Do functionality, strength, vascularization, inflammatory and biopsychosocial status improve by biopsychosocial model-based exercise in SSc?

OBJECTIVES: This study aimed to investigation of the effects of the Cognitive Exercise Therapy Approach (Bilissel Egzersiz Terapi Yaklasimi-BETY), a supervised biopsychosocial model-based exercise intervention, on functionality, muscle strength, vascularization, anti-inflammatory and biopsychosocial status in Systemic Sclerosis (SSc) patients. METHODS: Thirty-seven SSc patients were included. Twenty of them were recruited into the study group (SG) undergoing BETY group exercise sessions three times a week for three months and 17 were in the control group (CG) following a home exercise program. Assessments tools were the Modified Rodnan Skin Score (mRSS), Scleroderma Health Assessment Questionnaire (SHAQ), Modified Hand Mobility in Scleroderma (mHAMIS), Duruoz Hand Index (DHI), Six Minute Walk Test (6MWT), skeletal muscle strength measurements using an isokinetic dynamometer (Biodex System 3 Pro), Shear Wave Elastography (SWE), ELISA kits (for tumor necrosis factor-alpha, Interleukin-6, IL-10, serum irisin level), BETY-Biopsychosocial Questionnaire (BETY-BQ), Hospital Anxiety and Depression Scale (HADS), and Short Form-36 (SF-36). RESULTS: The SG demonstrated improvements in SHAQ, mHAMIS, 6MWT, BETY-BQ, HADS, and SF-36 values, excluding the DHI scores (p < 0.05). In contrast, CG showed worsening in SHAQ-general scleroderma symptoms and HADS scores compared to SG (p < 0.05). IL-10 and TNF-alpha increased in both groups, also various vascular parameters were significantly different changed in SG than CG (p < 0.05). Muscle strength values improved in the SG but decreased in the CG however this was statistically not significant (p > 0.05). CONCLUSIONS: BETY can be recommended as a nonpharmacologic approach to the disease management of SSc patients.

Restoring the spontaneous smile through free functional muscle transfer. A systematic review and meta-analysis of the last twenty years' experience.

BACKGROUND: The recovery of the spontaneous smile has become a primary focus in facial reanimation surgery and its major determinant is the selected neurotizer. We aimed to compare the spontaneity outcomes of the most preferred neurotization methods in free functional muscle transfer for long-standing facial paralysis. METHODS: The Embase, Ovid Medline, and PubMed databases were queried with 21 keywords. All clinical studies from the last 20 years reporting the postoperative spontaneity rate for specified neurotization strategies [cross-face nerve graft (CFNG), contralateral facial nerve (CLFN), motor nerve to the masseter (MNM), and dual innervation (DI)] were included. A meta-analysis of prevalence was performed using Freeman-Tukey double arcsine transformation, I2 statistic, and generic inverse variance with a random-effects model. Risk Of Bias In Non-randomized Studies of Interventions and Newcastle-Ottawa scale were used to assess bias and study quality. RESULTS: The literature search produced 2613 results and 473 unique citations for facial reanimation. Twenty-nine studies including 2046 patients were included in the systematic review. A meta-analysis of eligible data (1952 observations from 23 studies) showed statistically significant differences between the groups (CFNG: 0.94; 95% confidence interval [CI], 0.76-1.00, CLFN: 0.91; 95% CI, 0.49-1.00, MNM: 0.26; 95% CI, 0.05-0.54, DI: 0.98; 95% CI, 0.90-1.00, P < 0.001). In pairwise comparisons, statistically significant differences were found between MNM and other neurotization strategies (P < 0.001 in CFNG compared with MNM, P = 0.013 for CLFN compared with MNM, P < 0.001 for DI compared with MNM). CONCLUSIONS: DI- and CLFN-driven strategies achieved the most promising outcomes, whereas MNM showed the potential to elicit spontaneous smile at a lower extent. Our meta-analysis was limited primarily by incongruency between spontaneity assessment systems. Consensus on a standardized tool would enable more effective comparisons of the outcomes.

