Circadian Rhythms in Anticancer Immunity: Mechanisms and Treatment Opportunities.

Circadian rhythms of approximately 24 h have emerged as important modulators of the immune system. These oscillations are important for mounting short-term, innate immune responses, but surprisingly also long-term, adaptive immune responses. Recent data indicate that they play a central role in antitumor immunity, in both mice and humans. In this review, we discuss the evolving literature on circadian antitumor immune responses and the underlying mechanisms that control them. We further provide an overview of circadian treatment regimens-chrono-immunotherapies-that harness time-of-day differences in immunity for optimal efficacy. Our aim is to provide an overview for researchers and clinicians alike, for a better understanding of the circadian immune system and how to best harness it for chronotherapeutic interventions. This knowledge is important for a better understanding of immune responses per se and could revolutionize the way we approach the treatment of cancer and a range of other diseases, ultimately improving clinical practice.

Circadian tumor infiltration and function of CD8+ T cells dictate immunotherapy efficacy.

The quality and quantity of tumor-infiltrating lymphocytes, particularly CD8+ T cells, are important parameters for the control of tumor growth and response to immunotherapy. Here, we show in murine and human cancers that these parameters exhibit circadian oscillations, driven by both the endogenous circadian clock of leukocytes and rhythmic leukocyte infiltration, which depends on the circadian clock of endothelial cells in the tumor microenvironment. To harness these rhythms therapeutically, we demonstrate that efficacy of chimeric antigen receptor T cell therapy and immune checkpoint blockade can be improved by adjusting the time of treatment during the day. Furthermore, time-of-day-dependent T cell signatures in murine tumor models predict overall survival in patients with melanoma and correlate with response to anti-PD-1 therapy. Our data demonstrate the functional significance of circadian dynamics in the tumor microenvironment and suggest the importance of leveraging these features for improving future clinical trial design and patient care.

"A Life Slips Through Our Fingers" Experiences of Nurses Working in Pediatric Intensive Care Units About Children's Death: A Qualitative Study.

Caring for a dying child can be an experience full of all kinds of negative emotions, pain and stress for the pediatric nurse. In this study, which was carried out in Turkey, we aimed to determine how nurses working in a pediatric intensive care unit remembered and made sense of their experiences regarding children's deaths. In-depth interviews were held with 13 nurses. The data were analyzed using the content analysis method. Three themes were identified. These were (1) Personal effects of death, (2) Difficulties in care, and (3) Coping with death. It was clear that the nurses were traumatised by their exposure to infant deaths. The findings showed that nurses experienced regret, fatigue and posttraumatic stress disorder. In addition, it was determined that nurses should be supported to cope with child deaths, which is a complicated process involving the child and the family, especially emotionally. Moreover, providing institutional support to nurses and referring them to cognitive-behavioral therapies may make it easier for them to cope with the emotional burden they carry, as well as the burnout they experience.

Birth outcomes in pregnant women with epilepsy: A Nationwide multicenter study from Türkiye.

