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Tuğba Aydin,1 Meryem Merve Oren,2 Gulistan Bahat3 1Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey; 2Department of Public Health, Istanbul Medical School, Istanbul, Turkey; 3Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul, TurkeyIn their study, Mendoza-Núñez et al studied the effect of Tai chi (TC) exercise on oxidative stress (OxS) in elderly with metabolic syndrome (MetS), with a painstaking study protocol.1 They included a total of 85 older sedentary adults with MetS. The control group did not participate in physical exercise (n=37), and the experimental group was enrolled in a TC exercise training program (n=48). They measured in both groups, in the pre- and post intervention periods, the cardiovascular parameters, OxS markers and inflamma¬tion markers. They concluded that a statistically significant decrease in HbA1c and a decrease in the OxS score were observed in the TC group compared with the control group. They did not observe changes in the cardiovascular parameters.View the original paper by Mendoza-Núñez and colleagues.

Abstract Aims Heart failure in late pregnancy and the postpartum period (HFPP) is a rare but potentially life‐threatening condition, with peripartum cardiomyopathy (PPCM) being the most common subtype. This study aims to comprehensively investigate the prevalence of HFPP in the Finnish population and identify the underlying risk factors associated with its occurrence. Methods We conducted a retrospective analysis using data from the Finnish Medical Birth Register and the Finnish Care Register for Health Care, covering 1996 to 2021. The dataset comprised 1 387 457 deliveries. HFPP cases were identified based on specific ICD‐10 codes. To ensure the accuracy of our findings, we excluded cases with pre‐existing cardiomyopathies and other significant cardiac diseases diagnosed before pregnancy. We employed logistic regression models to evaluate the associations between maternal factors and the incidence of HFPP. Results We identified 159 cases of HFPP, resulting in an incidence rate of 11.5 per 100 000 deliveries. This incidence is comparable with rates reported in other Scandinavian countries and lower than those observed in Germany. Consistent with findings from European cohorts, our study confirmed that pregnancy‐associated hypertensive disorders, particularly preeclampsia, as well as complications such as preterm delivery, twin pregnancy and elective caesarean section, are substantial risk factors for HFPP. These results support previous research linking angiogenic imbalance to the pathogenesis of PPCM. Significant risk factors for HFPP included maternal pre‐pregnancy body mass index ≥35 [adjusted odds ratio (aOR) 2.04, 95% confidence interval (CI) 1.28–3.25, P = 0.003], history of maternal hypertensive disorder (aOR 2.44, 95% CI 1.22–4.88, P = 0.012), gestational hypertension without significant proteinuria (aOR 2.14, 95% CI 1.27–3.61, P = 0.004), preeclampsia (aOR 2.43, 95% CI 1.39–4.23, P = 0.002), type 1 or type 2 diabetes (aOR 3.27, 95% CI 1.66–6.45, P

Background: This study aims to investigate the frequency of familial relationships and genetic predispositions to kidney disease, analyzing their correlation with chronic kidney disease (CKD). Methods: This observational study included individuals aged 18-70 years (at the time of this study) from October 2009 to 2015. 2576 patients with diverse kidney diseases [mean age: 47 ± 16 years; 1455 men (56.5%)], were compared with 853 healthy individuals with an employed questionnaire. Variables such as siblings, familial kidney disease history, consanguineous marriage, etiology of CKD, age at the time of the study, and diagnosis were compared between groups. Results: Parental consanguinity frequency was similar between groups [n = 174 (6.8%) in the patient group vs. n = 74 (8.7%) in the control group, P = .06]. Kidney disease due to family history was signifcantly higher in the patient group than in the control group (466 [18.1%] vs. 72 [8.4%], P < .001). Parental consanguinity frequency was notably higher in patients with congenital anomalies of the kidney and urinary tract (CAKUT) (n = 31/234; 13.2%) and vesicoureteral refux (VUR) nephropathy (n = 27/131, 20.5%) compared to controls (8.7%) (P = .036 and P < .001, respectively). Multivariate analysis indicated that predictors of parental consanguinity were kidney disease due to family history (OR: 5.712; 95% CI, 4.136-7.890; P < .001), age at kidney disease diagnosis (OR: 0.968; 95% CI, 0.957-0.979; P < .001), and kidney disease replacement therapy (OR: 1.441; 95% CI, 1.020-2.038; P = .038). Conclusion: The CAKUT and VUR nephropathy risks are increased in consanguineous marriages. Patients with parental consanguinity develop the disease earlier and face a higher risk of kidney failure requiring replacement therapy. Consanguineous marriage might impact the severity of kidney diseases.

Abstract Swimming goggles (SG) are widely used in water sports, and this study aimed to evaluate the acute effects of wearing SG on intraocular pressure (IOP), anterior chamber biometrics, axial length (AL), and optic nerve head (ONH) morphology. Twenty-eight healthy young adults participated in this cross-sectional study, with assessed parameters including IOP, central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), AL, and optical coherence tomography (OCT) imaging of the ONH, specifically Bruch membrane opening (BMO), Bruch membrane opening-minimum rim width (BMO-MRW), lamina cribrosa depth (LCD), and prelaminar tissue (PLT). Measurements were taken at four time points: before wearing SG, at the 1st and 10th minutes of wearing, and immediately after removal. The results showed a significant increase in IOP at the 1st and 10th minutes of SG wear compared to pre-wear and post-removal values. Additionally, decreases in CCT, ACD, and ACA, along with an increase in AL, were observed while wearing SG. However, these changes reverted to baseline after the goggles were removed. No significant alterations were detected in ONH parameters during the study. The findings suggest that wearing SG induces an acute rise in IOP and changes in anterior segment parameters, likely due to oculopression, but does not appear to affect ONH morphology in the short term. Further studies are needed to investigate any potential long-term effects.

