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Objectives: To evaluate the role of shear wave elastography (SWE) in distinguishing acute from subacute thrombi in thrombosed arteriovenous fistulas (AVFs) and explore the relationship between thrombus stiffness and outcomes of balloon angioplasty., Materials and Methods: This retrospective study included 44 dialysis patients with thrombosed AVFs from June 2022 to June 2024. Patients underwent Doppler ultrasound and SWE to assess thrombus age, followed by balloon angioplasty. Based on ultrasound findings and clinical history, patients were classified into acute and subacute thrombus groups. SWE was used to measure thrombus stiffness (kPa values). Procedural outcomes, including technical and clinical success, and primary and secondary patency, were compared between groups., Results: The study included 23 patients with acute and 21 with subacute thrombus. SWE measurements (average, median, and maximum kPa) were significantly higher in subacute thrombi (P < .001). A strong positive correlation existed between thrombus age and kPa values (r = .770, r = .727, r = .835). Receiver operating characteristic analysis showed SWE could effectively distinguish acute from subacute thrombi, with an average cut-off of 31.733 kPa (sensitivity: 90.5%, specificity: 73.9%). No significant correlation was found between SWE values and procedural outcomes (P > .05)., Conclusion: SWE is a promising tool for assessing thrombus age in AVF thrombosis, effectively differentiating between acute and subacute thrombi. Although it did not predict procedural success, SWE could complement existing imaging for improved thrombus characterization and treatment planning., (© 2025 American Institute of Ultrasound in Medicine.)

Purpose: To systematically investigate the impact of image preprocessing parameters on the segmentation-based reproducibility of magnetic resonance imaging (MRI) radiomic features., Methods: The MRI scans of 50 patients were included from the multi-institutional Brain Tumor Segmentation 2021 public glioma dataset. Whole tumor volumes were manually segmented by two independent readers, with the participation of eight readers. Radiomic features were extracted from two sequences: T2-weighted (T2) and contrast-enhanced T1-weighted (T1ce). Two methods were considered for discretization: bin count (i.e., relative discretization) and bin width (i.e., absolute discretization). Ten discretization (five for each method) and five resampling parameters were varied while other parameters were fixed. The intraclass correlation coefficient (ICC) was used for reliability analysis based on two commonly used cut-off values (0.75 and 0.90)., Results: Image preprocessing parameters had a significant impact on the segmentation-based reproducibility of radiomic features. The bin width method yielded more reproducible features than the bin count method. In discretization experiments using the bin width on both sequences, according to the ICC cut-off values of 0.75 and 0.90, the rate of reproducible features ranged from 70% to 84% and from 35% to 57%, respectively, with an increasing percentage trend as parameter values decreased (from 84 to 5 for T2; 100 to 6 for T1ce). In the resampling experiments, these ranged from 53% to 74% and from 10% to 20%, respectively, with an increasing percentage trend from lower to higher parameter values (physical voxel size; from 1 x 1 x 1 to 2 x 2 x 2 mm 3 )., Conclusion: The segmentation-based reproducibility of radiomic features appears to be substantially influenced by discretization and resampling parameters. Our findings indicate that the bin width method should be used for discretization and lower bin width and higher resampling values should be used to allow more reproducible features., Competing Interests: Burak Koçak, MD, is Section Editor in Diagnostic and Interventional Radiology. He had no involvement in the peer-review of this article and had no access to information regarding its peer-review. Other authors have nothing to disclose.

