Istanbul Bilim University

Ureteral triplication is an extremely rare congenital anomaly, with just over 100 cases reported in the literature. Smith classified this anomaly into four types in 1946. However, variants that do not fit this classification present significant diagnostic and therapeutic challenges. We present the case of a 5-year-old female patient evaluated for recurrent febrile urinary tract infections. Investigations revealed a duplicated left collecting system with high-grade vesicoureteral reflux (VUR). Intraoperatively, a third, blind-ending ureter was unexpectedly identified within the same sheath, exhibiting a unique “rosary-bead-like” morphology not previously described in the literature. The patient was successfully treated with Politano-Leadbetter ureteroneocystostomy, preserving the blind-ending ureter alongside the two functional ureters. This case represents a unique variant of ureteral triplication that does not fit Smith’s original classification due to the absence of associated renal parenchyma and the specific morphology of the third ureter. We highlight the utility of detailed preoperative imaging and intraoperative assessment in managing such unclassifiable variants. Ureteroneocystostomy without excision of the blind-ending ureter is a viable option to avoid vascular compromise to the functional units.

The exponential growth of high-dimensional data across scientific, financial, and technological domains has intensified the demand for scalable pattern recognition systems capable of operating under noise, uncertainty, and computational constraints. Classical machine learning techniques, while effective in many contexts, often encounter limitations related to dimensionality, feature sparsity, and optimization complexity. This paper explores hybrid quantum–classical machine learning architectures for scalable pattern recognition in high-dimensional and noisy data environments, emphasizing the synergistic integration of quantum computational principles with established classical algorithms. By leveraging quantum feature mapping, variational quantum circuits, and classical optimization frameworks, hybrid architectures aim to enhance representational capacity and computational efficiency. The study synthesizes recent advances in quantum machine learning and evaluates their potential to address scalability and robustness challenges in real-world data analytics. The findings suggest that hybrid quantum–classical systems may serve as a complementary paradigm that bridges theoretical quantum advantage with practical machine learning applications.

Pectus excavatum is the most common congenital anterior chest wall deformity, typically corrected during adolescence. However, an increasing number of adult patients seek surgical repair due to persistent symptoms or cosmetic concerns. Surgical correction in adults poses unique challenges, and data on outcomes in older patients remain limited. This study aimed to evaluate the clinical characteristics, surgical techniques, and postoperative outcomes of pectus excavatum repair in patients aged 40 years and older. We retrospectively analyzed adult patients aged ≥ 40 who underwent surgical repair for pectus excavatum at our center between 2012 and 2025. Clinical indications, operative details, and postoperative outcomes were evaluated. Patients younger than 40 years were used as a comparative cohort. Postoperative complications were categorized as minor or major according to the Clavien-Dindo classification system. A total of 16 patients (mean age: 46.9 years) underwent minimally invasive repair of pectus excavatum (MIRPE). A cross-bar configuration was applied in 56.3% of patients, and two or more bars were required in 87.5%. The most common surgical indication was symptomatic presentation (50%). Postoperative complications occurred in 5 patients (31.3%), including 3 major and 2 minor events. Compared with younger patients (n = 1180), the older cohort demonstrated a higher complication rate, although this difference did not reach statistical significance. Surgical repair of pectus excavatum in patients over the age of 40 is feasible and safe when appropriate techniques are applied. Despite increased anatomical stiffness necessitating complex configurations, acceptable clinical outcomes can be achieved. Age alone should not be considered a contraindication for pectus repair in well-selected adult patients.

Objective: This study aimed to investigate the relationship between vaginal symptoms, sexual function, and vaginal lubrication levels, measured objectively with the Vaginal Lubrication Kit (VLK), in pregnant women. Material and Methods: This observational, cross-sectional study included 105 pregnant women (age: 30.2 ± 5.8 years, height: 161.4 ± 5.6 centimeter (cm), weight: 68.1 ± 10.3 kg, Body Mass Index (BMI): 26.2 ± 4.4 kg/m2) admitted to the Obstetrics and Gynecology Clinic of Istanbul Training and Research Hospital between January and August 2024. Sociodemographic and obstetric characteristics were recorded, and participants were assessed using the Female Sexual Function Index (FSFI) and Visual Analog Scale (VAS) for vaginal dryness, burning, and dyspareunia. The VLK scores were obtained using a modified Schirmer test strip adapted for vaginal application. Correlation analyses were performed using Spearman’s rank test. Results: The mean number of pregnancy weeks of participants was 20.5±11.4 weeks, and the mean parity was 2.0±1.4. The mean VLK score was 24.6±11.0 mm. The mean FSFI score was 16.6±11.2, whereas the mean VAS scores were 1.9±2.6 cm for vaginal dryness, 2.1±2.7cm for burning, and 1.9±2.7cm for dyspareunia. VLK scores were significantly positively correlated with FSFI scores (r=0.230, p=0.018) and moderate-to-strong negative correlations with VAS dryness (r=–0.680), burning (r= –0.530), and dyspareunia (r=–0.530), (p<0.001). Conclusion: VLK is a safe and non-invasive method to evaluate vaginal lubrication in pregnant women, lower scores being associated with more symptoms and reduced sexual function.

