Acıbadem Adana Hospital

Drainage is used to prevent complications such as hematoma and seroma formation during liposuction. This study aims to place the drain into the desired area in patients undergoing liposuction with the liposuction canulae. This technique enables the procedure to be completed without the need for instruments or additional incisions. In this technique, we used a thick, long liposuction cannula with a wide hole at its tip. The cannula was advanced along the desired tract through the liposuction trocar incision. Once the cannula reached the most distal point where the drain was intended to be placed, a 2/0 Vicryl suture was sequentially passed through the skin, between the holes of the cannula, and then through the skin again, exiting externally. The end of the suture emerging from the trocar site was tied to the distal end of the drain that was intended to remain within the tissue. Then, by gently pulling the externalized end of the suture at the skin, the drain was advanced through the tissue. No additional scars were created during the drain placement in any of the patients. Furthermore, no complications, such as hematoma or seroma, were observed in the liposuction area. No additional incisions are made, thereby preventing the formation of extra scars. The drainage tube can be placed precisely within the desired area or tract. Only instruments already utilized during the surgical procedure are employed, resulting in reduced overall cost. 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 .

Patient-ventilator asynchrony (PVA) is common during invasive mechanical ventilation in children and may increase respiratory workload and discomfort. The IntelliSync+ (IS+) algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms to optimize inspiratory and expiratory cycling in real time. This study evaluated the efficacy and safety of IS+ compared with conventional physician-tailored synchronization in spontaneously breathing pediatric patients. Multicenter, prospective, randomized controlled, single-blind crossover trial conducted in four pediatric intensive care units between March 2024 and May 2025. Patients aged 1 month to 18 years undergoing invasive mechanical ventilation were randomized to begin with either IS+ or conventional synchronization. Each mode was applied for 90 min (30-min run-in and 60-min measurement), separated by a 30-min washout period. The primary outcome was the Asynchrony Index (AI). Secondary outcomes included major and minor asynchrony indices, Comfort-B scores, end-tidal carbon dioxide (EtCO2), oxygen saturation (SpO2), and leak percentage. Twenty-five patients completed both study phases. Compared with conventional synchronization, IS+ significantly reduced the overall AI (median 5.1% [IQR 4.2-6.4] vs. 12.4% [IQR 9.9-15.6]; P < 0.001), as well as both major and minor asynchrony indices (P < 0.001 for both). The frequencies of double triggering, auto-triggering, trigger delay, and early cycling decreased significantly, while ineffective efforts were unchanged and late cycling slightly increased. Comfort-B scores improved modestly (P = 0.02) and EtCO2 decreased (P < 0.001), whereas SpO2 and leak remained stable. Closed-loop synchronization with IS+ significantly improved patient-ventilator interaction without compromising comfort, oxygenation, or safety. These results support closed-loop synchronization as a feasible and physiologically sound strategy for improving ventilatory support quality in pediatric invasive mechanical ventilation. [ClinicalTrials.gov], identifier [NCT05731024].

Lung cancer is the most prevalent malignancy worldwide and the leading cause of cancer-related deaths. The adrenal gland is a frequent site of metastasis in non-small cell lung cancer (NSCLC). The differentiation of adrenal metastases from benign lesions is imperative for accurate staging and treatment planning. Imaging methods such as FDG-PET/CT, CT, and MRI provide important diagnostic information; however, false negative and false positive results may occur with these methods. The employment of clinical, biochemical, and radiological predictors has the potential to enhance diagnostic precision. A retrospective cross-sectional study was performed on NSCLC patients diagnosed between 2015 and 2025. From 2,194 lung cancer cases, 121 patients who exhibited adrenal lesions on initial PET/CT and had no extrathoracic metastases were included. Clinical data (age, sex, T-N stage), biochemical markers (CEA, CA125) and radiological parameters (SUVmax, lesion size, laterality) were obtained. The relationship of these parameters with the presence of adrenal metastasis was systematically evaluated in order to identify potential predictors. Of 121 patients, 86 had adrenal metastases and 35 had benign adrenal lesions. Malignant lesions demonstrated significantly higher SUVmax, larger size, and elevated CEA and CA125 levels. ROC analysis revealed optimal cut-off values: SUVmax > 3.05 (AUC = 0.86, sensitivity 89%, specificity 69%), CEA > 4.45 ng/mL, CA125 > 24.5 U/mL, and lesion size > 14.5 mm. Multivariate regression identified N3 stage (OR = 12.75, p = 0.043), elevated CEA (OR = 1.02, p = 0.038), and lesion size (OR = 1.09, p = 0.037) as independent predictors of metastasis. Most patients with metastasis were diagnosed at advanced stages, with 91.9% being T3–4 or N2–3. The present study demonstrates that SUVmax, lesion size, CEA, T stage, and N stage are significantly associated with adrenal metastasis in NSCLC. Integrated assessment of these clinical, biochemical, and radiological parameters can improve the differentiation of adrenal metastases from benign lesions, facilitating more accurate staging and treatment planning.