OBJECTIVE: The present study was aimed at investigating the effects of anti-seizure medications (ASMs), patient demographic characteristics, and the seizure type and frequency on the development of congenital malformations (CMs) in the infants of pregnant women with epilepsy (PWWE). METHODS: PWWE followed up at the neurology outpatient clinic of 21 centers between 2014 and 2019 were included in this prospective study. The follow-up of PWWE was conducted using structured, general pregnant follow-up forms prepared by the Pregnancy and Epilepsy Study Committee. The newborns were examined by a neonatologist after delivery and at 1 and 3 months postpartum. RESULTS: Of the infants of 759 PWWE, 7.2% had CMs, with 5.6% having major CMs. Polytherapy, monotherapy, and no medications were received by 168 (22.1%), 548 (72.2 %), and 43 (5.7 %) patients, respectively. CMs were detected at an incidence of 2.3% in infants of PWWE who did not receive medication, 5.7% in infants of PWWE who received monotherapy, and 13.7% in infants of PWWE who received polytherapy. The risk of malformation was 2.31-fold (95% confidence interval (CI): 1.48-4.61, p < .001) higher in infants of PWWE who received polytherapy. Levetiracetam was the most frequently used seizure medication as monotherapy, with the highest incidence of CMs occurring with valproic acid (VPA) use (8.5%) and the lowest with lamotrigine use (2.1%). The incidence of CMs was 5% at a carbamazepine dose <700 mg, 10% at a carbamazepine dose ≥700 mg, 5.5% at a VPA dose <750 mg, and 14.8% at a VPA dose ≥750 mg. Thus the risk of malformation increased 2.33 times (p = .041) in infants of PWWE receiving high-dose ASMs. SIGNIFICANCE: Birth outcomes of PWWE receiving and not receiving ASMs were evaluated. The risk of CMs occurrence was higher, particularly in infants of PWWE using VPA and receiving polytherapy. The incidence of CMs was found to be lower in infants of PWWE receiving lamotrigine.

Autoimmune encephalitis and paraneoplastic syndromes in Turkey: a multi-centre study.

BACKGROUND: Autoimmune encephalitis (AIE) and paraneoplastic syndromes (PNS) are both rare groups of neurological diseases that are difficult to diagnose. AIM: We aimed to determine the common and distinct aspects of these two aetiologies of encephalitis as well as the characteristics of our patient group. METHODS: We respectively analysed the records of the patients including symptoms, demographic features, neurological examination, cranial-magnetic-resonance-imaging (MRI), electroencephalography (EEG) findings, cerebrospinal fluid results (CSF) findings. Autoimmune/paraneoplastic autoantibodies in blood and/or CSF were all documented. RESULTS: Forty-six patients fulfilled the diagnostic criteria. Thirty-eight of them were diagnosed with AIE, and 8 of them were diagnosed with PNS. The PNS group had higher nonconvulsive status epilepticus than the AIE (2/8 vs 0/38; p=0.027). PNS patients were diagnosed with a malignancy in their follow-ups more than those in the AIE group [4/38 vs 8/8] (p<0.001). When the symptoms of antibody-positive and negative patients were compared in the AIE group, the rates of consciousness/memory problems (13/15 vs 11/23; p=0.020) and speech impairment (8/15 vs 2/23; p=0.004) were significantly higher in patients without antibodies (n: 15) than in antibody-positive patients (n: 23). In antibody-negative groups, the rates of memory problems in neurological examination (13/15 vs 12/23 p=0.028) and temporal findings on electroencephalography were more prominent than antibody-positive groups (1/23 vs 5/15; p=0.027). The number of patients with cerebellar signs was higher in antibody-positive patients (6/23 vs 0/15; p=0.038). CONCLUSION: Although the positivity of autoantibodies is critical in the diagnosis of AIE and PNS, even minor differences in clinical and laboratory findings of patients are helpful in the diagnosis, especially in the autoantibody-negative patients. Comparing the data with other population studies has shown that several inherited and environmental factors may contribute to the pathophysiology of AIE and PNS, as well as clinical and laboratory differences.

Depression and sexual functions in epilepsy patients: Comparison before and during the COVID-19 pandemic.

