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REM-bağımlı Obstürktif Uyku Apne Sendromlu Hastalarda N3 Uyku Evresinde Mutlak Delta Gücünün Araştırılması: Tek Merkez Vaka-Kontrol Çalışması
No full textThis study aimed to evaluate macro- and micro-architectural parameters of the N3 sleep stage in patients with REM-dependent obstructive sleep apnea (OSA). This single-center retrospective study compared the macroarchitecture and delta band measures of Non-Rapid Eye Movement sleep stage 3 (N3) between healthy individuals (n=20), patients with Sleep-stage independent obstructive sleep apnea (OSA, n=20), and those with Rapid Eye Movement (REM)-dependent OSA (n=20). REM-dependent OSA was defined by an apnea–hypopnea index (AHI) ?5/hour, a REM/NREM AHI ratio ?2, and a REM duration of at least 30 minutes. Analyses were performed on the longest artifact-free 5-minute N3 segment in the first half of the night, using the F3–A2 derivation and a Welch-based spectral method. Absolute delta power (1–4 Hz, µV²) and % Slow-Wave Activity (SWA)-N3 (1–4/1–50 Hz) were calculated. The N3 duration and percentage showed significant differences between groups (p=0.004 and p=0.002, respectively), with longer and higher values in the control group. However, absolute delta power (p=0.396) and %SWA-N3 (p=0.122) showed no significant differences between groups. These findings indicate that N3 duration is significantly reduced in OSAS phenotypes, but N3 depth remains at the same level as in controls. To our knowledge, this study is among the few to directly assess N3 delta power in the REM-dependent OSA subgroup, thus contributing novel evidence to the field. Future research is needed in larger cohorts using multiple N3 segments and covariance-adjusted models (e.g., age, BMI, hypoxemia indices).Bu çalışmada REM-bağımlı obstrüktif uyku apne sendromlu (OUAS) hastalarda N3 uyku evresinin makro ve mikromimarisine ait parametrelerin değerlendirilmesi amaçlanmıştır. Bu tek merkezli retrospektif çalışmada sağlıklı bireyler (n=20), uyku evresi ile ilişkili olmayan OUAS’lı hastalar (n=20) ve REM-bağımlı OUAS’lı (n=20) hastalar arasında N3 uykusunun makro mimarisi ile delta bandı ölçütleri karşılaştırıldı. REM-bağımlı OUAS, AHI?5/saat, AHI REM/AHI NREM?2 ve REM süresi?30 dakika ölçütleriyle tanımlandı. Analizler gecenin ilk yarısındaki en uzun artefaktsız N3 segmentinde, F3–A2 kanalından Welch tabanlı spektral yöntemle yürütüldü; mutlak delta gücü (1–4?Hz, µV²) ve %SWA-N3 (1–4/1–50?Hz) hesaplandı. Gruplar arasında N3 süresi ve yüzdesi anlamlı farklılık gösterdi (N3 süre p=0.004; %N3 p=0.002); normal grupta N3 süresi ve yüzdesi daha uzun ve yüksekti. Buna karşın mutlak delta gücü (p=0.396) ve %SWA-N3 (p=0.122) açısından fark saptanmadı. Bu bulgular, OUAS fenotiplerinde N3 evresinin süresinin anlamlı düzeyde azaldığını, ancak N3 derinliğinin kontrol grubundakiyle aynı seviyede kaldığını göstermektedir. Çalışma, REM-bağımlı OUAS alt fenotipinde N3 delta gücünü doğrudan karşılaştıran az sayıdaki araştırmadan biri olması nedeniyle literatüre katkı sağlamaktadır. Gelecek çalışmalarda çoklu N3 segmentleri ve kovaryans ayarlı modellerle (örn. yaş, BMI, hipoksemi göstergeleri) daha geniş örneklemler önerilir
Non-targeted metabolomic profiling of Cistus species and association with anticholinesterase efficacy for Alzheimer's disease: In vitro and in silico evaluation
No full textEthnopharmacological relevance: Alzheimer's disease (AD) is characterized by decreased glucose utilization, and insulin therapy has been associated with improved memory. Therefore, AD is suggested to be classified as Type 3 diabetes. Cistus L. species are traditionally used to treat diabetes, which is highly associated with AD, and the potential of this genus for treating AD has not been sufficiently investigated. Aim: This study focused on the untargeted metabolomic profiling of methanolic extracts from five Cistus species to investigate the correlation between the metabolites and bioactivity. Materials and methods: Gas chromatography-mass spectrometry and liquid chromatography quadrupole