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In this study, time-dependent probabilistic tsunami hazard analysis (PTHA) is performed for Tuzla, Istanbul, in the Sea of Marmara, Turkey, using various earthquake scenarios of Prince Island Fault (PIF) within the next 50 and 100 years. The Monte Carlo (MC) simulation technique is used to generate a synthetic earthquake catalogue, which includes earthquakes having moment magnitudes between Mw6.5 and 7.1. This interval defines the minimum and maximum magnitudes for the fault in the case of an entire fault rupture, which depends on the characteristic fault model. Based on this catalogue, probability of occurrence and associated tsunami wave heights are calculated for each event. The study associates the probabilistic approach with tsunami numerical modeling. The tsunami numerical code NAMI DANCE was used for tsunami simulations. According to the results of the analysis, distribution of probability of occurrence corresponding to tsunami hydrodynamic parameters is represented. Maximum positive and negative wave amplitudes show that tsunami wave heights up to 1 m have 65 % probability of exceedance for the next 50 years and this value increases by 85 % in the Tuzla region for the next 100 years. Inundation depth also exceeds 1 m in the region with probabilities of occurrence of 60 % and 80 % for the next 50 and 100 years, respectively. Moreover, probabilistic inundation maps are generated to investigate inundated zones and the amount of water penetrated inland. Probability of exceedance of 0.3 m wave height ranges between 10 % and 75 % according to these probabilistic inundation maps, and the maximum inundation distance calculated in the entire earthquake catalogue is 60 m in this test site. Furthermore, synthetic gauge points are selected along the western coast of Istanbul by including Tuzla coasts. Tuzla is one of the areas that shows high probability exceedance of 0.3 m wave height, which is around 90 %, for the next 50 years while this probability reaches up to more than 95 % for the next 100 years.

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA., Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process., Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit., Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines., Competing Interests: The authors have nothing to disclose., (Copyright © 2025 Korean Society for Sexual Medicine and Andrology.)

