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Cognitive function (CF) is a core feature related to all psychiatric disorders. However, self-report scales of CF (SRSC) may not always correlate with CF's objective measures and may have different mediators. Tools to select for evaluating CF in diverse psychiatric populations and their determinants need to be studied. In this study, we aimed to assess the association of SRSC (Perceived Deficit Questionnaire-Depression (PDQ-D), and World Health Organization's Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) and its inattentiveness subscale) with Letter-N-back as an objective measure of CF, and to analyze their association with psychopathology. Two hundred nine (131 nonclinical, and 78 clinical with a psychiatric diagnosis of ICD10 F31-39 [mood disorders excluding Bipolar I] or F40-F49 [neurotic, stress-related or psychosomatic disorder] categories) participants were evaluated with PDQ-D, ASRS, Beck Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI), and N-back. Both groups' data were included in the analysis. PDQ-D showed a small correlation with N-back scores, whereas ASRS showed no correlation. PDQ-D and ASRS showed a large correlation. Age and BAI scores significantly predicted both PDQ-D and ASRS, whereas the cognitive subscale of BDI predicted PDQ-D, but not ASRS. Only BAI scores predicted N-back results. The mediation model revealed that 2-back scores of N-back task directly affects PDQ-D scores, independent of BDI scores. However, the cognitive subscale of BDI moderated 2-back and PDQ-D association. On the contrary, BAI scores significantly mediated the association of 2-back scores with PDQ-D. The direct effect of 2-back scores in PDQ-D was insignificant in the mediation of BAI scores. Our study validates the discordance between SRSC and an objective measurement of CF. Anxiety may affect both self-report and objective measurement of CF, whereas depressive thought content may lead to higher cognitive dysfunction reports in nondemented participants. [ABSTRACT FROM AUTHOR]

Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare neoplasm arising from spindle cells and most commonly arising from pleura. Spinal SFT/HPC is a rare entity; hence, it is not on the top of the differential diagnosis list when a clinician faces a spinal lesion. In the review of the literature, there exist less than 50 case reports of intradural extramedullary SFT/HPC. Here, we present a 54-year-old female patient who underwent subtotal surgical excision of an intradural extramedullary spinal mass pathologically reported to be SFT/HPC and had symptomatic recurrence in the 3rd year of follow-up. Surgical intervention was unachievable and the patient was given 45 Gy to the surgical cavity followed by a 5.4 Gy boost to visible tumor with external radiotherapy. Patient reported significant relief of her symptoms. We aim to contribute to the formation of a treatment algorithm for this rare entity. [ABSTRACT FROM AUTHOR]

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Purpose: This study aims to establish a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency and to evaluate the relationship between this classification, the demographics, and severity of clinical findings.Methods: This is a retrospective study from prospectively collected data of 503 patients who had the complaint of varicose vein. All patients had complete physical examination and their medical history was recorded. Lower limbs of all patients were examined with Doppler ultrasonography. A total of 787 limbs with great saphenous vein insufficiency were included in the analysis. The reflux patterns of great saphenous vein insufficiency were classified into 4 types as: type 1, great saphenous vein reflux without involvement of malleolar region and saphenofemoral junction (SFJ); type 2, reflux involving malleolar region with competent SFJ; type 3, reflux involving SFJ with competent malleolar region; and type 4, reflux involving both the SFJ and the malleolar region. We evaluated the association between the classification of great saphenous vein insufficiency and age, sex, body mass index (BMI), disease duration, clinical, etiological, anatomical and pathophysiological elements (CEAP) classification and venous clinical severity score (VCSS).Results: The mean age of the patients was 45.3±11.7 years, with a male-to-female ratio of 2:3. The most common reflux pattern in patients with great saphenous vein insufficiency was type 3 (48.9%), while 14.8% of patients had type 1, 10.4% had type 2, and 25.7% had type 4. Patients with type I reflux pattern were younger in age (p = 0.002), had lower BMI (p = 0.002), fewer number of children (p = 0.008), as well as milder clinical severity score (p = 0.002) compared to other reflux types. Duration of disease symptoms was not significantly correlated with the reflux patterns, but VCSS increased with the involvement of malleolar region as in type 2 compared to type 1 (2.82±1.67 vs. 2.74±2.31), and further increased with the involvement of SFJ as in type 3 (4.13±2.92 vs. 2.82±1.67). Patients with diffuse reflux pattern (type 4) had the most severe clinical presentation (4.59±2.9).Conclusion: We developed a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency based on the involvement of malleolar region and/or SFJ. We showed an association between weight, BMI, VCSS, CEAP classification and the extent of insufficiency. [ABSTRACT FROM AUTHOR]

