 0.40–1.96% and oncology: 0.84–1.48% for permanent NPSE). Regarding permanent NPSE, arguably the most critical consideration, the NPD group showed better outcomes in memory, language and social cognition than the epilepsy group, but worse outcomes in executive and perceptual-motor functions. Compared with the vascular group, the NPD group had better executive function but worse complex attention. Finally, the NPD group had fewer permanent deficits than the oncology group in executive function, complex attention and perceptual-motor domains, although language performance was lower. Conclusions Contemporary NPD apparently carries a similar risk of NPSE as other conventional neurosurgical procedures, challenging misconceptions and this unjustified barrier to its broader use.
Anthropometric analysis of nasal widening following bimaxillary orthognathic surgery
(Wolters Kluwer, 2026) Öztürk Muhtar, Merve; Yey Özkeskin, Sabahat Zeynep; Küçükçakır, Osman; Keskin Yalçın, Başak; Cansız, Erol
Orthognathic surgery aims to improve jaw function and aesthetics, but these procedures can also cause undesired changes in the nasal region, a crucial component of facial ap pearance. An alar cinch suture has been proposed to mitigate such nasal widening. This study aimed to evaluate changes in the interalar distance (distance between the right and left alar curvature points) and alar base distance (distance between the right and left alar base points) in patients who underwent bi maxillary orthognathic surgery with an alar cinch suture. This retrospective study included patients who underwent bimaxil lary orthognathic surgery at the Istanbul University Faculty of Dentistry Department of Oral and Maxillofacial Surgery from 2012 to 2018. Interalar and alar base distances were measured on standardized frontal photographs taken preoperatively and at 6 months postoperatively. Statistical evaluation was per formed using nonparametric methods, including the Wilcoxon signed-rank test applied for preoperative and postoperative comparisons and Spearman rho used to assess correlations, with the significance level set at P < 0.05. The interalar distance increased significantly from preoperative to postoperative measurements (median value: 8.04%; mean change: 7.33 ± 5.38%; P = 0.001). Similarly, the alar base distance showed a significant increase from preoperative to post operative measurements (median value: 11.90%, mean change: 12.49 ± 9.57%; P = 0.001). No statistically significant correla tion was found between the percentage changes in interalar and alar base distances (Spearman ρ = 0.201, P = 0.359). A tendency toward nasal soft tissue widening was noted after Le Fort I advancement, despite alar cinch suture application.
Predictors of re-biopsy in percutaneous musculoskeletal tumor biopsies: A single-center retrospective cohort study
(SAGE Publications, 2026) Yücesan, Ali; Arıkan, Yavuz; Doğukan, Fatih Mert; Mutlu, İlhan Nahit; Toy, Serdar; Atan, Tamer; Özer, Devrim
Purpose: This study aimed to evaluate the diagnostic success of percutaneous biopsies performed for suspected mus culoskeletal tumors and to identify clinical, anatomical, and procedural factors associated with the need for repeat biopsy (re-biopsy). The secondary objective was to assess the impact of multidisciplinary team (MDT) evaluation on reducing unnecessary re-biopsy procedures. Methods: A total of 565 patients (331 bone, 234 soft tissue lesions) who underwent percutaneous biopsy for suspected musculoskeletal tumors between 2020 and 2024 were retrospectively analyzed. Diagnostic success was defined as a biopsy yielding a definitive histopathological diagnosis sufficient to guide treatment planning without additional tissue sampling. Predictive factors including lesion size, depth, location, and performing specialty were evaluated using univariate and multivariate logistic regression analyses. Results: The initial diagnostic yield was 65.5%. Multivariate analysis revealed that lesion width <2 cm (OR = 2.01; 95% CI, 1.19–3.39; p = 0.009) and biopsy performed by an interventional radiologist (compared to an orthopedic surgeon) (OR = 5.25; 95% CI, 2.83–9.74; p < 0.001) were independent predictors of re-biopsy recommendation. Among 72 patients recommended for re-biopsy, MDT evaluation averted the need for a second procedure in 38 cases (52.8%). Conclusion: Smaller lesion size (<2 cm) and the medical specialty performing the biopsy were independent predictors of re-biopsy recommendation, with the latter likely reflecting systematic differences in case complexity and procedural environment rather than operator skill. Structured MDT evaluation significantly reduced unnecessary repeat procedures.