Introduction: This study evaluates the effectiveness of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system in predicting postoperative complications following radical cystectomy (RC)., Materials and Methods: In this single-center retrospective study, we analyzed data from patients who underwent open RC for muscle-invasive bladder cancer by a single surgeon between 2008 and 2023. Cases involving cystectomy for non-urothelial carcinoma or urinary diversion other than ileal conduit were excluded. We recorded patient demographics, body mass index (BMI), history of abdominal/retroperitoneal surgery, ASA score, performance status (PS), and pre-existing conditions, such as hypertension (HT), coronary artery disease (CAD), diabetes mellitus (DM), and chronic kidney disease (CKD). Intraoperative data included surgery duration, blood loss, and need for blood transfusion. Post-operative complications were classified using the Clavien-Dindo system. E-PASS score was calculated using the Preoperative Risk Score (PRS), Surgical Stress Score (SSS), and Comprehensive Risk Score (CRS)., Results: The study included 252 patients. Patients who experienced postoperative complications had higher age, BMI, prior surgical history, ASA score, PS, and rates of CAD, HT, DM, and CKD compared to those who did not. Surgery duration, blood loss, blood transfusion requirement, and E-PASS scores (PRS, SSS, CRS) were also higher in this group. The ROC curve for CRS revealed a predictive cutoff of 0.4911 (AUC = 0.905, p < 0.001). Independent risk factors for postoperative complications included high BMI (p = 0.031), longer surgery duration (p < 0.001), HT (p = 0.042), CKD (p = 0.017), and CRS > 0.4911 (p < 0.001)., Conclusion: E-PASS system effectively predicts postoperative complications in RC patients., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations., Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations., Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate., Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Background: Explainable Artificial Intelligence (XAI) is prominent in the diagnostics of opaque deep learning (DL) models, especially in medical imaging. Saliency methods are commonly used, yet there's a lack of quantitative evidence regarding their performance., Objectives: To quantitatively evaluate the performance of widely utilized saliency XAI methods in the task of breast cancer detection on mammograms., Methods: Three radiologists drew ground-truth boxes on a balanced mammogram dataset of women (n = 1496 cancer-positive and negative scans) from three centers. A modified, pre-trained DL model was employed for breast cancer detection, using MLO and CC images. Saliency XAI methods, including Gradient-weighted Class Activation Mapping (Grad-CAM), Grad-CAM++, and Eigen-CAM, were evaluated. We utilized the Pointing Game to assess these methods, determining if the maximum value of a saliency map aligned with the bounding boxes, representing the ratio of correctly identified lesions among all cancer patients, with a value ranging from 0 to 1., Results: The development sample included 2,244 women (75%), with the remaining 748 women (25%) in the testing set for unbiased XAI evaluation. The model's recall, precision, accuracy, and F1-Score in identifying cancer in the testing set were 69%, 88%, 80%, and 0.77, respectively. The Pointing Game Scores for Grad-CAM, Grad-CAM++, and Eigen-CAM were 0.41, 0.30, and 0.35 in women with cancer and marginally increased to 0.41, 0.31, and 0.36 when considering only true-positive samples., Conclusions: While saliency-based methods provide some degree of explainability, they frequently fall short in delineating how DL models arrive at decisions in a considerable number of instances., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Obtaining sperm from the testis surgically and using these sperm with the intracytoplasmic sperm injection technique, has opened the way for the possibility of biological fathering in men with non-obstructive azoospermia (NOA). We aimed to evaluate our sperm retrieval rate (SRR) by microdissection testicular sperm extraction (micro-TESE) in NOA patients with solitary testis. In this retrospective case-control study, fortyfive patients with NOA who had a congenital or acquired solitary testis were included, between September 2003 and January 2022. These patients were randomly matched with patients with NOA who had bilateral testes, using a 1:3 matching ratio. We found that SRR by micro-TESE in patients with solitary testis was similar to NOA patients with bilateral testis (51.1% vs. 50.4%). Age, infertility period, ejaculate volume, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone, history of varicocelectomy, history of orchiopexy, testicular stimulation therapy before micro-TESE, testicular volume, genetic status, TESE side, micro-TESE success, complications and histopathological evaluation results of both groups were evaluated, there was a statistically significant difference in only serum FSH and LH levels. There was no difference between the groups in terms of complications and hormonal effects in the early postoperative period. Micro-TESE in NOA patients with solitary testis has similar sperm retrieval and complication rates as NOA patients with bilateral testis., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Purpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice., Materials and Methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured., Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%)., Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Anti N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that often presents with various neurological and neuropsychiatric symptoms. Although most reported cases occur in children, only a limited number of studies on children are available. The subject of this case report is an 8-month-old female who presented with fever, vomiting, and seizure. She was diagnosed with encephalitis and treated with acyclovir. After 21 days, she showed irritability, seizure, orolingual-facial dyskinesias, choreodystonic movements, hemiparesis, dysphagia, strabismus, lack of interest in light and objects. Clinical signs, neuroimaging findings, and serum analysis of anti-NMDAR antibodies confirmed the diagnosis of anti-NMDAR encephalitis. After the first line of treatment, she showed full recovery. We update the infants with anti-NMDAR encephalitis in the literature. Clinical outcomes suggest that patients with anti-NMDAR encephalitis are mostly poor in the infants, excluding our case. We propose that early and appropriate treatments are critical for timely diagnosis and rapid improvement.

Objectives: Chronic stress may lead to depression and vascular endothelial dysfunction. We aimed to evaluate the effects of propolis on vascular functions and the possible mechanisms of its vascular effects in the rat model of chronic unpredictable mild stress (CUMS)-induced depression., Methods: Male Wistar rats were divided into control, stress (exposure to CUMS), control+propolis and stress+propolis groups (n = 8/each group). CUMS model was induced by exposing rats to various mild stressors daily for 5 weeks. The extract of propolis (100 mg/kg/day) was administered orally to propolis-treated groups for 5 weeks. The depression-like behaviours were assessed with the forced swimming test (FST). Chronic stress resulted in increased immobility response in FST and elevated serum corticosterone levels. Thoracic endothelial functions and expressions of endothelial nitric oxide synthase (eNOS), tumor necrosis factor-alpha (TNFα), interleukin-1beta (IL-1β), Heme oxygenase-1 (HO-1) and superoxide dismutase (SOD) level were assessed., Key Findings: Compared to control group, stress group exhibited a significant decrease in endothelium-dependent relaxations, and eNOS, SOD and HO-1 expressions, whereas a significant increase in the thoracic expressions of TNFα and IL-1β. Propolis ameliorated depression-like behaviours, vascular endothelial dysfunctions and alterations of protein expressions., Conclusion: Propolis exerted antidepressant-like and vasculoprotective effects in CUMS-induced depression in rats. Chronic propolis treatment may have a protective effect on CUMS-induced vascular endothelial dysfunction by its anti-inflammatory and antioxidant effects., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition., Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method., Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated., Conclusions: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians., Competing Interests: The authors have nothing to disclose., (Copyright © 2023 Korean Society for Sexual Medicine and Andrology.)

