Bağcılar Eğitim ve Araştırma Hastanesi

Axillary vein puncture (AVP) is an effective technique in cardiac implantable electronic device (CIED) implantation. This study evaluates the venous tenting (VnT) technique as a novel method and compares its effectiveness to contrast venography (CV) in reducing early and late complications. This retrospective multicenter study included 464 patients who underwent CIED implantation using VnT or CV techniques. Patients were matched 1:1 and divided into two groups: Group 1 (n = 232) included those who underwent VnT, and Group 2 (n = 232) included those who underwent CV. Early complications, including pneumothorax (PTX), pocket hematoma (PH), and pocket infection (PI), were collectively defined as total complications (TC). Late complications were defined as device lead integrity (DLI). Independent predictors of complications were identified using multivariate logistic regression analysis. The TC rate was 5.2%. VnT significantly reduced PH rates (0.9%vs. 4.3%, p = 0.019) and TC rates (2.2%vs. 8.19%, p = 0.003) compared to CV. No significant differences were observed between the groups in PTX, PI, or DLI rates. Multivariate logistic regression analysis identified VnT as an independent protective factor for both TC (p = 0.009) and PH (p = 0.022). During CIED implantation, the VnT technique was associated with lower TC and PH than the CV technique. This study highlights the potential of VnT to improve outcomes. Further prospective studies are recommended to confirm these findings.

Bu çalışmada, intraserebroventriküler apelin-13 enjeksiyonunun kan basıncı, kalp hızı, kardiyak kontraktilite ve kardiyak sirtuin 1 (SIRT1) düzeyi üzerindeki etkilerini araştırdık. Apelin-13 (5, 10 ve 20 nmol) veya 10 µl salin, Wistar sıçanlarına intraserebroventriküler olarak enjekte edildi. İlk olarak, ortalama arteriyel kan basıncı (MABP) ve kalp hızı ölçüldü. İkinci olarak sol ventrikül ±dP/dt değerleri belirlendi. Son olarak sıçanların kalpleri çıkarıldı ve kalp dokularındaki SIRT1 seviyesi Western Blot yöntemi ile belirlendi. 10 nmol dozundaki apelin-13 MABP'yi artırdı. Bununla birlikte, 20 nmol dozundaki apelin-13 MABP'yi azalttı. 5 ve 10 nmol dozlarındaki apelin-13 kalp hızını azalttı. Bununla birlikte, 20 nmol dozundaki apelin-13 kalp hızını artırdı. 10 ve 20 nmol dozlarında apelin-13 +dP/dt değerlerini artırdı. 20 nmol dozunda apelin-13 –dP/dt değerlerini artırdı. 5 nmol dozundaki apelin-13, kalp dokularındaki SIRT1 düzeyini artırdı. Bu bulgular, apelinin kan basıncının, kalp hızının ve kardiyak kontraktilitenin merkezi düzenlemesine katıldığı gerçeğini desteklemektedir. Bu çalışma, apelinin santral uygulamasının sol ventrikül kontraktil performansını artırdığını göstermektedir. Ayrıca bu çalışma, SIRT1'in apelinin kardiyovasküler fizyolojik etkilerinde rol oynayabileceğine işaret etmektedir.

Çalışmanın amacı, BİST’te işlem gören imalat şirketleri yöneticilerinin iç kontrol sistemi etkinliği algıları ile finansal başarısızlık riski üzerinde ne ölçüde etkiye sahip olduğunun tespit edilmesidir. Araştırmanın örneklemini, BİST’te 2000 ile 2022 yılları arasında işlem gören 101 imalat şirketi oluşturmaktadır. İşletmelerin finansal açıdan başarılı/ başarısız olduklarını belirlemek için finansal tablolarındaki 2022 yılına ait son altı ayı kapsayan ikinci dönem verileri baz alınmıştır. İşletmelerin finansal tablolarına BİST üzerinden ulaşılmıştır. Finansal tablolardaki finansal oranlardan yola çıkılarak işletmelerin başarılı ve başarısızlık durumu belirlenmiştir. Araştırma sonucunda, işletme yöneticilerinin iç kontrol etkinliliği ile finansal başarısızlık ilişkisi analiz edilmiştir. Firmaların finansal risk durumunun belirlenmesinde Altman Z Skor kullanılmıştır. Araştırma kapsamında iç kontrol ile finansal başarısızlık arasındaki ilişkiyi ölçen altı tane hipotez bulunmaktadır. Hipotezler arasındaki ilişkinin belirlenmesinde korelasyon analizi ve varyans analizi yapılmıştır. Çalışma kapsamındaki firmaların başarılı veya başarısızlık durumunun tespit edilmesinde lojistik regresyon analizi ve kümeleme analizi kullanılmıştır.