Biomarker detection using corrected degree of domesticity in hybrid social network feature selection for improving classifier performance.

BACKGROUND: Dimension reduction, especially feature selection, is an important step in improving classification performance for high-dimensional data. Particularly in cancer research, when reducing the number of features, i.e., genes, it is important to select the most informative features/potential biomarkers that could affect the diagnostic accuracy. Therefore, researchers continuously try to explore more efficient ways to reduce the large number of features/genes to a small but informative subset before the classification task. Hybrid methods have been extensively investigated for this purpose, and research to find the optimal approach is ongoing. Social network analysis is used as a part of a hybrid method, although there are several issues that have arisen when using social network tools, such as using a single environment for computing, constructing an adjacency matrix or computing network measures. Therefore, in our study, we apply a hybrid feature selection method consisting of several machine learning algorithms in addition to social network analysis with our proposed network metric, called the corrected degree of domesticity, in a single environment, R, to improve the support vector machine classifier's performance. In addition, we evaluate and compare the performances of several combinations used in the different steps of the method with a simulation experiment. RESULTS: The proposed method improves the classifier's performance compared to using the whole feature set in all the cases we investigate. Additionally, in terms of the area under the receiver operating characteristic (ROC) curve, our approach improves classification performance compared to several approaches in the literature. CONCLUSION: When using the corrected degree of domesticity as a network degree centrality measure, it is important to use our correction to compare nodes/features with no connection outside of their community since it provides a more accurate ranking among the features. Due to the nature of the hybrid method, which includes social network analysis, it is necessary to investigate possible combinations to provide an optimal solution for the microarray data used in the research.

Donor nerve selection in free gracilis muscle transfer for facial reanimation. A systematic review and meta-analysis of clinical outcomes.

BACKGROUND: One of the critical factors in facial reanimation is selecting the donor nerve. The most favored neurotizers are the contralateral facial nerve with a cross-face nerve graft (CFNG) and motor nerve to the masseter (MNM). A relatively new dual innervation (DI) method has shown successful results. This study aimed to compare the clinical outcomes of different neurotization strategies for free gracilis muscle transfer (FGMT). METHODS: The Scopus and WoS databases were queried with 21 keywords. Three-stage article selection was performed for the systematic review. Articles presenting quantitative data for commissure excursion and facial symmetry were included in meta-analysis, using random-effects model. ROBINS-I tool and Newcastle-Ottawa scale were used to assess bias and study quality. RESULTS: One hundred forty-seven articles containing FGMT were systematically reviewed. Most studies indicated CFNG as the first choice. MNM was primarily indicated in bilateral palsy and in elderly. Clinical outcomes of DI studies were promising. 13 studies including 435 observations (179 CFNG, 182 MNM, 74 DI) were eligible for meta-analysis. The mean change in commissure excursion was 7.15 mm (95% CI: 4.57-9.72) for CFNG, 8.46 mm (95% CI: 6.86-10.06) for MNM, and 5.18 mm (95% CI: 4.01-6.34) for DI. In pairwise comparisons, a significant difference was found between MNM and DI (p = 0.0011), despite the superior outcomes described in DI studies. No statistically significant difference was found in resting and smile symmetry (p = 0.625, p = 0.780). CONCLUSIONS: CFNG is the most preferred neurotizer, and MNM is a reliable second option. Outcomes of DI studies are promising, but more comparison studies are needed to draw conclusions. Our meta-analysis was limited by incompatibility of the assessment scales. Consensus on a standardized assessment system would add value to future studies.

Prognostic factors of overall and prostate-specific antigen-progression-free survival in metastatic castration-resistant prostate cancer patients treated with 177 Lu-PSMA-617. A single-center prospective observational study.