Abstract Background The integration of patient-centered care (PCC) and value-based healthcare (VBHC) principles, emphasizing personalized, responsive care and cost efficiency, is crucial in modern healthcare. Despite advocation from the International Consortium for Health Outcomes Measurement (ICHOM) for the global adoption of these principles through patient-reported measures (PRMs), their implementation, especially the pregnancy and childbirth (PCB) set, remains limited in maternity care. This study focuses on understanding the optimal organizational entity for integrating standard ICHOM-PCB-PRMs into routine maternity care in Finland. It aims to clarify the distribution of tasks among stakeholders and gather Finnish maternity healthcare professionals’ perspectives on organizational responsibility in PRM collection. The emphasis was on identifying the optimal organizational framework for managing PRMs in maternity care. Results A total of 66 maternity healthcare professionals participated in the study, reaching a consensus that public maternity care centers in Finland should be the primary entity responsible for managing PRMs in the maternity sector. Key aspects such as confidence with the role as a mother, maternal confidence with breastfeeding, and satisfaction with the result of care were identified as crucial and should be inquired about in both public maternity care centers and hospital maternity wards. The findings highlight the importance of comprehensive and consistent attention to these PRMs across public maternity care centers and hospital maternity settings to ensure holistic and effective maternal care. Conclusions The study highlights the central role of public maternity care centers in the collection and management of PRMs within Finnish maternity care, as agreed upon by the professional consensus. It underscores the importance of a consistent and holistic approach to PRM inquiry across different care settings to enhance the quality and effectiveness of maternity care. This finding is crucial for policymakers and healthcare practitioners, suggesting that reinforcing the collaborative efforts between public maternity care centers and hospital maternity wards is vital for a patient-centric, efficient healthcare system. Aligning with PCC and VBHC principles, this approach aims to improve healthcare outcomes for pregnant and postpartum women in Finland, emphasizing the need for a unified strategy in managing maternity care.

Background Immunoglobulin A (IgA) nephropathy (IgAN) treatment consists of maximal supportive care and, for high-risk individuals, immunosuppressive treatment (IST). There are conflicting results regarding IST. Therefore, we aimed to investigate IST results among IgAN patients in Turkiye.Method The data of 1656 IgAN patients in the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases Study Group were analyzed. A total of 408 primary IgAN patients treated with IST (65.4% male, mean age 38.4 ± 12.5 years, follow-up 30 (3–218) months) were included and divided into two groups according to treatment protocols (isolated corticosteroid [CS] 70.6% and combined IST 29.4%). Treatment responses, associated factors were analyzed.Results Remission (66.7% partial, 33.7% complete) was achieved in 74.7% of patients. Baseline systolic blood pressure, mean arterial pressure, and proteinuria levels were lower in responsives. Remission was achieved at significantly higher rates in the CS group (78% vs. 66.7%, p = 0.016). Partial remission was the prominent remission type. The remission rate was significantly higher among patients with segmental sclerosis compared to those without (60.4% vs. 49%, p = 0.047). In the multivariate analysis, MEST-C S1 (HR 1.43, 95% CI 1.08–1.89, p = 0.013), MEST-C T1 (HR 0.68, 95% CI 0.51–0.91, p = 0.008) and combined IST (HR 0.66, 95% CI 0.49–0.91, p = 0.009) were found to be significant regarding remission.Conclusion CS can significantly improve remission in high-risk Turkish IgAN patients, despite the reliance on non-quantitative endpoints for favorable renal outcomes. Key predictors of remission include baseline proteinuria and specific histological markers. It is crucial to carefully weigh the risks and benefits of immunosuppressive therapy for these patients.

Abstract Balancing is an essential challenge in healthcare systems that requires effective strategies. This study aims to address this crucial issue by suggesting a practical approach. We show the potential of balancing a regional healthcare system to improve its utility. We consider a regional healthcare system comprising multiple hospitals with different sizes, capacities, quality of service, and accessibility. We define a utility function for the system based on the sectorization concept, which endeavors to form a balance between hospitals in terms of essential outputs such as waiting times and demands. The dynamic nature of the system means that this balance degrades over time, necessitating periodic sectorization, which is called resectorization. Our methodology stands out for incorporating resectorization as a dynamic strategy, enabling more flexible and responsive adaptations to continuously changing healthcare needs. Unlike previous studies, based on a system-oriented approach, our resectorization scenarios include the periodic closure of some hospitals. This enables us to enhance both the capacity and quality of healthcare facilities. Furthermore, in contrast to other studies, we investigate the states of diminishing demand throughout the resectorization process. To provide empirical insights, we conduct a simulation using data from a real-world case study. Our analysis spans multiple time periods, enabling us to dynamically quantify the utility of the healthcare system. The numerical findings demonstrate that substantial utility improvements are attainable through the defined scenarios. The study suggests a practical solution to the critical challenge of balancing issues in regional healthcare systems.