time-offlight mass spectrometry were employed for metabolomics analysis. The inhibitory activity of the extracts on acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), as well as their antioxidant capacity, were assessed. Additionally, molecular modeling techniques were utilized to corroborate the correlation between the metabolites and their cholinesterase inhibitory potency. Results: The plant extracts demonstrated inhibitory effects on BChE with IC50 values ranging from 1.80 to 9.83 mu g/mL, which were notably lower than those observed for AChE. Correlation analysis revealed that chlorogenic acid demonstrated strong correlations with AChE inhibitory activity, while sinapyl alcohol was closely associated with BChE inhibitory activity. Additionally, molecular modeling studies supported the inhibitory potential of these metabolites. Conclusion: This study highlights the substantial cholinesterase inhibitory capabilities of Cistus species, with C. creticus demonstrating particularly strong activity against both AChE and BChE. The results indicate that extracts from these species could be valuable natural sources of active metabolites with potent cholinesterase inhibitory effects, presenting promising new options for AD therapy
Seaweed polysaccharides and their potential health effects via gut microbiota modulation
No full textMacroalgae, commonly known as seaweeds, are a valuable source of polysaccharides known to modulate gut microbiota. In this work, the impact of polysaccharide structural features on gut microbiota was explored. The low molecular weight algae polysaccharides showed better degradation by gut bacteria. Moreover, the content of sulfate and carboxylic groups seem to promote high fermentation, triggering an increase in gut microbiota health. The effect of ramification degree of algae polysaccharides on fermentability is still unclear. Agar polysaccharides with low molecular weight and a higher degree of sulfation have been shown to produce higher amounts of SCFA, and decrease in Firmicutes/Bacteroidetes ratio. An increase of sulfation degree of porphyran showed to increase the total SCFA production and a decrease on the ratio of butyric to propionic acid. Carrageenan's molecular weight does not seem to affect SCFA production, and the effect of sulfation degree is not clear. The consumption of these polysaccharides was shown to decrease the Firmicutes/Bacteroidetes ratio. Fucoidans of low molecular weight seem to promote a lower Firmicutes/Bacteroidetes ratio. Alginate consumption both of high and low molecular weight has been shown to increase Bacteroidetes. Low molecular weight laminarans are highly fermented and significantly increase the production of SCFA. Ulvan and sulfated rhamnan polysaccharides have been shown to increase the production of SCFA, although microbiota modulation data are still undisclosed. Overall, seaweed polysaccharides have shown several health benefits, which have been related with gut microbiota modulation
Comparison of postoperative balance and function between primary and revision total knee arthroplasty
No full textObjective: This study aimed to compare postural balance, functional performance, and patient-reported outcomes between primary total knee arthroplasty (pTKA) and revision total knee arthroplasty (rTKA) patients. Methods: A cross-sectional analysis was conducted on 37 patients (57 knees: 30 pTKA, 27 rTKA) who were at least one-year post-surgery. Balance was evaluated using the Biodex Biosway system (postural stability, limits of stability, sensory interaction), while functional mobility was assessed with the 2-Minute Walk Test (2MWT), Timed Up and Go Test (TUGT), and 30-Second Chair Stand Test (30CST). Patient-reported outcomes included the Hospital for Special Surgery knee scale, Lower Extremity Functional Scale, Activities-specific Balance Confidence Scale, and SF-12 health survey. The Benjamini-Hochberg correction was applied for multiple comparisons. Results: The rTKA group was significantly older compared to the pTKA group (p < 0.01). The rTKA group