Istanbul Medipol University

To determine how visual motion direction and the engagement of central versus peripheral visual fields modulate cervical vestibular evoked myogenic potentials (cVEMP). We investigated whether optokinetic stimulation and smooth pursuit, delivered centrally or peripherally, alter cVEMP latency and amplitude. Forty-five healthy adults completed cVEMP testing across seven visual conditions: baseline (fixed gaze) and various optokinetic stimulation directions and smooth pursuit tasks. These stimuli were delivered using either a light bar (central vision, n=13) or an expanded visual surround (peripheral vision, n=32). Primary outcomes were P13 and N23 latencies and peak-to-peak amplitudes, with within-subject comparisons assessing deviations from baseline. Central visual stimulation via the light bar produced no significant changes in cVEMP latencies or amplitudes relative to baseline (p > 0.008). In contrast, peripheral stimulation yielded significant latency prolongations, most prominently for N23 during vertical and horizontal optokinetic motion. P13 effects were less pronounced and inconsistent. Amplitudes did not show systematic changes across any condition. The divergent behaviour of P13 and N23 indicates differential susceptibility of early versus later cVEMP components to visual and cognitive influences. Peripheral visual motion exerts a more substantial influence on vestibulo-collic pathways than central foveal input, primarily by delaying cVEMP latencies without enhancing amplitudes. This pattern contrasts with prior vection-linked reports of latency reductions and amplitude increases, suggesting distinct neural processing for vection versus purely visual motion cues. These findings highlight the potential to leverage peripheral motion to modulate otolith reflex timing in vestibular rehabilitation, warranting confirmation in patient cohorts and with explicit vection quantification

The athlete disability index (ADI) is a self-administered scale developed specifically for athletes to assess functional disability due to low back pain. This study aimed to translate and adapt the ADI into Turkish, examine its validity and reliability, and to evaluate its clinical applicability in athletes with non-specific low back pain (NSLBP). A total of 130 athletes aged 18–35 years with NSLBP were recruited. Criterion validity was examined by correlating ADI-Tr scores with the visual analogue scale (VAS), Oswestry disability index (ODI), and Roland-Morris disability questionnaire (RMDQ). Floor and ceiling effects were evaluated. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach’s alpha, and measurement error using the standard error of measurement (SEM) and minimal detectable change (MDC₉₅). Structural validity was evaluated using exploratory (EFA) and confirmatory factor analyses (CFA). No floor or ceiling effect (0% for both) was observed. The ADI-Tr demonstrated excellent reliability (ICC = 0.98) and moderate to strong internal consistency (Cronbach’s α = 0.887) and significant correlations with established measures, such as the ODI (r = 0.646), and RMDQ (r = 0.615). The ADI-Tr demonstrated high measurement precision (SEM = 2.20; MDC₉₅=6.10). EFA and CFA supported a unidimensional structure of the ADI-Tr. These results indicate that the ADI-Tr is a reliable instrument for evaluating functional disability due to NSLBP in Turkish-speaking athletes. This study demonstrated that the ADI-Tr is a culturally adapted, valid, and reliable with excellent test-retest reliability and high internal consistency for assessing functional limitations due to non-specific low back pain in athletes. It can be effectively used in both clinical practice and research settings. Trial registration: NCT06700707 (Registration Date: 20 November 2024).

