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The letrozole use in reproductive medicine: Beyond aromatase inhibition - a comprehensive review
(Galenos Publishing House, 2026) Aydın, Gerçek; Hatırnaz, Şafak; Hatırnaz, Ebru Saynur; Çetinkaya, Mehmet Bilge; Akdeniz, Muhterem; Dokuzeylül Güngör, Nur; Güler, Oğuz; Merdanoğlu, Merdan Ali; Uzun, Asiye; Eroğlu, Semra; Dahan, Michael
Letrozole and other aromatase inhibitors are increasingly recognized as first-line ovulation induction (OI) medications, offering an efficient and physiologic approach to ovarian stimulation that enhances outcomes in reproductive medicine. By selectively inhibiting aromatase and maintaining lower peripheral estrogen levels, letrozole supports mono- or bi-follicular development while reducing the risk of supraphysiologic estradiol exposure seen with traditional gonadotropin regimens. These pharmacological characteristics have contributed to its expanding use not only in OI but also in various assisted reproductive technologies. To evaluate the clinical benefits, effectiveness, and safety of using letrozole in in vitro fertilization (IVF), in vitro maturation (IVM), and OI, with particular attention to reproductive outcomes, ovarian response, endometrial effects, cycle characteristics, and treatment-related adverse events. A comprehensive systematic search covering the period from December 2000 to November 2025 was conducted across major electronic databases including PubMed, Embase, the Cochrane Library, and Google Scholar. The search strategy incorporated predefined keywords related to letrozole, aromatase inhibition, OI, IVF, and IVM. Studies involving randomized controlled trials, observational cohorts, and meta analyses were included, while non-clinical and non-reproductive data were excluded. Relevant outcomes were extracted and synthesized qualitatively. Letrozole demonstrates broad clinical utility in reproductive medicine, spanning assisted reproductive techniques, ovarian stimulation strategies, and the management of ovarian hyperstimulation syndrome risk, ectopic pregnancy, and endometriosis-related infertility. Its targeted estrogen suppression, cost-effectiveness, and favorable safety profile make it a valuable component of individualized treatment protocols. Nonetheless, further high-quality research is required to refine optimal dosing strategies, identify ideal patient populations, and clarify long-term reproductive and obstetric safety.
Ozone treatment attenuates neuroinflammation and alters miRNA expression in a rat model of post-traumatic epilepsy
(Springer Nature Link, 2026) Demir, Hüseyin; Demirtaş, Cumaali; Yıldırım, Hava; Demir, Ecem; Kıroğlu Uzun, Sezin; Şevgin, Kübra; Beyaztaş, Hakan; Güler, Eray Metin; Hekimoğlu, Gulam; Çoşkunpınar, Ender Mehmet; Şanlıer, Nafiye; Yıldırım, Mehmet
The aim of this study was to investigate the effects of intraperitoneal ozone therapy in a post-traumatic epilepsy (PTE) model. An in vivo PTE model was established in male Sprague–Dawley rats, which were randomised to control (n=8), PTE (n=10), and PTE+Ozone (n=10) groups. 0.7 mg/kg ozone was administered intraperitoneally for 3 consecutive days. Seizure activity was video recorded for 120 min and evaluated for latency, frequency, duration, and severity. Behav ioral assessments of locomotor activity, anxiety, and spatial memory were conducted using open field, elevated plus, and radial arm maze tests on days 4–6 after the first ozone application. Blood and brain tissues were collected for biochemical assays (SUR1, TRPM4, IL-1β, IL-6, TNF-α, TAS, TOS, OSI, thiol–disulfide homeostasis), histological analyses (H&E, Cresyl Violet, and 8-OHdG immunostaining), and qRT-PCR of epilepsy-related miRNAs. Significant differences were observed among the groups for all serum and brain biomarkers (p<0.001). The PTE group showed marked increases in SUR1, TRPM4, IL-1β, IL-6, TNF-α, TOS, OSI, TT, NT, and DIS levels, accompanied by a decrease in TAS. Ozone treatment partially reversed these changes by reducing cytokine and oxidative stress markers, improving thiol–disulfide balance, and restoring TAS levels. Behavioural testing revealed beneficial effects of ozone, including reduced immobil ity, fewer errors in the radial arm maze, and increased open-arm exploration. Although seizure severity, latency, and duration were not significantly altered, seizure frequency showed a decreasing trend (p=0.067). Immunofluorescence for 8-OHdG revealed increased hippocampal oxidative DNA damage in the PTE group, which was attenuated following ozone treatment. Analysis of miRNA expression revealed downregulation in the PTE group, whereas ozone treatment resulted in overall upregulation. There was no statistically significant difference between miRNA expression results and the PTE+Ozone group (p=0.056–0.076). Ozone therapy mitigated oxidative stress and inflammation, improved redox homeostasis, enhanced cognitive and locomotor performance, and reduced hippocampal DNA damage in the PTE model. Furthermore, the observed upregulation of specific miRNAs following ozone treatment highlights a potential molecular mechanism contributing to its neuroprotective effects.