OBJECTIVE: The new coronavirus disease 2019 (COVID-19) is a major health problem with a high rate of spread. We aimed to investigate herein the effects of the COVID-19 outbreak on depression and sexual dysfunction in patients with epilepsy. MATERIAL AND METHODS: One hundred and sixteen epilepsy patients admitted to our hospital from October-November 2019 were evaluated for sexual functions and depression using the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Scale, respectively. These scales were re-applied in June 2020 and July 2020 to assess the impact of the outbreak on sexual function and depression in the same group of patients. The demographic and clinical characteristics of the patients were recorded and analyzed in SPSS. RESULTS: During the pandemic period, the total Beck Depression Scale values increased significantly in the patients with epilepsy compared to the pre-pandemic period (P = 0.048), and depressive symptoms showed an increasing trend (P = 0.032). Although an increase in sexual dysfunction was also recorded, it was not statistically significant compared to the pre-pandemic period. In eight patients (6.9%), seizure frequency increased during the pandemic period. In the multivariate analysis, the only parameter that predicted the increase in seizure frequency was the number of drugs used. The Beck Depression Scale values were positively correlated with total male/female ASEX values, age, marital status, duration of illness, and seizure frequency. CONCLUSION: The COVID-19 outbreak caused an increase in the tendency to depression in epilepsy patients and has also had a negative effect on sexual function. During public health outbreaks, clinicians should focus not only on seizure control in patients with epilepsy but also on their mental health.

OBJECTIF: La nouvelle maladie à coronavirus 2019 (COVID-19) est un problème de santé majeur avec un taux de propagation élevé. Nous visons à étudier ici les effets de l'épidémie de COVID-19 sur la dépression et la dysfonction sexuelle chez les patients atteints d'épilepsie. MATÉRIEL ET MÉTHODES: Cent seize patients atteints d'épilepsie admis dans notre hôpital d'octobre à novembre 2019 ont été évalués pour les fonctions sexuelles et la dépression en utilisant respectivement l'échelle des expériences sexuelles de l'Arizona (ASEX) et l'échelle de dépression de Beck. Ces échelles ont été réappliquées en juin 2020 et juillet 2020 pour évaluer l'impact de l'épidémie sur la fonction sexuelle et la dépression dans le même groupe de patients. Les caractéristiques démographiques et cliniques des patients ont été enregistrées et analysées dans SPSS. RÉSULTATS: Pendant la période pandémique, les valeurs totales de l'échelle de dépression de Beck ont augmenté de manière significative chez les patients atteints d'épilepsie par rapport à la période pré-pandémique (p = 0,048), et les symptômes dépressifs ont montré une tendance à la hausse (p = 0,032). Bien qu'une augmentation de la dysfonction sexuelle ait également été enregistrée, elle n'était pas statistiquement significative par rapport à la période pré-pandémique. Chez huit patients (6,9 %), la fréquence des crises a augmenté pendant la période pandémique. Dans l'analyse multivariée, le seul paramètre qui prédisait l'augmentation de la fréquence des crises était le nombre de médicaments utilisés. Les valeurs de l'échelle de dépression de Beck étaient positivement corrélées avec les valeurs ASEX totales des hommes/femmes, l'âge, l'état matrimonial, la durée de la maladie et la fréquence des crises. CONCLUSION: L'épidémie de COVID-19 a provoqué une augmentation de la tendance à la dépression chez les patients épileptiques et a également eu un effet négatif sur la fonction sexuelle. Pendant les flambées de santé publique, les cliniciens devraient se concentrer non seulement sur le contrôle des crises chez les patients atteints d'épilepsie, mais aussi sur leur santé mentale.

Effect of the COVID-19 pandemic on drug compliance and stigmatization in patients with epilepsy.

