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Trees that we see every day stay firm in the same place for several years. They are the symbol of nature and one of the most important living beings which are a bridge between the past, the present and the future. According to Andres [1], the monumental trees differ from others of their species regarding their unusual size, their age, or their unusual shape, which means that they are of special natural, historical, cultural, or scenic interest. Characteristics such as their height, trunk diameter, crown shape, or their having witnessed historical events or appearing in myths and legends make these trees of public interest and therefore protected by law. The veteran trees are also different from other trees with their ages, unusual size, unusual shape etc. They can be seen as a candidate for monumental trees. Istanbul, the biggest metropolitan city of Turkey, is particularly rich in monumental and veteran trees. In the study of IMM, the monumental trees and veteran trees of Istanbul city have been identificated and their locations have been stated. According to this study the monumental and veteran plane trees in the urban areas of the city are of special interest while they are of scenic value (throughout the history?!) but also have unwanted features like being nontolerant to arid conditions and also to various diseases [2]. Firstly, in this study the spatial distributions of the two monumental and veteran plane species (Platanus acerifolia, Platanus orientalis) in Istanbul have been revealed. Secondly, these 2518 taxa have been evaluated by the permeability of their existing place, in order to improve protection strategies. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis (HT). Design. This study is a retrospective study that conducted during 7 consecutive years with a median 119.5 months follow-up. Subjects and Method. Patients who underwent thyroidectomy in Dokuz Eylül University Hospital during 7 consecutive years were included. Patients' demographics, biochemical, radiological, and pathological results were retrospectively assessed. Results. Four hundred sixty nine patients were evaluated. Among 469 patients who underwent thyroidectomy, 132 (28.1%) were malignant, while 182 patients were diagnosed with HT (38.8%). PTC was ranked first at 92.4% (n: 122). The prevalence of HT was 54.9% in patients with PTC and 33.1% in patients without PTC diagnosis (p<0.001). Younger age and the presence of HT were independently associated with PTC. The presence of HT was associated with increased risk of development of PTC (OR: 2.2, %95 CI: 1.4-3.5, p<0.001) but not with TNM stage or recurrence. Lymph node metastasis at presentation was the strongest predictor of recurrence (OR: 13.9, CI: 3.5-54.6, p<0.001) Conclusions. HT was an independent risk factor for development of PTC. According to our findings, HT patients (particularly with nodular HT) should be observed carefully and thyroid fine needle aspiration biopsy (TFNAB) should be encouraged if necessary. [ABSTRACT FROM AUTHOR]

Purpose: Our study aimed to evaluate the genetic etiology of treatment-resistant nocturnal enuresis in children who have undergone at least 6 episodes of behavioral therapy, urotherapy, alarm therapy, and medical treatment., Materials and Methods: A total of 21 patients were included in the study. Inclusion criteria for the study comprised children aged 5-18 years diagnosed with treatment-resistant enuresis according to the International Children's Continence Society (ICCS) guidelines. The capture-based Sophia Hereditary Disease Panel by Sophia Genetics was used specifically for nocturnal enuresis, consisting of a panel of 19 genes (AGXT, AQP2, AVPR2, BNC2, CLCNKB, DLG3, ELN, FA2H, FAM20A, FOXP1, HPSE2, KCNJ10, MLXIPL, NPHP3, RNF168, SLC12A3, SLC25A13, SLC5A2, SMARCA2)., Results: Patients were analyzed for genetic variations in genes associated with nocturnal enuresis, including AGXT, AQP2, AVPR2, BNC2, CLCNKB, DLG3, ELN, FA2H, FAM20A, FOXP1, HPSE2, KCNJ10, MLXIPL, NPHP3, RNF168, SLC12A3, SLC25A13, SLC5A2, and SMARCA2. No pathogenic changes potentially explaining the etiology of the disease were detected in 20 patients. One patient exhibited a variant in the AQP2 gene at hg19:Chr12:50344908 exon 1, c.295G>A locus, classified as a Variant of Uncertain Significance (VUS) according to the American College of Medical Genetic and Genomics (ACMG) 2015 guidelines. The AQP2 gene is associated with autosomal dominant and autosomal recessive inherited nephrogenic diabetes insipidus (type 2) in the OMIM (Online Mendelian Inheritance in Man) database., Conclusion: Our study resembles studies indicating that nocturnal enuresis cases do not have a monogenic etiology but occur with multifactorial effects and have a weak correlation between genotype and phenotype.