Abstract There is a need to define regions of gene activation or repression that control human kidney cells in states of health, injury, and repair to understand the molecular pathogenesis of kidney disease and design therapeutic strategies. Comprehensive integration of gene expression with epigenetic features that define regulatory elements remains a significant challenge. We measure dual single nucleus RNA expression and chromatin accessibility, DNA methylation, and H3K27ac, H3K4me1, H3K4me3, and H3K27me3 histone modifications to decipher the chromatin landscape and gene regulation of the kidney in reference and adaptive injury states. We establish a spatially-anchored epigenomic atlas to define the kidney’s active, silent, and regulatory accessible chromatin regions across the genome. Using this atlas, we note distinct control of adaptive injury in different epithelial cell types. A proximal tubule cell transcription factor network of ELF3, KLF6, and KLF10 regulates the transition between health and injury, while in thick ascending limb cells this transition is regulated by NR2F1. Further, combined perturbation of ELF3, KLF6, and KLF10 distinguishes two adaptive proximal tubular cell subtypes, one of which manifested a repair trajectory after knockout. This atlas will serve as a foundation to facilitate targeted cell-specific therapeutics by reprogramming gene regulatory networks.

Background: Passenger lymphocyte syndrome (PLS) causes immune-mediated hemolysis in solid and bone marrow transplant recipients. Donor-derived antibodies against the recipient erythrocyte drive the pathogenesis. It is a rare entity in kidney transplantation, and most of the cases are self-limited. Case presentation: A 36-year-old woman presented with fatigue 13 days after living donor renal transplantation. The operation was uneventful, and she was discharged with normal graft functions on the 11th day of transplantation Findings were consistent with cold agglutinin disease at her admission. However, the cold agglutinin test was negative. Eventually, she was diagnosed with PLS. Refractory intravascular hemolysis and frank hemoglobinuria were also present in the patient. Hemolysis was resistant to steroids, intravenous immunoglobulin (IVIG), and Rituximab. Because of life-threatening anemia related to refractory PLS, mycophenolate and tacrolimus were interrupted. However, hemolysis persisted. Following that, immunoadsorption (IA) treatment was obtained. Unfortunately, graft loss occurred due to rejection despite the resolution of PLS after IA. Conclusion: PLS is a rare and usually self-limited entity. Our case was an atypical refractory PLS that resembled cold agglutinin disease. Also, frank hemoglobinuria was observed related to severe intravascular hemolysis. These features have not been described before in PLS, to the best of our knowledge. Additionally, IA treatment had never been reported in the literature for PLS, as far as we know. Treatment and management could be a challenge in refractory PLS. Rituximab, IVIG, and extracorporeal treatments could be beneficial. It should be borne in mind that refractory PLS can cause graft and patient loss. Resumen: Antecedentes: El síndrome de linfocitos pasajeros (PLS) causa hemólisis inmunomediada en receptores de trasplantes sólidos y de médula ósea. Los anticuerpos derivados del donante contra el eritrocito receptor impulsan la patogénesis. Es una entidad rara en el trasplante de riñón y la mayoría de los casos son autolimitados. Presentación del caso: Una mujer de 36 años presentó fatiga 13 días después del trasplante renal de donante vivo. La operación transcurrió sin incidentes y fue dada de alta con las funciones normales del injerto el día 11 del trasplante. Los hallazgos coincidían con la enfermedad por crioaglutininas en el momento de su ingreso. Sin embargo, la prueba de crioaglutininas fue negativa. Finalmente, le diagnosticaron PLS. La paciente también presentó hemólisis intravascular refractaria y hemoglobinuria franca. La hemólisis fue resistente a los esteroides, la inmunoglobulina intravenosa (IgIV) y el rituximab. Debido a la anemia potencialmente mortal relacionada con PLS refractario, se interrumpieron el micofenolato y el tacrolimus. Sin embargo, persistió la hemólisis. A continuación, se obtuvo el tratamiento de inmunoadsorción (IA). Desafortunadamente, la pérdida del injerto ocurrió debido al rechazo a pesar de la resolución de PLS después de la IA. Conclusión: El PLS es una entidad rara y generalmente autolimitada. Nuestro caso fue un PLS refractario atípico que se asemejaba a la enfermedad por crioaglutininas. Además, se observó hemoglobinuria franca relacionada con hemólisis intravascular grave. Estas características no se han descrito antes en PLS, según nuestro leal saber y entender. Además, el tratamiento IA nunca se había informado en la literatura para PLS, hasta donde sabemos. El tratamiento y el manejo podrían ser un desafío en PLS refractarios. El rituximab, la IgIV y los tratamientos extracorpóreos podrían ser beneficiosos. Debe tenerse en cuenta que los PLS refractarios pueden provocar la pérdida del injerto y del paciente.