Development of biodegradable alginate films with aloe vera and quince seed mucilage: Physical, chemical, and biological properties
(Elsevier, 2026) Keke, Zeynep Serra; Temizkan Özdamar, Kevser; Alanalp, Mine Begüm; Altıner Kurt, Eda
In this study, novel biodegradable hydrogel films derived from quince seed mucilage and Aloe vera gel were developed and evaluated for their physical, chemical, and biological properties. Four film formulations prepared by solvent casting were characterized for swelling capacity (2.61–11.95 g), solubility (61.70–99.15%), thermal stability (TGA/DTG), chemical structure (FT-IR), surface morphology (SEM), optical properties (UV–Vis), me chanical performance (tensile strength ranging from 7.4 to 12.7 MPa), antibacterial activity, antioxidant ca pacity, and biodegradability. Quince seed mucilage enhanced the mechanical strength and thermal stability of the films due to its high-viscosity polysaccharide structure. In contrast, Aloe vera gel significantly increased the films' biological activity, particularly their antioxidant potential. Films with higher quince seed content exhibited greater structural stability, whereas Aloe vera–rich films showed increased short-term bioactivity and stronger antioxidant performance. Overall, the results indicate that hydrogel films produced from environmentally friendly and sustainable natural components can serve as functional, biologically active, and promising alter native packaging materials.
Effectiveness of fissure sealants following different silver fluoride application protocols in MIH-affected molars: Randomized clinical study
(Springer Nature Link, 2026) Çayıroğlu, Nagihan; Ballıkaya, Elif; Erbaş Ünverdi, Gizem; Çehreli, Zafer Cavit
Objectives To compare the clinical efficacy of glass ionomer sealants (GIS) and resin-based sealants (RBS) applied imme diately or one week after silver fluoride (SF) application to permanent molars affected by molar incisor hypomineralization (MIH) in children at high risk for caries. Methods A total of 216 MIH-affected molars (ICDAS 1–2) from 102 children aged 6–14 years were randomly allocated to six groups: Resin- or glass ionomer–based fissure sealants were placed either one week after the application of silver fluoride or during the same clinical session. In the same-visit protocols, sealants were applied immediately after silver fluoride treatment, either following gentle blot drying with cotton or after immediate rinsing. Hypersensitivity, caries progression, and sealant retention were assessed at 1, 6, and 12 months. Hypersensitivity was evaluated using the Schiff Cold Sensitivity Scale (SCASS). Sealant performance was analyzed using modified USPHS criteria. Statistical analyses included Fisher’s Exact Test and the Friedman test. Results Full retention was achieved in all resin-based sealant groups, while the lowest retention rate (88.9%) was recorded in the glass ionomer sealant group applied one week after silver fluoride. Caries occurred in 2.8% of teeth and was confined to three groups: glass ionomer sealants placed one week after silver fluoride, resin-based sealants applied immediately following blot drying, and glass ionomer sealants applied immediately after rinsing. All other groups showed complete clinical success. No statistically significant differences were found among groups regarding caries prevention (p=1.000) or sealant retention (p=0.062). Hypersensitivity decreased significantly over time in all groups. Conclusion Resin-based and glass ionomer fissure sealants placed either one week after silver fluoride application or immediately following treatment, using rinsing or blot-drying protocols, showed similar outcomes over a 12-month follow-up period in terms of caries prevention and reduction of hypersensitivity. Nonetheless, within the limitations of this study, sealants placed immediately following silver fluoride application demonstrated a greater frequency of discoloration. Clinical significance Both glass ionomer and resin-based fissure sealants can be successfully applied either immediately or one week following silver fluoride treatment to provide protection for MIH-affected permanent molars. Clinical trials registration number NCT06641011.