Aim: Cognitive failures are suggested to be a transdiagnostic endophenotype that increases the vulnerability for psychiatric disorders. Broadbent’s Cognitive Failures Questionnaire (CFQ), is among the most widely used scales to assess cognitive function observed in an ecological manner. Despite its wide use in research and correlation with biological markers, CFQ is criticized for its unstable factorial structure among studies and 5-Likert structure that may lead to bias for neutral answers. Here we aimed to develop a 4-Likert Turkish version of CFQ, search its validity, reliability and factorial structure. Material and Methods: CFQ has been translated to Turkish in two steps. CFQ, Perceived Deficit Questionnaire-D (PDQ-D), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to 272 participants (187 healthy controls, 55 patients diagnosed with depression, 30 patients diagnosed with anxiety disorder). Results: The Cronbach’s alpha coefficient of 4-Likert Turkish version of CFQ was found as 0.91. Principal component analysis extracted five factors and explained 53.7 % of total variance. CFQ scores were significantly different among groups. Both depressive and anxious groups reported higher CFQ scores compared to controls. CFQ significantly and strongly correlated with PDQ-D and showed a moderate correlation with BDI and BAI. Conclusion: 4-Likert Turkish version of CFQ is a valid and reliable tool to assess cognitive failures in non-demented groups. Our analysis revealed a five factorial structure for CFQ, however previous literature with the 5-Likert version shows different factor structures and does not indicate a dimensional stability. [ABSTRACT FROM AUTHOR]

Several trials have been completed in patients with heart failure (HF) treated with uric acid (UA)-lowering agents with inconsistent results. We aimed to investigate whether lowering UA would have an effect on mortality and cardiovascular (CV) events in patients with HF in a systematic review and meta-analysis. The primary outcome measures were all-cause mortality, CV mortality, CV events, and CV hospitalization in patients with HF. We included 11 studies in our final analysis. Overall, allopurinol treatment was associated with a significant increase in the risk for all-cause mortality (hazard ratio [HR]: 1.24, 95% confidence interval [CI]: 1.04-1.49, P =.02). The trial heterogeneity is high (heterogeneity χ2 = 37.3, I2 = 73%, P <.001). With regard to CV mortality, allopurinol treatment was associated with a 42% increased risk of CV mortality (HR: 1.42, 95% CI: 1.11-1.81, P =.005). There was a trend toward increased CV hospitalization in the same group (HR: 1.21, 95% CI: 0.95-1.53, P =.12). Uric acid-lowering treatments increase all-cause and CV mortality but did not increase CV hospitalization significantly in this study. [ABSTRACT FROM AUTHOR]

Amaç: Radikal prostatektomi (RP) sonrası PSA nüksünde prostat lojuna kurtarma radyoterapisi (KRT) hormonal tedaviler ve/veya pelvise yönelik RT ile birlikte standart olarak kullanılmaktadır. Bu retrospektif tek merkezli çalışmada, RP sonrası KRT'nin lokal-bölgesel kontrol ve PSA düzeyleri üzerindeki etkisini araştırmak amaçlanmıştır. Gereç ve Yöntem: RP sonrası PSA veya lokal-bölgesel nüks nedeniyle 2009-2021 yılları arasında bölümümüzde KRT alan 85 hasta retrospektif olarak incelenmiştir. Androjen deprivasyon tedavisi (ADT) ve RT alanın PSA kontrolü, lokal-bölgesel ve uzak metastaz oranları üzerindeki etkisi incelenmiştir. Bulgular: Hastalara ve tümöre ait özellikleri Tablo 1'de özetlenmiştir. RP'den itibaren takip süresi medyan 111 aydır (10-257 ay arası). RP sonrası medyan 21 ay (1-155 ay) sonra PSA nüksü (PSA>0.2) tespit edilmiştir. 69 hastada PSA relapsı anında ek görüntülemeler yapılmıştır (GaPSMA +/- MRG). Pelvik RT hastaların %45,9'una, ADT %30,6'sı kullanmıştır. ADT eklenen hastaların daha yüksek risk grubunda, daha yüksek Gleason skora sahip olguğu görülmüştür. Prostat lojuna ve (varsa) lokal nükse medyan 66 Gy (58-76 Gy) ve pelvik lenfatiklere medyan 50 Gy (45-56 Gy) RT uygulanmıştır. Lenf nodu pozitifliği nedeniyle 26 hastada ek doz uygulanmıştır (medyan LN dozu 66 Gy). RT sonrası 3. ay PSA (medyan 0,05) RT öncesi PSA (medyan 0,34) ile karşılaştırıldığında anlamlı olarak daha düşük bulunmuştur (p=0.001). RT sonrası PSA nüksü 16 hastada (%18.8) görülmüştür, medyan süre 23 aydır. RT sonrası lokal nüks 2, pelvik lenfatik nüks 8, ve uzak metastaz 8 hastada gelişmiştir. Toplam 14 ölümden 3'ü prostat kanseri nedenlidir. RT'den itibaren 5-, 10-yıllık tümör yatağı, pelvik, uzak kontrol ve progresyonsuz sağ kalım sırasıyla; %96.5 ve %96.5; %89.8 ve %86.9; %92.6 ve %81.6; ve %86.1 ve %71.9 bulunmuştur. Tanıdan itibaren 5- ve 10-yıllık genel sağkalım %96.3 ve %87.9 olarak bulunmuştur. Pelvik alanın eklenmesi ve ADT kullanımı değerlendirilen parametreler üzerine anlamlı etkisi izlenmemiştir. Erken grad 3 ve üzeri GİS ve GÜS toksisite izlenmemiştir, geç grad 3 GİS toksisite 2 (%2.6) hastada, ve GÜS toksisite 8 (%9.4) hastada görülmüştür. Sonuç: RP sonrası PSA nükslerinde kurtarma radyoterapisi düşük ciddi yan etki profili ile basarıyla uygulanabilmiştir. KRT'ye ADT eklenmesi ile yüksek riskli hastaların sonuçlarının düşük risk hastalara benzer hale geldiğini görülmüştür. [ABSTRACT FROM AUTHOR]