BACKGROUND: Metastatic castration-resistant prostate cancer (mCRPC) is characterized by heterogeneity among patients as well as therapy responses due to diverse genetic, epigenetic differences, and resistance mechanisms. At this stage of the disease, therapy modalities should be individualized in light of the patients' clinical state, symptoms, and genetic characteristics. In this prospective study, we aimed to evaluate the outcome of patients with mCRPC treated with 177 Lutetium labeled PSMA-617 therapy (PSMA-RLT), as well as baseline and therapy-related parameters associated with survival. METHODS: This prospective study included 52 patients who received two to six cycles of PSMA-RLT. Primary endpoints were overall survival (OS) and prostate-specific antigen (PSA)-progression-free survival (PFS). 18 F-Fluorodeoxyglucose (FDG) and 68 Ga-PSMA (PSMA) Positron Emission Tomography/Computer Tomography (PET/CT) scans were performed for a comprehensive assessment of tumor burden and heterogeneity. Biochemical, imaging, clinical, and therapy-related parameters were analyzed with the Kaplan-Meier, log-rank, and Cox regression analyses to predict OS and PFS. RESULTS: Median OS and PSA-PFS were 17.7 (95% confidence interval [CI]: 15.2-20.2) and 6.6 months (95% CI: 4.5-8.8), respectively. Primary resistance to PSMA-RLT (hazard ratio [HR]: 12.57, 95% CI: 2.4-65.2, p: 0.003), <30% PSA response rate after first cycle of PSMA-RLT (HR: 1.016, 95% CI: 1.006-1.03, p: 0.003), FDG > PSMA disease (HR: 4.9, 95% CI: 1.19-20.62, p: 0.03), PSA doubling time (PSA DT) of ≤2.4 months (HR: 15.7, 95% CI: 3.7-66.4, p: <0.0001), and low hemoglobin levels (HR: 0.59, 95% CI: 0.41-0.83, p: 0.003) were correlated with poor OS in the multivariate analysis. Bone scintigraphy > PSMA disease (HR: 5.6; 95% CI: 1.8-17, p: 0.002) and high C-reactive protein (HR: 1.4, 95% CI: 1.1-1.7, p: 0.001) were significant predictive biomarkers for PFS in the multivariate analysis. CONCLUSION: PSA response rate and pattern to PSMA-RLT are the most important predictors of survival in patients receiving PSMA-RLT. Being a strong predictive biomarker, combined FDG and PSMA PET can be helpful for the decision of PSMA-RLT eligibility.

Development of preschool refugee children living under temporary protection status.

BACKGROUND: The conflict in Syria following the anti-regime demonstrations that started in March 2011 created one of the greatest humanitarian crises. The United Nations High Commissioner for Refugees (UNHCR) reports that refugee and resettlement experiences can influence the critical stages of intellectual, social, emotional and physical development of children. There is a lack of sufficient information about the prevalence of developmental delay in forcibly displaced children. In this study, we aimed to describe the impact of the Syrian crisis on the development of children after resettlement, factors that are associated with developmental problems and domains in which developmental delays are more likely to occur. METHODS: Refugee children (n=60) between the ages of 18-72 months admitted to the Yenimahalle Community Health Center Immigrant Health Unit to receive primary health care services between 1 November 2018- 1 March 2019 were included in this study. The control group included 60 Turkish children between 18-72 months admitted to the Ismail Ulucan Family Health Center which is in the same building. Developmental assessments were conducted by the researchers using the Denver II Developmental Screening Test (DDST-II). Sociodemographic characteristics of the child, family and caregivers as well as risk factors related to development were collected using a questionnaire. The interviews with refugee families were conducted with an interpreter. RESULTS: Developmental delay was more frequent in refugee children compared to Turkish children. The DDST-II were normal in 82.1%, questionable in 10.7% and abnormal in 7.1% of Turkish children; in the study group, 22.2% of the patients were found to be normal, 33.3% were questionable and 44.4% were abnormal. The differences were statistically significant (p < 0.05). Multiple logistic regression analysis revealed that, being a forcibly displaced refugee was the single significant risk factor for developmental delay alone. In the DDST II subdomain analysis, it was seen that high monthly income reduces the risk of caution-delay in personal-social domain. It was found that birth weight below 2500 g increased the risk of caution-delay in the fine-motor and gross-motor domain and being a forcibly displaced refugee and consanguinity increased the risk of caution -delay in the language domain. CONCLUSIONS: This study showed that being a forcibly displaced refugee was the most important risk factor for developmental delay. We emphasized the importance of surveillance and screening development in these highrisk children as well as early intervention services.