Pine turpentine essential oil (PTEO) obtained from Pinus pinaster Ait. is known to be used in many fields such as medicine, cosmetics, agriculture, and art. The medicinal use of essential oils puts pressure on industry to produce high-quality products. Pure essential oils derived from natural sources are mistakenly recognized as safe on the grounds of their natural origin. Unless they meet international standards, their safety remains questionable. Therefore, in this study, it was aimed to evaluate the quality of 14 different pine turpentine essential oil samples purchased from various sources on the Turkish market, based on the legally recognized pharmacopoeia in Türkiye, the European Pharmacopoeia (EP). As stated in the "Turpentine Oil" monograph, appearance, relative density, refractive index, optical rotation, acid value, peroxide value, fatty oils, and resinified essential oils analyses were performed for each sample. Additionally, phytochemical profiles were analyzed by high performance thin-layer chromatography (HPTLC) and gas chromatography-mass spectrometry (GC-MS). The results revealed that none of the samples were compliant with EP standards. With this in mind, it is found necessary to impose strict regulations on the production of commercial essential oils. Nevertheless, pharmacies emerge as preferable options for obtaining such products.

Response to neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer varies. This study compares tumor response to NACT across anatomical locations, considering clinicopathological differences. This retrospective study included 212 patients with gastric adenocarcinoma who received NACT followed by surgery. Tumors were classified by location (antrum-pylorus, corpus-fundus, cardia). Treatment response was assessed using the Modified Ryan Scoring System (0 = complete, 1 = near complete, 2 = partial, 3 = minimal/none). Tumor locations were antrum-pylorus (30.2%), corpus-fundus (28.3%), and cardia (41.5%). Localization showed no statistically significant differences in response (p = 0.337). However, cardia tumors were more frequent in Groups 3 (40.9%) and 4 (48.1%), which showed poorer pathological responses, whereas antrum (34.6%) and corpus (38.5%) tumors were more common in Group 1, representing patients with a pathological complete response. These findings suggest that cardia tumors may have a lower response to NACT, although definitive conclusions cannot be drawn. In multivariate analysis, only advanced T stage (T3-4) was independently associated with poor tumor regression grade response (odds ratio 14.3, 95% confidence interval 5.4-37.5, p < 0.001). Tumor response to NACT varied by anatomical location, although differences were not statistically significant. Cardia tumors showed a trend toward lower response rates. To the authors' knowledge, this is the first study evaluating gastric anatomical subgroups in this context. While not conclusive, the findings suggest that tumor location may influence treatment strategies, warranting validation in larger studies.

This study investigated an upper-extremity exoskeleton for machine learning–based discrimination of orthopedic shoulder pathology and identification of discriminative temporal features. Twelve patients with shoulder impairments and thirty healthy controls performed eight standardized tasks. Logistic regression with stratified 5-fold cross-validation was used for classification. Temporal effect sizes were computed using pointwise Cohen’s d, and permutation-based phase ablation quantified the contribution of movement phases to AUROC. Classification performance ranged from 0.70 to 1.00, with six tasks achieving AUROC ≥ 0.90. Mid-cycle phases dominated in flexion and abduction tasks, whereas early and late phases were most informative for rotational movements, supporting interpretable, phase-aware ML models.