OBJECTIVE: Pandemics like coronavirus disease 2019 (COVID-19) bring along many individual and social problems. We aimed to investigate what changes the COVID-19 pandemic can cause in patients with epilepsy on drug compliance and stigmatization. MATERIAL AND METHOD: Modified Morisky Scale (MMS) and stigmatization scales were used between October and November 2019 to assess drug compliance and stigmatization in epilepsy patients. These scales were renewed in June and July 2020 in the same patient group to assess the impact of the epidemic on drug compliance and stigmatization in patients with epilepsy. Statistical analysis was performed using the statistical software SPSS 17.0 for Windows (SPSS, Inc). Demographic and clinical characteristics of the patients were recorded in SPSS. The interviews were conducted during the interictal period. Paired-samples t-test was used to compare the stigma scale results of epilepsy patients before and during COVID-19. The Wilcoxon test was used to compare MMS groups before and during COVID-19. RESULTS: A total of 110 patients were included in the study. There was no significant difference between the pre-pandemic and pandemic period in epilepsy stigma scale used to evaluate stigmatization levels in patients. During the pandemic period, it was observed that patients had higher motivation and higher knowledge than before the pandemic (p = 0.048). There were seven patients (6.4%) whose seizure frequency increased during the pandemic period. There were two patients (1.8%) who had difficulty in accessing drugs during the pandemic period. In multivariate analysis, only parameter that predicted an increase in seizure frequency was the number of drugs used In the of COVID-19 period. In correlation analysis, a negative correlation was found between the stigma total score during COVID-19 period and education level. CONCLUSION: A slight increase in the frequency of seizures was observed in our patients during the pandemic period, and no significant problem was experienced in accessing drugs. The COVID-19 pandemic made patients more motivated and informed in drug compliance in the patient group and had no effect on stigmatization.

Whole genome sequencing of Thaumetopoea pityocampa revealed putative pesticide targets.

Insect neuropeptides play a major role in the regulation of the physiological processes. Due to their versatile effects on the development of insects, their corresponding receptors, which are mostly G-protein coupled receptors, are considered as ideal targets for designing next-generation pesticides. In this study, we aimed to find neuropeptide receptors of pine processionary moth (Thaumetopoea pityocampa), a pest in the Mediterranean countries, that feeds on the needles of pine trees. To this aim, Whole Genome Shotgun sequencing technique was used. de novo assembly of the genome was performed using two different assemblers, SGA and MaSuRCA. The results of two assemblers were compared, and MaSuRCA assembler showed higher N50 length. To find some target GPCRs, sequences of Drosophila melanogaster and evolutionarily close species were used as blast queries in the assembled data. Five GPCRs were chosen from the genome and their expression was confirmed in the larval stage of the insect.

COMPARISON OF REAL WORLD LIPID PROFILE OF PATIENTS WITH TYPE 2 DIABETES AND GUIDELINE RECOMMENDATIONS.

Diabetes is a major risk factor for cardiovascular disease. Despite recommendations and available therapeutic options, patients with diabetes do not always reach the recommended lipid levels. In this study, our aim was to compare the real world lipid profile of type 2 diabetes patients with guideline recommendations for dyslipidemia. Four hundred and sixty eight consecutive patients referred to Outpatient Diabetes Clinic of Istanbul Medeniyet University were recruited. Patient anthropometric measurements (height, weight, waist circumference), biochemical test results (LDL cholesterol (LDL-c), triglycerides, HDL cholesterol, HbA1c) and treatment modalities were recorded. Patients were stratified into cardiovascular risk categories according to the risk factors and their treatment dose was compared to the recommendations. Among 468 patients, 56 (12%) patients had coronary heart disease (CHD). Thirty-four percent of these patients were not on statin treatment (n=19) and their mean LDL-c level was 114±29 mg/dL (2.9±0.75 mmol/L). Nineteen percent of these patients were on high intensity statin treatment (atorvastatin 40-80 mg, rosuvastatin 20 mg). Only four patients with CHD had LDL-c levels <70 mg/dL (1.8 mmol/L). Four hundred and twelve patients had no CHD. In these patients, the mean LDL-c level was 132±38 mg/dL (3.4±0.9 mmol/L). Eighty (19%) patients had LDL-c level lower than 100 mg/dL (2.5 mmol/L). Overall 82% (n=384) of the cohort had not achieved treatment goal. In conclusion, a more pronounced approach for statin treatment is needed in diabetes patients for both primary and secondary prevention of cardiovascular diseases.

Development of a model to predict prostate cancer at the apex (PCAP model) in patients undergoing robot-assisted radical prostatectomy.