Abstract Background Systematically using standard patient-reported measures (PRMs) in clinical routines is trending. The International Consortium for Health Outcomes Measurement (ICHOM) has developed condition-specific standard sets of patient-centred measures, one of which is the Pregnancy and Childbirth Standard (PCB) set, where standard PRMs are included. There is limited knowledge on the use of ICHOM PCB set-included PRMs (ICHOM-PCB-PRMs) in routine care. This study investigates women’s perspectives on the future implementation of standard ICHOM-PCB-PRMs in routine maternity care in Finland. Methods Semi-structured interviews were conducted. Pregnant and postpartum women were asked to evaluate each ICHOM-PCB-PRM in several dimensions, e.g., importance and quality of questions, and to provide their views on future implementation in terms of benefits, difficulties, and practices. With the predefined topics and themes, deductive analysis was applied. Ethical committee approval (HUS 220/880/2015) and research permissions were obtained. Results 22 women participated. Participants felt that most of the ICHOM-PCB-PRMs were important, relevant, understandable, and appropriately designed, and agreed that some changes in ICHOM-PCB-PRMs were needed, e.g., adding other important measures, changing the wording, and adding open-ended questions. Women would be hesitant to answer questions honestly if follow-up actions were unclear. Most “outcome” measures could be asked repeatedly as maternal health status changes over time, and “experience” measures could be asked separately for different service providers. Disagreements regarding data collection at birth were observed. PRMs were regarded as a way for women to express their thoughts and feelings. Our participants were concerned about the possible consequences of negatively answering the PREMs questions and the availability of follow-up care. Participants expected that they could answer short and easy questions digitally before appointments, and that instructions and follow-up actions based on their answers should be available. Conclusion ICHOM-PCB-PRMs could be applicable in Finnish maternity care, but some modifications may be required. Careful consideration is needed regarding how and when PRMs questions are asked for eliciting more accurate and honest answers and minimizing women feeling judged, embarrassed, or offended. Follow-ups should be available according to women’s responses and needs. This study provides insights on the adoption and implementation of standard PRMs in routine maternity care.

Background: Treatment using direct-acting antivirals provides high rates of sustained virologic response and a favorable safety profile for patients with chronic hepatitis C virus infection. However, data on the efficacy of direct-acting antivirals in kidney transplant recipients are still limited. Aims: To evaluate the safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination in kidney transplant recipients. Study Design: Retrospective, observational, single-center study. Methods: Data of 29 kidney transplant recipients who received a fixed-dose safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination for 12 or 24 weeks with or without ribavirin were analyzed. The primary outcome was SVR12, which was defined as undetectable HCV-RNA levels 12 weeks after the treatment. Secondary outcomes were graft function, proteinuria, and calcineurin inhibitor trough level variability. Results: The predominant hepatitis C virus genotype was 1b (n = 19, 65.6%). All patients achieved SVR12. No graft failures nor deaths were reported during the study period. Throughout and after the treatment, the levels of aspartate aminotransferase [21 (range: 18-29.5) to 16 (range: 14-20) U/l, p < 0.001] and alanine aminotransferase [22 (range: 15-34) to 14 (range: 12-17.5) U/l, p < 0.001] improved significantly, unlike bilirubin, hemoglobin, and platelet levels. Renal function remained stable. Dose adjustments for calcineurin inhibitors were required. Serious adverse events were not observed. Conclusion: Safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination was effective and safe in kidney transplant recipients with hepatitis C virus. However, cautious monitoring of trough levels of calcineurin inhibitorss is needed due to potential drug-drug interactions during the treatment episode.

Hikmet kelimesi, Kitap, Sünnet ve kıyas delillerinde geçen önemli bir kavramdır. Söz konusu kavram usûl, furû ve fıkhın diğer alt türlerine ait literatürde de değişik münasebetlerle kullanılmaktadır. Bu çalışmada hikmet kavramının fıkıh edebiyatında hangi anlamlarda kullanıldığı Hanefî fakih Serahsî özelinde tespit edilmeye çalışmıştır. Bahsi geçen gayeye matuf olarak onun el-Mebsût, el-Usûl, Şerhu’s-Siyeri’l-kebîr, Şerhu’l-Câmii’s-sagîr ve en-Nüket adlı eserleri incelenmiştir. Serahsî, hikmet kelimesinin bir kısmını sözlük ve örfteki anlamında, diğer bir kısmını ise fıkıh usulündeki ıstılâhî anlamda kullanmıştır. Kendisi zaman zaman hükümlerin hikmetini belirtmişse de hükmün hikmete göre değil illete göre belirleneceğini açıkça ifade etmiştir. Şu var ki el-Usûl adlı eserinde bunun üzerinde özel olarak durmamıştır. Bu durumun onun döneminde mezkûr konuya dair ciddî bir tartışmanın yaşanmamış olması, zihninin net olması ve konuyu bir problem olarak görmemesinden kaynaklanmış olması muhtemeldir. Serahsî’nin de aralarında yer aldığı cumhura göre, illetin tespitinden maksat şer‘î hükmün bilinmesidir. Dolayısıyla illetin herhangi bir karışıklığa meydan vermeyecek şekilde açık, kişi veya durumlara göre değişiklik göstermeyen istikrarlı bir vasıf olması gerekir. Hâlbuki hikmette bu özellikler bulunmamaktadır. Hikmet, kıyasa konu edilmese de hükmün hikmetinin beyan edilmesinin, o hükmün daha net anlaşılmasını sağlamak ve kişiyi ona uyma konusunda ikna etmek gibi faydaları vardır. İnsanoğlunun ikna olduğu ve faydasına inandığı hususlarda emre imtisalde zorluk çekmeyeceği açıktır.

