Liv Hospital

AimIMpower133 was designed with 4 cycles of chemoimmunotherapy with atezolizumab, unlike many other studies permitted 6-cycle induction. This study aimed to compare the efficacy and safety of a 4-cycle regimen with an extended 6-cycle regimen of carboplatin, etoposide, and atezolizumab in the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC).MethodsThis retrospective multicenter study was conducted across 13 oncology centers in Turkey. A total of 181 patients with ES-SCLC who received first-line treatment with chemotherapy plus atezolizumab were analyzed and grouped into those receiving 4 cycles (n = 101) and 6 cycles (n = 80) of treatment.ResultsThe median follow-up time was 20.9 months. The objective response rates were similar between the 4- and 6-cycle groups (79.2% vs 78.8%, P = .940). The disease control rates were also comparable (84.2% vs 86.3%, P = .940). The median progression-free survival (PFS) was 6.3 months in the 4-cycle and 8.1 months in the 6-cycle group (P = .357). The median overall survival (OS) was 16.6 months for the 4-cycle and 13.6 months for the 6-cycle group (P = .583). Intracranial progression was higher in the 4-cycle group (50.0% vs 25.5%, P = .007). Immune-related adverse events were similar between the groups.ConclusionThis is one of the largest real-world datasets comparing the efficacy and safety of 4 versus 6 cycles of induction chemoimmunotherapy. Although there were no significant improvements in PFS or OS, the 6-cycle regimen was associated with a lower observed rate of intracranial progression, predominantly among patients without baseline brain metastases. Further studies are needed to identify this subject in future.

Cardiovascular diseases are a leading health problem in Türkiye and worldwide. Digital platforms now offer ways to gauge public awareness through internet searches. This study explores how cardiovascular search trends align with regional epidemiological data in Türkiye and whether such data can indicate awareness and disease burden. Terms were chosen for clinical relevance and 'related queries.' Since Google Trends reports relative interest, this is noted as a limitation. Google Trends data for five terms ('coronary artery disease,' 'heart attack,' 'ischemic heart disease,' 'stent,' 'heart failure') were collected for Türkiye's seven regions and 81 provinces between January 2020 and July 2025. Term selection was based on guidelines and related queries; synonyms were not fully reviewed. Data were compared with prevalence, mortality, and disability-adjusted life years (DALYs) from national and global sources. Correlation and regression analyses assessed associations. A prototype Digital Disparity Index (DDI) combined disease burden, search activity, and socioeconomic context. Search activity correlated with epidemiological indicators, with the strongest associations in the Marmara and Aegean regions (Pearson's r = 0.68, P < 0.01). Some eastern provinces showed high burden but low search activity. Regression analysis indicated that search interest explained 46% of the variance in prevalence (R² = 0.46, P < 0.01). The DDI highlighted Eastern and Southeastern Anatolia as high-disparity areas. Internet search data reflect awareness and cardiovascular burden in Türkiye and may support public health planning. The DDI helps identify areas where burden is high but awareness is low. Broader term inclusion, multilingual coverage, and validation with clinical outcomes are needed in future research.

Aims: Acute diverticulitis (AD) and primary epiploic appendagitis (EA) are two distinct pathological entities that often present with similar clinical features, complicating the process of differential diagnosis. While AD is an inflammatory condition of the diverticula that may progress to significant complications, EA represents a self-limiting inflammatory process originating from ischemic infarction of an epiploic appendage. Accurate differentiation between these two conditions is crucial, as management strategies differ significantly: AD may require hospitalization and antibiotic therapy, while EA is typically managed conservatively. Laboratory parameters have been increasingly investigated to assist in the early and accurate diagnosis of these conditions. This study aims to evaluate the diagnostic value of routine laboratory parameters and to develop a novel scoring system to help clinicians distinguish between AD and EA. Methods: A retrospective analysis was conducted on 184 patients diagnosed with either EA or AD at Hitit University Medical Faculty Erol Olçok Training and Research Hospital between January 1, 2013, and January 1, 2022. Demographic data, laboratory values, including white blood cell count (WBC), neutrophil (NE), lymphocyte (LY), hemoglobin (Hb), platelet (Plt), mean platelet volume (MPV), albumin (Alb), creatine kinase (CK), and C-reactive protein (CRP), lesion localization, comorbidities, hospitalization status, length of stay, complications, interventions, recurrence, and colonoscopy findings were recorded. Comparative analyses between the EA and AD groups were performed. Multivariate analysis identified significant predictors for developing the Ramcho Index (RI) and the Ramcho Score (RS), which integrate laboratory and clinical parameters to create an objective, numeric index and a 0–9 point scale. Results: Among the 184 patients, 109 were diagnosed with AD and 75 with EA. CRP, neutrophil-lymphocyte ratio (NLR), and CRP-albumin ratio (CAR) were significantly elevated in AD (all p