PURPOSE: To develop a model based on preoperative variables to predict apical prostate cancer. METHODS: We performed a retrospective analysis of 459 patients who underwent a robotic assisted radical prostatectomy (RALP) between January 2016 and September 2017. All patients had a preoperative biopsy and mpMRI of the prostate. Significant apical pathology (SAP) was defined as those patients who had a dominant nodule at the apex with a Gleason score > 6 and/or ECE at the apex. Binary logistic regression analyses were adopted to predict SAP. Variables included in the model were PSA, apical lesions prostate imaging reporting and data system (PI-RADS) score and apical biopsy Gleason score. The area under the curve (AUC) of the model was computed. RESULTS: A total of 121 (43.2%) patients had SAP. On univariable analysis, all apex-specific variables investigated emerged as predictors of SAP (all p < 0.05). On multivariable analysis PSA and apical PI-RADS score > 3 (all p < 0.05) emerged as significant predictors of SAP. The AUC of the model was 0.722. CONCLUSION: Patients with PI-RADS 3, 4 or 5 lesions at the apex were three times as more likely to have true SAP compared to those who have PI-RADS < 3 or negative mpMRI prior to undergoing RALP.

Serum HDL Associated Antioxidant Activity in Alzheimer's Disease: Paraoxonase1 and Dysfunctional HDL.

BACKGROUND: Human serum paraoxonase1 (PON1) is a high-density lipoprotein (HDL) associated antioxidant enzymes. We aimed to research the PON1 activity in Alzheimer's disease (AD) not accompanied with any disorders and other conditions influencing the PON1 activity. METHODS: We studied the PON1 activity and PON1 related lipid parameters in two groups, probable sporadic late onset AD (n:30) and those with healthy subjects (n:32). These groups were homogeneous, in which the subjects did not have any cardiovascular risk factors or other conditions affecting PON1 activity. RESULTS: We found increased high-density lipoprotein cholesterol (HDL-C) and significantly decreased PON1 activity in the AD patients. A patient with a PON1 activity value of ≤ 151 U/L had a 5.48-fold higher risk for AD, compared to those with a PON1 activity value of > 151 U/L. CONCLUSIONS: Decreased PON1 activity may play a role in the oxidative stress (OS) related pathogenesis of AD. An increased HDL-C with the decreased PON1 activity may bring the concept of dysfunctional HDL into question in the pathogenesis of AD. It may be emphasized in the pathogenesis of AD for further studies.

Robotic partial nephrectomy: The current status.

INTRODUCTION: Since its introduction, robotic partial nephrectomy (RPN) has become increasingly popular, in part as a result of several advances in technique. The purpose of this paper is to review these techniques as well as the perioperative, functional, and oncologic outcomes after RPN and compare these outcomes to those after laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). METHODS: A literature review was performed to identify papers and meta-analyses that compared outcomes after RPN to OPN or LPN. All meta-analyses were included in this review. RESULTS: Technical advances that have contributed to improved outcomes after RPN include the first-assistant sparing technique, the sliding clip technique, early unclamping, and selective arterial clamping. All five meta-analyses that compared LPN to RPN found that RPN was associated with a shorter warm ischemia time (WIT), but that there were no differences in estimated blood loss (EBL) or operative times. Those meta-analyses that compared intraoperative and postoperative complications, conversion to open or radical nephrectomy, length of stay (LOS), and postoperative estimated glomerular filtration rate (eGFR) either found no difference or favored RPN. Four meta-analyses compared RPN to OPN. All four found that EBL, LOS, and postoperative complications favor RPN. There were no significant differences in intraoperative complications, conversion to radical nephrectomy, or positive surgical margin rates. One meta-analysis found that eGFR was better after RPN. Operative time and WIT generally favored OPN. CONCLUSIONS: Several techniques have been described to improve outcomes after RPN. We believe that the literature shows that RPN is as good if not better than both LPN and OPN and has become the preferred surgical approach.

Pathological downstaging as a novel endpoint for the development of neoadjuvant chemotherapy for upper tract urothelial carcinoma.