demonstrated significantly worse postural stability with higher scores on the Anteroposterior Stability Index (p = 0.01) and Overall Stability Index (p = 0.007). In functional performance, the pTKA group significantly outperformed the rTKA group on the 2MWT (p = 0.003), TUGT (p = 0.03), and 30CST (p = 0.03). However, there were no significant differences in most patient-reported outcomes, except for a higher SF-12 Mental Component score in the rTKA group (p = 0.036). Conclusions: rTKA patients exhibit significantly worse objective postural balance and functional performance compared to pTKA patients, despite achieving similar pain and functional scale scores. These findings, while influenced by the rTKA group's older age, highlight the need for tailored rehabilitation protocols that specifically address balance deficits and proprioception in this patient population
Predictive Ability of Inflammatory Markers on In-Hospital Outcomes in Patients Admitted to Coronary Care Unit (MORCOR-TURK INFLAME)
No full textWe investigated the prognostic implications of the systemic immune-inflammatory index (SII), atherogenic index of plasma (AIP), C-reactive protein/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and triglyceride/glucose index (TGI) in the MORtality predictors in the CORonary Care Units in TURKey (MORCOR-TURK) population. This is the largest registry of coronary care unit (CCU) patients in Turkey (3157 patients admitted to CCU in 50 different centers). The study population was divided into two according to in-hospital survival status; 137 patients (4.3%) died in-hospital follow-up. A significant correlation was found between death and SII, CAR, NLR, and PNI but not for AIP and TGI in logistic regression. In Model 1 (combining parameters proven to be risk predictors), the -2 log-likelihood ratio was 888.439, Nagelkerke R2 was 0.235, and AUC (area under curve) was 0.814 (95% CI: 0.771-0.858). All other models were constructed by adding each inflammatory marker separately to Model 1. Only Model 3 (CAR + Model 1) had a significantly greater AUC than Model 1 (DeLong P = .01). Our study showed that CAR, but not other inflammatory index, is a significant predictor of in-hospital mortality in CCU patients when added to proven risk predictors
Within-and Between-Subject biological variation estimates of serum free light immunoglobulin chains in healthy individuals in Turkey
No full textSerum light immunoglobulin chains (LCs) are critical biomarkers for the diagnosis, prognosis, and treatment response monitoring in monoclonal plasma cell dyscrasias. Robust performance standards based on biological variation (BV) data are essential for optimizing patient care. This study aimed to provide updated BV estimates for serum free LCs (kappa and lambda) as well as their kappa/lambda LC ratio. Serum samples from 25 healthy volunteers (10 men, 15 women) were collected weekly over approximately 9 weeks. Serum free LCs were measured in duplicate using the Roche Cobas c501 analyzer. BV estimates with 95 % confidence intervals were calculated using coefficient of variation (CV) in ANOVA for the entire group and by sex, following assessments for outliers, normality, steadystate conditions, and variance homogeneity. The within-subject BV (CVI) estimates were 9.2 %, 8.6 %, 6.6 % for free kappa, free lambda, free kappa/lambda ratio, respectively. The between-subject BV (CVG) estimates were 24.6 %, 26.6 %, and 17.5 %for free kappa, free lambda and free kappa/lambda ratio, respectively. No significant sex differences were observed for CVI with the exception of free kappa and free kappa/lambda ratio or CVG in serum free LCs and their ratio. Free LCs and their kappa/lambda ratio exhibited marked individuality. Analytical performance specifications (APSs) for desirable imprecision and bias ranged 3.9 %-5.4 %, 4.3 %-5.8 % and 2.9 %-4.6 % for free kappa, free lambda and free kappa/ lambda ratio, respectively. This study provides updated, well-characterized BV estimates for serum free (kappa and lambda) and free kappa/lambda ratio, providing essential data to define APSs. The individuality of kappa and lambda underscores the importance of prioritizing reference change values over traditional reference intervals for improved diagnosis and monitoring in clinical practice.Research Fund of the Afyonkarahisar Health Sciences University [22.KARIYER.007]This study was funded by the Research Fund of the Afyonkarahisar Health Sciences University, Project number: 22.KARIYER.007