The aim of this study was to identify preoperative and perioperative predictors of radiation exposure during retrograde intrarenal surgery and to develop a scoring system to estimate intraoperative fluoroscopy time. Data from 753 patients who underwent retrograde intrarenal surgery for renal stones were obtained from a multicenter database. All procedures were performed under general anesthesia using fluoroscopy. Fluoroscopy time, recorded in seconds, was the primary outcome. Ordinal regression analysis was applied to evaluate the association between clinical variables and fluoroscopy duration. A predictive score was developed based on statistically significant factors. The performance of the score was tested using receiver operating characteristic curve analysis and a calibration plot.The mean fluoroscopy time was 58 seconds, while the median was 5 seconds. In 140 procedures, fluoroscopy time exceeded 120 seconds. Six parameters were independently associated with longer fluoroscopy use: absence of preoperative ureteral stenting, low stone density (<1000 Hounsfield units), small stone burden (<250 cubic millimeters), multiple stone localizations, failure of ureteral access sheath insertion, and use of large-caliber sheaths (≥10-12 French). Each parameter was assigned a weighted value, generating a score ranging from 0 to 15. The scoring system demonstrated excellent discriminatory ability (area under the curve: 0.901). A score of 10 or more predicted fluoroscopy duration above 120 seconds with 87.5% sensitivity and 86.2% specificity.The RIRSearch Score is a practical tool for anticipating prolonged radiation exposure before retrograde intrarenal surgery. Surgeons may use this model to minimize unnecessary fluoroscopy and enhance occupational safety.

Amaç: Bu çalışma, işletmelerin dijital dönüşüm süreçlerindeki konumlarını değerlendirebilmeleri amacıyla güvenilir ve geçerli bir Dijital Olgunluk Seviyesi (DOS) ölçeği geliştirmeyi hedeflemektedir. Geliştirilen ölçek ile işletmelerin mevcut durumlarını tespit etmeleri ve iyileştirmeye ihtiyaç duyulan alanları belirleyebilmeleri amaçlanmaktadır. Yöntem: Çalışmada ölçek geliştirme adımları olarak kapsamlı literatür taraması, pilot uygulama ve faktör analizlerini içeren üç aşamalı bir yöntem izlenmiştir. Yapılan literatür incelemesi sonucunda, kavramsal çerçeveye uygun olacak şekilde, araştırmacılar tarafından 164 ifadeyi kapsayan geniş bir madde havuzu geliştirilmiştir. Oluşturulan taslak madde havuzu dijital dönüşüm alanı sektör temsilcileri ve akademik uzmanlarının geri bildirimleriyle 46 maddeye, ardından açıklayıcı faktör analizleriyle 18 maddeye indirgenmiştir. Araştırma, iki ayrı örneklem grubuyla yürütülmüştür. Bulgular: İlk çalışma grubu (n=171) ile yapılan açıklayıcı faktör analizi sonucunda ölçek; Stratejik Dijital Yönelim, Dijital Tedarik ve Süreçler, Altyapı ve Güvenlik, İleri Dijital Uygulamalar ve Dijital Yetkinlik ve Kültür olmak üzere beş faktörden oluşmuştur. Tüm alt boyutların Cronbach-α katsayıları kabul edilebilir düzeyde bulunmuştur. İkinci çalışma grubunda (n=205) yapılan doğrulayıcı faktör analizleri beşli yapının kuramsal yapıyla örtüştüğünü ve uyum indekslerinin model geçerliliğini desteklediğini göstermiştir. Betimsel bulgular, işletmelerin stratejik dijital yönelime önem verdiklerini; ancak altyapı, güvenlik ve dijital kültür alanlarında gelişim ihtiyaçlarının devam ettiğini ortaya koymuştur. Sonuç: Geliştirilen DOS ölçeği, farklı büyüklükteki ve sektörel çeşitliliğe sahip işletmelerin dijital olgunluk düzeylerini çok boyutlu bir bakış açısıyla ve sistematik şekilde değerlendirmelerine imkân tanımaktadır. Elde edilen bulgular, ölçeğin beş boyutlu yapısının hem istatistiksel hem de kuramsal açıdan anlamlı ve tutarlı olduğunu göstermektedir. Ölçek, işletmelerin stratejik dijital yönelim açısından görece daha ileri seviyede olduklarını, ancak dijital altyapı, güvenlik uygulamaları ve dijital kültür alanlarında gelişim alanlarının bulunduğunu ortaya koymuştur. Bu durum, dijital dönüşümün yalnızca teknolojik yatırımlar değil; aynı zamanda stratejik vizyon, kurumsal kültür ve insan kaynağı gibi boyutlarla birlikte ele alınması gerektiğine işaret etmektedir. DOS ölçeğinin farklı sektörlerdeki ve çeşitli büyüklükteki işletmelerde yeniden denenmesi, bulguların genellenebilirliğini değerlendirmek açısından anlamlı sonuçlar doğurabilir. Özgünlük: Bu çalışma, dijital olgunluk kavramının stratejik, teknolojik, operasyonel ve kültürel boyutlarını bütüncül biçimde ele alarak, mevcut ölçeklerle benzer temelleri paylaşan ancak yerel bağlama uyarlanmış bir ölçüm aracı geliştirmeyi amaçlamaktadır. Böylece hem teorik kapsam korunmuş hem de uygulamada kullanılabilirlik güçlendirilmeye çalışılmıştır.