Objective: This study aimed to determine the role of oxidative stress (OS) in carboplatin-induced gonadotoxicity and whether Nigella Sativa oil (NSO), an herbal antioxidant, has a protective effect on ovarian apoptosis, OS, and the anti-Müllerian hormone (AMH) level in a rat model., Materials and Methods: The study included 24 adult female rats that were divided into 4 treatment groups. Group A saline + saline (sham group); group B: NSO + saline; group C: saline + carboplatin; group D: NSO + carboplatin. Saline, NSO, and carboplatin were administered intraperitoneally 24 and/or 48 h before sacrification as 4 mL/kg, 4 mL/kg, and 80 mg/kg, respectively. Apoptosis, OS parameters, and AMH were measured., Results: Oxidant levels and apoptosis were higher, whereas AMH and the antioxidants were lower in group C than in group A. Apoptosis, OS parameters, and AMH levels were negatively affected by chemotherapy (CTx) in group C whilst improvement in those parameters was observed in group D following NSO pretreatment. The levels of apoptosis and malondialdehyde (MDA), an OS parameter, in group D were lower than in group C as they declined from 34.3% to 8.65% (p = 0.002) and from 199.4 nmol/g tissue to 136.4 nmol/g tissue (p = 0.002), respectively. However, the slight increase in AMH level from 2.7 ng/mL to 3.5 ng/mL due to the NSO effect was not significant between groups C and D., Conclusions: The present findings show that carboplatin has adverse effects on AMH, ovarian tissue apoptosis, and OS parameters. NSO pretreatment might protect ovarian tissue and decrease CTx-induced ovarian injury by decreasing OS and apoptosis, but the protective effect of NSO on AMH is limited.

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations., Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus., Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing., Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians., Competing Interests: The authors have nothing to disclose., (Copyright © 2023 Korean Society for Sexual Medicine and Andrology.)

Recombinant protein-based SARS-CoV-2 vaccines are needed to fill the vaccine equity gap. Because protein-subunit based vaccines are easier and cheaper to produce and do not require special storage/transportation conditions, they are suitable for low-/middle-income countries. Here, we report our vaccine development studies with the receptor binding domain of the SARS-CoV-2 Delta Plus strain (RBD-DP) which caused increased hospitalizations compared to other variants. First, we expressed RBD-DP in the Pichia pastoris yeast system and upscaled it to a 5-L fermenter for production. After three-step purification, we obtained RBD-DP with > 95% purity from a protein yield of > 1 g/L of supernatant. Several biophysical and biochemical characterizations were performed to confirm its identity, stability, and functionality. Then, it was formulated in different contents with Alum and CpG for mice immunization. After three doses of immunization, IgG titers from sera reached to > 10 6 and most importantly it showed high T-cell responses which are required for an effective vaccine to prevent severe COVID-19 disease. A live neutralization test was performed with both the Wuhan strain (B.1.1.7) and Delta strain (B.1.617.2) and it showed high neutralization antibody content for both strains. A challenge study with SARS-CoV-2 infected K18-hACE2 transgenic mice showed good immunoprotective activity with no viruses in the lungs and no lung inflammation for all immunized mice., (© 2023. The Author(s).)

