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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.
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.
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.
Safety, feasibility and indications of transabdominal oocyte pick-up: Initial experience
(World Scientific, 2026) Turan, Volkan; Öktem, Özgür
Although the transvaginal route is the preferred method for the oocyte retrieval procedure, the transabdominal (TA) route may be preferred in certain conditions. In this opinion we presented our experience with TA oocyte pick-up in 101 patients across several different indications and assessed the safety of the procedure.
WCN26-6583 Oral lactoferrin in anemia of chronic kidney disease: A systematic review and meta-analysis
(Elsevier, 2026) Magal, Abhijith; Arslan, Felemez; Silva, Rafaela Pereira; Bayer, Ekin Şiar; Paiva de Almeida, Vitor
Introduction: Anemia is a prevalent and multifactorial complication of chronic kidney disease (CKD), often driven by inflammation, impaired iron metabolism, and reduced erythropoietin production. Lactoferrin, an iron-binding glycoprotein with immunomodulatory and antimi crobial properties, has demonstrated efficacy in improving iron indices in general iron deficiency anemia. However, its role in CKD-associated anemia remains inadequately characterized. Methods: A systematic review and meta-analysis were conducted to evaluate the effectiveness of oral lactoferrin compared to standard-of care therapies—including iron supplementation and/or erythropoiesis stimulating agents—for the treatment of anemia in adult and pediatric CKD patients. PubMed, Embase, and Cochrane CENTRAL were searched through May 7, 2025. Data were pooled using a random-ef fects model, and heterogeneity was assessed using the I2 statistic. Sensitivity analyses and trial sequential analysis (TSA) were performed to assess robustness and adequacy of cumulative evidence. Results: Four studies comprising 413 participants were included in the final analysis. Lactoferrin supplementation was associated with a statistically significant increase in transferrin saturation (MD: 8.12%; 95% CI: [0.61, 15.63]; p = 0.03), while improvements in hemoglobin (MD: 0.66 g/dL; 95% CI: [-0.06, 1.38]; p = 0.07) and serum iron (MD: 19.20 mcg/dL; 95% CI: [-4.56, 42.96]; p = 0.11) did not reach statistical significance. Conclusion: Oral lactoferrin supplementation was associated with a significant improvement in transferrin saturation and a non-significant trend toward higher hemoglobin and serum iron levels in CKD-related anemia. While these findings suggest a potential role in improving functional iron availability, further well-designed trials are needed to confirm its clinical utility.
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.
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.
The effect of phosphoric acid on the development of neural tube defects in chick embryos
(International Scientific Information, Inc., 2026) Yücel, Murat; Çetin, Eyüp; Canbaz, Halime Tuba; Karip, Betül Zehra; Demir, Emine; Kocaoğlu, Sarper; Demir, Hüseyin
Introduction: Neural tube defects (NTDs) are among the most common congenital malformations and arise from disruption of early neurulation. Phosphoric acid is a widely used food additive; however, its potential effects on early neu ral tube development have not previously been evaluated in experimental neurulation models. This proof-of concept study aimed to investigate the embryotoxic and teratogenic effects of phosphoric acid on neural tube development in a chick-embryo model of neurulation, at a single tested concentration. Material/Methods: Fertilized pathogen-free chicken eggs (n=30) were randomly allocated into 2 groups. Control embryos (n=15) received no injection, whereas embryos in the experimental group (n=15) were injected beneath the embryon ic disc with 0.25 mM phosphoric acid, at Hamburger-Hamilton stage 9. Embryos were incubated for 72 hours, after which survival was recorded and neural tube development was evaluated macroscopically and histopath ologically. Statistical comparisons were performed using Fisher’s exact test. Results: All control embryos survived (15/15, 100%) and exhibited normal neural tube closure. In the phosphoric acid–treat ed group, survival was significantly reduced (10/15, 66.7%; P=0.0421). Among surviving treated embryos, 80% (8/10) demonstrated NTDs, including cranial and caudal closure abnormalities (P<0.001). Histopathological ex amination confirmed incomplete neural fold closure, irregular notochord morphology, and disrupted somite or ganization in affected embryos. Conclusions: Phosphoric acid exposure at the tested concentration and developmental stage markedly reduced embryo sur vival and induced a high incidence of neural tube closure defects in a chick-embryo model. These findings pro vide the first experimental proof-of-concept evidence that phosphoric acid can directly disrupt early neurula tion in a vertebrate neurulation model. However, vehicle-controlled replication, dose–response analyses, and exposure-bridging studies are required to distinguish teratogenic specificity from general embryotoxicity and to assess potential relevance to human embryogenesis.