Aim: This study aims to conduct a comprehensive analysis of the interrelationships among career stress, work stress, career regret, job satisfaction and career adapt abilities within the nursing profession., Design: The research involved a sample of 576 nurses from ten urban hospitals, distributed across five distinct cities in Turkiye, between December 2023 and January 2024. The study employed regression models to systematically test hypotheses, providing nuanced insights into the complex dynamics of the variables under investigation., Methods: Regression models were utilized to test the hypotheses systematically, considering the moderating role of career adapt abilities. The study included a sample of 576 nurses from 10 urban hospitals in Turkey, distributed across five distinct cities. This approach allowed for a detailed examination of the intricate relationships between career stress, work stress, career regret, job satisfaction and career adapt abilities within the nursing profession., Results: The findings underscore the delicate balance between the positive gains of job satisfaction and the challenges posed by career stress, work stress and career regret in the multifaceted landscape of nursing., Conclusion: In nursing, the relationship between career stress, work stress, career regret and job satisfaction include progress, resilience and obstacles. Developing strategies requires a cooperative effort from health care organizations, nursing leaders and individual nurses., Impact: The research provides valuable insights into the interplay of these factors and emphasizes the moderating role played by career adapt abilities. The implications of the study extend to healthcare organizations, nursing leaders and individual nurses. The research advocates for collaborative strategies aimed at enhancing job satisfaction, alleviating stressors and addressing career regret. The ultimate goal is to contribute to the retention of a resilient nursing workforce, emphasizing the importance of strategies that support the well-being and satisfaction of nurses in their careers., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

Objective: This retrospective study was conducted in a tertiary hospital in Turkiye, it was aimed to evaluate the results of kidney and bladder ultrasonography, uroflowmetric study and volume frequency chart in children diagnosed with bedwetting at night., Methods: This study focused on patients aged 5-17 years who were treated for nocturnal enuresis in the single-center pediatric urology clinic of a tertiary hospital between 2017-2021. Patients' comorbidities, surgical history, urinary ultrasonography findings, uroflowmetry examination results, and two-day voiding diary were requested., Results: The number of pediatric patients diagnosed with enuresis nocturna was 956. Abnormal ultrasonography findings were observed in 13.9% of patients. Almost half of the patients had a positive family history, and 13.4% had a history of previous surgical procedures. While the voiding diary indicated that 54.2% of patients had bladder volumes equivalent to the expected bladder capacity, uroflowmetry examination revealed low bladder capacity in 65% of patients., Conclusion: This study underscores the significance of comprehensive evaluations, including detailed ultrasonography and voiding diary measurements, in pediatric patients with monosymptomatic enuresis nocturna. Our study suggests that bladder volume measured through a two-day weekend voiding diary may provide more effective information for estimating optimal bladder capacity compared to measurements obtained through uroflowmetry., Competing Interests: No conflict of interest was declared by the authors.

Introduction: Lipodystrophy is a rare disease characterized by the loss of adipose tissue. Visceral adipose tissue loss in certain forms of lipodystrophy may affect the amount of mesenteric fat., Method: We studied visceral adipose tissue by measuring the thickness of mesenteric and retroperitoneal adipose tissue and the aortomesenteric (AOM) distance in patients with genetic forms of lipodystrophy (n = 48; 7 males; 41 females; mean age 39.1 ± 11.9 years; 19 with congenital generalized lipodystrophy [CGL], and 29 with familial partial lipodystrophy [FPLD]). An age- and gender-matched control group with a ratio of 1:2 was generated., Results: Patients with CGL had severely depleted mesenteric adipose tissue (2.0 [IQR: 1.5-3.5] mm vs. 18.8 [IQR: 4.4-42.2] mm in FPLD, P < .001; 30.3 [IQR: 13.9-46.6] mm in controls, P < .001) and retroperitoneal adipose tissue (1.3 [IQR: 0.0-5.3] mm vs. 33.7 [IQR: 21.6-42.1] mm in FPLD, P < .001; 29.7 [IQR: 23.1-36.7] mm in controls, P < .001). The AOM distance was shorter in patients with CGL (8.1 [IQR: 6.0-10.8] mm) compared to patients with FPLD (vs. 13.0 [IQR: 8.8-18.1] mm; P = .023) and controls (vs. 11.3 [IQR: 8.4-15.5] mm, P = .016). Leptin levels were positively correlated with AOM distance in lipodystrophy (r = .513, P < .001). Multivariate linear regression analysis identified body mass index as a significant predictor of AOM distance (data controlled for age and sex; beta = 0.537, 95% CI: 0.277-0.798, P < .001). Twelve of 19 patients (63%) with CGL had an AOM distance of < 10 mm, a risk factor that may predispose patients to developing superior mesenteric artery syndrome., Conclusion: CGL is associated with a severe loss of mesenteric adipose tissue, which leads to a narrowing of the space between the superior mesenteric artery and the aorta., (© 2024. The Author(s).)