Functional and surgical outcomes of ventral mesh rectopexy in male patients with rectal prolapse: A nationwide multicenter retrospective cohort study by the pelvic floor working group of the Turkish society of colon and rectal surgery (TSCRS)
(Springer Nature Link, 2026) Gültekin, Fatma Ayça; Balcı, Bengi; Kuzeyli Yıldırım, Yasemin; Arslan, Çiǧdem; Yaşar, Necdet Fatih; Bisgin, Tayfun; Bayraktar, Adem; Zenger, Serkan; Şengül, Neriman; Bulut, Türker Mehmet
Background The indications and outcomes of ventral mesh rectopexy (VMR) in the treatment of rectal prolapse in males have been minimally addressed in the literature. This study aimed to evaluate the demographics, clinical characteristics, and surgical outcomes associated with VMR in male patients. Methods This nationwide retrospective cohort study included male patients who underwent VMR at centers performing pelvic floor surgery across Turkey. Clinical and surgical characteristics were obtained, and functional outcomes were evalu ated using Cleveland Clinic Incontinence score (CCIS) and Altomare Obstructed Defecation Syndrome (ODS) scores at the pre- and postoperative periods. Results Forty-one male patients (mean age, 45.4 years; mean BMI, 25.6 kg/m2 ) underwent VMR (2 open, 5 robotic, and 34 laparoscopic). The cohort comprised 11 patients with internal rectal prolapse (IRP) and 30 with external rectal prolapse (ERP). The overall complication rate was 17.1% (2.4% related to mesh), with a 12% recurrence rate. The median follow-up was 33 (6–127) months. The recurrence rate was 36.4% for IRP patients and 3.3% for ERP patients (p=0.014). Significant improvements were observed in the CCIS (preoperative: 6.1±4.8; postoperative: 2.8±3.3, p=0.005) and Altomare ODS (preoperative: 11.9±4.6; postoperative: 7.26±5.8, p<0.001). Conclusions In this nationwide retrospective cohort study, VMR was associated with favorable functional outcomes in males. Recurrence rates were significantly higher in those with internal rectal prolapse. As sexual function was not systematically assessed, prospective studies with standardized patient-reported outcomes are warranted.
Artificial intelligence in medical education: Curriculum design, assessment models, and educational infrastructure across undergraduate and residency training – A narrative review
(Turkish Society of Cardiology, 2026) Göçer, Hakan; Durukan, Ahmet Barış; Özyüksel, Arda
Artificial intelligence (AI) is rapidly becoming an integral part of everyday clinical practice, including cardiology and cardiovascular surgery. As AI increasingly influences diagnostic and therapeutic decisions, physicians are expected to interact with these systems in a critical, safe, and ethically grounded manner. This narrative review aims to explore how AI can be systematically integrated into undergraduate and residency medical education, with a particular focus on curriculum design, teaching strategies, assessment models, and educational infrastructure, while considering the context of the Turkish medical education system. A narrative synthesis of international medical education literature, policy documents, and institutional reports was conducted without quantitative meta-analysis. The review was guided by the principles of human-in-the-loop clinical reasoning, ethical AI use, and patient safety. Effective integration of AI into medical education requires a longitudinal and staged curriculum spanning preclinical, clinical, and residency training. Assessment strategies must explicitly address AI-assisted decision-making and be supported by transparent institutional policies governing AI use in examinations, as well as by secure, regulation-compliant digital infrastructure. Educational approaches should encourage learners to critically appraise and contextualize AI outputs rather than accept them uncritically. The reviewed literature supports a competency-based educational framework that integrates AI literacy, ethical reasoning, and context-aware clinical judgment. AI education should be viewed as a core clinical competency that strengthens rather than replaces human judgment. Particularly in high-risk cardiovascular disciplines, a standardized, ethics-centered, and competency-based educational framework is essential to prepare future physicians for AI-augmented healthcare environments.
Comparison of caudal and retrolaminar blocks for postoperative analgesia in pediatric orchidopexy: A randomized controlled trial
(Edizioni Minerva Medica S.p.A., 2026) Özen, Volkan; Umutoğlu, Tarık; Turan, Engin İhsan; Ayas, Tahir Arda; Yiğit, Doğakan; Çiftçi, Bahadır; Alver, Selçuk
Background: Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. METHODS: In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. RESULTS: Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. CONCLUSIONS: In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways.
Shrinking follow-up duration in pilonidal sinus surgery, 1970–2020: A patient-weighted longitudinal analysis of 2,285 studies
(Springer Nature Link, 2026) Arslan, Çiğdem; Seifert, Jannik; Doll, Dietrich
Background: Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP). Despite evidence suggesting ≥5 years is necessary, contemporary reports appear to adopt progressively shorter surveillance windows. Methods: We assembled a structured database of 2,285 pilonidal surgery series (1850–present) and extracted publication mid-decade, FUP since surgery, and cohort size (n). For 1970–2020, we calculated decade-wise patient-weighted mean FUP. Secular change was estimated using weighted least squares (WLS; weights=n), with unweighted sensitivity analyses. Associations between decade and FUP were assessed via weighted Pearson correlation with Kish effective sample size. We summarized proportions meeting ≥2, ≥5, ≥10 years and patient shares by FUP bands. Results: Median FUP was 1.67 years; mean 2.50 years. Only 14.2% of studies reported ≥5 years and 2.9% ≥10 years. Patient-weighted mean FUP peaked in the 1980s at 6.69 years, declining to 5.26 (1990s), 4.26 (2000s), 3.14 (2010s), and 2.55 years (2020s). Relative to the 1970s (3.78 years), the 2020s were −1.23 years (−32.5%), and −4.14 years (−61.9%) below the 1980s. The WLS slope was −0.0766 years·year⁻¹ (95% CI −0.0856 to −0.0675; p=4.57×10⁻⁵⁸); unweighted slope −0.0407 (95% CI −0.0479 to −0.0334; p=1.47×10⁻²⁷). Weighted correlation: Rw=−0.342 (Kish n≈216; p=2.5×10⁻⁷). In the 2020s, patients were distributed as 55.3% <2 years, 26.6% 2–<5, 15.8% 5–<10, 2.3% ≥10. Conclusions: Follow-up windows have contracted substantially, risking under ascertainment of late recurrences. A minimum of ≥5-year FUP with staged reporting at 5 and 10 years and registry-based surveillance is recommended. The absence of a pilonidal core outcome set (COS) in guidelines impedes consistent, long-horizon reporting; COS development and guideline adoption should be prioritized.
