Characterizing cognitive phenotypes and clinical correlates in type 2 diabetes using fuzzy clustering and decision tree analysis.

Cognitive impairment is frequently seen in patients with type 2 diabetes (T2DM), ranging from mild impairment to dementia. However, our knowledge of the specific profiles and risk factors for these different levels of impairment is limited. In this study involving 152 patients with T2DM, cognitive function was assessed using the Montreal Cognitive Assessment test. The Fuzzy C-means clustering algorithm was utilized to group individuals with similar cognitive characteristics. The study evaluated how well clinical parameters could classify characteristics of clusters using the Classification and Regression Trees algorithm. ROC analysis was then used to assess the classification success. Three distinct cognitive clusters were identified. Cluster 1 had the poorest cognitive performance and was characterized by more women, lower education levels, and lower levels of iron, hemoglobin, and creatine. Cluster 3, the amnestic cluster, was distinguished by low TSH levels. The decision tree model highlighted several parameters, including education level, hemoglobin, duration of diabetes mellitus (DM), iron, TSH, gender, family history of diabetes, and microalbumin/creatinine ratio, as significantly affecting the distinction of cognitive clusters. Diabetes-associated cognitive impairment stems from multifaceted pathophysiological mechanisms influenced by complex risk factors, resulting in diverse types of cognitive deficits.

Associations between anemia and dependence on basic and instrumental activities of daily living in older women.

AIM: The aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older female patients. METHODS: 540 older female outpatients were included in this cross-sectional study. Anemia was defined as a hemoglobin below 12 g/dL. Patients' demographic characteristics, comorbidities, Geriatric Depression Scale, Mini Nutritional Assessment, and Mini-Mental State Examination (MMSE) were also recorded. Handgrip strength (HGS) was measured with a hand dynamometer to detect dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity. RESULTS: The mean age of the participants was 77.42 ± 7.42 years. The prevalence of patients with anemia was 35%. A significant difference was observed between anemic and non-anemic groups in terms of age, presence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), chronic kidney disease (CKD), malnutrition, dynapenia, and MMSE, BADL and IADL scores (p < 0.05). In multivariate analysis, after adjustment for age, DM, hypertension, CAD and CKD; there were significant associations between anemia and reduced BADL/IADL scores, dynapenia, falls, the risk of falls, MMSE, and malnutrition (p < 0.05). After adjusting for all confounding variables, deterioration in total BADL and IADL total scores were still more common among anemic older females than those without anemia (p < 0.05). CONCLUSION: One out of every three older women presenting at one outpatient clinic were anemic. Anemia was observed to be associated with dependence in both BADL and IADL measures. Therefore, the presence of anemia in elderly women should be routinely checked, and possible causes should be investigated and treated to improve their functional capacity.

Non-invasive estimation of cerebrospinal fluid pressure in idiopathic intracranial hypertension: magnetic resonance imaging analysis of optic nerve and eyeball.

PURPOSE: Invasive methods such as lumbar puncture and intraventricular catheters are commonly used to measure intracranial pressure (ICP). This study aims to develop quantitative and non-invasive techniques to measure ICP in patients with Idiopathic Intracranial Hypertension (IIH) using magnetic resonance imaging (MRI) findings. METHODS: MRI data obtained from 50 patients with IIH and 30 age- and sex- matched controls were analyzed and optic nerve sheath diameter (ONSD), eyeball transverse diameter (ETD) and optic nerve diameter (OND) were measured. ONSD, ONSD/ETD and OND/ONSD indexes were calculated according to different ONSD measurement distances. Correlations of MRI findings with ICP were calculated. Sensitivity and specificity of all methods were analyzed. RESULTS: ONSD and ONSD/ETD index at 3 mm and 10 mm behind the eyeball were significantly higher (p < 0.001) and OND/ONSD index at 3 mm behind the eyeball was significantly lower (p < 0.001) in the IIH group. The ONSD/ETD index at 3 mm had the highest area under the curve (AUC) value (0.898) with a cut-off of 0.27 mm (82% sensitivity and 91.67% specificity) for predicting high cerebrospinal fluid (CSF) pressure, followed by ONSD measurements at 3 mm (AUC = 0.886) with a cut-off of 6.17 mm (83% sensitivity and 86.67% specificity). The OND/ONSD index at 3 mm posterior to the eyeball decreased significantly as ICP increased, and the strength of the relationship was moderate (p < 0.001; r = -0.358). CONCLUSIONS: ONSD and ONSD/ETD index measured on MRI sequences are potentially useful in detecting elevated ICP. The OND/ONSD index correlates with CSF pressure and these techniques may be helpful in diagnosing IIH.