OBJECTIVES: To evaluate whether pathological downstaging (pDS) was more informative in predicting overall survival (OS) than pathological complete response (pCR) in patients treated with neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: The National Cancer Database was queried for patients with high-grade cN0M0 disease who had received NAC. pDS was defined as a decrease of at least one stage from cT to pT stage along with pN0, including pCR. A multivariable Cox model predicting OS was generated by fitting alternatively either pDS or pCR, and adjusted for potential confounders. The discrimination of the Cox models for predicting OS was evaluated using Harrell's C-index. The analyses were repeated in patients diagnosed as having cT2-4N0M0 disease. RESULTS: Among 264 patients meeting the inclusion criteria, 72 (27%) and 39 (15%) achieved pDS and pCR, respectively. On multivariable analysis, both pDS (hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.13, 0.45; P < 0.001) and pCR (HR 0.37, 95% CI 0.18, 0.79; P = 0.01) were associated with OS. The model including pDS achieved better discrimination with respect to the model including pCR: C-index 76.4 vs 72.7, respectively. In the 128 patients diagnosed with cT2-4 disease, both pDS (HR 0.19, 95% CI 0.09, 0.40; P < 0.001) and pCR (HR 0.31, 95% CI 0.11, 0.85; P = 0.023) were confirmed as predictors of OS. The model including pDS was confirmed to discriminate better than the model including pCR: C-index 75 vs 68.9, respectively. CONCLUSION: The study showed that pDS after NAC for UTUC was more informative than pCR when predicting OS. These findings, although requiring prospective validation, can aid in the design of clinical trials seeking to refine the use of chemotherapy and other systemic therapies in this setting.

BPH: Why Do Patients Fail Medical Therapy?

PURPOSE OF REVIEW: In this article, we review why patients may fail medical therapy for benign prostatic hyperplasia (BPH) and by doing so, gain a better understanding of the disease process and how to optimize the care of these patients. RECENT FINDINGS: A growing body of literature has attempted to better characterize the various mechanisms by which patients develop BPH as well as identify predictors of disease progression and treatment failure. BPH is a heterogenous disease process. A more personalized approach to treatment, including patient selection for medical or surgical management, would allow us to optimize patient care.

Predicting procedural pain after ureteroscopy: does hydrodistention play a role?

PURPOSE: To identify perioperative predictors of immediate pain after ureteroscopy, specifically evaluating the impact of hydrodistention from irrigation on pain. MATERIALS AND METHODS: We retrospectively identified patients who underwent ureteroscopy for the treatment of calculi. Data recorded for these patients included their maximum pain score in the post-anesthesia care unit (PACU), average flow rate of irrigant used during the procedure, patient and stone characteristics, operative procedure, and details of patients' immediate, post-operative course. Spearman's rho was used to determine the relationship between non-parametric, continuous variables. Then, a linear regression was performed to assess which variables could predict the peak pain score. RESULTS: A total of 131 patients were included in the study. A non-parametric correlation analysis revealed that maximum pain score was negatively correlated with being male (r = -0.18, p=0.04), age (r = -0.34, p<0.001), and post-op foley placement (r = -0.20, p=0.02) but positively correlated with the preoperative pain score (r = 0.41, p<0.001), time in the PACU (r = 0.19, p = 0.03), and the morphine equivalent dose (MED) of narcotics administered in the PACU (r = 0.67, p<0.001). On linear regression, the significant variables were age, preoperative pain score, and stent placement. For every ten-year increase in age post-operative pain score decreased by 4/10 of a point (p = 0.03). For every 1 point increase in preoperative pain score there was a 3/10 of a point increase in the maximum pain score (p = 0.01), and leaving a stent in place post-operatively was associated with a 1.6 point increase in the maximum pain score. CONCLUSIONS: Hydrodistention does not play a role in post-ureteroscopy pain. Patients who are younger, have higher preoperative pain scores, or who are stented will experience more post-operative pain after ureteroscopy.