A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses.

The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Prevalence of delirium according to clinical impression was 3.3% (n = 4), whereas prevalence was 12.4% (n = 17) according to DSM-5 criteria and 13.8% (n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 (p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [Journal of Gerontological Nursing, 48(8), 43-51.].

Efficacy of platelet-rich fibrin and connective tissue graft in papilla reconstruction.

PURPOSE: To evaluate efficacy of platelet-rich fibrin (PRF) or connective tissue graft (CTG) in papilla reconstruction (PR) with the semilunar incision (SI) technique. MATERIALS AND METHODS: The analysis consisted of 55 sites (27 CTG and 28 PRF) from 20 patients who underwent PR with either PRF or CTG placed in the maxillary anterior region with SI technique. Baseline (BL) and follow-up (T1 , first month, T3 , third month, T6 , sixth month) clinical data including periodontal evaluations (gingival index (GI), plaque index (PI), pocket depth (PD), keratinized tissue width (KTW), gingival recession), papilla-associated recordings (alveolar crest-interdental contact point [AC-IC], alveolar crest-papilla tip [AC-PT], papilla tip-interdental contact point [PT-IC], papilla height loss [PHL], interdental tissue stroke [ITS] and papilla presence index [PPI]) and patient satisfaction were analyzed. RESULTS: CTG provided better PR outcomes. GI, PI, and PD showed a slight increase at T1 and then, turned to their BL levels. The other periodontal parameters showed significant improvement after both treatment modalities. No inter-group difference was found except for KTW, which was in favor of CTG. CONCLUSION: Based on the results, CTG is recommended over PRF in PR treatment due to its superior outcomes with less recurrence risk. CLINICAL SIGNIFICANCE: Connective tissue graft provides superior results than platelet-rich fibrin in papilla reconstruction with the semilunar incision technique.

The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery.

Objective: To investigate the effect of the diameter of ureteral access sheath (UAS) used during retrograde intrarenal surgery (RIRS) on operative parameters, perioperative ureteral injury, and ureteral stricture development. Materials and Methods: The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to the diameter of UAS (9.5F/11.5F [Group 1] and 12F/14F [Group 2]) placed during the operation. At the end of the operation, ureteral injury was checked visually using semirigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images were used to observe newly developing ureteral dilatation. Results: There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury, while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p = 0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p = 0.371). Conclusion: The results of our study showed that the use of a 12F/14F UAS in patients who are not previously stented increases the risk of high-grade ureteral injuries; however, despite this increase there is no difference in ureteral stricture formation.

Gastric Carcinoma with Lymphoid Stroma: A Combination of Mismatch Repair Deficient Medullary Type and Epstein-Barr Virus-associated Gastric Carcinomas.

Gastric carcinomas consist of a heterogeneous group of neoplasms with broad cytological and architectural variations. Gastric carcinomas with lymphoid stroma show poor correlation between their histomorphology and biological behavior. This contrast causes a need for more detailed analysis and molecular exploration of lymphoid stroma-rich gastric carcinomas with medullary like features and lack of glandular differentiation. In this study, we performed a detailed retrospective analysis of 53 gastric carcinomas among 654 gastric tumors from surgical resection specimens, all of which had no prominent glandular differentiation. Morphological and clinical data were compared with immunohistochemistry (MLH1, PMS2, MSH2 and MSH6 for mismatch repair mechanism deficiency; CD2, CD8 and CD163 for immune infiltration; and PD-1, PD-L1, LMP-1, ERBB2 and ki-67) besides EBER in situ hybridization and molecular studies (PCR based microsatellite instability and BRAF V600E mutation analysis). Morphological, immunohistochemical and molecular findings lead us to classify lymphoid stroma-rich advanced gastric carcinomas (n = 40/53) into two distinct entities originating from two different pathogenetic pathway: one is gastric carcinomas revealing predominantly medullary type morphology with defective DNA mismatch repair mechanism (n = 30/53) and the other is EBV associated carcinomas (n = 10/53). In addition, we suggest that biomarker based classification algorithms besides morphological evaluation are necessary to identify these two entities. Distinguishing these entities is crucial to apply different treatment strategies, including alternative treatments such as immunotherapy.