Background: Young-onset hypertension is defined as hypertension diagnosed before the age of 40 years. Aortic pulse wave velocity is an indication of aortic stiffness. MRI assessment has been well verified compared to invasive pressure recordings for evaluating aortic pulse wave velocity. In this study, we aimed to determine whether aortic stiffness played a role in the aetiology of young-onset hypertension by calculating pulse wave velocity using MRI., Methods: We enrolled 20 patients diagnosed with young-onset hypertension and 20 volunteers without hypertension. Aortic pulse wave velocity was measured by cardiac MRI and protocol for the pulse wave velocity measurement involved the use of a 1.5 T scanner to acquire velocity-encoded, phase-contrast transverse aortic cine images. Sagittal oblique images used to measure the distance (ΔX) between the ascending aorta and descending aorta for the calculation of pulse wave velocity. The aortic flow versus time curves of ascending aorta and descending aorta were automatically obtained from the phase-contrast MRI images. Using these curves, the temporal shift (ΔT) was measured by Segment Medviso., Findings: The mean pulse wave velocity was 8.72 (SD 2.34) m/second (range: 7-12.8 m/second) for the patient group and 5.96 (standard deviation 1.86) m/second (range: 4.8-7.1 m/second) for the control group. The pulse wave velocity values were significantly higher in the patient group compared to the control group (p < 0.001)., Interpretation: Aortic stiffness may play a role in the aetiology of young-onset hypertension and serve as a non-invasive and reliable screening tool when measured by MRI.

Introduction: Vesicoureteral reflux (VUR) is a complex disease as patient spectrum is variable. Some cases struggle with recurrent febrile urinary tract infections (UTI) and end-up with renal scars despite intervention. While others suffer no clinical problems and need no treatment. The detrimental effect of VUR on kidneys depends on many factors like grade of reflux, detrusor pressure, and presence of voiding dysfunction. The adverse effects of sterile VUR on kidneys is still under discussion. Thus, we assessed the impact of detrusor pressure at VUR onset on renal scarring in children with sterile reflux., Materials and Methods: We retrospectively reviewed the five years follow-up data of 38 children who had unilateral VUR without UTI under treatment. No febrile or afebrile UTIs were detected during the follow-up in any children. All children were assessed with annual video-urodynamics and renal scintigraphy for five consecutive years. The detrusor pressure at VUR onset, grade of VUR, presence of involuntary detrusor contractions, bladder capacity and the presence of renal scaring were recorded. All VURs were recorded during the voiding phase and children with VUR during the filling phase were excluded from the study., Results: In the first line of video-urodynamic studies, the mean detrusor pressure at VUR onset was 24.3 ± 14.8 cm/H 2 O (median 34.5 cm/H 2 O, min: 6 - max: 47). There was no relation between boys and girls regarding median detrusor pressure at VUR onset (p = 0.356). Eventually, 22 (57.9%) children developed renal scars and ended up with surgery. There was no relation between scar development and age at first presentation (p = 0.888) The cut-off value for detrusor pressure at VUR onset was noted as 26 cm/H 2 O (AUC: 0.849 [p < 0.01], Figure). In children who developed renal scars eventually, the median detrusor pressure at VUR onset was significantly higher (p < 0.01)., Discussion: The detrimental effect of VUR on kidneys is associated with recurrent infections, bladder dysfunction, and detrusor pressure. Dispute over risk of renal scarring in patients with sterile VUR still continues., Conclusion: Children in whom VUR start at higher voiding pressures suffer more renal scars. The threshold of voiding detrusor pressure for risky patients is identified as 26 cm/H 2 O. It is true that patients suffering recurrent febrile UTIs have higher risk of developing renal scarring. However, the impact of sterile reflux should not be underestimated, since renal scars due to sterile reflux may develop in patients under antibiotic prophylaxis., Competing Interests: Conflicts of interest None declared., (Copyright © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: EWGSOP2 defines "probable sarcopenia" as the presence of low muscle strength without non-muscle causes. The associations of probable sarcopenia have been studied in few reports to date, and our intention in this study is to identify associations of probable sarcopenia with common geriatric syndromes in a sample of older adults who attended the geriatric outpatient clinic of Istanbul University Hospital., Methods: The present study was designed as a retrospective cross-sectional study. We performed a comprehensive geriatric assessment to the participants. Univariate analyses were performed to determine relationship of probable sarcopenia with age, sex, common geriatric syndromes, i.e., frailty, falls, polypharmacy, malnutrition, and comorbidities, i.e., diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), depression, osteoporosis, and the variables found to be significant were included in logistic regression analyses. The results are presented as an odds ratio (OR), with a 95% confidence interval (CI)., Results: Included in the study were 456 participants with a mean age of 74.6 ± 6.6 years, of which 71.1% were female. Probable sarcopenia was identified in 12.7% (n = 58) of the sample. A multivariate analysis was carried out, the factors associated with probable sarcopenia were identified as male sex (OR 0.269, 95% CI 0.142-0.510), frailty (OR 4.265, 95% CI 2.200-8.267) and chronic kidney disease (OR 3.084, 95% CI 1.105-8.608)., Conclusion: Probable sarcopenia was more significantly associated with frailty than with other geriatric syndromes, signifying its importance as a marker for frailty. The study further identified chronic renal failure as a factor significantly associated with probable sarcopenia among the variety of studied diseases that frequently accompany aging., (© 2022. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Objectives: Patients with adult sickle cell disease and severe sequelae are treated with nonmyeloablative allogeneic hematopoietic stem cell transplant. So far, data on gonadal effects are lacking for older cured patients. We assessed the gonadal reserve and sexual function of patients cured of sickle cell disease with transplant and with anti-T-lymphocyte globulin and posttransplant cyclophosphamide-containing regimen within the context of the Baskent Organ Damage Mitigation and Medical Care Development Program., Materials and Methods: All adult patients (≥18 years) with sickle cell disease who underwent peripheral stem cell transplant from September 2013 to July 2019 and were graft-versus-host disease free for 2 years and not immunosuppressed were invited to participate in this prospective observational study. Of 61 eligible patients, 43 participants (~10% from international registries) were included (median age at transplant was 29 years; range, 18-45 years). Gonadal status, risk of gonadal damage posttransplant, conception, and sexual function posttransplant were evaluated., Results: Allogeneic hematopoietic stem cell transplant was associated with increased risk of secondary amenorrhea (odds ratio of 93; 95% CI, 4.94-17.50; P = .002) and ovarian insufficiency (odds ratio of 37.8; 95% CI, 2.03 to -700.94; P = .014) but not with female sexual dysfunction. Secondary ovarian insufficiency developed in all women posttransplant. Transplant was associated with significant risk of azoospermia (odds ratio of 4.35; 95% CI, 1.02-18.45; P = .017). Moderate-to-severe erectile dysfunction developed in 2 men (10%). Among female participants, 1 had spontaneous conception that ended in miscarriage and 1 had term delivery after in vitro fertilization. Among male participants, 1 had a child by in vitro fertilization and 1 experienced spontaneous conception., Conclusions: Although spontaneous conception was shown in our patient group, gonadal damage was evident at >2 years posttransplant. This risk was associated with age in female patients. Better fertility preservation measures should be incorporated into medical care development programs.