Objective: The objective was to investigate the association between anogenital distance (AGD) and adenomyosis in reproductive-age women and to evaluate the potential of AGD as a non-invasive biomarker reflecting prenatal hormonal environment. Methods: This prospective case-control study included 40 women with adenomyosis diagnosed according to the Morphological Uterus Sonographic Assessment (MUSA) 2022 criteria and 40 age-matched healthy controls. Two AGD measurements were obtained: AGD-af (anus to posterior fourchette) and AGD-act (anus to clitoral tip). Measurements were performed by two independent observers using vernier calipers. Hormonal parameters, reliability analyses, receiver operating characteristic (ROC) curve analysis, and logistic regression were conducted. Results: Women with adenomyosis had significantly shorter AGD-af compared to controls (23.78 ± 7.20 vs. 27.88 ± 7.50 mm, p = 0.015), whereas AGD-act did not differ significantly (p = 0.574). Inter- and intra-observer reliability was excellent (intraclass correlation coefficient [ICC] = 0.87-0.93). ROC analysis revealed an area under the curve (AUC) of 0.658 (95% confidence interval [CI]: 0.55-0.76) for AGD-af (optimal cut-off = 24 mm; sensitivity: 57.5%, specificity: 67.5%). In multivariate logistic regression, AGD-af remained independently associated with adenomyosis after adjusting for age and body mass index (BMI) (adjusted odds ratio [OR] = 0.925, 95% CI = 0.866-0.989, p = 0.022). No significant difference was observed in hormonal parameters between groups. Conclusions: Women with adenomyosis exhibit a modest but significant reduction in AGD-af, suggesting a possible influence of prenatal hormonal environment in disease pathogenesis. Although its diagnostic accuracy is fair, AGD-af may serve as a complementary, non-invasive biomarker in clinical assessment of adenomyosis.

Anterior glenohumeral instability is a common issue, particularly among young and active individuals. Arthroscopic Bankart repair is an effective surgical method for achieving long-term shoulder stability. However, despite favorable biomechanical outcomes, return to sport rates vary widely. Psychological factors, especially kinesiophobia, may play a decisive role in this variability. The aim of this study was to evaluate the impact of postoperative kinesiophobia on clinical outcomes, functional scores, and return to sport following arthroscopic Bankart repair. A retrospective review was conducted on 73 patients who underwent arthroscopic Bankart repair between December 2019 and June 2024. All patients had a minimum follow-up of 12 months. The Tampa Scale for Kinesiophobia (TSK), Western Ontario Shoulder Instability Index (WOSI), and American Shoulder and Elbow Surgeons Shoulder Score (ASES) were utilized for assessments. Patients were stratified based on their TSK scores, and the relationships between kinesiophobia levels, functional outcomes, and return-to-sport rates were analyzed statistically. The mean patient age was 28 years (range, 15-47 years), with a mean follow-up period of 22 months (range, 12-50 months). Patients with high TSK scores demonstrated significantly worse WOSI and ASES outcomes (p < 0.001), indicating poorer shoulder-related quality of life and diminished shoulder function. Elevated levels of kinesiophobia were also associated with reduced rates of high-level return to sport. A strong positive correlation was observed between preoperative and postoperative TSK scores (r = 0.611), suggesting persistence of kinesiophobia over time. Despite achieving surgical stability, fear of reinjury emerged as a significant barrier to returning to sport. Kinesiophobia is a critical psychological factor that adversely affects functional recovery and return to sport following arthroscopic Bankart repair. Patients with high levels of kinesiophobia demonstrated poorer shoulder function, reduced shoulder-related quality of life, and lower rates of return to high-level sport, despite achieving surgical stability. These findings highlight the importance of incorporating psychological assessment and targeted interventions into postoperative rehabilitation protocols to optimize functional outcomes and facilitate a successful return to sport.