Purpose: The reproducibility of relative cerebral blood volume (rCBV) measurements among readers with different levels of experience is a concern. This study aimed to investigate the inter-reader reproducibility of rCBV measurement of glioblastomas using the hotspot method in dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC-MRI) with various strategies., Methods: In this institutional review board-approved single-center study, 30 patients with glioblastoma were retrospectively evaluated with DSC-MRI at a 3.0 Tesla scanner. Three groups of reviewers, including neuroradiologists, general radiologists, and radiology residents, calculated the rCBV based on the number of regions of interest (ROIs) and reference areas. For statistical analysis of feature reproducibility, the intraclass correlation coefficient (ICC) and Bland-Altman plots were used. Analyses were made among individuals, reader groups, reader-group pooling, and a population that contained all of them., Results: For individuals, the highest inter-reader reproducibility was observed between neuroradiologists [ICC: 0.527; 95% confidence interval (CI): 0.21-0.74] and between residents (ICC: 0.513; 95% CI: 0.20-0.73). There was poor reproducibility in the analyses of individuals with different levels of experience (ICC range: 0.296-0.335) and in reader-wise and group-wise pooling (ICC range: 0.296-0.335 and 0.397-0.427, respectively). However, an increase in ICC values was observed when five ROIs were used. In an analysis of all strategies, the ICC for the centrum semiovale was significantly higher than that for contralateral white matter ( P < 0.001)., Conclusion: The inter-reader reproducibility of rCBV measurement was poor to moderate regardless of whether it was calculated by neuroradiologists, general radiologists, or residents, which may indicate the need for automated methods. Choosing five ROIs and using the centrum semiovale as a reference area may increase reliability for all users.

Aim: CT-guided radiofrequency ablation (RFA) is among the thermal ablative procedures and provides great benefits with a minimally invasive procedure. In this prospective study, we aimed to reveal the significance of a multidisciplinary method in reducing the recurrence and complications in osteoid osteoma patients with CT-guided RFA performed by a team of experts in the field., Materials and Methods: A total of consecutive 40 patients with osteoid osteoma were prospectively evaluated and treated with CT-guided RFA. Before and the post ablation the visual analog scale (VAS) and use of nonsteroidal anti-inflammatory drugs (NSAIDS) were compared., Results: Post-ablation VAS of the patients at the 1st week and 3rd month after the procedure decreased significantly (p < 0.01) compared to the pre-ablation. The frequency of NSAID use after the ablation decreased significantly (p < 0.01) compared to the pre-ablation time. The pre-procedure NSAID use of our patients included in the study was average 6.93 per week, the NSAID use in the 3rd month post-procedure controls was average 0.53 per week. Recurrence was detected in 4 of our patients, 36 patients had complete recovery., Conclusion: Radiofrequency ablation is an effective treatment method in the management of osteoid osteomas. Radiofrequency ablation has low recurrence rates and provides rapid regression in patients' pain after treatment., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Abstract: In this prospective study, the diagnostic performance of MicroV Doppler ultrasonography (US) and Q-pack application in distinguishing malignant thyroid nodules from benign nodules will be examined. Given the emerging irregular vascular structures in malignant nodules, it is thought that MicroV Doppler US and Q-pack application can help in diagnosis. One hundred sixteen nodules that were suggested a biopsy by a clinician were examined with B-mode US, color, X-flow, and MicroV Doppler US, respectively. In addition, during MicroV Doppler US examination, thyroid nodule and its adjacent thyroid parenchyma were evaluated with Q-pack application. After US examinations, biopsy was performed on the nodules and histopathological results were obtained. Eighty-nine nodules were histopathologically proven as benign, and the rest of them were malignant. In Doppler types, the thyroid findings in score 1, 2, and 3 nodule blood supply type were benign, whereas the thyroid findings in the score 4 have a possibility of malignancy between 63% and 66.7%. It was found that MicroV Doppler was significantly superior to X-flow and color Doppler ( P = 0.037 and P = 0.042, respectively). Nodule/parenchyma Q-pack mean values were statistically significantly higher in malignant findings compared with benign findings ( P < 0.001). Nodule/parenchyma Q-pack peak values were also statistically significantly higher in malignant findings compared with benign findings ( P < 0.001).As a result, although Q-pack application enables us to obtain quantitative values about vascularity, due to its ability to demonstrate slow blood flow, microvascular vessel structure, and distribution, MicroV Doppler US has promises to detect malignant thyroid nodules., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Chronic myeloid leukemia (CML) is a clonal hematologic disorder characterized by t(9;22) translocation, in which cytogenetic aberrations can occur in Ph(+) and (-) clones. These aberrations develop due to clonal evolution as well as treatment and they have prognostic significance. They are grouped as major and minor route anomalies in terms of their effects on prognostic parameters, such as treatment response, overall survival (OS), disease stage, complete cytogenetic response (CCyR), and major molecular response (MMR). It is stated that major route anomalies have unfavorable prognostic effects compared to minor route anomalies. We aimed to investigate the frequency and prognostic effects of cytogenetic anomalies detected in Ph(+) and (-) clones., Materials and Methods: In this study, we retrospectively analyzed the cytogenetic results of 450 patients diagnosed with CML between 2005 and 2020., Results: We detected cytogenetic aberrations in Ph-positive and negative clones in 41 of 450 patients. The most common anomalies were trisomy 8 (+8), additional Ph chromosome (+Ph), and loss of chromosome Y. Rarely, aneuploidy of the Y chromosome, dup (22), +11, and +6 were seen in CML patients. We observed that these identified aberrations negatively affected MMR and CCyR, and generally resulted in changing imatinib treatment for second-generation tyrosine kinase activity inhibitors. Our results are compatible with the literature., Conclusion: We suggest that cytogenetic aberrations detected in Ph(+) and (-) clones should be a warning sign in terms of treatment and require close observation. The use of cytogenetic methods for the identification of these anomalies is also important., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Hematology | Turkish Journal of Hematology, Published by Galenos Publishing House)