Devices may be used for special purposes different than their production purpose. For instance, Amplatzer Ductal Occluder is actually designed for duct closure and its usage for closing defects other than ductus is named as off-label. The aim of this study is to emphasize off-label use of device: not only for PDA and VSD but also for other various defects. This study is designed retrospectively, performed by the evaluation catheterization records of patients in whom ADO II and ADO II-AS devices were used in Erciyes University Medical Faculty Children Hospital, Pediatric Cardiology Department between 2011 and 2018. Patients’ demographic criteria: age, weight at the time of procedure was gathered. The diagnosis, size of device, follow-up period and complications were also noted. From April 2011 to March 2018, a total of 121 patients underwent transcatheter closure by ADO II and 66 patients by ADO II AS. The number of PDA closure with ADO II was 48; with ADO II AS were 62. Rest of the procedures were all off-label. Types of off-label procedures performed were: VSD closure, residual mitral cleft closure, Aorta-Right atrium tunnel closure, pulmonary arteriovenous fistula occlusion, aorta-pulmonary window closure, and occlusion of the artery feeding accessory lobe in scimitar syndrome, Gerbode defect occlusion. Up to our knowledge; this study includes the largest pediatric case series with various different congenital heart defects which were closed with ADO-II. Also our ADO-II occluded VSD case series is one of the largest series in the literature with almost 6 years’ follow-up. We believe in that ADO-II device may be an alternative in percutaneous closure of various rare heart defects. It is used successfully for non-ductal defects with low complication and high compliance rates.

6-Chloro-2-ferrocenyl-1H-benzimidazole and (E)-((4-chloro-2-hydroxyphenylimino)methyl)ferrocene ligands and their Fe(III), Co(II), Cu(II), Zn(II) and Pd(II) complexes were synthesized. The structure of ligands and metal complexes has been investigated by different methods. In addition, magnetic moment, molar conductivity measurements and antibacterial activity of the ligands and the complexes were investigated.

Background: Non-invasive vagus nerve stimulation (nVNS) using a hand-held stimulator placed on the neck is an FDA-approved treatment for primary headache disorders. The safety of nVNS is unknown in stroke patients. Objective: To assess the safety and feasibility of nVNS for the acute treatment of stroke. Methods: TR-VENUS (clinicaltrials.gov identifier NCT03733431) was a randomized, sham-controlled, open-label, multicenter trial conducted in patients with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH). Patients were randomly assigned to standard-dose nVNS, high-dose nVNS, or sham stimulation. The primary endpoint was a composite safety outcome defined as bradycardia or reduction in mean arterial blood pressure during treatment or progression of neurological or death within 24 h of treatment. The feasibility endpoints were the proportion of eligible subjects receiving nVNS within 6 h of symptom onset and the proportion completing all pre-specified treatment doses. Efficacy assessments included infarct growth from baseline to 24 h after treatment. Results: Sixty-nine patients (61 IS, 8 ICH) completed the study. The composite safety outcome was achieved in 32.0% in sham and 47.7% in nVNS group (p = 0.203). Treatment was initiated in all but two randomized patients. All dosed subjects received 100% of prespecified stimulations. A non-significant reduction in infarct growth was observed in the high-dose nVNS group (184.2% in sham vs. 63.3% in high-dose nVNS; p = 0.109). Conclusions: The results of this study suggest that nVNS may be safe and feasible in the setting of acute stroke. These findings support further development of nVNS as a potential treatment for acute ischemic stroke.

Flexible job shop scheduling has received considerable attention due to its extensive applications in manufacturing. High-quality scheduling solutions are desired but hard to be guaranteed due to the NP-hardness of computational complexity. In this work, a novel energy-efficient hybrid algorithm is proposed to effectively address the scheduling of flexible job shop problems within reasonable time frames. The hybrid framework hybridizes gene expression programming, variable neighborhood search, and simplified mixed integer linear programming approaches to minimize the total energy consumption. It is utilized to address 20 benchmark examples with moderate- or high-complexities. Computational results show that the hybrid algorithm can reach optimality for all considered moderate-size examples within two seconds. The proposed algorithm demonstrates significant competitive advantages relative to the existing mathematical programming approaches and a group-based decomposition method. Specifically, it shortens the computational time over one order of magnitude in some cases and leads to lower total energy consumption with a maximum decrease by 14.5 %.

In this study, we compare the performance of optimization software to solve the bi-objective sectorization problem. The used solution method is based on an approach that has not been used before in the literature on sectorization, in which, the bi-objective model is transformed into single-objective ones, whose results are regarded as ideal points for the objective functions in the bi-objective model. Anti-ideal points are also searched similarly. Then, using the ideal and anti-ideal points, the bi-objective model is redefined as a single-objective one and solved. The difficulties of solving the models, which are basically non-linear, are discussed. Furthermore, the models are linearized, in which case how the number of variables and constraints changes is discussed. Mathematical models are implemented in Python's Pulp library, Lingo, IBM ILOG CPLEX Optimization Studio, and GAMS software, and the obtained results are presented. Furthermore, metaheuristics available in Python's Pymoo library are utilized to solve the models' single- and bi-objective versions. In the experimental results section, benchmarks of different sizes are derived for the problem, and the results are presented. It is observed that the solvers do not perform satisfactorily in solving models; of all of them, GAMS achieves the best results. The utilized metaheuristics from the Pymoo library gain feasible results in reasonable times. In the conclusion section, suggestions are given for solving similar problems. Furthermore, this article summarizes the managerial applications of the sectorization problems.

Delayed cerebral ischemia after subarachnoid hemorrhage is one of the most important causes of mortality and poor functional outcome in patients. Initially, the etiology and treatment of delayed cerebral ischemia focused primarily on cerebral vasospasm. However, recent studies have detected that depolarization, microcirculation, and autoregulation disorder, which spreads together with cerebral vasospasm, also play a role in the etiology. The main treatment strategies in the prevention and treatment of delayed cerebral ischemia are the regulation of blood pressure and the use of calcium channel blockers, especially nimodipine. The main step in the early diagnosis and treatment of the disease is to monitor the neurological clinical status. In addition to transcranial Doppler ultrasonography, computed tomography, or magnetic resonance imaging angiography, continuous electroencephalography and invasive brain multimodal examination may be required in the follow-up period of the disease. In addition to blood pressure regulation, optimization of cardiac output, endovascular interventions, angioplasty, and/or intra-arterial vasodilator infusion are other treatment methods. This review aimed to evaluate delayed cerebral ischemia, one of the most important complications of subarachnoid hemorrhage, in the light of current literature.