Comparison of periprocedural and long term outcomes of proximal versus distal cerebral protection method during carotid artery stenting.

BACKGROUND: The aim of this study was to assess the periprocedural and one-year outcomes of two different cerebral protection systems used during carotid artery stenting (CAS). PATIENTS AND METHODS: We enrolled 90 consecutive patients with carotid artery stenosis who underwent CAS with a proximal flow blockage protection system (mean age 69.7 ± 8) or distal protection with a filter (mean age 70.8 ± 7). RESULTS: CAS was performed successively on 89 patients (99 %). Adverse events were defined as major stroke, minor stroke, transient ischemic attack (TIA), myocardial infarction, and death. Two strokes, one TIA, one death, and one myocardial infarction were observed in-hospital. There were no significant differences in safety or benefits between the proximal flow blockage embolic protection system (n = 45) and the distal filter protection system (n = 45) in terms of clinically apparent cerebral embolism, TIA, death, or myocardial infarction during the periprocedural stage or during the one-year follow-up period. CONCLUSIONS: Although it has been shown that the proximal flow blockage cerebral protection system decreases the risk of silent cerebral embolism, it has no advantage over the distal filter protection system in terms of adverse cerebrovascular or cardiac events during the periprocedural stage or during the long-term follow-up period.

Investigation of the Rho-kinase 2 gene Thr431Asn polymorphism in migraine.

BACKGROUND: Migraine has a complex etiology determined by genetic and environmental factors, but the molecular mechanisms and genetics of this disease have not yet been fully clarified. AIM: This case/control study was designed to analyze the genotype distributions and allele frequencies for the Rho-kinase 2 (ROCK2) gene Thr431Asn polymorphism among the migraine patients. MATERIALS AND METHODS: A total of 155 migraine patients and 155 healthy age and sex matched controls were included in this study. Genomic deoxyribonucleic acid from migraine patients and controls was analyzed by real-time polymerase chain reaction. RESULTS: Neither genotype distributions nor the allele frequencies for the Thr431Asn polymorphism showed a significant difference between the groups. In addition, there were no marked differences in genotype and allele frequencies for the migraine without aura and migraine with aura subgroups when compared with control group. CONCLUSION: This is the first study to show that the ROCK2 gene Thr431Asn polymorphism is not a risk factor for the migraine in the Turkish population.

Telemedicine in urologic oncology care: Will telemedicine exacerbate disparities?

INTRODUCTION: Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient populations who suffer worse oncologic outcomes are the same as those who are less likely to use telemedicine. METHODS: Using an institutional database, we identified all prostate, bladder and kidney cancer encounters from March 14, 2020 to October 31, 2021 (n = 15,623; n = 4, 14; n = 3,830). Telemedicine was used in 13%, 8%, and 12% of these encounters, respectively. We performed random effects modeling analysis to examine patient and provider characteristics associated with telemedicine use. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported as measures of association. RESULTS: Among prostate, bladder, and kidney cancer patients, Black patients had lower odds of a telemedicine encounter (OR 0.51, 95% CI 0.37-0.69; OR 0.22, 95% CI 0.07-0.70; OR 0.46, 95% CI 0.24-0.86), and patients residing in small and isolated small rural towns areas had higher odds of a telemedicine encounter (OR 1.44, 95% CI 1.09-1.91; OR 2.12, 95% CI 1.14-3.94; OR 1.89, 95% CI 1.12-3.19). Compared to providers in practice ≤5 years, providers in practice for 6 to 15 years had significantly higher odds of a telemedicine encounter for prostate and bladder cancer patients (OR 4.10, 95% CI 1.4511.58; OR 3.42, 95% CI 1.09-10.77). CONCLUSION: The lower rates of telemedicine use among Black patients could exacerbate pre-existing disparities in prostate, bladder, and kidney cancer outcomes.