Prognostic and diagnostic value of node-RADS before and after neoadjuvant therapy in locally advanced gastric cancer
No full textPurpose: The aim of this study was to evaluate the performance of the Node-RADS scoring system in predicting lymph node metastasis in patients with locally advanced gastric cancer(LAGC) before and after neoadjuvant chemotherapy(NAC), and to determine its prognostic value for overall survival(OS) and disease-free survival (DFS). Methods: Data from 131 patients diagnosed with LAGC who underwent NAC were retrospectively reviewed. All patients had undergone surgical treatment. The Node-RADS score was re-assessed by radiologists based on both preand post-NAC CT images. A Node-RADS score of >= 3 was considered positive, and its diagnostic value and prognostic impact were analyzed. Survival analyses were performed using Kaplan-Meier curves and Cox regression analysis. Results: In the pre-treatment period, a Node-RADS score >= 3 was significantly associated with overall survival (OS) only in the univariate analysis (HR = 2.20 [95 % CI:1.12-4.34],p = 0.023),with no association observed for DFS. In the post-treatment period, OS was significantly associated in both univariate and multivariate analyses (univariate HR = 1.21, [95 % CI:1.00-1.45], p = 0.049;multivariate HR = 3.60, [95 % CI:1.05-12.3], p = 0.041), while DFS was significant only in the univariate analysis(HR = 1.96 [95 % CI:1.16-3.30], p = 0.012).In terms of diagnostic accuracy, applying a Node-RADS >= 3 threshold achieved an AUC of 0.786, with 86.7 % sensitivity and 53.7 % specificity in the pre-treatment period, whereas in the post-treatment period it yielded an AUC of 0.717, with 41.1 % sensitivity and 97.6 % specificity. A total of 61(46.5 %) patients died, and 68(51.9 %) patients experienced disease recurrence during the follow-up period. Among 131 patients, the median follow-up duration OS was 36.5 months [IQR: 19.5-55.7], and the median DFS was 28.5 months [IQR: 16.2-45.4]. Conclusion: The Node-RADS score, particularly in the post-NAC period, is an effective prognostic tool for predicting residual lymph node metastases and survival in patients with LAGC. These findings suggest that the scoring system may aid in clinical decision-making after treatment
N-acetylcysteine loaded electrospun core/shell nanofibers: a promising system for ferroptosis in spinal cord injury
No full textSpinal cord injury (SCI) induces a cascade of secondary damage mechanisms, including oxidative stress, inflammation, and cell death, which severely impair neuronal recovery. In this study, N-acetylcysteine (NAC), a thiol-based antioxidant with limited CNS bioavailability, was encapsulated in polycaprolactone (PCL) nanofibers using emulsion electrospinning. This approach allows localized and sustained drug delivery. Span 80 and Poloxamer 407 were used as surfactants to stabilize the emulsion and increase the hydrophilicity of the fibers. The resulting core/shell nanofibers (NAC-CSN) exhibited uniform morphology, improved wettability, and favorable mechanical properties, while supporting cell viability and migration in vitro. Sustained NAC release over several days was achieved, indicating diffusion-controlled delivery. In a rat model of SCI, NAC-CSN treatment attenuated oxidative and ferroptotic damage and promoted early neuroregeneration, which enabled measurable locomotor recovery. These findings suggest that NAC-CSN scaffolds offer an effective neuroprotective strategy against secondary SCI damage and, by enabling localized antioxidant delivery at the lesion site, represent a clinically applicable platform for future tissue engineering and translational therapies.Scientific and Technological Research Council of Turkiye (TUBITAK) [222S821, 223S129]; TUBITAKThis research was supported by the Scientific and Technological Research Council of Turkiye (TUBITAK) under Project No: 222S821 and 223S129. The authors gratefully acknowledge TUBITAK for funding this study