Resumo Fundamento A doença arterial coronariana (DAC) devido à isquemia miocárdica causa perda permanente de tecido cardíaco. Objetivos Nosso objetivo foi demonstrar o possível dano ao miocárdio em nível molecular através dos mecanismos de autofagia e apoptose em pacientes submetidos à cirurgia de revascularização miocárdica. Métodos Um grupo recebeu uma solução de cardioplegia Custodiol e o outro grupo uma solução de cardioplegia sanguínea. Duas amostras miocárdicas foram coletadas de cada paciente durante a operação, imediatamente antes da parada cardíaca e após a liberação do pinçamento aórtico. Foram avaliadas as expressões de marcadores de autofagia e apoptose. O nível de significância estatística adotado foi de 5%. Resultados A expressão do gene BECLIN foi significativa nos tecidos miocárdicos do grupo CS (p=0,0078). Os níveis de expressão dos genes CASPASE 3, 8 e 9 foram significativamente menores no grupo CC. Os níveis pós-operatórios de TnT foram significativamente diferentes entre os grupos (p=0,0072). As expressões dos genes CASPASE 8 e CASPASE 9 foram semelhantes antes e depois do pinçamento aórtico (p=0,8552, p=0,8891). No grupo CC, os níveis de expressão gênica de CASPASE 3, CASPASE 8 e CASPASE 9 não foram significativamente diferentes em amostras de tecido coletadas após pinçamento aórtico (p=0,7354, p=0,0758, p=0,4128, respectivamente). Conclusões Com nossos achados, acreditamos que as soluções CC e CS não apresentam diferença significativa em termos de proteção miocárdica durante as operações de by-pass.

Abstract Background Kidney transplant recipients have an increased risk of complications from COVID-19. However, data on the risk of allograft damage or death in kidney transplant recipients recovering from COVID-19 is limited. In addition, the first and second waves of the pandemic occurred at different times all over the world. In Turkey, the Health Minister confirmed the first case in March 2020; after that, the first wave occurred between March and August 2020; afterward, the second wave began in September 2020. This study aims to demonstrate the clinical presentations of kidney transplant recipients in the first two waves of the pandemic in Turkey and explore the impact of COVID-19 on clinical outcomes after the initial episode. Methods Patients with COVID-19 from seven centers were included in this retrospective cohort study. Initially, four hundred and eighty-eight kidney transplant recipients diagnosed with COVID-19 between 1 March 2020 to 28 February 2021 were enrolled. The endpoints were the occurrence of all-cause mortality, acute kidney injury, cytokine storm, and acute respiratory distress syndrome. In addition, longer-term outcomes such as mortality, need for dialysis, and allograft function of the surviving patients was analyzed. Results Four hundred seventy-five patients were followed up for a median of 132 days after COVID-19. Forty-seven patients (9.9%) died after a median length of hospitalization of 15 days. Although the mortality rate (10.1% vs. 9.8%) and intensive care unit admission (14.5% vs. 14.5%) were similar in the first two waves, hospitalization (68.8% vs. 29.7%; p

Purpose: The aim of the study was to examine the relationship of white matter hyperintensities (WMHs) and measurements of corpus callosum (CC) with migraine characteristics. Materials and Methods: This study was conducted as a case-control and prospective study that included 50 migraine patients and 40 individuals in the control group. The severity and frequency of headaches and headache pain characteristics were questioned. The effects of the disease were determined using the migraine disability rating scale (MIDAS). WMH lesions were evaluated with the FAZEKAS scale. Morphometric measurements of CC were performed. The relationship between pain characteristics and measurements was examined. Results: There were 50 migraine patients (44 women, 6 men) with a mean age of 30,86±8,64 (18-51) years. The frequency of multi-point WMHs was higher in migraine patients compared to the control group. There were no differences in the measured values of CC between the two groups. WMHs were more common in patients with nausea complaints. Measured CC genu values were lower in patients with phonophobia and visual aura symptoms. Conclusion: This study has revealed that patients with migraines have a high rate of WMHs, and this rate is even higher when nausea accompanies attacks. No relationships were found between the measured values of CC and migraines.