The impact of conventional chemotherapy regimens and targeted drugs on ovarian function in breast cancer patients
(Springer Nature Link, 2026) Hasköylü, Şeyma; Şahin, Şevval Berfin; Altıntaş, Alara; Yıldız, Şule; Bildik, Gamze; Benlioğlu, Can; Turan, Volkan; Kim, Samuel; Öktem, Özgür
Breast cancer is the most common malignancy among women, affecting nearly 1.5 million individuals worldwide every year. While survival rates improve, many reproductive-age survivors confront significant long-term consequences, particu larly diminished ovarian reserve, infertility, and premature ovarian insufficiency due to the gonadotoxic effects of chemo therapy. Postponement of pregnancy for five years or more after treatment exacerbates the decline in fertility due to ongo ing ovarian aging and depletion of residual ovarian reserve. Women carrying BRCA1/2 mutations may already exhibit reduced ovarian reserve and are more vulnerable to gonadal damage, possibly due to impaired DNA repair mechanisms associated with these mutations. The contribution of other breast cancer susceptibility genes (e.g., ATM, CHEK2, PALB2, BARD1, RAD51C, RAD51D, and TP53) to chemotherapy-induced gonadotoxicity remains unclear. Although animal data shows depletion of primordial follicle pool and granulosa cells dysfunction, the ovarian effects of the poly(ADP-ribose) polymerase (PARP) inhibitors in women with and without BRCA mutation are not clear. Immune-check point inhibi tors (ICIs) causes immune-mediated destruction of the primordial follicle pool and reduction in ovarian reserve. Cyclin dependent kinase inhibitors appear to be less toxic than ICIs. In this narrative review of the current literature we aimed to provide a comprehensive overview of the molecular mechanisms underlying ovarian toxicity associated with conventional chemotherapy and targeted therapies in breast cancer treatment.
An update on fertility preservation from the asian society for fertility preservation
(Wiley, 2026) Turan, Volkan; Faizal Bin Ahmad, Mohd; Di, Wen; Gook, Debra; Kaul, Nalini; Kim, Seok Hyun; Ko, Jennifer; Chau Le, Thi Minh; Lee, Jung Ryeol; Öktem, Özgür
Fertility preservation (FP) is a rapidly expanding field in reproductive medicine with still limited data on outcomes. FP aims to protect the fertility of children, women, and men who face the potential risk of fertility loss for various medical conditions, including but not limited to cancer and its gonadotoxic treatment forms. Therefore, it is crucial to provide evidence-based recommendations to assist health professionals in discussing FP options. Our aim was to provide a guideline for multidiscipli nary medical staff in considering the availability of FP options and to help them decide whether to provide FP. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure the maintenance or preserving reproductive health. Therefore, people who are at risk of losing fertility should be evaluated for and counseled about future reproductive risks. Embryo, oocyte, and ovarian tissue cryopreservation are the established FP options in adult females, with ovarian tissue cryopreservation the only option for prepubertal girls. A wide range of variables affect the choice of the FP strategy. These include age and ovarian reserve of women, the time available before the initiation of cancer treatment, puber tal status, and cancer type and stage. In males, sperm cryopreservation is a highly effective method in adolescent and adult males, while testicular tissue cryopreservation, which is experimental, is the only available option for prepubertal males. This review addressed the important clinical questions and provided answers for FP in females, males, and children according to the indications and availability of FP.