Chrysin Enhances Anti-Cancer Activity of Jurkat T Cell and NK-92 Cells Against Human Breast Cancer Cell Lines.

Chrysin, a naturally occurring flavonoid in plant and bee products, demonstrates notable biological activities, including anti-cancer effects. These properties are partially attributed to its capability to activate immune cells. This study focused on exploring the immunomodulatory potential of chrysin on NK-92 and Jurkat-T cells targeting breast cancer cells (BCC). Chrysin leads to activation of NK-92 and T cells facilitated by the addition of human recombinant IL-2 and PHA-M. The anti-cancer efficacy of chrysin on these immune cells was evaluated in a co-culture setup with EGF-stimulated MCF-7 and MDA-MB-231 cells. Findings revealed that chrysin notably increased the cytotoxicity of NK-92 and T cells towards MCF-7 and MDA-MB-231 cells, with the most significant impact observed on MCF-7 cells (20 %). The activation of NK-92 cells, marked by increased IFN-γ production and CD56 expression, correlated with enhanced secretion of cytokines. Additionally, the activation of these cells against BCC was linked with elevated levels of granzyme-B, TNF-α, and nitric oxide (NO). Similarly, the cytotoxic activation of Jurkat-T cells against BCC was characterized by increased production of granzyme-B, IL-2, and IFN-γ. Consequently, these results support the hypothesis that chrysin significantly contributes to the activation and functional enhancement of NK-92 and T-cells against two distinct BCC lines.

Effect of Medical Ozone Therapy in Preventing Compromised Nasal Skin in Revision Rhinoplasty.

BACKGROUND: Ozone is often used as an additive therapy for skin conditions like infectious diseases, wound healing, diabetic foot, and pressure ulcers. The viability of the nasal skin has crucial importance in revision rhinoplasty cases. The study investigates the potential benefits of medical ozone therapy in healing the nasal skin in multiple-operated cases. METHODS: The study retrospectively examined 523 revision rhinoplasty patients operated by the first author from January 2017 to January 2024. Patients consenting to ozone therapy received 3 major autohemotherapy sessions post-surgery. Patients were divided into 2 groups: those with compromised nasal skin (infection, poor vascular supply) and those with normal healing. Age, gender, smoking, diabetes, previous surgeries, grafting materials, and techniques were considered. RESULTS: Of the 523 patients, 12 (2.3%) experienced major skin complications like infection and necrosis, while 511 (97.7%) had no or minor issues, such as discoloration. In total, 301 patients accepted and received ozone therapy. Of the patients without major complications, 299 (58.3%) received ozone therapy, while 212 (41.7%) did not. Among the 12 with major complications, two (16.7%) received ozone therapy, and the remaining 10 (83.3%) did not. Ozone therapy recipients showed statistically fewer skin problems (p<0.05). Costal cartilage as tip and septal extension graft was linked to skin issues (p<0.05). No major adverse effects from ozone therapy were noted. CONCLUSIONS: Our findings indicate that ozone therapy may be a safe and potentially effective option for patients undergoing revision rhinoplasty, especially those with compromised nasal skin. It appears to aid in skin healing and regeneration, possibly through enhancing oxygen delivery and modulation of the immune response. Ozone therapy is a promising adjunct treatment for managing skin complications in revision rhinoplasty patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of capacitive-resistive therapy on the treatment of myofascial pain - A randomized control trial.