Acute kidney injury (AKI) remains a clinically relevant complication after transcatheter aortic valve implantation (TAVI). Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated nephroprotective effects in chronic kidney disease (CKD); however, TAVI-specific data are limited. We analyzed a single-center registry of consecutive patients who underwent transfemoral TAVI for aortic stenosis between January 2015 and December 2025. After exclusions, 532 patients were included (SGLT-2i users, n = 112; non-users, n = 420). The primary endpoint was post-procedural AKI. Secondary outcomes were need for hemodialysis and in-hospital mortality. Propensity score matching (PSM) was performed (1:1), yielding 110 matched pairs. In the overall cohort, AKI occurred more frequently in SGLT-2i non-users than users (16.0% vs. 4.5%, p < 0.001), along with a higher requirement for hemodialysis (6.0% vs. 0.9%, p = 0.025). In the CKD subgroup, non-users had higher AKI (35.0% vs. 4.5%, p < 0.001) and hemodialysis rates (15.0% vs. 0.0%, p = 0.005), whereas outcomes were similar in the non-CKD subgroup. In the PSM cohort, non-users had higher AKI (20.0% vs. 4.5%, p < 0.001), hemodialysis (7.3% vs. 0.9%, p = 0.035), and in-hospital mortality (10.0% vs. 1.8%, p = 0.019). In the PSM CKD subgroup, non-users demonstrated markedly higher AKI (43.2% vs. 4.5%, p < 0.001), hemodialysis requirement (13.6% vs. 0.0%, p = 0.026), and in-hospital mortality (20.5% vs. 2.3%, p = 0.015), while non-CKD subgroup showed comparable outcomes. In multivariable analysis, SGLT-2i use independently predicted lower AKI risk in both the overall and matched cohorts. SGLT-2i use was associated with reduced AKI after TAVI, particularly in patients with CKD, and remained significant after propensity matching and multivariable adjustment.

Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways.

Abstract PurposeThe aim of this study was to evaluate the performance of the YOLOv11 deep learning–based object detection model in detecting dental restorations on digital panoramic radiographs.Materials and MethodsA total of 320 panoramic radiographs obtained from adult patients were included in this study. Four types of dental restorations—amalgam, composite, crown, and bridge—were manually annotated and used for model training and evaluation. The dataset was divided into training and testing subsets at a ratio of 75% and 25%, respectively. A validation subset was derived from the training data. Model performance was assessed using precision, recall, F1-score, and mean Average Precision (mAP) metrics.ResultsThe YOLOv11 model achieved an overall precision of 0.663, recall of 0.665, and F1-score of 0.663 across all restoration categories. The mAP@50 value was 0.671, while the mAP@50–95 value was 0.432, indicating variations in detection performance across different Intersection over Union thresholds. Differences in detection performance were observed among the various types of dental restorations.ConclusionThe findings indicate that YOLOv11 demonstrates measurable potential as an automated support tool for detecting dental restorations on panoramic radiographs; however, the achieved performance remains lower than that reported in several previous studies. Successful clinical integration of such AI-assisted systems requires further optimization and validation using larger and more heterogeneous datasets to enhance generalizability and clinical applicability.Keywords: deep learning; dental restorations; panoramic radiography; YOLOv11

Failin kastettiği suçu elverişli hareketlerle doğrudan doğruya icraya başlamasına rağmen, elinde olmayan nedenlerle tamamlayamaması durumunda TCK m. 35 gereğince suça teşebbüsten dolayı cezai sorumluluğu doğmaktadır. Ancak suça teşebbüs hükümlerinin somut olayda uygulanabilmesi her şeyden önce şartlarının gerçekleşmesine bağlıdır. Bu çalışmada suça teşebbüsün temel şartları olan kasten işlenebilen bir suçun varlığı, fiilin icra aşamasında olması, elverişlilik ve suçun elde olmayan sebeplerle tamamlanamaması, ceza hukuku bağlamında Yargıtay kararları ve doktrin görüşleri ile değerlendirilecektir. Bu kapsamda teşebbüsün şartlarının somut olaya uygulanmasındaki yaklaşımları özellikle, olası kasta teşebbüs, hareketin elverişliliği, hazırlık hareketi icra hareketi ayrımının tespiti ve suçun elde olmayan sebeplerle tamamlanmaması konuları kapsamında incelenecektir.