Introduction: The disease caused by the novel coronavirus (COVID -19) is a vital public health problem that has now affected approximately 68,037,473 people and caused 1,552,802 deaths around the world. We aimed to correlate the frequency of the lung involvement patterns, the segmental distribution of lung infiltration, and TLSS in COVID-19 pneumonia patients with and without splenomegaly., Material and Methods: This retrospective study included patients admitted to Yunus Emre State Hospital Emergency, Internal Medicine and Infectious Disease Departments between March 11, 2020, and June 10, 2020, and diagnosed with COVID-19 by PCR test with a throat and nasal swab. The thoracic and upper abdomen CTs and the clinical and demographic features of the patients were analyzed at the time of initial diagnosis., Results: Consolidation (group 1 - 18 (47%), group 2 - 69 (28.2%); P = 0017), crazy pavement pattern (15 (39.5%), 42 (17.1%); p = 0.001), pleural band formations (24 (63.2%), 87 (35.5%); p = 0.001), interlobular septal thickening (23 (60.5%), 79 (32.2%); p = 0.001), and sequelae of secondary tuberculosis (4 (10.5%), 8 (3.3%); p = 0.039) were more frequent in the patient with splemomegaly. The total lung severity score was high in the group with splenomegaly (7.32 ± 6.15, 3.69 ± 5.16; p = 0.001)., Conclusion: Consolidation, interlobular septal thickening, tuberculosis sequela, pleural band, and crazy pavement patterns were frequent in the COVID-19 pneumonia patients with splenomegaly. The most frequently affected segment was the superior segment of the right lower lobe. TLSS was higher in the COVID-19 pneumonia patients with splenomegaly., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: In this prospective study, the diagnostic performance of the new version of superb microvascular imaging (SMI) in differentiating malignant from benign lesions was evaluated., Material and Methods: Ninety breast lesions were included. During color SMI examination, both free-hand region of interest (ROI) and box ROI were used. Vascular index (VI) values were obtained from the lesion using both types of ROI and from normal breast tissue via box ROI. VI values, monochrome SMI grading and histopathological results were compared. The efficacy of color SMI and monochrome SMI was investigated in differentiating between benign and malignant breast lesions., Results: The cut-off value, in the differentiation of benign and malignant lesions with color SMI was 0.50 for box ROI, while it was 0.30 for free-hand ROI. The specificity of VI values obtained with box ROI was higher than that of free-hand ROI when differentiating malignant lesions from benign. Comparison of VI values from a lesion and from normal breast tissue showed that VI values in malignant lesions were significantly higher (p<0.05). The VI values of benign lesions and VI values of normal breast tissue were similar. There was a statistically significant relationship between monochrome SMI grading and the malignancy or benign status of the lesion (p<0.001)., Conclusion: Drawing the lesion circumference free-hand using a free-shape ROI did not enhance the sensitivity and specificity. Contrary to popular belief, a more easy and practical measurement method may be more suitable for SMI examination. It is hoped that this will be one of the earliest studies to assess the clinical performance of the latest version of SMI., Competing Interests: Conflict of Interest: No conflict of interest declared by the authors., (©Copyright 2022 by Turkish Federation of Breast Diseases Associations.)