Testicular torsion (TT) is a urological emergency that results in ischemia/reperfusion (I/R) injury, leading to oxidative stress, cellular apoptosis, and impaired spermatogenesis. This study investigated the protective effects of the HMG-CoA reductase inhibitor rosuvastatin on TT-induced I/R injury and explored the underlying mechanisms. Male Balb/C mice (n = 28) were subjected to 720° testicular torsion for two hours, followed by 24 h of detorsion. Rosuvastatin was administered either acutely (post-torsion) or prophylactically (prior to injury). Histopathological evaluation, assessment of oxidative stress parameters, sperm motility and morphology analysis, and Western blot examination of survival and stress related signaling proteins (pAKT, pJNK1/2, pERK1/2, and Bcl-xL) were performed. Rosuvastatin treatment significantly reduced tissue damage decreased oxidative stress (as indicated by increased TAS and reduced TOS/OSI), and improved sperm motility and morphology. Both acute and prophylactic treatment regimens enhanced cell survival by increasing pAKT and Bcl-xL levels, reducing pERK1/2 activation, and modulating stress responsive JNK1/2 signaling. These findings suggest that rosuvastatin mitigates I/R induced testicular damage primarily through modulation of key intracellular pathways, particularly PI3K/AKT, and support its therapeutic potential in acute testicular injuries and related degenerative conditions.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-29283-w.

There is no consensus on whether to ligate or preserve uncomplicated vascular access (VA) after kidney transplantation (KT), as International Guidelines do not address this issue. Enhanced survival rates of kidney grafts may elevate the risk of cardiac morbidity and mortality due to prolonged exposure to the hemodynamic effects of arterio-venous fistulas (AVF). Although VA ligation reduces left ventricle (LV) mass, its impact on cardiovascular (CV) morbidity or mortality is unclear. High-flow VAs can complicate KT patients, and immunosuppressive medication may increase these complications. Despite preserving VA for future hemodialysis (HD) use, central catheters are used in nearly two-thirds of patients. Detecting transplant patients who can undergo AVF ligation and reconstruction when returning to HD allows for flexible decision-making with a multidisciplinary approach, personally tailored to patients at their discretion. Therefore, an algorithm involving Doppler ultrasound and cardiac evaluation is advisable.

Introduction: Colchicine and NSAIDs are commonly used as flare prophylaxis during urate-lowering therapy (ULT) in gout, a chronic inflammatory condition linked to elevated cardiovascular risk. Oxidative stress and endothelial dysfunction may contribute to major adverse cardiovascular events (MACE). Although colchicine shows cardioprotective effects in non-gout populations and NSAIDs remain widely used despite risks, their effect on MACE in gout patients is unclear. Research Question: Does flare prophylaxis with colchicine or NSAIDs alter the cardiovascular risk profile in patients with gout initiating ULT therapy? Methods: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251017700). MEDLINE, EMBASE, and CENTRAL were searched through April 2025 for studies of gout patients initiating ULT with flare prophylaxis using colchicine, NSAIDs, or no prophylaxis. Studies involving non-gout crystal arthropathies, isolated hyperuricemia, or prophylaxis without ULT were excluded. The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and coronary revascularization. Log-transformed hazard ratios (HRs) were pooled using a random-effects meta-analysis. Results: Five studies from the UK, US, and Canada were included: three retrospective cohorts, one observational reanalysis of an RCT, and one target trial emulation. To avoid duplication with Cipolletta et al., only the CPRD GOLD subset was extracted from Roddy et al. Across four studies, 148,345 gout patients were included, with Singh et al. reporting 10,195 person-years of follow-up. Among them, 37,168 (25.1%) received colchicine and 19,461 (13.1%) received NSAIDs. Colchicine prophylaxis was not significantly associated with MACE risk compared to no prophylaxis [log(HR) = 0.005; 95% CI: -0.21 to 0.22, Figure 1]. NSAIDs also showed no significant difference [log(HR) = 0.19; 95% CI: -0.18 to 0.57, Figure 2]. Risk was similar between colchicine and NSAID groups [log(HR) = -0.02; 95% CI: -0.32 to 0.28, Figure 3]. Conclusion: Our meta-analysis found that flare prophylaxis with colchicine or NSAIDs did not reduce cardiovascular event risk in gout patients. These findings may contradict recent evidence of colchicine’s cardioprotective effects compared to NSAIDs. Further studies are needed to guide cardiovascular risk management in this high-risk population.