In nasal surgery, autologous cartilage grafts are routinely used to correct structural weakness, contour deformities, and irregularities, yet current techniques still face challenges related to long-term cartilage graft viability and resorption. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that may improve graft survival through its sustained release of bioactive molecules within a natural fibrin matrix. To evaluate the biochemical and histopathological effects of combining PRF with autologous cartilage grafts of different forms (block, crushed, and diced) in a rabbit model and to determine which combination provides optimal cartilage viability and matrix stability. Twenty-four New Zealand rabbits divided into six groups based on their form: block, crushed, and diced. PRF was applied to three groups, while the remaining three served as controls. The grafts were placed in subcutaneous pockets on the rabbits' backs and harvested after 8weeks for histopathological and biochemical analyses. Cartilage tissues, growth factors, matrix components, angiogenesis, oxidative stress, and apoptosis markers were evaluated. PRF-treated groups demonstrated significantly higher growth factor levels, antioxidant status, lower oxidative stress and apoptosis markers compared with controls (p < 0.05). Histological analyses showed better cellular proliferation and extracellular matrix preservation, particularly in PRF-combined diced and block cartilage grafts, whereas crushed cartilage exhibited marked degeneration. PRF enhanced the viability, proliferation, and angiogenic response of autologous cartilage grafts through its sustained release of growth factors and scaffold-like fibrin matrix. These findings suggest that PRF may improve graft stability and reduce postoperative complications in nasal surgery. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Modified radical mastectomy (MRM) is associated with persistent psychological and physical sequelae in geriatric breast cancer survivors. This study examines the 60-month longitudinal associations between pain catastrophizing, depression, pain interference, shoulder dysfunction, and lymphedema. In this retrospective cohort study, 89 geriatric women (median age = 72, IQR = 69-76, range = 65-88) who underwent MRM were assessed at baseline (pre-surgery), 1, 3, and 2 months after completion of radiotherapy (median 5 months post-surgery, IQR 4.5-5.5), and 12, 24, 36, 48, and 60 months post-surgery. Pain Catastrophizing Scale (PCS), Geriatric Depression Scale (GDS), Brief Pain Inventory (BPI) interference, shoulder range of motion (ROM) differences (flexion and abduction), and lymphedema severity (Frustum formula, ISL staging) were measured. Lymphedema was defined using a primary threshold of ≥ 5% inter-limb volume difference and a sensitivity analysis threshold of ≥ 10% or ≥ 200 mL. Patients were stratified by baseline PCS median (high: ≥25; low: <25). Spearman correlations, Wilcoxon signed-rank tests, Mann-Whitney U tests, and Fisher's exact tests were used. All statistical tests were two-tailed, and p-values were adjusted for multiple comparisons using the false discovery rate (FDR) method. Strong correlations were observed between PCS, GDS, and BPI across all time points (ρ = 0.911-0.994, q < 0.001). Shoulder ROM differences correlated significantly with PCS, GDS, and BPI from 1 month onward (ρ = 0.864-0.939, q < 0.001), peaking at 24 months. Lymphedema (≥ 5% threshold ) showed moderate correlations at 3 months (ρ = 0.443-0.516, q < 0.001), strengthening by 24-36 months (ρ = 0.687-0.803, q < 0.001). High PCS patients had significantly worse GDS, BPI, ROM differences, and lymphedema incidence (see Table3). Pain catastrophizing is strongly and persistently associated with shoulder dysfunction and lymphedema in geriatric breast cancer survivors. Early PCS-based risk stratification is recommended to guide targeted interventions.

Erectile dysfunction (ED) is a concern for men undergoing prostate biopsy. With the increasing adoption of transperineal (TP) biopsy over transrectal (TR) biopsy, it remains unclear which approach carries a lower risk of erectile dysfunction. This study aims to be the first meta-analysis to evaluate erectile dysfunction following TR versus TP prostate biopsy at 1, 3 and 6months intervals, thereby providing clinicians with evidence-based guidance for patient counseling and shared decision-making. This review was prospectively registered on PROSPERO (CRD42024541557) and followed PRISMA guidelines, with searches conducted in PubMed, Scopus, and the Cochrane Library databases up to July 2024. A total of 22 studies reporting erectile function outcomes (IIEF scores) at baseline and 1, 3 and 6months post-biopsy were identified. After applying inclusion and exclusion criteria, 12 studies were included in the final meta-analysis. TR and TP biopsy methods were compared using a random-effects model to assess standardized mean differences (SMD) in erectile function at each follow-up point. The risk of bias for each study was evaluated to ensure result reliability. At 1month follow-up, a significant decline in erectile function was observed overall (SMD: - 0.3785, p = 0.038). The TP approach showed a slightly more significant decline than the TR approach; however, this difference was not statistically significant (p = 0.074). At 3months follow-up, no significant differences were observed between methods overall (SMD: - 0.1663, p = 0.132), although TP biopsy alone showed a modest yet considerable decline (SMD: - 0.1868, p = 0.03). At 6months, erectile function had generally returned to baseline, with no significant differences observed between biopsy techniques (p = 0.41). Both TR and TP prostate biopsies are associated with a transient decline in erectile function. These effects typically resolve by 6months in most patients, with no significant long-term impact observed. While the initial functional impact may be slightly greater with the TP technique, this difference attenuates over time. These findings are crucial for managing patient expectations post-biopsy.