Clinical and molecular features of ovarian stimulation in peripubertal girls with mosaic turner’s syndrome
(Oxford University Press, 2026) Öktem, Özgür; Kalajahi, Hesam Ghafouri; Esmaeilian, Yashar; Benlioğlu, Can; Hela, Francesko; Yusufoğlu, Sevgi; Kalkan, Üzeyir; Turan, Volkan; Ata, Barış
STUDY QUESTION: Do peripubertal girls with mosaic Turner’s syndrome (TS) respond to ovarian stimulation (OS) for oocyte freezing as adult women with normal ovarian reserve? SUMMARY ANSWER: Clinical and molecular reproductive/endocrine features of OS in these patients are similar to those of adult females. WHAT IS KNOWN ALREADY: OS for oocyte freezing is quite a new concept in peripubertal and young adolescent girls with TS be cause ovarian tissue cryopreservation (OTC) does not have proven efficacy, likely due to already diminished ovarian reserve and ac celerated follicle atresia. No data are available in the literature regarding the molecular IVF characteristics of these cycles in this group of patients. We aimed to address this issue in the current study by analyzing gonadotropin receptor expression, response to gonadotropins, and steroidogenic function at the molecular level in four peripubertal patients aged 9, 12, 13, and 15 in comparison to control adult females with normal ovarian reserve undergoing OS for male factor infertility. STUDY DESIGN, SIZE, DURATION: This is a clinical and research study that simultaneously analyzes the clinical and molecular characteristics of OS in peripubertal young girls with TS between 2021 and 2023 at a university hospital and translational re search center. PARTICIPANTS/MATERIALS, SETTING, METHODS: All participants underwent OS using a progestin-primed protocol with recombi nant forms of FSH and LH, and final maturation was induced with recombinant hCG. Control patients who had normal ovarian re serve and underwent OS for male factor infertility were randomly recruited during the study period to simultaneously compare and analyze the clinical and molecular OS characteristics of the peripubertal TS cases. Luteinized mural granulosa cells obtained during oocyte retrieval procedures were used for the experiments. Cell culture, quantitative real-time PCR, immunoblotting, confocal time lapse live-cell imaging, and hormone assays were used. MAIN RESULTS AND THE ROLE OF CHANCE: All TS cases responded to gonadotropin stimulation. Nine mature oocytes were re trieved and vitrified in the 9-year-old prepubertal mosaic TS case after four cycles of OS with r-FSH (300 IU) and r-LH (150 IU)/day after a mean stimulation period of 9.72 ± 2.1 days. Eight mature oocytes were retrieved in the case aged 13 after three rounds of OS. The other cases, aged 12 and 15, underwent only one cycle of OS, and two mature oocytes from each were retrieved. The expression of FSH/LH receptors and steroidogenic enzymes, basal and gonadotropin-induced up-regulation in the expression of the steroidogenic enzymes, and estradiol and progesterone productions of the GCs of the TS patients were similar to those of adult control patients. Confocal immunofluorescence microscopy and live imaging revealed no differences in cholesterol uptake/trafficking or in staining patterns of the steroidogenic enzymes and their co-localization with mitochondria and cholesterol-laden lipid droplets. LIMITATIONS, REASONS FOR CAUTION: Findings were obtained from a limited number of mosaic TS patients. It is unclear if these findings are reproducible in non-mosaic peripubertal cases. Furthermore, no data are available yet regarding the post-thaw survival, fertilization, embryo development competency, euploidy status, and obstetrical outcomes of the vitrified oocytes of these patients. WIDER IMPLICATIONS OF THE FINDINGS: This study provides reassuring clinical and molecular evidence that OS for oocyte freez ing can be an option in young girls with mosaic TS who are not ideal candidates for OTC due to diminished ovarian reserve. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the School of Medicine, the Graduate School of Health Sciences, and the Research Center for Translational Medicine (KUTTAM) at Koc¸ University. The authors declare no competing interests. TRIAL REGISTRATION NUMBER: Not applicable.