Comparative Assessment of Outcomes in Drug Treatment for Smoking Cessation and Role of Genetic Polymorphisms of Human Nicotinic Acetylcholine Receptor Subunits.

Objective: To investigate the effects of genetic polymorphisms of human nicotinic acetylcholine receptor subunits α3, α4 and α5, which are encoded by CHRNA3, CHRNA4 CHRNA5 genes, respectively, on nicotine addiction and outcomes of pharmacological treatments for smoking cessation. Methods: A total of 143 smokers and 130 non-smokers were included. Genotyping for CHRNA3 rs578776, CHRNA4 rs1044396-rs1044397, CNRNA5 rs16969968 polymorphisms was performed by PCR, flowed by RFLP. Clinical outcomes and success rates of pharmacological treatments for smoking cessation with nicotine replacement therapy (NRT), bupropion or varenicline were determined at the 12th week of the treatment. Results: Overall, 52 out of 143 (36.4%) smokers who received pharmacotherapy were able to quit smoking. Success rates for smoking cessation were similar for female (30.3%) and male (41.6%) subjects (p = 0.16). The success rate for smoking cessation treatment with varenicline (58.5%) was significantly higher as compared to other treatments with NRT (20.0%), bupropion (32.3%) or bupropion + NRT (40.0%) (chi-square test, p = 0.001). Smoker vs. non-smoker status and the clinical outcomes of drugs used for smoking cessation were found similar in subjects carrying wild-type and variant alleles of human nicotinic acetylcholine receptor α subunits. Conclusion: In this study, smoking cessation treatment with varenicline was significantly more effective than treatments with nicotine replacement or bupropion in a cohort of Turkish subjects. Smoker/non-smoker status and the clinical outcomes of treatment with pharmacological agents were similar in subjects with wild-type or variant alleles for human nicotinic acetylcholine receptor subunits α3 (CHRNA3), α4 (CHRNA4) and α5 (CHRNA5).

Evaluation of GCF IL-17, IL-10, TWEAK, and sclerostin levels after scaling and root planing and adjunctive use of diode laser application in patients with periodontitis.

BACKGROUND: The aim of the present study was to evaluate the clinical efficacy of the diode laser as an adjunct to scaling and root planing (SRP) and also determine the biochemical profile by evaluating the gingival crevicular fluid (GCF) levels of interleukin (IL)-17, IL-10, tumor necrosis factor-related weak inducer of apoptosis (TWEAK), and sclerostin. METHODS: A total of 40 systemically healthy, patients with Stage III periodontitis were included in this randomized controlled study. Participants were randomly divided into two groups as SRP + diode laser (L) (0.80W power, 940 nm wavelength and 0.80J/s energy level) and only SRP group. Recording of periodontal parameters and collecting GCF samples were performed at baseline, first and 3rd months. Biomarker levels in GCF were measured with ELISA RESULTS: At baseline, no significant difference was detected between groups in terms of both clinical and biochemical parameters. All biochemical parameters (except for IL-10 in control group), presented a statistically significant difference for 3 months study period in both groups. When laser and control groups were compared, significant differences were not observed, except the lower GCF IL-17 levels (P = 0.025), bleeding on probing (P = 0.028), and clinical attachment level (CAL) (P = 0.0002) values in laser group at third, first, and third months, respectively. Statistically significant correlations were also noted between biochemical parameters and clinical parameters. CONCLUSIONS: The GCF IL-17, TWEAK, and sclerostin levels may be useful for monitoring response to SRP+L therapy. However, long-term studies on higher populations are needed to evaluate the effectiveness of adjunctive use of diode laser application to SRP.