No-reflow phenomenon (NRP) after primary PCI in STEMI is strongly linked to early mortality and adverse events. Conventional indices such as the systemic immune-inflammation index (SII), the CRP to albumin ratio (CAR), and the SYNTAX 1 score (SXscore) appear to provide only moderate discrimination for NRP. The endothelial activation and stress index (EASIX), calculated as LDH × creatinine / platelet count, reflects endothelial dysfunction and microvascular stress and may add to risk stratification. This two-center retrospective cohort study included 983 consecutive STEMI patients undergoing primary PCI. NRP was defined as the failure to achieve distal TIMI 3 flow despite a fully patent epicardial artery, or the need for pharmacological therapy to reverse NRP. We evaluated the relationships of EASIX, SII, CAR and SXscore with NRP; key exclusion criteria were non-ticagrelor P2Y12 loading, advanced renal/hepatic failure, active infection/inflammatory–hematologic disease or malignancy, shock/arrest (Killip ≥ 2), door-to-balloon time > 60 min, prior CABG/PCI, and pre-PCI fibrinolytic therapy. NRP occurred in 267 patients (27.2%). EASIX, SII, CAR and SXscore were significantly higher in the NRP (+) group (all p < 0.001). In multivariable models, EASIX (OR 18.97, 95% CI 11.83–30.43; p < 0.001), CAR (OR 2.45, 95% CI 1.90–3.16; p < 0.001), SII (OR 1.000, 95% CI 1.000–1.000; p = 0.003), and SXscore (OR 1.04, 95% CI 1.03–1.06; p < 0.001) were independently associated with NRP. In ROC analysis, EASIX demonstrated the highest discriminative ability for predicting NRP (AUC = 0.835). The optimal cut-off value of 1.248 provided 62.2% sensitivity and 93.6% specificity. In comparison, CAR, SII, and SXscore showed lower discrimination (AUC = 0.687, 0.562, and 0.583, respectively). EASIX demonstrated a stronger association with NRP than CAR, SII, and the SXscore. Easily derived from routine laboratory tests, EASIX may represent a practical and readily applicable index for early NRP risk stratification in STEMI.

Bu araştırmanın amacı, sosyal medya kullanıcılarının mizah kullanımlarını değerlendirmeye yönelik geçerli ve güvenilir bir ölçme aracı geliştirmek üzere Sosyal Medyada Mizah Tarzları Ölçeği’ni (SMMTÖ) oluşturmaktır. Etkileşimlerin daha görünür, kalıcı, geniş kitlelere açık ve çoğu zaman yüz yüze iletişimden farklı sosyal normlar çerçevesinde gerçekleştiği sosyal medya ortamlarının, mizah tarzlarının kullanımını da etkileyebileceği düşünülmektedir. Bu kapsamda hazırlanan madde havuzunun psikometrik özellikleri iki ayrı çalışma ile değerlendirilmiştir. Birinci çalışmada, ölçeğin yapı geçerliliğini incelemek amacıyla açımlayıcı faktör analizi uygulanmıştır. Çalışma, sosyal medya kullanan 417 katılımcıdan oluşan bir örneklem üzerinde yürütülmüş ve analizler sonucunda ölçeğin 20 maddeden oluşan iki faktörlü bir yapıya sahip olduğu belirlenmiştir. Birinci faktör toplam varyansın %37.53’ünü, ikinci faktör ise %18.78’ini açıklamıştır. Alt boyutlara ilişkin iç tutarlık güvenirlik katsayıları sırasıyla .91 ve .90 olarak hesaplanmıştır. İkinci çalışmada, ölçeğin iki faktörlü yapısının doğrulayıcı faktör analizi ile test edilmesi amaçlanmıştır. Bu çalışma 446 katılımcı ile gerçekleştirilmiş ve yapılan beş modifikasyon sonrasında elde edilen modelin uyum indeksleri iyileşmiş; iki faktörlü yapının veriyle uyumlu olduğu görülmüştür (χ²(164) = 465.00, χ²/df = 2.83, p &amp;lt; .001, CFI = .93, TLI = .92, RMSEA = .064, %90 GA [.057, .071]). Bu örneklem için iç tutarlık katsayıları .91 ve .87 olarak bulunmuştur. Her iki çalışma için ölçeğin ve alt boyutlarının madde-toplam korelasyonları hesaplanmıştır. İlk çalışmadaki maddelerin, orta ve yüksek düzeyde; ikinci çalışmadaki maddelerin ise yüksek düzeyde madde-toplam korelasyonları olduğu görülmüştür. Sonuç olarak, geliştirilen SMMTÖ’nün, sosyal medyada mizahın kullanım biçimlerini ölçmeye yönelik geçerli ve güvenilir bir araç olduğu ortaya konmuştur.