Ovarian stimulation: Cycle essentials for managing a cycle
(Livre de Lyon, 2025) Aydın, Gerçek; Taşkıran, Deniz
This section discusses ovarian stimulation, the cornerstone of infertility treatment. While ovarian reserves and targeted responses may vary depending on the patient’s characteristics and the clinician’s assessment, the primary goal is the same for all: to obtain the most appropriate and sufficient response without causing any harm. This section not only provides definitions but also highlights the key steps in managing an ovarian stimulation cycle, beginning with ovulation induction as the initial treatment and extending to IVF as the most advanced option.
Retrospective analysis of outcomes following expandable titanium cage and iliac graft applications in patients undergoing corpectomy for cervical spinal canal stenosis
(Galenos Publishing House, 2026) Demir, Hüseyin; Şanlıer, Nafiye
Introduction This study aimed to compare the clinical and radiological outcomes of iliac crest autografts and expandable titanium cages in anterior cervical column reconstruction among patients undergoing cervical corpectomy for cervical spinal stenosis. Methods A retrospective analysis of 93 patients who underwent anterior cervical corpectomy between 2016 and 2023 was conducted; 61 were treated with iliac grafts and 32 with expandable cages. Clinical efficacy was assessed using the modified Japanese Orthopaedic Association (mJOA) score, while radiological outcomes were evaluated by measuring cervical lordosis (C2-C7 Cobb angle), intervertebral height, and fusion status, three months post-surgery. Complications, operative duration, and revision surgery rates were also analysed. Results Both the iliac graft and cage groups demonstrated significant postoperative improvements in mJOA scores (p<0.001). The iliac graft group exhibited superior early correction of cervical kyphosis, with the Cobb angle increasing from 3.17° to 9.12° (p<0.001), compared with the cage group’s increase from 0.99° to 5.83° (p=0.025). Cervical alignment remained more stable over time in the iliac graft group. Complication rates were comparable between the groups; however, graft displacement occurred more frequently in the iliac graft group. In contrast, cage malposition occasionally necessitated revision surgery. Conclusion Both iliac grafts and expandable cages are effective for anterior cervical reconstruction, yielding comparable clinical outcomes and complication rates. Iliac grafts may be better suited for achieving immediate postoperative correction and maintaining stable long-term alignment. The choice of surgical technique should take into account specific patient needs and the distinct risk profiles associated with each method.
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.