Abstract: Primitive myxoid mesenchymal tumor of infancy (PMMTI) is a rare soft tissue tumor that has been recently described in only a few cases. A 10-month-old boy was admitted with a mass filling the abdomen and right hemothorax. Gross examination revealed a fragile, and occasionally gelatinous and rubbery mass. On microscopic examination, there were fibrillary off-white appearance with occasionally myxoid microcystic areas. Immunohistochemical examination results were as follows: BCOR (+), and SATB2 (+) with diffuse nuclear expression, Desmin (-), CD34 (-), S-100 (-), MyoD1 (-), Myogenin (-). The next-generation sequencing showed internal tandem duplication of the BCOR exon 15. In conclusion, PMMTI is a distinctive entity with unique characteristics. However, it can be clinically confused with other childhood malignancies such as neuroblastoma. Recurrence can be seen despite chemotherapy in patients with microscopic residue., (Copyright © 2024 Copyright: © 2024 Indian Journal of Pathology and Microbiology.)

Background In this study, we aim to report our single-center experience with laparoscopic pediatric urological surgeries. We aim to determine the feasibility of various urological and urogenital laparoscopic procedures and the tricks that increase surgical success. Methodology Data from 98 patients who underwent laparoscopic urological and/or urogenital procedures for diagnostic and therapeutic purposes in our clinic between June 2018 and February 2023 were retrospectively analyzed. All surgeries were performed by the same surgical team. Laparoscopic procedures included orchidopexy, gonadectomy, vaginoplasty, hysterectomy, pyeloplasty, nephrectomy/partial nephrectomy, ureteroneocystostomy, bladder diverticulum excision, renal cyst excision, proximal ureter stone removal, oophorectomy, ovarian detorsion, oophoropexy, and lymph node excision for diagnostic purposes. The surgical planning of the patients was based on the decisions of the pediatric nephrology, pediatric endocrinology, and pediatric oncology departments and the multidisciplinary council. Demographic characteristics of the patients, surgical indications, and intraoperative data, as well as postoperative pathological diagnoses and complications, were recorded. All patients underwent a transperitoneal approach. The duration of the operation was obtained from anesthesia records and defined as the time from the beginning of the surgical incision to the closure of the skin incision. Results Of the patients, 54 were males and 44 were females. The median age was 7.8 years. No complications other than grade 1 according to the Clavien-Dindo classification were observed in our patients. As different types of surgeries were analyzed, the mean operative duration was estimated. Conclusions The laparoscopic method should be performed by surgeons experienced in advanced surgeries in pediatric urology. It is critical to consider the difference in the size of pediatric patients in preparation for laparoscopic surgery to minimize technical and ergonomic problems. We believe that each surgery has its specific tricks and that these should be a part of laparoscopy training. Moreover, developing and sharing this information would be very useful for pediatric urologists., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Medical Ethical Committee of Umraniye Research and Training Hospital issued approval 2023-B.10.1.TKH.4.34.H.GP.0.01/124. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yener et al.)

