Search Results (46)

Background/Objectives: Vestibular socket therapy (VST) is a minimally invasive technique for immediate implant placement (IIP) in compromised extraction sockets that reconstructs the deficient buccal plate while preserving the crestal soft tissue. Despite growing clinical adoption, the randomized evidence on its predictability and biological performance remains limited. Methods: Following PRISMA 2020 and prospectively registered in PROSPERO (CRD420261288724), PubMed/MEDLINE and EMBASE were searched to January 2026 for randomized controlled trials (RCTs) evaluating VST with IIP. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed. Final follow-up buccal bone plate thickness was pooled using a random-effects model; trials comparing variations within VST were reported narratively but not pooled. Results: Seven RCTs (186 participants) were included; implant survival was 99.5%, with no shield exposure, peri-implantitis, or dehiscence. Meta-analysis of the three trials comparing VST against a distinct alternative technique showed no significant between-group difference in final buccal bone plate thickness at any level: crestal +0.24 mm (95% CI−0.13 to 0.61; I² = 45%), mid-root +0.32 mm (−0.45 to 1.09; I² = 82%), or apical +0.19 mm (−0.48 to 0.87; I² = 67%). VST showed minimal mid-facial recession, stable papillae, and Pink Esthetic Scores of 10.29–13.17. Certainty was very low for all outcomes. Conclusions: VST achieved high implant survival and favorable soft tissue and esthetic outcomes but did not significantly outperform comparator techniques in buccal bone plate thickness, with very low certainty. Adequately powered, independent trials with longer follow-up are needed. Full article

Background: Lung cancer remains the leading cause of cancer-related mortality, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. Over the past decade, immune checkpoint inhibitors have become a core component of first-line treatment for advanced-stage NSCLC lacking driver mutations. Programmed death-ligand 1 (PD-L1) expression is currently used as the standard biomarker, yet its predictive value remains limited, and in most immunotherapy trials, treatment efficacy has been observed independently of PD-L1 expression status. Enhancer of zeste homolog 2 (EZH2), an epigenetic regulator, promotes immune escape by suppressing antigen presentation and impairing CD8+ T-cell function, thereby generating an immune-cold tumor microenvironment, positioning it as a promising candidate biomarker. Methods: We retrospectively analyzed 102 NSCLC patients treated with immunotherapy at a single center between 2018 and 2024. EZH2 expression was assessed by immunohistochemistry. A cohort-derived 25% threshold was used for the primary exploratory analysis, and the analyses were repeated using a 50% threshold as a sensitivity analysis. Patients were classified as EZH2-high (45.1%) and EZH2-low (54.9%) at the 25% threshold. Results: At the 25% threshold, objective response rate (ORR) was 53.6% in the EZH2-low group and 45.7% in the EZH2-high group (Fisher’s exact p = 0.551), while disease control rate (DCR) was 64.3% and 60.9%, respectively (p = 0.837). Median overall survival (OS) was 37 versus 27 months (log-rank p = 0.323), and median progression-free survival (PFS) was 15 versus 12 months (p = 0.387). No significant correlation was found between EZH2 and PD-L1 expression (r = 0.167, p = 0.138). In treatment-line-adjusted Cox models, EZH2 expression was not associated with OS (hazard ratio (HR) 0.953, 95% confidence interval (CI) 0.533–1.704; p = 0.870) or PFS (HR 0.996, 95% CI 0.573–1.733; p = 0.989), whereas squamous histology was an independent predictor of survival. Results remained non-significant at the 50% threshold. Early progression was uncommon and did not differ significantly by EZH2 status overall or within PD-L1 strata. Conclusions: In this real-world cohort, EZH2 expression was not independently associated with response, early progression, OS, or PFS, and showed no correlation with PD-L1. These exploratory findings do not support the clinical use of EZH2 as a biomarker at this stage; prospective, multicenter studies using predefined thresholds and standardized immunohistochemical methods are needed to clarify its potential role as a marker complementary to PD-L1. Full article

Background/Objectives: Finerenone improves cardiovascular and renal outcomes in diabetic kidney disease (DKD), but hyperkalemia remains a key safety concern. Patients with elevated baseline potassium levels (≥4.9 mEq/L) are largely excluded from clinical trials, and real-world data in this population are scarce. Methods: In this retrospective multicenter cohort study derived from the FINE-TURK cohort, adults with DKD who initiated finerenone with baseline potassium ≥ 4.9 mEq/L were included. The primary outcome was clinically significant hyperkalemia (K ≥ 5.5 mEq/L) within three months. Multivariable logistic regression analyses were used to identify associated factors, with multiple sensitivity analyses performed. Results: A total of 166 patients were included, of whom 47 (28.3%) had baseline potassium levels between 5.1 and 5.5 mEq/L. Of the 166 patients, 35 (21.1%) reached the primary outcome, and 10 (6%) patients had follow-up potassium ≥ 6.0 mEq/L. 126 (76.8%) patients required no intervention, 24 (14.6%) were initiated on potassium binders, and finerenone was discontinued in only 12 (7.3%) patients. Lower baseline estimated glomerular filtration rate, baseline urinary albumin, loop diuretic use and 20 mg finerenone dose were associated with the primary outcome. In contrast, baseline potassium was not associated with the primary outcome. Conclusions: In patients with DKD and elevated baseline potassium levels, finerenone initiation was associated with manageable rates of hyperkalemia. Our findings support the cautious use of finerenone in selected patients under close monitoring, as well as highlight the need for a multidimensional approach to hyperkalemia risk assessment. Full article