Can large language models perform clinical anamnesis? Comparative evaluation of ChatGPT, Claude, and Gemini in diagnostic reasoning through case-based questioning in oral and maxillofacial disorders
No full textIntroduction: This study aimed to evaluate whether large language models (LLMs) can emulate the clinical anamnesis process and diagnostic reasoning of oral and maxillofacial surgeons. Materials and methods: Twenty-five real clinical cases from five diagnostic categories maxillary sinus diseases, periapical pathologies, orofacial pain disorders and neuropathic pain syndromes, odontogenic cysts and tumors, and temporomandibular joint disorders were simulated. Three LLMs (ChatGPT 4o, Claude 4, and Gemini 2.5) were each provided only the patient's chief complaint and instructed to ask up to ten sequential questions to reach a diagnosis. One independent evaluators scored model performances on a 100 point scale, deducting 10 points for each additional question asked. Statistical comparisons were conducted using Kruskal-Wallis and Bonferroni post-hoc tests. Results: No statistically significant difference was found among the models (p = 0.431). Gemini achieved the highest mean diagnostic score (43.6 +/- 40.71), followed by ChatGPT-4o (37.2 +/- 36.8) and Claude (31.6 +/- 33.0). Diagnostic accuracy was highest in moderately difficult cases (p = 0.021) and markedly decreased in difficult ones (p = 0.016). Conclusion: LLMs demonstrated the ability to perform structured anamnesis and reach clinically meaningful diagnostic conclusions using limited information. Although no significant difference was observed among the models, Gemini achieved the highest overall mean score. These findings indicate that LLMs hold potential as complementary tools for diagnostic reasoning and as simulation-based educational resources in oral and maxillofacial surgery
Incorporation and release of epidermal growth factor for spinal cord injury using emulsion based nanofibrous scaffolds
No full textSpinal cord injury (SCI) presents a major public health challenge due to its severe and often irreversible neurological consequences. This study investigates the use of nanofibrous scaffolds, prepared by electrospinning of polymeric emulsions, for the incorporation and controlled release of epidermal growth factor (EGF) to enhance neuronal repair and regeneration following SCI. Polycaprolactone (PCL) was used as a biodegradable polymer, combined with Span 80 and Poloxamer 407 (Plx P407) to optimize the scaffolds for sustained EGF release. The emulsion electrospinning technique successfully encapsulated EGF while preserving its bioactivity, mitigating burst release issues. Morphological evaluation of the scaffolds revealed continuous structures with a distinct core-shell arrangement, and in vitro release studies demonstrated a prolonged release of EGF up to 25 days. Cumulative release for F10-EGF, F11-EGF, and F12-EGF nanofibers reached 97.4 ± 0.5 %, 94.7 ± 1.3 %, and 88.9 ± 1.6 %, respectively, with burst release values of 23.4 ± 2.6 %, 14.2 ± 1.6 %, and 8.6 ± 1.0 %. Cell viability assays confirmed the scaffolds' biocompatibility, and wound healing assays showed enhanced tissue regeneration in the presence of EGF. These findings highlight the amplified and prolonged therapeutic effects of EGF as both a neuroprotective agent and a promoter of tissue healing, offering a promising therapeutic approach for SCI. The developed scaffolds provide a platform for the long-term release of therapeutic agents, potentially enhancing recovery outcomes for patients with SCI. Future studies will explore in vivo applications to further validate these results in clinical settings. © 2025 Elsevier B.V.Türkiye Sağlık Enstitüleri Başkanlığı, TUSEB, (28043