Investigation of the validity and reliability of the Turkish version of the Functional Assessment of Cancer Therapy-Cognitive Function in cancer patients.

OBJECTIVE: The Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) is a questionnaire that is used to evaluate the quality of life and cognitive functions according to individual self-reports. The aim of this study was to investigate the validity and reliability of the Turkish version of the FACT-Cog. METHODS: Cancer patients who were treated with chemo or radiotherapy and had a score of 24/30 and more in Mini-Mental State Examination (MMSE) were included in this study. Cognitive functions assessed with the FACT-Cog and the European Organization of Research and Treatment of Cancer Quality of Life Core Questionnaire Core 30: Cognitive Function subscale (EORTC QLQ-CF). RESULTS: One hundred and forty cancer patients [female = 87 (62.1%), male = 53 (37.9%)] were included. The mean age of the participants was 47.93 ± 11.90 years. The Cronbach's α of the FACT-Cog scale was 0.82. Test-retest intraclass correlation coefficient values of the FACT-Cog questionnaire were varied from 0.855 to 0.954. There were found low correlations between the total score of the FACT-Cog and the MMSE (r = 0.26, p = 0.002), and moderate correlations between the EORTC QLQ-CF subscale and the FACT-Cog (r = -0.43; p < 0.001). SIGNIFICANCE OF RESULTS: It showed the validity and reliability of the Turkish version of the FACT-Cog questionnaire for cancer patients. It may be beneficial to use this questionnaire for the effects of cancer treatment.

Quasi-least squares regression method with dentistry data.

BACKGROUND: In dentistry, single-jaw surgery or double-jaw surgery is performed depending on the patient's need to correct severe skeletal malocclusions. The effect of these surgical methods used in treatment is to be investigated with quasi-least squares regression (QLS), which is a new data analysis method for correlated data obtained by extending generalized estimating equations (GEE). AIM: The aim of this study is to investigate whether jaw surgery methods (single jaw and double jaw) and time are effective on some outcome variables (C point menton distance, cervical plane angle, distance from point C to pogonion perpendicular, angle between cervical plane and facial plane) using QLS method. METHODS: In application, 114 measurements were performed on the lateral cephalometric radiographs of 34 patients aged 18 years and older who received orthodontic treatment and underwent surgery in the period of 2000-2018. The effects of time and group variables on four dependent variables were investigated and evaluated using QLS and GEE methods. RESULTS: Single-jaw surgery and double-jaw surgery as a group variable on all outcome variables were not significant. Among the working correlation structures used in QLS, the highest correlation value was obtained by "Markov" working correlation structure. CONCLUSION: Single-jaw surgery and double-jaw surgery were found to be statistically insignificant for outcome variables examined. QLS is superior to GEE in cases where repeated measurements are performed at unequal time intervals and there are missing observations.

Estimating the impact of achieving Turkey's non-communicable disease policy targets: A macro-simulation modelling study.