Abstract Background Biallelic pathogenic variants in the SCARB2 gene have been associated with action myoclonus-renal failure (AMRF) syndrome. Even though SCARB2 associated phenotype has been reported to include typical neurological characteristics, depending on the localization and the feature of the pathogenic variants, clinical course and the presentations have been shown to differ. Case presentation Whole exome sequencing (WES) analysis revealed a homozygous truncating variant (p.N45MfsX88) in SCARB2 gene in the index case, and subsequent sanger sequencing analysis validated the variant in all affected family members from a Turkish family with the clinical characteristics associated with AMRF and related disorders. Intrafamilial clinical heterogeneity with common features including dysarthria, tremor and proteinuria, and distinct features such as peripheral neuropathy (PNP), myoclonus and seizures between the affected cases, was observed in the family. In-depth literature review enabled the detailed investigation of the reported variants associated with AMRF and suggested that while the type of the variant did not have a major impact on the course of the clinical characteristics, only the C terminal localization of the pathogenic variant significantly affected the clinical presentation, particularly the age at onset (AO) of the disease. Conclusions In this study we showed that biallelic SCARB2 pathogenic variants might cause a spectrum of common and distinct features associated with AMRF. Of those features while the common features include myoclonus (100%), ataxia (96%), tonic clonic seizures (82%), dysarthria (68%), tremor (65%), and renal impairment (62%), the uncommon features involve PNP (17%), hearing loss (6.8%), and cognitive impairment (13.7%). AO has been found to be significantly higher in the carriers of the p.G462DfsX34 pathogenic variant. SCARB2 pathogenic variants have not been only implicated in AMRF but also in the pathogenesis of Parkinson’s disease (PD) and Gaucher disease (GD), suggesting the importance of genetic and functional studies in the clinical and the diagnostic settings. Given the proven role of SCARB2 gene in the pathogenesis of AMRF, PD and GD with a wide spectrum of clinical symptoms, investigation of the possible modifiers, such as progranulin and HSP7, has a great importance.

Aim:Monocyte/high-density lipoprotein (HDL) ratio (MHR) is an inflammatory marker associated with vascular diseases. The aim of this study is to evaluate the MHR in patients with symptomatic carotid artery stenosis and to examine its relationship with the degree of stenosis.Methods:The study was conducted as a case-control study, with data obtained from patients’ files between January 2020 and May 2021. Ninety patients with symptomatic carotid stenosis and 40 healthy controls were included in the study. For vascular imaging, computed tomography angiography and/or digital subtraction angiography were used. Carotid artery stenosis was grouped according to North American Symptomatic Carotid Endarterectomy Trial criteria. Tests for monocyte and HDL cholesterol were performed, and the MHR was calcu-lated.Results:There were 67 male and 23 female patients with a mean age of 65.10±12.26 years in the study. In 46 (51.1%) of the patients, there was 50% or more carotid artery stenosis. The HDL cholesterol level was lower, and the MHR was higher in the patient group (p=0.042, p=0.041, respectively). Monocyte and MHR levels were higher in patients with 50% or more carotid stenosis (p=0.04).Conclusion:The MHR is a predictive biomarker for the degree of symptomatic stenosis in the carotid artery.

The effectiveness of parasitoids as organism for biological control is at times limited by food sources. Most of parasitoids rely on carbohydrate foods to enhance their longevity and reproductive capacity. Honey is the miraculous product of honey bees and is naturally delicious. A preliminary study was conducted on the use of different kinds of honey as food sources for the Trichogramma species. The value of honey as a food source for Trichogramma was evaluated by testing the influence of several honey diets on parasitism and longevity in the laboratory. The most commonly available honey is made from a variety of flowers, pine, citrus, chestnut, sunflower, and cotton. Trichogramma females fed on chestnut and sunflower honey parasitized relatively more than when fed on citrus honey. Trichogramma females fed on flower, sunflower, and citrus honey survived drastically longer than females fed on chestnut and pine honey. These results showed that supplying sugar, sunflower, and flower honey to Trichogramma resulted in greater longevity and total fecundity. Overall, feeding Trichogramma females on different kinds of honey had a negligible effect on parasitization but did certainly affect longevity. Of the Trichogramma species evaluated, T. brassicae appears to be the most suitable parasitoids regarding high parasitization and longer life span.

Organophosphate poisoning is a common form of suicide due to the widespread use of pesticides. A twenty-seven-year-old male patient presented with impaired consciousness, recurrent seizures and thick secretions in the mouth. The patient with frequent seizures and cholinergic findings was evaluated as compatible with organophosphate poisoning. Brain magnetic resonance imaging revealed symmetrical and bilateral lesions in the globus pallidus. The treatment of the patient whose epileptic seizures continued was rearranged. The possibility of poisoning should always be considered in the differential diagnosis of new-onset acute seizures and disorders of consciousness. Early recognition of poisoning, appropriate treatment and seizure control are important. Attention should also be paid to epileptic seizures after orgonaphosphate poisoning.

A 20-year-old woman presented with left eye ptosis without any headache and pupillary dysfunctions. After the radiological examination, the oculomotor nerve compression was detected in the interpeduncular space by the posterior communicating artery (PCoA) with normal size and shape. The patient underwent frontotemporal craniotomy, and during the surgery, the nerve was detached from the PCoA. Immediately after surgery, all symptoms disappeared. Although oculomotor nerve palsy (ONP) owing to internal carotid-PCoA aneurysm is common, vascular compression due to a non- aneurysmal PCoA is very rare. To the extent of our knowledge, this is the first case in which a slightly displaced, otherwise normal, PCoA causes ONP without any pupillary involvement. After ruling out an aneurysmal artery, this should be considered as one of the possible causes of the ONP.

Abstract Background Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. This study aims to determine the association of the positivity of IgG and the intensity of IgG staining with a poor renal prognosis. Methods A total of 943 IgAN patients were included in the study. Glomerular IgG staining negative and positive patients were compared using Oxford classification scores, histopathological evaluations, proteinuria, eGFR, albumin, blood pressures. IgG positive patients were classified as (+), (++), (+++) based on their staining intensity, and the association with the prognostic criteria was also evaluated. Results 81% (n = 764) of the patients were detected as IgG negative, while 19% (n = 179) were positive. Age, gender, body mass index, blood pressure, proteinuria, eGFR, uric acid values were similar in IgG positive and negative patients who underwent biopsy (p > 0.05). Intensity of glomerular IgG positivity was not found to be associated with diastolic and systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p > 0.05 for all, r = − 0.084, r = − 0.102, r = − 0.006, r = 0.062, r = 0.014, r = − 0.044, r = − 0.061, r = − 0.066, r = 0.150, respectively). There was no difference for histopathological findings between IgG (+), IgG (++), IgG (+++) groups (for all, p > 0.05). Conclusion Glomerular IgG negativity and positivity detected by routine IFM in IgAN patients is not associated with poor renal prognostic risk factors.