Background: The digitalization studies in public hospitals in Türkiye started with the Health Transformation Program in 2003. As digitalization was accomplished, the policymakers needed to measure hospitals' electronic health record (EHR) usage and adoptions. The ministry of health has been measuring the dissemination of meaningful usage and adoption of EHR since 2013 using Electronic Medical Record Adoption Model (EMRAM). The first published study about this analysis covered the surveys applied between 2013 and 2017. The results showed that 63.1% of all hospitals in Türkiye had at least basic EHR functions, and 36% had comprehensive EHR functions. Measuring the countrywide EHR adoption level is becoming popular in the world. This study aims to measure adoption levels of EHR in public hospitals in Türkiye, indicate the change to the previous study, and make a benchmark with other countries measuring national EHR adoption levels. The research question of this study is to reveal whether there has been a change in the adoption level of EHR in the three years since 2018 in Türkiye. Also, make a benchmark with other countries such as the US, Japan, and China in country-wide EHR adoption in 2021., Methods: In 2021, 717 public hospitals actively operating in Türkiye completed the EMRAM survey. The survey results, deals with five topics (General Stage Status, Information Technology Security, Electronic Health Record/Clinical Data Repository, Clinical Documentation, Closed-Loop Management), was reviewed by the authors. Survey data were compared according to hospital type (Specialty Hospitals, General Hospitals, Teaching and Research Hospitals) in terms of general stage status. The data obtained from the survey results were analyzed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured., Results: We found that 33.7% of public hospitals in Türkiye have only basic EHR functions, and 66.3% have extensive EHR functions, which yields that all hospitals (100%) have at least basic EHR functions. That means remarkable progress from the previous study covering 2013 and 2017. This level also indicates that Türkiye has slightly better adoption from the US (96%) and much better than China (85.3%) and Korea (58.1%)., Conclusions: Although there has been outstanding (50%) progress since 2017 in Turkish public hospitals, it seems there is still a long way to disseminate comprehensive EHR functions, such as closed-loop medication administration, clinical decision support systems, patient engagement, etc. Measuring the stage of EHR adoption at regular intervals and on analytical scales is an effective management tool for policymakers. The bottom-up adoption approach established for adopting and managing EHR functions in the US has also yielded successful results in Türkiye., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective Rare syndromes are defined as diseases that affect a small number of people compared to the general population. In the literature, rare syndromes have variable definitions according to countries. In this study, patients diagnosed with various rare syndromes who were referred to the pediatric urology clinic were examined in terms of associated urological anomalies. Patients and methods In this study, patients who were referred to our outpatient clinic between 2017 and 2022 with a diagnosis of a rare syndrome with or without urological or urogenital findings were retrospectively analyzed. The urinary system ultrasonography and scrotal ultrasonography of the patients were also recorded. Comorbidities, diseases, and surgeries they had undergone were determined through detailed medical history. Results A total of 32 patients were identified. Eleven (35%) of the patients were female and 21 (65%) were male. The average age of the patients was 6.5 years. The syndromes observed in the patients, in order of frequency, were microdeletion syndromes (n = 4), Roberts syndrome (n = 3), and Ehlers-Danlos syndrome (n = 2), and a variety of different syndromes were found in the remaining 22 patients. Despite having no symptoms, the second patient was found to have left hydronephrosis, and the third patient was found to have right renal ectopia on their urinary system ultrasound. Pathological findings were observed in 10 (31.2%) patients on their urinary system ultrasound. Conclusion Although only a small portion of these findings require surgery, the presence of urological anomalies should be investigated. Therefore, we recommend urological evaluation for all patients with rare syndromes, regardless of whether they have symptoms or not., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yener et al.)

Objective: To review the presentation characteristics, clinical and hormonal evaluations, and histopathological results of patients with adrenal lesions over a 21-year period and evaluate the changes across the two decades., Methods: This single-center, retrospective study included 1003 patients with adrenal lesions who presented to our department between 2000 and 2021. Clinical, metabolic, hormonal, radiological, and pathological data of the patients were collected., Results: Forty-seven percent of the lesions were non-functioning adrenal adenomas. Possible autonomous and autonomous cortisol secretion were detected in 22.2% of the patients. The percentages of the patients diagnosed with pheochromocytoma, primary hyperaldosteronism, adrenal Cushing syndrome, adrenocortical carcinoma, and adrenal metastasis were 7.4%, 4.8%, 4.7%, 0.9%, and 5.6%, respectively. Adrenalectomy was performed in 31.3% of the patients. Functional adrenal lesions were the leading cause of surgery (46.5%), followed by large size and/or suspicious imaging features (38.6%). Among the patients referred to surgery due to large size (≥6 cm), the diagnosis in 19% was metastasis, and in 12.1%, it was primary adrenocortical carcinoma. In patients with adrenal lesions with a size of 4-6 cm and suspicious imaging properties, the rates of metastasis and primary adrenocortical carcinoma were 44.4% and 4.8%, respectively. From the first to the second decade, major differences in presentation characteristics were increased detection of bilateral lesions and increased prevalence of possible autonomous and autonomous cortisol secretion., Conclusions: Adrenal lesions are common in the adult population, and while it is important to avoid overtreatment, hormone secretion, and malignancy should not be overlooked., Competing Interests: The authors declare that there is no conflict of interest., (Thieme. All rights reserved.)