Amaç: Bilateral akciğer ışınlanması özellikle çocukluk çağında görülen Wilm's tümörü, Ewing sarkomu ve rabdomyosarkomun pulmoner metastazlarının tedavisinde kullanılan bir tedavi modalitesidir. Bilateral akciğerin ışınlanması, çevre organlarda uzun dönem toksisitelere neden olabilir. Bu dozimetrik çalışmada solunum kontrolüyle yapılan bilateral akciğer ışınlamalarında 3-Boyutlu konformal radyoterapi (3-B RT) ve Volümetrik Ark Tedavi (VMAT) planlarının dozimetrik sonuçları karşılaştırılmıştır. Gereç ve Yöntem: Kliniğimizde 2014-2022 yılları arasında bilateral akciğer ışınlaması yapılan hastalardan, tedavilerini solunum kontrolü-nefes tutma tekniğiyle alanlar değerlendirilmiştir. Hastalar 3-B RT ve VMAT yöntemiyle tedavi görenler olarak iki grupta toplanmıştır. İki grup arasında hedef hacim ve riskli organ dozları karşılaştırılmıştır. Bulgular: Bilateral akciğer ışınlaması yapılan toplam yirmi dört hastadan nefes tutma yöntemiyle tedavi alan on dört hasta çalışmaya dahil edildi. Hastalardan sekizinin tedavisi 3-B RT tekniği ile; altısının tedavisi VMAT tekniği ile planlanmıştı. 3-B RT grubunda medyan doz 15 Gy'dir. Bu grupta maksimum spinal kord dozu, ortalama kalp dozu ve ortalama özofagus dozunun değerleri sırasıyla 14,98 Gy, 16,45 Gy ve 15,39 Gy olarak saptandı. VMAT grubunda medyan doz 17,5 Gy'dir. Bu hastaların üçüne kalp koruması yapılmıştır. Bu grupta maksimum spinal kord dozu, ortalama kalp dozu ve ortalama özofagus dozunun değerleri sırasıyla 14,33 Gy, 11,15 Gy ve 14,99 Gy olarak bulunmuştur. Hedef hacmin %95'i 3-B RT grubunda dozun = %95'ini kapsarken, VMAT grubunda = %96'sını kapsamaktaydı (Tablo 1). Sonuç: Bilateral akciğer ışınlamasında akciğerleri homojen şekilde ışınlayabilmek için solunum kontrolü tekniği uygulanması tavsiye edilmektedir. VMAT tekniği; kalp koruma yapılmasına olanak tanıması, doz homojenitesi ve yüksek doz bölgelerinin bulunmaması nedeniyle hastalarda uzun dönem toksisiteleri azaltmak amacıyla tercih edilebilir. [ABSTRACT FROM AUTHOR]