BACKGROUND: The Burden of non-communicable disease (NCDs) has continued to rise globally, particularly in low- and middle-income countries. In Turkey, NCDs account for 89% of all deaths, with nearly one in five deaths occurring before age 70. This study investigates the number of NCD deaths that could be prevented if Turkey met national and international targets for major modifiable NCD risk factors. METHODS: Preventable deaths were estimated using the World Health Organization (WHO) 'Preventable Risk Integrated ModEl' (PRIME), by combining: 1) Baseline exposure data for risk factors, referenced from national surveillance and cohort studies; 2) Aetiological associations from published meta-analyses; and 3) Demographic and mortality statistics obtained from the Turkish Statistical Institute (TurkStat). Confidence intervals were estimated using Monte Carlo simulations. FINDINGS: If Turkey met its NCD risk factor targets for reducing tobacco and salt consumption by 30%, and physical inactivity by 10% in 2017, an estimated 19,859 deaths (95%CI: 12,802 to 26,609) could have been prevented. Approximately two thirds of these preventable deaths were in men, and one in three were in adults below 75 years. A 30% relative reduction in the consumption of alcohol, tobacco, and salt, as well as physical inactivity, would prevent 180 (107 to 259); 4,786 (3,679 to 5,836); 13,112 (5,819 to 19,952); and 7,124 (5,053 to 9,212) deaths, respectively. INTERPRETATION: Among major modifiable NCD risk factors, population-level reductions in salt intake and physical inactivity present the greatest opportunity for reducing NCD mortality in Turkey. These findings can help Turkey prioritise interventions to meet the Sustainable Development Goal target of reducing NCD mortality by one third, by 2030.

Predictive factors of tumor sink effect: Insights from 177Lu-Prostate-specific membrane antigen therapy.

OBJECTIVE: Tumor sink effect (TSE) has been defined as; decreased uptake in healthy tissue with increased tumor sequestration of the radiopharmaceuticals. It enables us to give high tumoral radiation doses while resulting in lower absorbed radiation to critical organs. However, the factors which influence this effect are yet to be defined. In this study, we have investigated the predictive factors of the tumor sink effect in a group of patients who received 177Lu-Prostate-specific membrane antigen (PSMA) therapy due to progressive metastatic castration-resistant prostate cancer (mCRPC). METHODS: We have retrospectively analyzed the pre-therapy 68Ga-PSMA positron-emission tomography (PET)-computed tomography (CT) and post-therapy planar whole-body scans of 65 patients who received at least two cycles of 7.4 GBq of 177Lu-PSMA therapy. All patients with mCRPC were referred to our department after multiple treatment lines. Age, previous therapies, International Society of Urological Pathology (ISUP) score, and pre-therapy serum tumor marker levels were recorded. Post 177Lu-PSMA therapy images were analyzed for TSE. 68Ga-PSMA PET-CT images were used for the calculation of SUVmax in malignant and healthy tissues as well as metabolic tumor volume (MTV) and total lesion PSMA index (TLPI). RESULTS: Based on the post-therapy scans, TSE was seen in 17/65 (26.2%) patients. In univariate analysis, patients with TSE had higher pre-therapy PSA, PSA velocity, and ALP (p < 0.0001). In relation to PET parameters, patients with TSE had higher 68Ga-PSMA MTV, 68Ga-PSMA TLPI and lower pretherapy renal SUVmax (p < 0.0001)), pretherapy liver SUVmax (p:0.012), pretherapy parotid gland SUVmax (p:0.032), and pretherapy parotid gland SUVmean (p:0.038). In the multivariant analysis, 68Ga-PSMA TLPI, pre-therapy PSA, and PSA velocity were found to be statistically significant. When analyzed according to Youden index, pretherapy PSA level of 133 ng/ml (sensitivity 0.765 and 0.875), PSA velocity of 246 ng/ml/year (sensitivity 0.765 and 0.833), and 68Ga-PSMA TLPI of 2969 g (sensitivity 0.765 and 0.875) was found to be the best cut-off points to predict TSE. CONCLUSION: The tumor sink effect was seen in 26.2% of patients. 68Ga- PSMA TLPI, pre-therapy PSA, and PSA velocity was found to be the predictors of TSE. Accurate prediction of TSE may lead to increased tumoral doses while sparing healthy organs. Clinical trials that consider this effect as a part of a dose algorithm may further increase therapeutic efficacy.