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including liraglutide and semaglutide, has expanded rapidly due to their effectiveness in weight management and glycemic control. Rising public interest, off-label cosmetic use, and prescription-free requests highlight the critical role of community pharmacists in ensuring appropriate patient counselling, safe dispensing, and rational use of these agents. This study aimed to assess the knowledge, attitudes, and practices of community pharmacists regarding GLP-1 RAs in Türkiye. A cross-sectional survey was conducted among 500 community pharmacists in Türkiye between January and April 2025. Data were collected using a structured, literature-based questionnaire covering sociodemographic characteristics, attitudes, knowledge, and professional practices. Knowledge was evaluated using a 25-item scoring system. Statistical analyses included descriptive statistics, chi-square tests, independent samples t-tests, and one-way ANOVA, with significance set at p<0.05. Requests for semaglutide and liraglutide were primarily for weight loss purposes (82.6% and 79.4%, respectively), and these agents were often sought without a prescription (over 60%) or medical recommendation (over 35%). The mean knowledge score was 15.8±4.3. Differences were observed across gender, professional experience, and pharmacy setting (p<0.05), with higher scores among female pharmacists, those with more than 16 years of experience, and those working in shopping mall pharmacies. Although most respondents correctly identified both medications as GLP-1 RAs (85.6% for semaglutide; 83.6% for liraglutide), gaps remained in regulatory awareness and consistency of routine counselling. A substantial proportion perceived misuse, with over 60% reporting concerns for both medications. Community pharmacists demonstrate moderate knowledge and active involvement in counselling for GLP-1 RAs; however, gaps persist in addressing off-label demand and safety-related patient guidance. Targeted pharmacist education and clearer regulatory communication may enhance safe and evidence-based use of GLP-1 RAs.

Background:Endoscopic plantar fascia release (EPFR) is a common surgical option for recalcitrant plantar fasciitis. Although calcaneal spur excision (CSE) is frequently performed as an adjunct, its added clinical benefit remains unclear. This study compared outcomes of EPFR alone vs EPFR combined with CSE.Methods:This retrospective study included 23 patients (30 feet) who underwent endoscopic surgery for plantar fasciitis between 2017 and 2024. Patients were divided into 2 groups according to surgical procedure performed: EPFR (n = 22 feet) and EPFR+CSE (n = 8 feet). Pain and functional outcomes were assessed pre- and postoperatively using the visual analog scale (VAS), first-step VAS, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and Foot Function Index (FFI).Results:Both procedures were associated with significant postoperative improvement in pain and function (all P < .001). Mean VAS scores improved from 6.2 to 1.5 in the EPFR group and from 6.4 to 1.2 in the EPFR+CSE group. AOFAS scores increased from 66.4 to 95.3 and from 64.5 to 94.5, respectively. Postoperative FFI values decreased from approximately 107 to 30 in both groups. However, comparison between groups revealed no statistically significant differences for any parameter (VAS p = 0.24; AOFAS p = 0.23; FFI p = 0.61). No recurrence or complications were observed.Conclusion:EPFR, with or without CSE, was associated with clinical and functional improvement. With the numbers available, no additional benefit of CSE could be detected.Level of Evidence:Level III, retrospective comparative study.