BACKGROUND: Myofascial pain syndrome is a painful musculoskeletal condition with muscle spasm, referred pain, stiffness, restricted range of motion. Capacitive-resistive diathermy heats deep tissues by transferring energy through radiofrequency waves. Although this modality is used to treat various musculoskeletal disorders, there is no specific data on myofascial trigger points. Thus, we aimed to evaluate the effectiveness of capacitive-resistive diathermy on the myofascial trigger points. METHODS: Thirty-six volunteers with active myofascial trigger points were included. Patients were randomly and equally allocated into two groups. Group-1 is the capacitive-resistive diathermy treatment group; Group-2 is the placebo capacitive-resistive diathermy (PG). Visual analog scale (VAS), pain pressure threshold (PPT), neck disability index (NDI), neck range of motion (nROM), Short form-36 (SF-36) were used as outcomes before and after the intervention. RESULTS: In both groups, VAS, PPT, NDI score significantly improved within the groups (p < 0.05). The CRG showed a statistically significant improvement in nROM for flexion, extension, and rotation (p < 0.05). However, ROM increase in CRG is not superior to PG (p > 0.05). CONCLUSIONS: There was no significant difference between the two groups. We thought positive results in the PG might attributed to doing exercise. As a result, capacitive-resistive diathermy is not superior to exercise, but can be used as an adjuvant modality in myofascial trigger points treatment.

Conservative Treatment in Adult Degenerative Scoliosis: a Prospective Cohort Study.

Background: Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. Methods:Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. Results:Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. Conclusion:Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.

Attitudes toward COVID-19 vaccines during pregnancy and breastfeeding.

Background: Although vaccination is one of the most effective means of controlling the spread of COVID-19, public concerns and indecision about vaccination still continue. Because pregnant and breastfeeding individuals are at high risk for severe outcomes in case of infections, determining their level of hesitation and attitude toward COVID-19 vaccines will guide the management of the disease. This study aimed to determine pregnant and breastfeeding women's levels of hesitation and attitude toward COVID-19 vaccines as well as their related factors. Methods: The sample of this descriptive research consisted of 103 pregnant or breastfeeding individuals who were seen at the obstetrics and gynecology outpatients clinic of a state hospital in Istanbul, Turkey. The data were collected using a 'demographic data form', the 'Vaccine Hesitancy Scale in Pandemic', and the 'Attitudes toward COVID-19 Vaccine Scale'. The research data were analyzed with appropriate statistical methods. Results: The mean age of the participants was 29.71 ± 4.75, 51% were pregnant, and 74.8% had received the COVID-19 vaccine. The mean score of the 'Vaccination Hesitancy Scale in Pandemic' was 30.83 ± 6.91, and the mean score for the 'Attitude Scale toward the COVID-19 Vaccine' was 25.50 ± 5.20. A significant difference was found between the total score of the 'Vaccine Hesitation Scale in the Pandemic' and the mean score of the 'Lack of Confidence' sub-dimension between the 'working status' and the 'influenza vaccination' status. In terms of the mean score of the 'Risk' sub-dimension, a significant difference was found between the 'period of vaccination' (p < 0.05). According to the mean total score of the 'Attitude Towards COVID-19 Vaccine Scale', there was a significant difference between the 'smoking' status. There was a significant difference in the 'Positive Attitude' sub-dimension in terms of the 'flu vaccination' status. There was a significant difference in the 'Negative Attitude' sub-dimension in terms of the 'chronic disease' status. A positive correlation was found between the total scores of the scales. Conclusion: It was concluded that although the participants had a high level of hesitation toward the COVID-19 vaccine, they had a positive attitude. The results obtained will be guided in determining the strategies to be developed for these specific groups in future pandemics.

Beneficial effects of adipose-derived stromal vascular fraction on testicular injury caused by busulfan.