In this study, unit-speed the Legendre curves are studied in Sasakian 3-manifold. Firstly, differential equations characterizing the Legendre curves are obtained and the method used for the approximate solution is explained. Then, the approximate solution is found for one of the characterizations of the Legendre curve with the Legendre matrix collocation method. In addition, a sample application is made to make the method more understandable. And finally, with the help of these equations and the approximate solution, the geometric properties of this curve type are examined.

Objective Masked hypertension (MH) and non-dipping pattern are conditions associated with target organ damage and cardiovascular risk, which are frequently observed together. We aimed to show the relationship between the target organ damage observed in MH and the deterioration in the dipping pattern. Methods Patients who underwent ambulatory blood pressure monitoring (ABPM) and office blood pressure (BP)

Abstract Background The importance and potential benefits of introducing patient reported measures (PRMs) into health care service have been widely acknowledged, yet the experience regarding their implementation into practice is limited. There is a considerable paucity of research in adopting PRMs in maternity care routine. This study, which utilizes the PRMs included in Pregnancy and Childbirth (PCB) outcome set developed by International Consortium for Health Outcomes Measurement (ICHOM) as sample measures, aims to elicit Finnish professionals’ views on PRMs and to explore the applicability of PRMs in Finnish public maternity care. Methods This qualitative study, applying semi-structured interviews, described the local professionals’ views towards the application of PRMs in Finnish public maternity care. Professionals were asked to assess the PRMs defined in ICHOM PCB set and provide their expectations and concerns on the implementation of PRMs in Finnish public maternity service. Results Twenty professionals participated in the interviews. Participants agreed on the importance and relevance of the PRMs questions included in ICHOM PCB set for delivering and developing maternity care in Finland. However, they criticized the number and length of questions as well as the recommended time points of data collection. In addition, for a successful implementation, various steps like developing suitable questions, redesigning service pathway and protocols, and motivating women to respond to PRMs questions were considered to be important. Also, some potential obstacles, difficulties and risks associated with the implementation were underlined. Conclusion This study indicates that the implementation of PRMs into Finnish public maternity service is possible, highly relevant and important. However, the adoption of PRMs into routine practice may be challenging and will require a series of efforts. This study shows viewpoints from Finnish professionals who have not participated in developing the ICHOM PCB standard set and provides important insights on the development and implementation of PRMs.

In the present study, the effects of STEM based robotics applications on students' creativity and scientific attitudes in the Electricity Unit of 7th grade have been investigated by using the nested pattern of the mixed method. Sixty students, 30 of whom are the experimental group and the other 30 constitute the control group, attending a post-school course in Istanbul in the academic year of 2018-2019, participated 2 weeks of pre-applications and 4 weeks of applications. TOSRA,to measure attitude towards science, and “Torrance Creative Thinking Test”,to measure creativity, were applied as pre and posttest. The data gained from the tests were analyzed with SPSS 21. Semi-structured interviews' data were analyzed by using content analysis. As a result, it was observed that STEM based robotics applications significantly increased students' creativity and attitudes towards science. Interview findings show that students enjoy using STEM applications that contain applications instead of theoretical knowledge. Using robotic and complex software materials to solve daily life problems, they felt like scientists during the practices and the applications affected their future career choices. Keywords STEM; creativity; robotic application; attitude; TOSRA

Abstract Introduction: This study aimed to review the surgical excision results and pathological diagnostic features of rarely observed intracardiac masses in the light of the literature. Diagnosis and treatment approaches and complications were evaluated. Methods: Forty patients (26 females, mean age 52.1±18.1 years, and 14 males, mean age 48.1±20.5 years), who had undergone surgery for intracardiac mass between January 2008 and December 2018, were included in this study. The patients’ data were analyzed retrospectively from the medical records of both centers. Results: When the pathological diagnoses were examined, 85.8% of the masses (n=35) were observed to be benign (benign tumor + hydatid cyst) and 14.2% (n=5) were malignant tumors. The masses were most commonly located in the left atrium (75%, n=30), and this was followed by the right ventricle (12.5%, n=5), right atrium (7.5%, n=3), and left ventricle (5%, n=2). Of the patients, 7.5% (n=3) died during the early postoperative period, while the remaining 92.5% (n=37) were discharged with healing. In the histopathological diagnosis of the patients, in whom in-hospital major adverse cardiovascular events were observed, there was malignancy in two cases. Conclusion: Intracardiac masses, which have pathological features, are severe life-threatening problems. In-hospital mortality is frequent, especially in malignant tumors.

The curves of constant width are special curves used in engineering, architecture and technology. In the literature, these curves are considered according to different roofs in different spaces and some integral characterizations of these curves are obtained. However, in order to examine the geometric properties of curves of constant width, more than characterization is required. In this study, firstly differential equations characterizing quaternionic space curves of constant width are obtained. Then, the approximate solutions of the differential equations obtained are calculated by the Morgan-Voyce polynomial approach.The geometric properties of this curve type are examined with the help of these solutions.