Effects of intraoperative blood loss during liver resection on patients' outcome: a single- center experience

Background/aim: Operative bleeding is one of the major determinants of outcome in liver surgery. This study aimed to describe the impact of intraoperative blood loss on the postoperative course of liver resection (LR). Materials and methods: The data of 257 patients who were treated with LR between January 2007 and October 2018 were retrospectively analyzed. LRs were performed via intermittent portal triad clamping (PTC) under low central venous pressure. Results: LRs were performed for 67.7% of patients with a malignant disease and 32.3% of patients with a benign disease. Major LR was performed in 89 patients (34.6%). The mean PTC period was 20.32 min (±13.7). The median intraoperative bleeding amount was 200 mL (5­3500 mL), the 30-day mortality rate was 4.3%, and the morbidity rate was 31.9%. The hospital stay (p = 0.002), morbidity (p = 0.009), and 30-day mortality (p = 0.041) of patients with a bleeding amount of more than 500 mL significantly increased. Conclusion: Surgeons should consider the adverse effects of intraoperative bleeding during liver resection on patients' outcome. Favorable outcomes would be obtained with diligent postoperative care.

Awareness and wound assesment decrease surgical site infections.

Objectives: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection. Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed. Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p <0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p <0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p <0.001). Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.

Topical co-delivery of platelet rich fibrin and tranexamic acid does not decrease blood loss in primary total knee arthroplasty compared to the standard of care: a prospective, randomized, controlled trial.

PURPOSE: The purpose of this study was to evaluate the efficacy of intra-operative co-administration of tranexamic acid (TA) and platelet rich fibrin (PRF) using a proprietary co-delivery system on the amount of blood loss, early functional outcomes and wound complications after primary total knee arthroplasty (TKA). The intervention was compared to the standard of care (combined intravenous & topical TA) in a prospective, randomized, blinded setting. METHODS: 80 patients undergoing primary cemented TKA without tourniquet were prospectively randomized into control (combined intravenous and topical TA) and PRF (intra-venous TA and co-delivery of topical PRF and TA) groups after informed consent. Total blood loss, drainage blood loss, knee range of motion, VAS pain scores, length of stay and wound complications were analysed. Data collection was performed in a double blind manner on days 1, 3 and 21. RESULTS: There was no statistically significant difference in drainage blood loss (550 ml vs. 525 ml, p = 0.643), calculated total blood loss on day 1 (401 ml vs. 407 ml, p = 0.722), day 3 (467 ml vs 471 ml, p = 0.471) and day 21 (265 ml vs. 219 ml, p = 0.082) between the PRF and control groups respectively. The PRF group had a small but statistically significant increase in median knee extension in the early post-operative period, however this difference evened out at 3 weeks. No significant difference could be demonstrated between the PRF and control groups in length of stay, VAS pain scores, narcotic usage, wound complications and knee flexion at all time points. CONCLUSIONS: The topical co-delivery of PRF and TA does not significantly decrease blood loss in primary TKA compared to the standard of care. Slightly better active knee extension in the first 3 postoperative days can be achieved, however this benefit is not clinically relevant. LEVEL OF EVIDENCE: I, Therapeutic study.

FTO gene-lifestyle interactions on serum adiponectin concentrations and central obesity in a Turkish population.

The aim of the study was to investigate whether lifestyle factors modify the association between fat mass and obesity-associated (FTO) gene single nucleotide polymorphisms (SNPs) and obesity in a Turkish population. The study included 400 unrelated individuals, aged 24-50 years recruited in a hospital setting. Dietary intake and physical activity were assessed using 24-hour dietary recall and self-report questionnaire, respectively. A genetic risk score (GRS) was developed using FTO SNPs, rs9939609 and rs10163409. Body mass index and fat mass index were significantly associated with FTO SNP rs9939609 (p = 0.001 and p = 0.002, respectively) and GRS (p = 0.002 and p = 0.003, respectively). The interactions between SNP rs9939609 and physical activity on adiponectin concentrations, and SNP rs10163409 and dietary protein intake on increased waist circumference were statistically significant (Pinteraction = 0.027 and Pinteraction = 0.044, respectively). Our study has demonstrated that the association between FTO SNPs and central obesity might be modified by lifestyle factors in this Turkish population.