To investigate the performance of a joint convolutional neural networks-recurrent neural networks (CNN-RNN) using an attention mechanism in identifying and classifying intracranial hemorrhage (ICH) on a large multi-center dataset; to test its performance in a prospective independent sample consisting of consecutive real-world patients. All consecutive patients who underwent emergency non-contrast-enhanced head CT in five different centers were retrospectively gathered. Five neuroradiologists created the ground-truth labels. The development dataset was divided into the training and validation set. After the development phase, we integrated the deep learning model into an independent center's PACS environment for over six months for assessing the performance in a real clinical setting. Three radiologists created the ground-truth labels of the testing set with a majority voting. A total of 55,179 head CT scans of 48,070 patients, 28,253 men (58.77%), with a mean age of 53.84 ± 17.64 years (range 18-89) were enrolled in the study. The validation sample comprised 5211 head CT scans, with 991 being annotated as ICH-positive. The model's binary accuracy, sensitivity, and specificity on the validation set were 99.41%, 99.70%, and 98.91, respectively. During the prospective implementation, the model yielded an accuracy of 96.02% on 452 head CT scans with an average prediction time of 45 ± 8 s. The joint CNN-RNN model with an attention mechanism yielded excellent diagnostic accuracy in assessing ICH and its subtypes on a large-scale sample. The model was seamlessly integrated into the radiology workflow. Though slightly decreased performance, it provided decisions on the sample of consecutive real-world patients within a minute., (© 2022. The Author(s).)