Rosacea is a chronic inflammatory disorder with a prevalence reported between less than 1% and 22% across populations, increasing annually. In the context of rosacea management, numerous aspects of the condition’s pathophysiology remain insufficiently understood. Despite the availability of various topical and oral treatments and laser therapies for rosacea, their limitations, common adverse effects, and high costs frequently lead to premature discontinuation, driving greater interest in plant-based formulations among both clinicians and patients. Consequently, herbal products containing natural ingredients are increasingly preferred over synthetic alternatives, owing to their multiple benefits and lower frequency and severity of side effects. This review emphasizes that a range of herbal extracts and oils, traditionally used in Anatolian medicine which is supported by literature mainly for their anti-inflammatory, antioxidant, antimicrobial, and anti-erythematous effects, possess significant potential in managing rosacea. Drawing on recent preclinical and clinical studies, Our study outlines the mechanisms by which various phytochemicals alleviate the clinical symptoms of rosacea, thereby enhancing understanding of the therapeutic potential of plant-based products and guiding future researches.

&amp;lt;p&amp;gt;The aim of this paper is to show that a successful process of disposal of discarded and wornout objects, equipment and technical means, which may represent ecologically unknown waste, is possible if it is approached, from the collection phase to final disposal in a very professional and responsible manner, with the aim of using secondary raw materials as correctly as possible, in order to minimize the harmful impact on the environment. Recycling is a priority in waste management. It is an ecologically and economically efficient measure that has a positive effect, not only on the environment but also on society as a whole. This paper presents the collection, recycling and waste products as one of the options for reducing waste. If waste is treated only as such, it represents only a cost, and waste recycling can bring significant profits. Recycling is a business in which everyone wins and producers save on raw materials, consumers get cheaper equipment, and discarded vehicles and equipment would no longer end up in unauthorized places and pollute the environment. Example: Japan recycles out of eighty-five European Union countries, about sixty percent, and Bosnia and Herzegovina up to ten percent, of the waste it produces.&amp;lt;/p&amp;gt;

The molecular basis of adenoid hypertrophy (AH) has not yet been fully elucidated. This study aims to investigate specific plasma amino acid alterations in children with AH and evaluate their associations with systemic inflammatory markers. By characterizing the metabolic profile of AH and identifying potential amino acid signatures, we sought to uncover metabolic biomarkers associated with systemic effects of upper airway obstruction, ultimately contributing to improved diagnostic and therapeutic strategies in pediatric patients. This prospective study included pediatric patients with upper airway obstruction due to adenoid hypertrophy, confirmed by endoscopic examination and clinical symptoms, and scheduled for adenoidectomy, along with age- and sex-matched healthy controls. Targeted metabolomic analysis of plasma amino acid levels was performed using liquid chromatography-mass spectrometry (LC-MS/MS). To identify significant metabolic alterations and assess their clinical relevance, statistical comparisons, correlation analyses, and pathway enrichment mapping were conducted. Among the 36 amino acids analyzed, eight exhibited significant differences between groups. Glutamic acid, phenylalanine, and leucine were elevated in AH patients, while GABA, tryptophan, alanine, citrulline, and anserine were decreased. Pathway analysis highlighted dysregulation in alanine, aspartate, and glutamate metabolism. Clinical correlations suggest potential links to endothelial dysfunction, excitotoxicity, and neurodevelopmental vulnerability. The study presents the first metabolomic characterization of systemic responses related to obstruction-causing adenoid hypertrophy, implicating amino acid dysregulation as a contributor to both local proliferation and multisystem complications. These findings offer insight into disease mechanisms, propose early biochemical markers for adenoid hypertrophy-induced airway obstruction, and support the development of targeted metabolic and microbiota-informed therapies.

This study examined the relationship between obsessive-compulsive disorder (OCD) symptom severity and psychological resilience within the framework of dominant depressive temperament (DDT). A total of 129 patients with OCD were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Resilience Scale for Adults (RSA), and the TEMPS-A questionnaire for temperament evaluation. Participants were classified as having DDT based on both established cut-off scores and standardized z-scores for the depressive subscale. Depression and anxiety levels were measured with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Patients with DDT showed significantly higher depression, anxiety, and obsession scores than those without DDT. They also displayed significantly lower scores in most RSA subdimensions (perception of future, structured style, social competence, family cohesion, and social resources), while perception of self did not differ. Interestingly, some resilience subdimensions such as structured style were relatively higher in the DDT group despite greater symptom severity, indicating a paradoxical pattern. Partial correlation analyses controlling for depressive symptoms revealed that, in the DDT group, higher OCD symptom severity was inversely associated with several resilience resources—particularly family cohesion. The presence of DDT is linked to greater emotional vulnerability and reduced resilience resources, which may exacerbate OCD severity. These findings indicate that the interplay between affective temperament and resilience in OCD remains significant even after accounting for depressive symptoms, underscoring the importance of incorporating temperament profiling and resilience assessment into clinical evaluation. Interventions that target resilience may be particularly beneficial for OCD patients with DDT. Not applicable.