To evaluate the additional effect and safety of peloidotherapy to usual care at short- and middle-term in patients with rheumatoid arthritis (RA). RA patients were recruited in the medical ecology and hydroclimatology department of Istanbul Medical Faculty and were randomized into two parallel groups. Peloidotherapy group was treated with heated mudpack (41-42 °C) on painful and active joints (5 days/week, during 2 weeks) + usual care. Control group received usual care alone. Randomization was performed by using a computer-generated table of random numbers and was blinded. The sequence was concealed until interventions were assigned. The investigator was blinded. The assessments were done before and after the intervention, 1 month and 3 months after the completion of treatment. The main criterion was the number of patients with low disease activity (DAS 28 ≤ 3.2) at the end of follow-up. Other judgment criteria were pain (VAS), patient's global assessment (VAS), physician's global assessment (VAS), Health Assessment Questionnaire (HAQ), Disease Activity Score (DAS 28), CRP, and ESR. Fifty-six patients were recruited and analyzed: 29 in peloidotherapy group and 27 in the control group between 11/2011 and 02/2012. At the third month, 9/29 patients were with low disease activity in peloidotherapy group and 4/27 in the control group (p = 0.15). There was a statistically significant improvement in favor of peloidotherapy group for HAQ during all follow-up period (0.25 vs 0.63, p = 0.007 at the end of the treatment, 0.29 vs 0.68 p = 0.007 at the 1st month and 0.30 vs 0.59, p = 0.040 at the 3 rd month). Pain (35vs50, p = 0.028), patient's global assessment (37vs53, p = 0.028), physician's global assessment (33vs48, p = 0.030), and DAS28 (3.76vs4.58, p = 0.049) improved significantly more in peloidotherapy group at the 3 rd month. There were no between group differences for ESR and CRP. There were no important adverse events. There is no significant improvement for the main criteria so we can't conclude that peloidotherapy has additional effect over usual care. But most of the other judgment criteria improved more in the peloidotherapy group than in the control group and peloidotherapy was well tolerated. A trial with higher statistical power is necessary to if we want to reveal the effects on disease activity and confirm the short and middle term efficiency of this treatment modality on pain and quality of life., (© 2021. ISB.)

Objectives: To investigate the relationship of the neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) with lung involvement and total lung severity score (TLSS) in computed tomography (CT) of patients with coronavirus disease -19 (COVID-19) and to evaluate their clinical usability., Methods: Basic laboratory, clinical features and imaging data of patients was obtained by examining the file and archive records of our hospital. According to the findings of lung CT scan at the time of diagnosis among COVID-19 patients, 2 groups were formed., Results: The NLR was 2.22±11.15 and the PLR was 142.77±387.10 in patients with COVID-19 pneumonia. The NLR was 1.88±7.47 and the PLR was 130.65±203.6 8 in patients without COVID-19 pneumonia. The differences in the NLR and the PLR were determined to be statistically significant between the 2 groups. A positive correlation was observed between NLR and PLR (r=0.225, p =0.010) and TLSS (r=0.244, p =0.005)., Conclusion: This study showed that the NLR and PLR values can be 2 inflammatory markers that can be used to evaluate lung involvement and disease severity in COVID-19 patients. At the time of initial diagnosis and during follow-up, these markers can give an idea in terms of prognosis, together with other clinical findings and markers., (Copyright: © Saudi Medical Journal.)