The use of stem cells can attenuate testicular injury and promote sperm production. The adipose-derived stromal vascular fraction (SVF) has become an attractive cell source for cell-based therapies. In this study, we aimed to investigate the therapeutic efficacy of SVF on busulfan-induced testicular damage in rats. Twenty-four male rats were randomly divided into control, busulfan, SVF, and busulfan + SVF groups. Testicular damage was induced by intraperitoneal administration of busulfan (35 mg/kg). SVF obtained from human adipose tissue using Lipocube SVF™ was injected into rats 5 weeks after busulfan administration. At the end of the 8th week, rats were sacrificed, and histopathological, biochemical, and western blotting analyses were performed. No harmful effects of SVF on healthy testis tissue and sperm parameters were detected. SVF improved busulfan-induced oxidative stress in both testis tissue and serum. SVF injection to damaged testicular tissue resulted in increases in the healthy spermatozoon numbers and decreases in the abnormal tail numbers. Additionally, SVF increased bax/Bcl, DAZL, and TGF-ß1 levels whereas decreased ATG5 and NF-kB levels. According to the results we obtained in this study, we suggest that SVF is beneficial in restoring damaged tissue by primarily being a multipotent cell source, by inhibiting oxidative stress and converting necrotic cell death to apoptotic cell death. In the future, clinical applications should bring higher benefits. Since SVF is the patient's own tissue, being harmless, it will offer an advantageous supportive treatment option for patients already weakened by cancer and anticancer therapy.

Aberrant miR-3135b and miR-1273g-3p expression in the peripheral blood samples of BRCA1/2 (±) ovarian cancer patients.

Ovarian cancer (OC) ranks as the eighth most prevalent malignancy among women globally. The short non-coding RNA molecules, microRNAs (miRNAs) target multiple mRNAs and regulate the gene expression. Here in this study, we aimed to validate miR-3135b and miR-1273g-3p as novel biomarkers for prognostic and diagnostic factor OC. After RNA isolation, we analyzed the miR-3135b and miR-1273g-3p expression in peripheral blood samples derived from 150 OC patients. Subsequently, we compared their expression levels with 100 healthy controls. The differences of miR-3135b and miR-1273g-3p expression were detected using the Quantitative Real Time-PCR (qRT-PCR) technique following miRNA-specific cDNA synthesis pursing miRNA separation. The miR-3135b and miR-1273g-3p were higher in OC patients who tested positive for BRCA1/2 compared to BRCA-negative patients, and healthy cases. The level of miR-3135b demonstrated a roughly 4.82-fold increase in OC patients in comparison to the healthy cases, while miR-1273g-3p expression exhibited a roughly 6.77-fold increase. The receiver operating characteristic (ROC) analysis has demonstrated the potential of miR-3135b and miR-1273g-3p as markers for distinguishing between OC patients and healthy controls. The higher expressions of miR-3135b and miR-1273g-3p could be associated with OC development. Moreover, miR-3135b may have a diagnostic potential and miR-1273g-3p may have both diagnostic and prognostic potential in OC cell differentiation. The string analysis has revealed an association between miR-1273g-3p and the MDM2 gene, suggesting a potential link to tumor formation through the proteasomal degradation of the TP53 tumor suppressor gene. Additionally, the analysis indicates an association of miR-1273g-3p with CHEK1, a gene involved in checkpoint-mediated cell cycle arrest. String analysis also indicates that miR-3135b is associated with the MAPK1 gene, causing activation of the oncogenesis cascade. In conclusion, miR-1273g-3p, and miR-3135b exhibit significant potential as diagnostic markers. However, further research is needed to comprehensively investigate these miRNAs diagnostic and predictive characteristics in a larger cohort.

Initiating luteal phase support with sc progesterone based on low serum progesterone on the transfer day in true natural cycle frozen embryo transfers.