Background: Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing., Methods: Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient., Results: Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05)., Conclusion: Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.

Background: The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing)., Methods: We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800-0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50-138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants., Findings: Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53-68]; median follow-up 7·0 years [IQR 4·7-10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19-1·94) and autonomous cortisol secretion (1·77, 1·20-2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93-9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values <0·001)., Interpretation: Cortisol autonomy is associated with increased all-cause mortality, particularly in women younger than 65 years. However, until results from randomised interventional trials are available, a conservative therapeutic approach seems to be justified in most patients with adrenal incidentaloma., Funding: Deutsche Forschungsgemeinschaft, Associazione Italiana per la Ricerca sul Cancro, Università di Torino., Competing Interests: Declaration of interests IB has served as a consultant for Corcept Therapeutics, Sparrow Pharmaceutics, and Spruce Biosciences; was as a member of advisory or data safety monitoring boards for Adrenas Therapeutics, Recordati, and Strongbridge Biopharma (in all cases, institution fees were provided); and reports personal honoraria from Elsevier ClinicalKey. IC reports consulting fees and honoraria from HRA Pharma Rare Diseases and Recordati; was a member of advisory or data safety monitoring boards for HRA Pharma Rare Diseases and Recordati; and has participated in clinical studies from Corcept Therapeutics. ACh reports personal support for attending meetings or travel from Sanofi; personal honoraria from Ipsen; and was a member of advisory or data safety monitoring boards for Ipsen. TDe reports personal consulting fees for being a member of advisory or data safety monitoring boards for HRA Pharma Rare Diseases and Recordati; personal honoraria from Novartis; and has participated in clinical studies from Corcept Therapeutics and HRA Pharma Rare Diseases (for these, institution fees were provided). MF has participated in clinical studies from Corcept Therapeutics and HRA Pharma Rare Diseases (for these, institution fees were provided). LM was a member of the expert panel “Focus Area Adrenal and Cardiovascular Endocrinology” from the European Society of Endocrinology, and led the working group 5 of the project “CA20122—Harmonizing clinical care and research on adrenal tumours in European countries” from the European Cooperation in Science in Technology. JN-P reports grants from Diurnal Group; and has served as a consultant for and received honoraria from HRA Pharma Rare Diseases, Crinetics Pharmaceuticals, and Recordati (in all cases, institution fees were provided). CS reports consulting fees and honoraria from HRA Pharma Rare Diseases and Recordati; was a member of advisory or data safety monitoring boards for HRA Pharma Rare Diseases and Recordati; and has served as coordinator of the Pituitary Club of the Italian Society of Endocrinology. MT reports personal consulting fees (for being a member of advisory or data safety monitoring boards for Corcept Therapeutics and HRA Pharma Rare Diseases); and has participated in clinical studies from HRA Pharma Rare Diseases (for which institution fees were provided). ST reports personal support for attending meetings or travel from Ipsen, Pfizer, and Recordati; personal honoraria from Recordati; and has participated in clinical studies from Crinetics Pharmaceuticals, Novartis, and Strongbridge Biopharma. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Duplex renal collecting systems are one of the most common congenital anomalies of the urinary tract. The exact prevalence of this anomaly is difficult to ascertain because most patients are asymptomatic, and the abnormality is frequently detected incidentally. The aim of this study is to retrospectively review the demographic characteristics and different clinical presentations, related pathology, and treatment methods of patients with duplex system anomaly who applied to our institution, with a literature review., Methods: This is a retrospective study, performed at the Department of Pediatric Urology and Pediatric Surgery, Umraniye Training and Research Hospital, a tertiary center, from 2010 to 2021. Age, gender, presenting symptoms, and associated anomalies were determined in all patients. Asymptomatic patients with variants of duplex kidney anomaly detected incidentally did not require any surgical intervention. Necessary surgical interventions were performed depending on the pathologies of other symptomatic patients associated with duplex kidney anomaly variants., Results: A total of 239 patients had duplex systems. The patients were divided into two groups according to their age, 0-24 months (newborn and infant) and over 24 months. There were 45 (18.8%) patients in the 1st group and 194 (81.1%) patients in the 2nd group. It was seen that the most common symptom in 85 (35.6%) patients was urinary tract infection (UTI). It was observed that 5 (2%) patients had no symptoms and were detected during routine screening. When comorbidities detected with the duplex system were examined, the most common ones were antenatal hydronephrosis 23 (9.6%). Ureterocele excision was performed in ten patients, laparoscopic heminephrectomy was performed in six patients, and ureteroneocystostomy was performed in one patient., Conclusions: It is important that magnetic resonance urography (MRU) duplex renal collecting systems, which is a current imaging method used in the evaluation of the duplex system, provide detailed information about the morphology and function and are useful in the evaluation of associated anomalies. Diagnosis and treatment before it becomes symptomatic or results in further kidney damage are important for the preservation of renal function in advanced follow-ups., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Yener et al.)