Günümüz iş dünyasında sadece görevleri yerine getiren değil, yenilik üreten çalışanlar ön plana çıkarken; yenilikçi davranışların arkasındaki sebepler neler olabilir? Buradan yola çıkarak bu araştırmanın amacı işyerinde mutluluğun yenilikçi iş davranışı üzerindeki etkisini incelemektir. Araştırmanın evrenini İstanbul ve Ankara illerinde yaşayan kamu, özel sektör ve sivil toplum kuruluşu çalışanları oluşturmaktadır. Kolayda örnekleme yönetimi ile 509 çalışana ulaşılarak anket uygulaması ile araştırmanın verileri elde edilmiştir. Araştırmanın sonuçlarına göre işyerinde mutluluğun yenilikçi iş davranışı üzerinde pozitif ve anlamlı etkisi olduğu tespit edilmiştir. Ayrıca işyerinde mutluluğun alt boyutları işe angaje olma, iş tatmini ve örgüte bağlılık boyutlarının da yenilikçi iş davranışı üzerinde pozitif yönde ve anlamlı etkiye sahip olduğu sonucuna ulaşılmıştır. Analiz sonuçlarına göre çalışanların yenilikçi iş davranışı ve işyerinde mutluluk düzeyleri çalışılan sektöre göre farklılık göstermektedir.

This multicenter observational study aimed to retrospectively evaluate the mid-term clinical outcomes of the mini-crush technique (MCT) and double kissing culotte technique (DKCT) in patients with coronary bifurcation lesions (CBLs). This large-scale, multicenter study ( n = 8) included patients with CBLs who underwent percutaneous coronary intervention with either MCT or DKCT. The primary endpoint was defined as major adverse cardiac events (MACE), which include cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. A total of 728 patients [male: 584 (80.2%), mean age: 60.93 ± 10.46 years] were included. The initial revascularization strategy was MCT in 476 (65.4%) cases and DKCT in 252 (34.6%) cases. The number of balloons used (6.30 ± 1.84 vs. 5.43 ± 1.99, P < 0.001) and procedure time (65.10 ± 20.34 vs. 61.30 ± 18.48 min, P = 0.020) were significantly higher in the DKCT group. In multivariate Cox regression analysis, risk-adjusted mid-term MACE [hazard ratio (HR): 0.645, (95% confidence interval: 0.395-1.053), P = 0.079] did not differ in the MCT group compared to the DKCT group. Additionally, chronic kidney disease (HR = 2.434, P < 0.001), high SYNTAX score (HR = 1.085, P < 0.001), final kissing balloon inflation (HR = 0.110, P < 0.001), presence of nonfatal intraprocedural complications (HR = 5.818, P < 0.001), and high total cholesterol level (HR = 1.007, P = 0.005) were found to be independent predictors of MACE. This multicenter registry demonstrates that in patients with CBLs, the risk-adjusted MACE rate was similar between both techniques, with a nonsignificant trend favoring MCT at mid-term follow-up.

To evaluate the predictive performance of the Quadruple-D score in determining stone-free status after percutaneous nephrolithotomy (PCNL) and to compare it with established nephrolithometry systems including the Guy's Stone Score, STONE nephrolithometry, and CROES nomogram. This retrospective study included 451 patients who underwent PCNL between January 2017 and December 2024. Preoperative parameters including stone volume, density, skin-to-stone distance (SSD), and stone location were assessed to calculate the Quadruple-D score. Outcomes were compared across scoring systems using univariate and multivariate logistic regression and receiver operating characteristic (ROC) analyses. The overall stone-free rate was 66.7%. In univariate analysis, higher Quadruple-D scores were significantly associated with an increased likelihood of achieving stone-free status (odds ratio [OR] = 2.01; 95% confidence interval [CI]: 1.60-2.54; p < 0.001). Although the CROES score demonstrated the highest area under the curve (AUC), the Quadruple-D score outperformed both the Guy's and STONE scores. In multivariate analysis, only the CROES score remained an independent predictor. Patients with higher Quadruple-D and CROES scores had lower complication rates and higher stone clearance, while higher Guy's and STONE scores were associated with poorer outcomes. While the CROES score remained the only independent predictor in multivariate analysis, the Quadruple-D score demonstrated promising discriminatory ability in univariate comparisons. Owing to its simplicity and reliance on standard non-contrast computed tomography (CT) imaging, it may serve as a practical risk stratification tool. Prospective, multicenter validation is warranted to confirm its clinical utility in the PCNL setting.