Introduction: Concerning contemporary in-vitro fertilisation (IVF) practice, the use of frozen embryo transfer (FET) cycles has become more common than fresh transfers. Natural cycle (NC), programmed artificial cycle and mild stimulation cycle are primary endometrium preparation cycles. Monitoring serum progesterone levels in FET cycles are in the scope of current research focus. Low progesterone levels on the day of embryo transfer is presumed to negatively affect pregnancy outcomes, while progesterone supplementation may improve pregnancy rates. The purpose of our trial is to evaluate whether initiating subcutaneous (SC) progesterone supplementation on the day of embryo transfer when serum progesterone levels are below 10 ng/mL in tNC-FET will result in pregnancy rates comparable to those of patients with sufficient serum progesterone. Methods: Retrospective single centre study was conducted between August 2022 and April 2023 with 181 tNC-FETs. Patients were separated into groups according to serum progesterone concentrations (≥10 ng/mL and <10 ng/mL) on embryo transfer (ET) day. S.c progesterone (25 mg) was given on the day of ET when serum progesterone was <10 ng/mL, continuing until the 10th gestational week. Blood samples for pregnancy tests were collected 12 days after ET. Outcome parameters were pregnancy rate, clinical pregnancy rate (CPR), miscarriage rate, multiple pregnancy rate, biochemical pregnancy, and ongoing pregnancy rate (OPR). Results: About half (49.7%) had adequate progesterone concentrations (≥10ng/mL) on ET day. There was no significant difference between the groups regarding positive pregnancy test, OPR, multiple pregnancies, and miscarriage rates (57.8% versus 52.7%; 34.4% versus 29.7%, 1.1% versus 2.2%; 7.8% versus 5.5%; respectively, for progesterone concentrations on ET day ≥10 ng/mL and <10 ng/mL). With 55.2% of transfers leading to clinical pregnancy, significant differences emerged in biochemical pregnancy and CPR (3.3% vs 12.1%, P=0.02; 54.4% vs 40.7%, P=0.03, for ≥10 ng/mL and <10 ng/mL progesterone concentrations on ET day). Discussion: This study indicates that nearly half of the tNC-FETs may need luteal phase support due to low progesterone. However, 25 mc sc progesterone rescued the luteal support and yielded similar OPR as compared to normal progesterone group. Further studies are needed for understanding optimal progesterone levels, supplementation effectiveness, and potential benefits of earlier supplementation in FETs.

Chronic fatigue syndrome in caregivers of children with cerebral palsy and affecting factors.

OBJECTIVE: In this study, the frequency of chronic fatigue syndrome (CFS), sleep disturbances, and quality of life levels in mothers of children with cerebral palsy (CP) was compared in relation to the functional status of the child. METHODS: The caregivers were evaluated with the sociodemographic data form, Chalder fatigue scale (ChFS), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index, and Short Form-12, respectively. In addition, the functional status of the child with CP was evaluated with the gross motor function classification system, manual ability classification system (MACS), communication function classification system, and eating and drinking ability classification system. RESULTS: According to CDC-1994 criteria, 80.4% of the participating mothers have CFS (n=45). While the mean ChFS and FSS scores of housewives were found to be significantly higher than those of full-time workers (p=0.002; p=0.003, respectively), the mean SF-12 MCS was found to be significantly lower (p=0.007). The rate of housewives was found to be significantly higher in those diagnosed with CFS (p<0.001). The relationship between independent variables and dependent variables data sets as a result of canonical correlation analysis was obtained as 0.815. While the variable with the highest effect among the independent variables is the MACS variable, the variable with the highest percentage of explanation for the dependent variables is ChFS. CONCLUSION: The frequency of CFS is very high in mothers of children with CP, and the most important factors in the presence and severity of CFS are the mother's occupational status and the child's manual skills.

Carbetocin versus Oxytocin with or without Tranexamic Acid for Prophylactic Prevention of Postpartum Hemorrhage after a Vaginal Delivery: A Randomized Clinical Trial.

OBJECTIVE: Our study's primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid. DESIGN: A multicentric randomized controlled trial. PARTICIPANTS/MATERIALS, SETTING, AND METHODS: This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient's bed within 2 h after delivery. Group I: carbetocin 100 µg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75). RESULTS: The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6). LIMITATIONS: The most important limitation of the study is a relatively small number of participants. CONCLUSION: In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.