The aim of this study was to analyze the effect of fat and protein supplementation to dairy cattle rations on milk fat triacylglycerol (TAG) composition, fatty acid (FA) positional distribution in the TAG structure, and milk solid fat content (SFC). Fifty-six lactating Holstein-Friesian cows were blocked into 14 groups of 4 cows and randomly assigned 1 of 4 dietary treatments fed for 28 d: (1) low protein, low fat, (2) high protein, low fat, (3) low protein, high fat, and (4) high protein, high fat. The high protein and high fat diets were obtained by isoenergetically supplementing the basal ration (low protein, low fat) with rumen-protected soybean meal and rumen-protected rapeseed meal, and hydrogenated palm FA (mainly C16:0 and C18:0), respectively. Fat supplementation modified milk TAG composition more extensively compared with protein supplementation. Fat supplementation resulted in decreased concentrations of the low molecular weight TAG carbon number (CN) 26 to CN34 and medium molecular weight TAG CN40, CN44, and CN46, and increased concentrations of CN38 and the high molecular weight TAG CN50 and CN52. Increased contents of C16:0, C18:0, and C18:1cis-9 in TAG in response to fat supplementation were related to increases in the relative concentrations of C16:0 and C18:0 at the sn-2 position and C18:0 and C18:1cis-9 at the sn-1(3) positions of the TAG structure. Increased concentrations of high molecular weight TAG species CN50 and CN52 in response to fat supplementation was associated with increased milk SFC at 20, 25, and 30°C. Our study shows that important alterations in milk TAG composition and structure occur when feeding hydrogenated palm FA to lactating dairy cattle, and that these alterations result in an increased SFC of milk fat. These changes in milk SFC and TAG composition and structure may improve absorption of both fat and minerals in milk-based products for infants and may affect processing of milk fat., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

The aim of this study was to determine the seasonal variation in the positional distribution of fatty acids (FA) in bovine milk fat. Bovine milk samples were collected from May 2017 to April 2018 in the Netherlands, and the FA composition in the sn-2 position was determined by using sn-1(3)-selective transesterification of Candida antarctica lipase B. The majority of the FA showed significant variation at sn-2 and sn-1(3) positions between different seasons. The seasonal variation in sn-2 position was higher than the sn-1(3) positions. Parallel to the changes in the diet of the cows throughout a year, we observed an increase in blood-derived FA (i.e. C18:0, C18:1 cis-9) concentrations and a decrease in de novo-synthesized FA during summer. In winter, more saturated FA were esterified in sn-2 position of milk fat. Highest concentrations of palmitic acid, C16:0, was observed in sn-2 position in winter, whereas the amount of unsaturated FA at this position was highest in summer. These results showed that the FA compositions in different regiospecific positions changed due to season; however, the proportions of a specific FA within the 3 positions of the triacylglycerols in milk fat did not change upon seasonal variation., (Copyright © 2021 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)