Complete healing after umbilical mesenchymal stem cell-derived exosome therapy for a refractory complex anal fistula
(Springer Nature Link, 2026) Arslan, Çiğdem; Erenler, İlknur; Karaöz, Erdal
Complex anal fistulas pose a persistent challenge due to high recurrence and the risk of continence impairment. While sphincter-sparing techniques exist, outcomes are variable in refractory disease. Mesenchymal stromal cell (MSC) therapies show promise but face logistical barriers, prompting interest in acellular exosome-based approaches. We report a 45-year-old woman with a complex anterior anal fistula refractory to multiple surgeries, including two endoanal advancement flaps, complicated by new-onset flatus incontinence. Following the second endoanal advancement flap, the patient's Cleveland Clinic Continence Score (CCIS) was 10, and the Quality of Life in Patients with Anal Fistula Questionnaire (QoLAF-Q) score was 51. A two-stage salvage strategy was undertaken: meticulous curettage and closure of the internal opening, followed by local administration of MSC-derived exosomes at baseline and three weeks. Significant wound reduction was observed, progressing to complete epithelialization within two weeks after the second exosome application. At six months after combined surgical intervention and exosome therapy, CCIS and QoLAF-Q scores improved to 0 and 28, respectively, indicating full restoration of continence and a marked improvement in quality of life. This case suggests that local exosome therapy, used as an adjunct to careful surgical preparation, may support healing and functional recovery in refractory complex anal fistulas. Controlled studies with standardized protocols are warranted to define efficacy, dosing, and durability.
Phenol for pilonidal sinus disease: A nationwide survey of practice patterns and safety gaps among surgeons in Türkiye
(BioMed Central, 2026) Ergüder, Ender; Yahya, Duha; Turan, Ersin; Şimşek, Gürcan; Bulut, Sezer; Arslan, Çiğdem
Background Phenol is widely used as a minimally invasive treatment for pilonidal sinus disease (PSD); however, its clinical application is characterized by substantial heterogeneity in indications, technique, dosing, and safety practices. Despite its routine use in outpatient settings, standardized safety frameworks addressing occupational exposure, environmental controls, and dose documentation are lacking. These gaps may have important implications for both patient outcomes and workplace safety. This nationwide survey aimed to characterize real-world phenol practice patterns among surgeons in Türkiye, with a particular focus on safety infrastructure, exposure control measures, and clinical decision-making. Methods A nationwide, internet-based, cross-sectional survey of surgeons managing PSD in Türkiye (July 8– August 15, 2025), aligned with CHERRIES. The 38-item instrument captured demographics; workload/experience; environmental controls (ventilation), institutional exposure-prevention policies, and personal protective equipment (PPE); patient-side protection strategies; phenol procurement, formulation/concentration, and dosing; treatment planning; and outcomes/perceptions. Descriptive statistics summarized item-level responses. Results A total of 132 surgeons provided responses. 81.1% evaluated more than 30 PSD patients annually, and 48.5% conducted more than 30 phenol procedures per year. Surgeons frequently procured phenol from external pharmacies (36.4%); crystalline phenol predominated (77.3%); 50.8% did not know the concentration (most reported 99.9%); and only 7.6% measured dose per procedure. The majority of surgeons performed 2 to 3 sessions (69.0%) at intervals of 2 to 3 weeks (38.6%). Key safety gaps were identified: only 34.8% reported dedicated ventilation, 53.0% reported none, and 62.1% had no institutional exposure-prevention policy. Routine mask use was reported by 53.8% (primarily surgical masks); additional PPE beyond mask and gloves was used by 22.0% (gowns 51.7%, eye protection 48.3% among those reporting). Patient-side skin protection was common (81.3%). Adverse events in patients were recorded at a rate of 20.5%, with skin burns being the most prevalent, while operator adverse effects occurred at a rate of 5.3%. Despite these gaps, perceived safety was relatively high (patients 83.3%, operators 68.9%), and 89.4% would personally choose phenol if affected. Conclusions Findings support a safety-first national framework specifying permissible formulations/concentrations, mandating dose documentation and skin-protection protocols, and implementing a core safety bundle (effectiveventilation, written exposure-control policies/checklists, and PPE including eye protection). Prospective exposure monitoring with standardized outcomes is warranted.
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.

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