DNA methylation of KIFC1 gene in determination of histological diagnosis, prognosis and metastasis of lung cancer.

BACKGROUND: One of the main features of cancer, especially lung cancer (LC), is abnormal cell division. Abnormal expression of kinesin family member C1 (KIFC1/HSET), which is involved in mitotic cell division and ensures equatorial alignment of chromosomes during division, is observed in both premalignant and malignant lesions. There are no studies in the literature addressing the role of KIFC1 in the diagnosis and follow-up of LC. In this study, we investigated the epigenetic role of KIFC1 in the diagnosis, stage, and prognosis of various histological subtypes diagnosed with LC. MATERIAL AND METHODS: The expression and methylation status of the KIFC1 gene were examined after DNA/RNA isolation in tumor, conjugate normal tissue, and blood samples from 39 patients diagnosed with LC and in blood samples from 39 healthy controls. Changes in KIFC1 gene expression were examined by the Quantitative Real Time-PCR (qRT-PCR) method after cDNA synthesis following RNA isolation. The Methylation-Specific PCR (MSP) method was used to determine the methylation status of the KIFC1 gene. In this study, the expression/methylation profiles of the KIFC1 gene and the clinical and pathological characteristics of the patients were analyzed by statistical methods. RESULT: Hypomethylation was detected in 95.8% of the 62.1% of patients' tissues with increased KIFC1 gene expression. The expression level of the KIFC1 gene was found to be increased 3.2-fold in the tumor tissues of the patients compared with the conjugated normal tissues and 2.4-fold in the serum of the patients compared with the healthy serum. Statistical comparison of patients' clinical parameters and methylation and expression results revealed statistical significance between KIFC1 expression and metastasis, tumor stage and tumor grade. CONCLUSION: In conclusion, the increase in the expression level of the KIFC1 gene is higher in patients diagnosed with LC than in the healthy population, and therefore, the increase in the expression level of the KIFC1 gene due to hypomethylation can be used as a screening biomarker in LC. It can also be considered that the methylation profile of the KIFC1 gene may be a potential biomarker for determining the subtype of squamous cell carcinoma in LC. The results of the study need to be analyzed and continued with a larger number of patients.

The efficacy of three regimes of uterotonic agents for prevention of postpartum blood loss at undergoing cesarean section: a prospective randomized clinical trial.

OBJECTIVES: To compare the efficacy of three regimes of uterotonic agents on PPH in women undergoing cesarean section in our RCT. MATERIAL AND METHODS: This study was a randomized controlled study (NCT05083910) performed at the Bezmialem Vakif University between July 2021 and January 2022. All women were randomly allocated into three groups: Group I (n = 52) - oxytocin only; Group II (n = 52) - the combination of oxytocin plus intrauterine misoprostol; Group III (n = 52) - carbetocin only. The primary outcome measures were: PPH to evaluate with the change between the concentrations of preoperative and postoperative hemoglobin, hematocrit and intraoperative blood loss. RESULTS: The blood loss characteristics, including the change in hemoglobin and the change in hematocrit concentration, intraoperative blood loss, intraoperative additional hemostatic uterine sutures and the need for additional uterotonics, were lowest in group III, although all groups were comparable in terms of blood loss parameters. Group III had the highest blood loss ratio, exceeding 1000 mL. For the combination of oxytocin and intrauterine misoprostol, the ARR was 3.8% (95% CI 20.02-12.33), with a RR of 1.18 (95% CI 0.58-2.39) and a NNT of 26 (95% CI 8.1-4.9); for carbetocin, the ARR was 5.8% (95% CI 22.15-10.61), with a RR of 1.27 (95% CI 0.63-2.53) and a NNT of 17 (95% CI 9.41-4.51). CONCLUSIONS: Our results demonstrate that carbetocin shows no superiority in the prevention of PPH in women undergoing cesarean section. Oxytocin still seems to be a highly effective alternative to prevent PPH.