Evaluation of changes in oral and dental health and deleterious oral habits after adenoidectomy or adenotonsillectomy in children
(Korean Association of Orthodontists, 2026) Arat Maden, Eda; Yoğurucu Değerli, Gizem; Kurt Dizdar, Senem; Turgut, Suat
Objective: This study aimed to evaluate changes in oral health status and related oral habits in children undergoing adenoidectomy or adenotonsillectomy, focusing on dental indices and mouth breathing-associated symptoms. Methods: This prospective observational study included 52 children (mean age: 7.4 ± 2.1 years) who underwent adenoidectomy or adenotonsillectomy. Clinical evaluations included decayed, missing, and filled teeth for primary dentition/ decayed, missing, and filled teeth for permanent dentition (dmft/DMFT) scores, plaque index (Silness and Löe), gingival index (Löe and Silness), and unstimulated salivary flow rate. Parents completed structured questionnaires assessing their children’s medical and dental history, oral health-related behaviors, and symptoms. Oral health-related quality of life was evaluated using the Early Childhood Oral Health Impact Scale. Results: Statistically significant improvements were found in salivary flow rate (from 0.43 ± 0.21 mL/min to 0.75 ± 0.19 mL/min), plaque index (1.58 ± 0.48 to 1.06 ± 0.33), and gingival index (1.28 ± 0.55 to 0.70 ± 0.39) (all P = 0.001). Several mouth breathing related symptoms, such as snoring, dry mouth, daytime sleepiness, and halitosis, also showed a significant postoperative reduction (P < 0.05). Conclusions: Adenoidectomy or adenotonsillectomy significantly improved periodontal parameters and reduced mouth breathing-associated symptoms in children. These findings highlight the importance of interdisciplinary management involving otolaryngologists, pediatric dentists, and orthodontists.
Restless legs syndrome in children with celiac disease: Associations with vitamin D and iron deficiency and the role of gluten-free diet adherence
(BioMed Central, 2026) Cebe Tok, Ayşegül; Köle, Mehmet Tolga; Güven, Deniz; Tehçi̇, Ali Kansu; Kandemi̇r, İbrahim
Background Celiac disease (CD) is a systemic autoimmune disorder frequently associated with micronutrient deficiencies and extraintestinal manifestations, including neurological complications. Restless Legs Syndrome (RLS) is a sensorimotor disorder linked to dopaminergic dysfunction and iron and vitamin D deficiency, both of which are common in pediatric CD. Objective To evaluate the prevalence and severity of RLS in children with CD and to investigate the associations between RLS symptoms and serum vitamin D and iron parameters, as well as the potential effect of gluten-free diet (GFD) adherence. Methods This prospective cross-sectional study included 67 children with CD (aged 10–18 years) and 68 age- and sex-matched healthy controls. RLS was assessed using the International Restless Legs Syndrome Study Group rating scale. Demographic, anthropometric, clinical, and biochemical data—including serum iron, ferritin, folate, vitamin B12, and 25-hydroxyvitamin D—were recorded. Group comparisons were performed using appropriate parametric or non-parametric tests. Associations were evaluated using Spearman correlation and Bayesian correlation analyses. Results RLS scores were significantly higher in the CD group compared with controls (median 6 [0–13] vs. 0 [0–0]; p < 0.001), and RLS duration was also longer in children with CD (p < 0.001). Serum vitamin D levels showed a significant negative correlation with RLS scores (r = −0.251, p < 0.05). RLS duration demonstrated a strong positive correlation with RLS severity (r = 0.838, p < 0.001). Transglutaminase IgA levels were inversely correlated with ferritin (r = −0.417, p < 0.001) and folate levels (r = −0.332, p < 0.05), while transglutaminase IgG levels were negatively correlated with ferritin (r = −0.285, p < 0.05) and vitamin D (r = −0.304, p < 0.05). Bayesian correlation analysis revealed no strong associations between Marsh classification and most clinical or biochemical variables, except for a strong association between RLS duration and severity (BF₁₀ > 100). Adherence to a gluten-free diet was not significantly associated with RLS severity (p > 0.05). Conclusions Children with celiac disease exhibit significantly higher RLS symptom severity than healthy peers. Lower serum vitamin D levels and reduced iron stores appear to be associated with increased RLS severity, regardless of Marsh stage or dietary adherence. These findings highlight the potential value of screening for RLS and monitoring vitamin D and ferritin levels in pediatric patients with celiac disease.