Amaç: Meninjiomlar ikinci en sık primer intrakranyal neoplazm olup genelde benign seyirlidirler. Atipik ve anaplastik histolojideki meninjiomlar nispeten daha agresif seyirle ilişkilendirilmiş olup bu tümörlerde rekürrens riski yüksektir. Literatürde bu tümörlerin multipl ekstrakraniyal metastazı nadir olarak bildirilmiştir. Olgu: 61 yaşında erkek hasta 2014 yılında ağrılı, fikse, sağ paryetal yerleşimli kitle nedeniyle başvurmuş, yapılan MR tetkikinde kemik destrüksiyonu yapan ekspansil kitle saptanmış. Kitle gross total rezeke edilmiş, multifokal pandural ve epidural invazyon yapan WHO Grade II atipik meninjiom olarak rapor edilmiş. Hasta rutin takipteyken 2017'de sağ parietalde ekstraaksiel uzanan nüks meninjiomla uyumlu görüntü nedeniyle 07.03.2017'de opere edilmiş ve patoloji atipik meninjiom, WHO Grad II olarak gelmiş, postoperatif loja 60 Gy/30 fraksiyon radyoterapi (RT) uygulanmış. Hasta bu arada sağ akciğerde nodül sebebiyle de radyolojik takibe alınmış. Meninjioma yönelik takiplerinde tümör nüksü nedeniyle 4 kere daha opere olmuş, hastaya bu aralıkta 3 ay Oktreotid verilmiş. Kasım 2020'de oksipital bölgede nüks saptanan lezyonda PR reseptör pozitif bulunmuş ve tamoksifen başlanmış ancak progresyon olması nedeniyle ikinci seri RT için bölümüze yönlendirilmiştir. Definitif RT 60 Gy/30 fr olarak uygulanmıştır. Hastaya sonrasında Bevasizumab başlanmış. 28.12.2021'de yapılan PET/BT'de sol akciğer üst lobda yeni nodül ve sağ akciğerdeki nodülde progresyon saptanmış, biyopsi meninjiom metastazıyla uyumlu gelmiştir. Her iki lezyona 27 Gy/3 fraksiyon Stereotaktik Vücut Radyoterapisi (SBRT) uygulanmış, sonrasında sistemik tedavi devam etmiştir. Hasta, takiplerde stabil olarak izlenmiştir. 7.12.2022'de yapılan kranyal MR'da tentorium serebellide 2 odakta progrese lezyon görüşmüş ve bu lezyonlara da 25 Gy/5 Gy SBRT uygulanmıştır. Sonuç: Atipik meninjiomlarda kısa aralıklarla yineleme ve uzak metastazlar görülebilir. İkinci seri kranyal RT kararı eski tedavi planları ve dozları göz önüne alınarak dikkatle yapılmalı ve sistemik tedaviyle mümkün olabildiğince ertelenmelidir. Sınırlı uzak metastaz varlığında definitif dozlarda SBRT uygulabilir. [ABSTRACT FROM AUTHOR]

Volume overload is an important, may be the foremost, independent prognostic factor determining the outcome of hemodialysis patients. Therefore, it is crucial to measure fluid status of these patients and avoid volume overload. This review aims to evaluate volume overload, its effects on patients with renal diseases and current methodologies measuring volume status in the body. These techniques will be first classified as clinical evaluation and non-clinical and/or instrumental techniques, which includes biomarkers, ultrasonography, relative blood volume monitoring, bioimpedance, echocardiography, pulmonary artery catheterization, esophageal and/or suprasternal Doppler, and blood viscosity. Advantages and limitations of these different techniques will be reviewed extensively by comparing each other. At last, insights gained from this review can highlight the future prospects in this active area of research. [ABSTRACT FROM AUTHOR]

Context: Although the physiology of sodium, water, and arginine vasopressin (AVP), also known as antidiuretic hormone, has long been known, accumulating data suggest that this system operates as a more complex network than previously thought., Evidence Acquisition: English-language basic science and clinical studies of AVP and osmolarity on the development of kidney and cardiovascular disease and overall outcomes., Evidence Synthesis: Apart from osmoreceptors and hypovolemia, AVP secretion is modified by novel factors such as tongue acid-sensing taste receptor cells and brain median preoptic nucleus neurons. Moreover, pharyngeal, esophageal, and/or gastric sensors and gut microbiota modulate AVP secretion. Evidence is accumulating that increased osmolarity, AVP, copeptin, and dehydration are all associated with worse outcomes in chronic disease states such as chronic kidney disease (CKD), diabetes, and heart failure. On the basis of these pathophysiological relationships, an AVP receptor 2 blocker is now licensed for CKD related to polycystic kidney disease., Conclusion: From a therapeutic perspective, fluid intake may be associated with increased AVP secretion if it is driven by loss of urine concentration capacity or with suppressed AVP if it is driven by voluntary fluid intake. In the current review, we summarize the literature on the relationship between elevated osmolarity, AVP, copeptin, and dehydration with renal and cardiovascular outcomes and underlying classical and novel pathophysiologic pathways. We also review recent unexpected and contrasting findings regarding AVP physiology in an attempt to explain and understand some of these relationships., (Copyright © 2019 Endocrine Society.)