Knowledge levels and community guidance of doctors working in family health centers on HPV screening and HPV vaccination.

AIM: Our aim is to evaluate the level of knowledge, compliance with the screening program, and tendency to inform patients of the doctors working in FHCs where HPV testing is performed within the scope of the cervical cancer screening program in our country. METHODS: This cross-sectional study was performed between June and September 2022 with 113 family physicians working in different FHCs in different provinces in Turkey. Questionnaires prepared by the researchers were delivered to family physicians via online platforms. RESULTS: When the different age groups were evaluated, in two of the 24 knowledge-level questions (How many types of HPV are there? Can HPV infect men?) the rate of correct answers for participants under the age of 35 years was statistically significantly higher (p = 0.007; p = 0.032). With regard to professional experience, the group with fewer than 10 years of experience gave a statistically significant correct answer to two questions (How many types of HPV are there? Can HPV infect men?; p = 0.008; p = 0.037). It was observed that 107 (94.7%) of the 113 family physicians who participated in the survey recommended that their patients use condoms during intercourse, 110 (97.3%) recommended cervical cancer screening tests to patients who applied for another reason, 105 (92.9%) recommended the HPV vaccine to patients and their relatives and 60 (53.1%) recommended the HPV vaccine to patients who applied for another reason. CONCLUSIONS: The success of HPV vaccination programs is directly related to the beliefs of health personnel and their recommendations to the general population.

The Effect of Upper Abdominal Surgery on Complication Profile in Ovarian Cancer.

Introduction: Due to the superficial peritoneal spread of ovarian cancer, upper abdominal surgical procedures are often required to achieve optimal surgical cytoreduction. This study compares the mortality and morbidity rates of patients undergoing upper and lower abdominal cytoreductive surgery in our institution. Material and Methods: Patients who underwent cytoreductive surgery for ovarian malignancies from 2014 to 2020 were retrospectively identified from an institutional database. Upper abdominal cytoreduction was defined anatomically as debulking of disease proximal to the ligament of Treitz. Perioperative and postoperative outcomes were analyzed. Results: A total of 148 operations were performed. A single gynecologic oncologist performed all procedures. When all cytoreductive procedures were evaluated, diaphragm injury, blood transfusion, hospital stay, atelectasis, pneumonia, effusion, wound infection and need for intensive care were found to be statistically significantly higher in patients who underwent upper abdominal surgery compared to patients in the lower abdominal surgery group (p=0.001, p=0.017, p=0.002, p=0.045, p=0.006, p=0.005, respectively). Conclusion: In patients scheduled for cytoreductive surgery with the diagnosis of ovarian cancer, upper abdominal surgery is a viable procedure, although it carries a higher risk of complications compared to lower abdominal surgery alone. Upper abdominal surgery in advanced ovarian cancer can be applied to patients with an acceptable complication profile when the possible survival advantage is considered.

Prevalence of urinary incontinence and anal incontinence: an internet-based cross-sectional study of female Turkish University students.

INTRODUCTION AND HYPOTHESIS: The objective of this cross-sectional, epidemiological study was to characterize urinary tract and bowel symptom prevalence and the extent of discomfort/bother associated with them. Additionally, the authors aimed to explore factors associated with both conditions among Turkish female university students. Also, an insight into women's "communication regarding urinary incontinence and anal incontinence" with their family members was sought. METHODS: This is an internet-based national cross-sectional study. A study-specific 30-item questionnaire containing validated measures of symptom prevalence and bother (Urogenital Distress Inventory questionnaire short form and Colorectal-Anal Distress Inventory) were incorporated into the survey. Out of a total of 2,125 e-mail invitations that were sent, 1,226 responded with data included in this analysis. RESULTS: The age and BMI of all respondents were 26.53 ± 10.082, 23.45 ± 6.609 respectively. Nine hundred and eighty-five (80.5%) respondents claimed that they did not suffer a UI episode in the last year, whereas 10 people (0.08%) claimed that they had a urinary incontinence episode every day. Three hundred and fifty-seven responders (29.1%) stated that they suffered from "gas incontinence," 6 (0.5%) stool incontinence, and 20 (1.6%) declared that they had episodes of both stool and gas incontinence. Five hundred and forty-four participants (44%) reported that they had family relatives with a problem of "urinary incontinence" and 576 (47%) stated they had a conversation on "urinary incontinence." Seventy-five of the responders (6.1%) stated that they had a family member with "anal incontinence" and 246 (20.1%) responded that they had a conversation regarding "anal incontinence" with them. CONCLUSION: We have demonstrated that the prevalence of UI was 19.5%. Twenty-nine percent stated they suffered "gas incontinence," 0.5% stool incontinence, and 1.6% declared that they had episodes of both stool and gas incontinence.