Incidence and prognostic factors of isolated para-aortic lymph node metastasis in endometrial cancer: A single-center study
(Minerva Medica, 2025) İbrahimov, Akbar; Boyraz, Gökhan
Para-aortic lymph node metastasis (PALNM) is a key prognostic factor in endometrial cancer (EC). This study aimed to de- termine the incidence and prognostic factors of lymph node metastasis (LNM) and isolated PALNM in endometrioid-type EC patients. METHODS: EC patients treated surgically between 2000 and 2015, staged by FIGO 2009 criteria, were retrospectively analyzed. Included were patients with endometrioid histology grades I-III who underwent pelvic and PALN dissection. Excluded were those without lymph node dissec tion or with non-endometrioid histology. RESULTS: A total of 417 patients met the criteria. Of these, 246 (59%) were grade I, 117 (28.1%) grade II, and 46 (11%) grade III. Pelvic LNM (PLNM) was found in 43 (10.3%), and PALNM in 22 (5.3%). Five patients (1.19%) had isolated PALNM. PALNM was more frequent in patients with stage III, tumors >2 cm, cervical glandular/stromal involvement, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, PLNM, and LVSI. Isolated PALNM was notably higher with adnexal involvement. Independent predictors of PALNM were cer vical glandular involvement and LVSI. Deep myometrial invasion, LNM, PLNM, LVSI, and adnexal involvement were linked to disease-free survival (DFS), while peritoneal cytology, PLNM, and LVSI were linked to recurrence. There was no significant difference in recurrence and DFS between PALNM and isolated PALNM. CONCLUSIONS: Isolated PALNM without PLNM is rare in EC patients but should be assessed for optimal staging and treatment.
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
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.
Holmium/thulium laser enucleation of the prostate
(Springer, 2026) Açıkgöz, Onur; Yılmaz, Mehmet; Kaya, Engin; Tonyalı, Şenol; Liatsikos, Evangelos N.; Seçkiner, İlker; Kadıoğlu, Ateş
With the introduction of lasers into endourological practice, there has been a major paradigm shift in terms of urological interventions. Especially in the last 10 years, Holmium laser enucleation followed by Thulium laser enucleation of the prostate has become increasingly popular in the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). With low perioperative complication rates and successful postoperative outcomes, laser enucleation of the prostate (LEP) is now a globally accepted surgical approach for the surgical treatment of LUTS due to BPH. The aim of this chapter is to provide an overview of laser enucleation of the prostate; including operating theatre preparation prior to LEP, different surgical techniques, details of the learning curve, and postoperative complications.
Sahin transvaginal extracorporeal myomectomy as a novel minimally‑invasive technique for the management of uterine myomas: A retrospective cohort analysis
(Medycyna Praktyczna, 2025) Şahin, Turan; Şahin, Eda A.; Şahin, Hanifi
Introduction: Vaginal myomectomy (VM) is a minimally-invasive surgery to remove uterine fibroids; however, limited exposure, difficulties in suturing, and challenges in achieving hemostasis restrict its wider adoption. To address these limitations, the Sahin transvaginal extracorporeal (STVEC) technique was developed, allowing for complete uterine exteriorization for extracorporeal reconstruction. Aim: We aimed to evaluate the safety, feasibility, and perioperative outcomes of the STVEC technique in women undergoing surgery for symptomatic uterine myomas. Materials and methods: This retrospective cohort included 200 consecutive patients who underwent VM using the STVEC technique between February 2021 and October 2024. Demographic characteristics, myoma features according to the International Federation of Gynecology and Obstetrics (FIGO) classification, operative variables, postoperative outcomes, and complications were analyzed. The complications were graded using the Clavien–Dindo system. Conversion to laparotomy was performed when safe continuation of the STVEC approach was not feasible. Results: Mean (SD) age of the study cohort was 39.1 (6.5) years and mean (SD) body mass index was 27.5 (5.8) kg/m². Mean (SD) myoma count was 1.8 (1.4; range: 1–5) and mean (SD) diameter was 6.7 (2.4; range, 5–10) cm. Intramural myomas (FIGO type 2–5) were the most common (55%). Conversion to laparotomy occurred in 8 patients (4%) due to adenomyotic uteri, adhesions, prior vaginal surgery, or altered cervical anatomy. Median (interquartile range [IQR]) hemoglobin decrease was 1.7 g/dl, median (IQR) estimated blood loss was 180 ml, and mean (SD) operative time was 71.9 (19.5) minutes. Blood transfusion was required in 18 patients (9%). Early complications occurred in 7 participants (3.5%), and all were minor. Conclusions: The STVEC technique appears safe and feasible, offering good bleeding control, low complication rates, and rapid recovery. Further multicenter studies are needed to confirm our findings.