Introduction/objective: The general public may utilize online information through search engines for implications and risks of some anti-rheumatic drugs. These drugs have been used in the management of coronavirus disease 2019 (COVID-19) and associated inflammatory sequelae or cytokine storm of infection. Therefore, the objective of this study was to investigate the population-level interest in anti-rheumatic drugs during the COVID-19 era, by analyzing changes in Google search frequency data., Method: To obtain the relative search volume (RSV) of anti-rheumatic drugs, we queried Google Trends for 78 search terms representing non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, antigout agents, conventional disease-modifying anti-rheumatic drugs (DMARDs), immunosuppressants, biologics, and Janus kinase (JAK) inhibitors within the USA. Three 8-week periods in 2020 (March 15-May 9), (May 10-July 4), and (July 5-August 29) representing the initial- and short-term periods were compared to overlapping periods of the preceding 3 years (2017-2019)., Results: We found statistically significant increases in RSV for colchicine, hydroxychloroquine, tocilizumab (and its brand name-Actemra), and anakinra, and statistically significant decreases among brand names of immunosuppressive agents (i.e., mycophenolate mofetil, azathioprine, cyclophosphamide, tacrolimus, cyclosporine) during both the initial- and short-term COVID-19 periods as compared to overlapping periods of the preceding 3 years., Conclusion: There were significant increases in RSV of colchicine, hydroxychloroquine, tocilizumab, and anakinra during both initial- and short-term COVID-19 periods when compared to overlapping periods of the preceding 3 years reflecting a heightened level of information-seeking on these drugs during the pandemic. Rheumatologists should address this increase in informational demand. Further research assessing medium- and long-term interest in anti-rheumatic drugs is required to increase our knowledge on this new pandemic. Key Points •This study was aimed to investigate the population-level interest in anti-rheumatic drugs in the COVID-19 era, by analyzing changes in Google search frequency data. •Significant increases were seen in relative searches for colchicine, hydroxychloroquine, tocilizumab, and anakinra during both initial and short-term COVID-19 periods when compared to similar periods of 2017-2019 reflecting a heightened level of information-seeking on these drugs during the pandemic. •Rheumatologists should address this increase in informational demand for colchicine, hydroxychloroquine, tocilizumab, and anakinra.

To evaluate the public interest in rheumatic diseases during the coronavirus disease 2019 (COVID-19) pandemic. Google Trends was queried to analyze search trends in the United States for numerous rheumatic diseases and also the interest in a rheumatologist. Three 8-week periods in 2020 ((March 15-May 9), (May 10-July 4), and (July 5-August 29)) were compared to similar periods of the prior 4 years (2016-2019). Compared to a similar time period between 2016 and 2019, a significant decrease was found in the relative search volume for more than half of the search terms during the initial March 15-May 9, 2020 period. However, this trend appeared to reverse during the July 5-August 29, 2020 period where the relative volume for nearly half of the search terms were not statistically significant compared to similar periods of the prior 4 years. In addition, this period showed a significant increase in relative volume for the terms: Axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's syndrome, antiphospholipid syndrome, scleroderma, Kawasaki disease, Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis, and rheumatologist. There was a significant decrease in relative search volume for many rheumatic diseases between March 15 and May 9, 2020 when compared to similar periods during the prior 4 years. However, the trends reversed after the initial period ended. There was an increase in relative search for the term "rheumatologist" between July and August 2020 suggesting the need for rheumatologists during the COVID-19 pandemic. Policymakers and healthcare providers should address the informational demands on rheumatic diseases and needs for rheumatologists by the general public during pandemics like COVID-19.