Validity, reliability and minimal detectable change of Mini-BESTest Turkish version in neurological disorders.

AIMS: It is aimed to investigate the psychometric properties of Mini-BESTestTR in Turkish patients with neurological disorders. METHODS: A total of 61 people between the ages of 42 and 80, who were patients with Parkinson's disease, stroke or multiple sclerosis for more than 1 year, were included in the study. For inter-rater reliability, two independent researchers applied the scale two times within 5 days for test-retest reliability. The relationship of mini-BESTestTR with Berg Balance Scale (BBS) to assess concurrent validity, and Timed Get up and Go (TUG), Functional Reach Test (FRT) and Functional Ambulation Classification (FAC) for convergent validity was investigated. RESULTS: The scores of the two evaluators were within the range of agreement (mean = - 0.278 ± 1.484, p > 0.05), and the Mini-BESTestTR had excellent inter-rater reliability [ICC (95% CI) = 0.989 (0.981-0.993)] and test-retest reliability [ICC (95% CI) = 0.998 (0.996-0.999)]. Mini-BESTestTR had a strong correlation with BBS (r = 0.853, p < 0.001) and TUG (r = - 0.856, p < 0.001), had a moderate correlation with FAC (r = 0.696, p < 0.001) and FRT (r = 0.650, p < 0.001). CONCLUSIONS: Mini-BESTestTR showed significant correlations with other balance assessment measures, and concurrent and convergent validity of Mini-BESTestTR was demonstrated when administered to a sample of patients with chronic stroke, Parkinson's disease and multiple sclerosis.

Hypomagnesemia Is Associated with Excessive Daytime Sleepiness, but Not Insomnia, in Older Adults.

The aim of this study was to investigate associations between serum magnesium levels with insomnia and excessive daytime sleepiness (EDS) in older adults. A total of 938 older outpatients were included in the study. Hypomagnesemia was defined as serum magnesium concentration below <1.6 mg/dL. Patients were divided into two groups: hypomagnesemia and normomagnesia (1.6-2.6 mg/dL). The Epworth Sleepiness Scale was implemented and scores of ≥11 points were categorized as EDS. The Insomnia Severity Index was implemented and scores of ≥8 indicated insomnia. The mean age was 81.1 ± 7.6 years. While the presence of EDS, hypertension, diabetes mellitus, and coronary artery disease were more common in the hypomagnesemia group than the normomagnesia group, Parkinson's disease was less common (p < 0.05). Hemoglobin and HDL cholesterol were lower, whereas HbA1c, triglyceride, and number of drugs used were higher in the hypomagnesemia group compared to the normomagnesia group (p < 0.05). In both univariate analysis and multivariate analysis adjusted for gender, age and all confounders, there were significant associations between hypomagnesemia and EDS [odds ratio (OR):1.7; 95% confidence interval (CI): 1.6-2.6, and OR: 1.9; 95%CI: 1.2-3.3, respectively (p < 0.05)]. There was no significant relationship between hypomagnesemia and insomnia (p > 0.05). The present study identified an association between hypomagnesemia and EDS in older adults. Therefore, it may be prudent to consider hypomagnesemia when evaluating older adults with EDS and vice versa.