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.
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.
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.
Can blastocyst formation rate play a role as a predictor of PGT-A cycle outcomes?
(Elsevier, 2025) Aydın, Gerçek
OBJECTIVE To investigate clinical and embryological parameters that may serve as predictors of pregnancy outcomes in preimplantation genetic testing for aneuploidy (PGT-A) cycles. MATERIALS AND METHODS A total of 98 PGT-A cycles at a private in-vitro fertilization (IVF) center between April 2022 and July 2025 were enrolled. Trophectoderm biopsy cases without any known uterine anomalies and endometrial factor are included. Ovulation induction with letrozole (n=29) or hormone replacement therapy (HRT) (n=69) were used for endometrium preparation. Clinical and embryological cycle characteristics are analysed. Blastocyst formation rate (BFR) was calculated as the number of blastocysts per MII, and the euploidy rate refers to euploid embryos per biopsied embryos. Statistical analysis included t-tests or Mann-Whitney U for continuous variables, and Chi-square test for categorical variables. To identify potential confounding factors subgroup analyses and multivariate logistic regression were performed. RESULTS Among the 98 patients, 62 (63.3%) achieved pregnancy and 36 (36.7%) did not. There were no significant differences between the groups regarding age, BMI, total gonadotropin dose, or stimulation duration. Recombinant FSH agents were the most frequently administered (n=38), followed by hMG (n=23), combination of both (n=15) and recombinant FSH+recombinant LH (n=22). Analyzing the pregnancy results, no statistically significance was observed regarding the agents used, (p>0,05). The BFR was significantly higher in the pregnant group (0.36 ± 0.28) compared to the non-pregnant group (0.27 ± 0.24, p = 0.045). The estradiol/oocyte ratio was slightly higher in the pregnant group (319 ± 180 pg/mL) than in the non-pregnant group (287 ± 148 pg/mL), although not statistically significant (p = 0.48). The euploidy rate per was 59.3% (89/150) in the pregnant group and 68.8% (66/96) in the non-pregnant group, being not statistically significant (p = 0.13). Regarding confounding factors (female or male aneuploidy, the type of gonadotropin, the type of endometrial preparation protocol), none of these demonstrated a statistically significant association with pregnancy outcome in either univariate or multivariate models. CONCLUSIONS Given our results, BFRs may predict pregnancy outcomes whereas euploidy rates do not, despite being higher in non-pregnant cases contrary to expectations. IMPACT STATEMENT BFR in PGT-A cycles may help clinicians both to counsel current patients and to shape more individualized management strategies for future cases.
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.
Can neoadjuvant chemoradiotherapy be omitted in cT2N+ and cT3 mid-rectal cancer: Protocol for a prospective, observational, cohort study (CANO)
(Public Library of Science, 2025) Karakayalı, Feza; Arslan, Çiğdem; Bisgin, Tayfun; Erenler Bayraktar, İlknur; Bayraktar, Onur; Canda, Aras Emre
Background Neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer. However, nCRT is associ ated with significant morbidity, impacting patients’ quality of life. Recent advancements in MRI-based risk stratification have raised the possibility of omitting nCRT in selected patients without compromising oncologic outcomes. This study aims to evaluate whether upfront TME alone achieves similar 3-year disease-free survival compared to the standard approach of nCRT followed by TME in patients with cT2N+ and cT3Nx mid-rectal cancer without MRI-based high-risk features regarding local recurrence. Methods The CANO trial is a prospective, multicenter, observational cohort study involving 436 patients across Türkiye. Eligible patients will be classified into two groups: those undergoing direct TME and those receiving nCRT followed by TME. The primary endpoint is 3-year disease-free survival (DFS), with secondary outcomes including 5-year DFS, overall survival, local recurrence rates, and quality of life assessments using validated questionnaires. Data will be prospectively collected and monitored by the steering committee with predefined interim analyses. Discussion The CANO trial addresses the ongoing debate regarding selective omission of nCRT in low-risk mid-rectal cancer. By leveraging MRI-based risk stratification and PLOS One | https://doi.org/10.1371/journal.pone.0321819 November 5, 2025 2 / 11 a collaborative national network, the study aims to provide high-quality evidence supporting a more personalized treatment approach. The findings have the potential to reduce treatment-related morbidity without compromising oncologic safety, contrib uting to the refinement of current guidelines.
Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study
(Wiley, 2025) Bilgin, İsmail Ahmet; Ramoğlu, Nur; Saylık, Onur; Benlice, Çigdem; Erkaya, Metincan; Kurtul, İnci; Aghayeva, Afag; Turan, Ersin; Maden, Abdullah Sami; Acar, Fahrettin; Karahasanoğlu, Tayfun; Hamzaoğlu, İsmail; Baca, Bilgi; Doğru, Osman
Aim: Pilonidal sinus disease (PSD) primarily affects young adults; rapid recovery is essential and yet lacks a standardized treatment approach. While excisional techniques delay recovery, minimally invasive options like laser ablation and phenol application are gaining interest, yet comparative long-term evidence is scarce. This study compared short- and long-term outcomes of laser versus phenol treatment in PSD. Method: In this multicentre retrospective cohort study (Nov. 2017–Sep. 2024), patients treated with laser or phenol were included. 1:3 propensity score matching using the nearest neighbour algorithm was performed based on age, gender, prior surgical history and year of operation. Categorical variables were analysed using chi-squared or Fisher's exact tests, whereas continuous variables were compared using Student's t-test or Mann– Whitney U test depending on distribution normality. Results: Out of 897 eligible patients, 644 were included (median age: 26 years, body mass index [BMI]: 26.2 kg/m2 , male-to-female ratio: 4:1). The number of sinuses/pits was 2–3 in both groups. Operating time was significantly longer in the laser group. Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1–3] vs. 1 [0–2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%–86%). Conclusion: Both treatments demonstrated low complication and recurrence rates with high recovery rates. Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.
Labia majora lifting technique with polydioxanone threads
(Oxford University Press, 2025) Ağlamış, Savaş Özgür; Akkaya, Selver Kübra; Şahin, Elif; Şahin, Hanifi
Background: Polydioxanone (PDO) thread is a synthetic absorbable surgical suture used for rejuvenation and lifting. Aim: The aim of this study is to use PDO threads for rejuvenation and enlargement effect in patients with labium majus hypotrophy. Methods: Twenty-one patients with labia majora hypotrophy were included in the study. Conventionally, surgery, fat filling or hyaluronic acid filling is used for labia majora rejuvenation. In this study, a different technique, the PDO thread suspension technique, was applied. For PDO thread, Hyundae Meditech Co.Ltd’s Secret Line Up product containing 50 mm screw thread with 30 G-38 mm needle tip was used. It was planned to use 10 PDO threads for right and left labia majora. After a total of 20 needles were inserted, the needles were removed one by one and the PDO threads remained in the subcutaneous superficial layer and the procedure was terminated 5 min later. Preoperative and postoperative the Female Genital Self-Image Scale (FGSIS) scores of the patients were compared. Outcomes: The overall FGSIS total score demonstrated a significant increase following the intervention. Results: The FGSIS total mean score in the preoperative period was increased in the postoperative period. This difference was statistically significant. Moreover, the mean score calculated for each parameter of FGSIS in the preoperative period increased significantly in the postoperative period. Clinical Implications: These findings indicate a favorable safety profile for the use of PDO threads in this clinical context. Strengths and Limitations: The strength of the study is to introduce a minimally invasive and effective method for labia majora lifting, on the other hand, the small number of patients in the study, limitation of the study. Conclusion: We would like to point out that in this study, we evaluated labium majus rejuvenation from the same perspective, based on the shaping and enlargement of genital appearance and its positive effect on self-confidence and increase in sexual functions. Unlike many labium majus rejuvenation procedures, this less invasive procedure has achieved similar results. In this context, it is a preferable alternative to surgery.

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