To investigate the physical, chemical, and mineralogical characteristics of peloids, which are being used traditionally and historically across Turkey, and evaluate their suitability and potential for use in peloidotherapy. Five peloid samples were gathered from their places of origin, namely Gölemezli, Dalyan, Köprüköy, Gökçeada, and Dikili. Mineral analysis and physical and chemical analyses including electrical conductivity, density, cations, anions, trace elements, organic matters, and water retention capacity at 105 °C were performed. The peloids contained a combination of clay minerals (mainly montmorillonite, kaolinite, and muscovite) and non-clay minerals (mainly quartz, calcite, dolomite, and albite) except for Gölemezli peloid, which was dominated by calcite. The other minerals (i.e., chloride-serpentine, sphalerite, pyrite, magnesium calcite, cristobalite) were also found in some peloids. Gölemezli, Dalyan, and Köprüköy peloids had high total organic matters, mainly humic substances. The water retention capacity was high in Dalyan, Köprüköy, and Dikili peloids. All peloids had a pH value slightly greater than 7 (range 7.93-8.69). Dalyan, Köprüköy, and Dikili peloids had a high water retention capacity. Dalyan and Gökçeada peloids had a high electrical conductivity, 22.040 and 9.020 μS/cm, respectively. The density of peloids was ranged between 1.240 (Gölemezli) and 1.450 (Gökçeada) g/cm 3 . Total mineralization of investigated peloids was greater than 1000 mg/L: Köprüköy, 2754.8 mg/L; Gölemezli, 3092.8 mg/L; Dikili, 4044.6 mg/L; Gökçeada, 6576.6 mg/L; and Dalyan, 11782.9 mg/L, mainly sodium, magnesium, calcium, chloride, sulfate, bicarbonate, and metasilicic acid. The levels of trace elements were low (≤ 2.0 mg/L) in all peloids. The peloids contained various amounts of clay minerals (mainly montmorillonite, kaolinite, and muscovite), non-clay minerals (mainly quartz, calcite, dolomite, and albite), organic matters (mainly humic acid), cations (mainly sodium, magnesium, and calcium), anions (mainly chloride, sulfate, and bicarbonate), and insoluble compounds (mainly metasilicic acid). The physical, chemical, and mineralogical properties of peloids suggest their suitability and potential for use in peloidotherapeutic applications.

Natural waters containing originally hydrogen sulfide (H2S) gas with an S2-level at least 1 mg/L are classified as "sulfur waters" or "hydrogen sulfide waters." This systematic review aimed to evaluate in vivo experimental studies investigating the biological effects of natural H2S water drinking in healthy or with disease model laboratory animals. A comprehensive databases search (PubMed, Embase, Web of Science, and Google Scholar) was performed and PICOS criteria were used to assess eligibility. All relevant studies were identified, screened, and examined. The qualitative assessment was performed with the help of the SYRCLE Risk of Bias tool. A total of nine articles were included. The extracted data showed that ad libitum drinking of such waters by rats and mice exert beneficial effects on animal model of diabetes and glucose metabolism plus protective effects on diabetic cardiac, testicular, and nephrological complications as shown biochemically, histopathologically, and bio-molecularly. Additional effects were gastroprotection, antioxidant effects and improvement of intestinal physiology in healthy animals, reduction in general signs of murine model of colitis in mice, improvement in lipid metabolism and lipid-lowering effect, and positive interference with the enterohepatic cycle of the bile acids and biliary functions in hyperlipidemic rats. This systematic review provides preliminary insights into the "biological truth" about natural H2S waters and partly elucidates their potential therapeutic role in balneology and health resort medicine. However, it should be kept in mind that the retrieved preclinical data cannot be directly extrapolated to humans. Additionally, most of the included studies were rated for unclear risk of bias across all categories except random allocation, reflecting very poor reporting of methodological details. These limitations should be addressed when planning similar studies in the future. The question "can traditional hydropinic therapies or drinking cures with H2S waters at natural sulfur water spas/health resorts or natural (even artificial) H2S water consumption at home exert similar effects in humans?" remains to be clarified by clinical trials.