Anxiety levels and associated sociodemographic factors in mothers of children with first febrile seizures: A case-control study
(Elsevier, 2026) Küçük, Elif; Köle, Mehmet Tolga; Erkin, Gökşen; Kandemir, İbrahim; Hüsrevoğlu Esen, Feyza; Güven, Deniz; Uysal, Feride; Akın, Yasemin
Objective: The prognosis of febrile seizures (FS) is generally favorable; however, a child's first febrile seizure can be distressing for parents. The aim of this study was to assess the anxiety levels of mothers whose children present to the pediatric emergency department with FS for the first time and to examine the relationship between these anxiety levels and the sociodemographic characteristics of the mothers. Methods: This case-control study included mothers presenting for the first time to the pediatric emergency department of our hospital with children aged 6 months to 6 years, either for simple FS or for fever without seizures. Maternal anxiety levels were assessed using the State–Trait Anxiety Inventory (STAI) approximately 12 h after the initial seizure. Sociodemographic characteristics were also collected, and the relationship between these characteristics and anxiety levels was analyzed. Results: A total of 103 participants (52 in the FS group, 51 controls) were included. Higher maternal education and family income were associated with lower STAI-S and STAI-T scores. The FS group had significantly higher mean STAI-S (p < 0.001) and STAI-T (p = 0.007) scores, by 14.6 and 3.6 points, respectively. Multivariate analyses revealed that income was a significant confounder for both STAI-T and STAI-S. Conclusion: Mothers of children with FS report higher levels of anxiety. Sociodemographic factors, such as income and maternal education level, play a significant role in maternal anxiety levels. Targeted educational and support programs addressing income inequalities in healthcare could help reduce maternal anxiety and improve the management of FS.
Survival at stake: Surgical decision-making in metastatic femoral
(Acta Medica Belgica, 2025) Yücesan, Ali; Arıkan, Yavuz; Toy, Serdar; Karaduman, Volkan; Özer, Devrim
Pathological femoral fractures resulting from primary or metastatic tumors represent a complex clinical challenge for orthopedic surgeons, often requiring individualized treatment strategies. This retrospective study aimed to evaluate and compare the outcomes of different surgical approaches used in the management of pathological femoral fractures secondary to metastatic disease. A total of 46 patients (52 femoral fractures) who underwent surgical treatment between 2020 and 2023 were included in the study. Data collected encompassed demographic characteristics, tumor histology, surgical techniques employed, and clinical outcomes. Statistical analysis was conducted using appropriate parametric and non-parametric tests, depending on data distribution. Of the patients included, 51% underwent tumor resection followed by endoprosthetic reconstruction, 40% were treated with intramedullary nailing, and 9.4% underwent plate osteosynthesis. The highest postoperative mortality rate was observed among patients with lung cancer metastases. Blood transfusions were necessary in 66% of cases. The overall mean survival time following surgery was 4.5 months, with significant variation according to tumor type and metastatic burden. The findings of this study underscore the importance of a multidisciplinary approach in the surgical management of pathological femoral fractures caused by metastatic tumors. Surgical interventions such as intramedullary nailing, plate fixation, and endoprosthetic reconstruction can effectively restore mechanical stability and contribute to improved patient quality of life. Selection of the optimal surgical technique should be guided by tumor histopathology, anatomical location and extent of bone involvement, number of metastatic lesions, and overall patient prognosis. Timely and appropriate surgical intervention remains critical to minimizing complications and enhancing survival outcomes in this patient population.

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