Existing classification systems for lateral clavicle fractures have low interobserver reliability and provide limited information for treatment decisions. The aim of this study was to introduce a new classification system and to evaluate its comprehensiveness, inter- and intraobserver reliability, and concordance of associated treatment strategy for lateral clavicle fractures compared with existing classifications. Four raters, all experienced in shoulder surgery, independently assessed routine radiographs of 100 patients with lateral clavicle fractures. They were asked to classify the fractures according to the Neer and Jäger/Breitner classification systems, as well as a new classification system, and to determine appropriate treatment for each case based on the new classification system. The assessment was performed at 2 different time points 6 weeks apart. The new classification divides the fractures into 3 zones according to the attachment of the coracoclavicular (CC) ligaments, as well as displacement (1: lateral to the CC ligament attachment; 2: at the attachment of the CC ligaments; 3: medial to the CC ligament attachment; a: nondisplaced, b: displaced). Furthermore, 30 orthopedic surgeons were surveyed about their knowledge regarding the Neer and Jäger/Breitner classification systems. Inter-rater reliability was moderate for the Neer classification (κ = 0.565), substantial for the Jäger/Breitner classification (κ = 0.781) and for the new classification system (κ = 0.798). Although 28 cases with the Neer classification and 28 cases with the Jäger/Breitner classification could not be classified by at least 1 of the raters, 99% of the cases could be classified with the new classification. Intrarater reliability was moderate for the Neer classification (κ = 0.693) and for the Jäger/Breitner classification (κ = 0.660) and substantial for the new classification system (κ = 0.762). The inter- and intrarater reliability of treatment choice was regarded as substantial (κ = 0.659, κ = 0.738, respectively). Although the raters would treat 94%-99% of all cases classified as subgroup b surgically, only 0%-26% of cases classified as subgroup a were classified as requiring surgery. The knowledge of Jäger/Breitner and Neer classification among the surgeons surveyed was relatively poor: None of the 30 surgeons was able to describe the fracture types of Neer classification, while 2 of 30 surgeons could detail all types of Jäger/Breitner classification. Our study demonstrated a high inter- and intrarater reliability of the new classification system and the associated treatment choices. Furthermore, the new classification system appears capable of categorizing the vast majority of lateral clavicle fractures.

Evaluating The Impact of Covid-19 on Nursing Sensitive Quality Indicators: A Multicenter Study ABSTRACT: The COVID-19 pandemic has significantly disrupted healthcare systems worldwide, necessitating a reevaluation of Nursing Sensitive Quality Indicators (NSQIs) to maintain and improve care quality during these unprecedented challenges. This study aims to assess the impact of the COVID-19 pandemic on quality-of-care indicators, specifically examining how the pandemic has influenced the workload of healthcare systems and altered NSQIs within a network of hospitals. Utilizing a multicenter, retrospective, cross-sectional, descriptive design, this study analyzed NSQIs in fifteen hospitals affiliated with a private healthcare group. Data from January 2018 to December 2021 were compared to evaluate the pandemic's effects on patient care quality indicators, including patient satisfaction, pressure injury rates, and thrombophlebitis incidents. The study revealed a significant increase in pressure injuries and thrombophlebitis rates post-pandemic, alongside a decrease in patient satisfaction scores. These findings suggest that the COVID-19 pandemic has adversely impacted nursing care quality, raising concerns about patient safety and satisfaction. However, the data also indicate a generally high standard of nursing care, with low incidence of adverse events and high patient satisfaction overall. The COVID-19 pandemic has markedly influenced NSQIs, highlighting the need for healthcare systems to adapt to maintain high-quality nursing care. Despite the challenges, ongoing evaluation and improvement of NSQIs are crucial for addressing the evolving needs of patients and ensuring effective, patient-centered care. Future strategies should leverage insights from this period to enhance the resilience of healthcare delivery against current and future health crises. Keywords: Nursing Care, Quality Indicators, Health Services COVID-19, Patient satisfaction, Quality in Healthcare Main Points: The study shows that Nursing Sensitive Quality Indicators (NSQIs) in Nursing have undergone significant changes during the pandemic. These changes include increased rates of pressure injuries and thrombophlebitis, as well as decreased levels of patient satisfaction. The findings highlight the profound impact of the pandemic on nursing care quality and patient outcomes. It is crucial to continue assessing and improving NSQIs to maintain high-quality nursing care, despite the challenges posed by the pandemic. The study highlights the importance of health systems adapting their practices to provide patient-centered, safe, and effective care. It also demonstrates the resilience of nursing staff and healthcare organizations during an unprecedented global health crisis. Additionally, it emphasizes the need for innovative strategies and continuous professional development to increase the capacity of the nursing workforce to respond to future challenges. Funding Information This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.