The aim of this study was to evaluate the efficacy of balneological outpatient treatment including hydrotherapy and peloidotherapy on patients with chronic low back pain. In this retrospective observational study, the records (between 2008 and 2016) of patients who have undergone balneological outpatient treatment at the Department of Medical Ecology and Hydroclimatology were analyzed. The patients were examined and assessed by an experienced physician before and after the treatment. Outcome measures were the Pain Visual Analog Scale (VAS), patient's and physician's global assessment (VAS), Health Assessment Questionnaire (HAQ), and the Waddell Disability Index. A total of 139 patients were included in the study. After the treatment, statistically significant improvement in all evaluated outcome measures was found. The detailed analysis showed age, the duration of treatment, and sex did not affect the effectiveness of the treatment. Balneological outpatient treatment may be an effective option for treatment of chronic low back pain patients with the advantages of being integrated into daily routine and not causing any days off by improving pain and increasing the quality of life. Randomized controlled trials are needed to confirm these preliminary results.

Objective: To evaluate the effectiveness and safety of outpatient balneological treatment consisting of hydrotherapy and peloid therapy in elderly patients with osteoarthritis., Methods: In this retrospective observational study all patients aged ≥65 years with any type of osteoarthritis who received balneological treatment (hydrotherapy and peloid therapy) at our clinic between 2007 and 2016 were included. Hydrotherapy was applied as head-out immersion in a tap water pool at 36-38 °C for 20 min and then peloid therapy was applied as a local peloid pack on the painful region or joint at 42-43 °C for 20 min, on each weekday for 2 weeks. Patients were evaluated before and after the treatment and outcome measurements were pain, patient's global assessment, physician's global assessment, Western Ontario and McMaster Universities index, Lequesne hip index, Waddell index, neck pain and disability scale, and health assessment questionnaire., Results: In total, 235 osteoarthritis patients comprising 61 generalized, 91 knee, 6 hip; 32 lumbar, 12 cervical, 1 foot and 32 hand osteoarthritis, were included in the analysis. We found significant improvements in pain and function scores in generalized, knee, lumbar, cervical and hand osteoarthritis. Patient's global assessment was also improved in all subtypes except hip (p = 1.000) and hand (p = 0.132) osteoarthritis subtypes. The majority of patients (59.1%) fulfilled the outcome measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. The treatment demonstrated a good safety profile., Conclusion: Study results provide initial evidence for the potential beneficial effects and safety of outpatient balneological treatment (hydrotherapy and peloid therapy) in the management of older patients with osteoarthritis. Future randomized controlled studies are needed to confirm these results.

We aimed to test the anti-inflammatory and angiogenic properties of two different thermal waters at the cellular level in human keratinocyte cells in the present study. Two different thermal waters, thermo-mineral BJ1 (Bursa, Turkey) and oligomineral BG (Bolu, Turkey), were tested in human keratinocyte (HaCaT) cell line. HaCaT cells were incubated for 3 days with thermal waters; RNA isolation was carried out in the treated and untreated cells. The gene expressions of TNFα, IL-1α, and VEGF were measured using the RT-qPCR. The tested thermal waters significantly decreased the expression of IL-1α (BJ1 93% p = 0.0024 and BG 38% p = 0.0303). BJ1 and BG thermal waters downregulated the expression of TNFα (59% p = 0.0001 and 23% p = 0.0238 respectively). Furthermore, BJ1 and BG significantly downregulated the gene expression of VEGF (98% p = 0.0430 and 15% p = 0.0120). The observed decrease in the gene expression of TNFα and IL1α could be interpreted as an anti-inflammatory effect of mineral waters on HaCaT cells. Moreover, the suppressed VEGF expression might be an indicator of the antiangiogenic effect on human keratinocytes. Therefore, we hypothesized that depending on their specific chemical composition such as silica (128 mg/L) in BJ1 and hydrogen sulfide (1.2 mg/L) in BG, thermal waters suppress pro-inflammatory cytokines and angiogenic growth factor. These preliminary findings might give insight on the underlying mechanisms of the therapeutic benefits observed in some skin diseases such as rosacea and psoriasis.