Background/Objectives: Despite improved survival with immune checkpoint inhibitors, the optimal treatment after anti-PD-1 progression in metastatic melanoma remains unclear. This study compared survival outcomes and treatment responses between chemotherapy (CT)- and immunotherapy (IO)-based therapies administered after nivolumab progression in patients with BRAF-negative metastatic melanoma. Methods: This multicenter retrospective study included patients with BRAF-negative metastatic melanoma who developed disease progression during nivolumab treatment. Post-progression systemic therapies were categorized as CT- or IO-based treatments. Treatment responses were assessed according to RECIST version 1.1 criteria. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method, and prognostic factors were evaluated using Cox regression analyses. Results: A total of 141 patients were included. Following nivolumab progression, 107 (75.9%) received CT and 34 (24.1%) received IO. Based on best response to nivolumab, the objective response rate (ORR; CR + PR) was 55.1% in the CT group and 44.1% in the IO group. After post-nivolumab treatment, ORRs were 29.9% and 32.4% in the CT and IO groups, respectively, whereas complete response rates were higher with IO (21.2% vs. 3.0%). Median PFS was 4.17 months in the CT group and 3.9 months in the IO group (p = 0.403). Median OS was 7.83 and 8.17 months, respectively (p = 0.416). Elevated LDH level was identified as an independent adverse prognostic factor. Conclusions: In this multicenter real-world cohort, no statistically significant differences in survival were observed between patients receiving CT or IO after nivolumab progression. Given the retrospective, non-randomized study design, these findings should not be interpreted as evidence of comparative treatment efficacy. The higher CR rate observed with IO should be interpreted cautiously due to potential selection bias. Prospective studies are warranted to define the optimal treatment strategy after anti-PD-1 failure. Full article

Germline BRCA1/2-mutated (gBRCAm) hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (MBC) is a biologically distinct subset in which the efficacy of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors remains incompletely characterized. We evaluated real-world outcomes and prognostic factors in a multicenter retrospective Turkish cohort treated with a CDK4/6 inhibitor plus endocrine therapy (June 2020–September 2025). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier and Cox methods. Among 121 patients, 30 (24.8%) had BRCA1, 88 (72.7%) had BRCA2, and three (2.5%) had dual mutations; 66.9% received first-line therapy, with ribociclib in 69.4% and palbociclib in 29.8%. Objective response rate was 69.4% and the clinical benefit rate was 82.6%. Median PFS was 17.0 months and OS 47.0 months. PFS was numerically longer in BRCA1 than in BRCA2 carriers (25.0 vs. 14.0 months), although the difference was not statistically significant in the pairwise comparison (HR 1.50, 95% CI 0.88–2.56; log-rank p = 0.135); the dual BRCA1/2 subgroup (n = 3) had the poorest outcomes and was assessed descriptively. OS did not differ significantly between BRCA1 and BRCA2 carriers (57.0 vs. 49.0 months; log-rank p = 0.520). PFS did not differ between ribociclib and palbociclib (p = 0.192); OS favored ribociclib at borderline significance (p = 0.050), but this was not confirmed in Cox regression. In multivariable analysis, ECOG ≥ 1 (HR 1.85; p = 0.010) and fulvestrant-based therapy (HR 1.74; p = 0.041) predicted shorter PFS; fulvestrant also predicted worse OS (HR 2.39; p = 0.008). CDK4/6 inhibitor-based therapy shows meaningful activity in gBRCAm HR+/HER2- MBC; the numerically poorer outcomes observed in BRCA2 carriers are hypothesis-generating and warrant validation in larger cohorts. Full article

This study aims to provide insight into consumer purchasing decisions by integrating eye-tracking data with forecasting techniques. First, the study investigates how consumption motives (hedonic vs. utilitarian) and purchasing purposes (for oneself vs. for others) influence visual attention and decision-making processes. An experimental design was conducted with 128 participants in a simulated online shopping environment, where eye-tracking data were collected based on fixation counts and durations across defined Areas of Interest (AOIs). Second, a total of 20 input features were collected, comprising fixation counts and fixation durations for 10 review-related Areas of Interest (AOIs), and these features were evaluated across the experimental scenarios, while the binary output variable represented the participant’s purchase decision. These biometric features, together with scenario information, were used to forecast purchasing decisions using six machine-learning methods, including Artificial Neural Networks, Random Forest, Support Vector Machine, K-Nearest Neighbors, Naive Bayes, and Logistic Regression. The results indicate that consumers’ visual attention aligns with their consumption motives and purchasing purposes, revealing distinct gaze patterns across different scenarios. In the forecasting phase, the accuracy of different methods for predicting purchasing decisions using review-related eye-tracking data is evaluated. Support Vector Machines achieved the highest overall accuracy, approximately 59–60% across the evaluated datasets, compared with a validation-specific majority-class baseline of 53.85%. This corresponds to a modest improvement of approximately 5.15–6.15 percentage points over the naive benchmark. Overall, the findings suggest that objectively recorded review-related eye-tracking data can be operationalized as behavioral input features in a machine-learning-based purchase-decision classification framework, highlighting the methodological value of integrating eye-tracking insights with consumer behavior forecasting. Full article

Background radiation and nuclear applications are deeply embedded in modern life. With the continuous advancement in nuclear techniques, daily radiation exposure is commonplace. The level of knowledge within this field among the general public must therefore be assessed to ensure that fundamental and essential information on radiation and nuclear energy is attained and to prevent the spread of misinformation. The aim of this study is to evaluate the level of knowledge and awareness of this topic among the general public in Oman. The study was performed using a cross-sectional survey specifically designed to measure the knowledge of different aspects in the field of radiation and nuclear applications. We achieved this aim by assessing the level of knowledge among the general public and medical professionals. Overall, 500 individuals participated in the study, 75 of whom were from the medical field. The results demonstrate varying levels of knowledge on this topic. In general, the public and medical professionals show a high level of confidence in basic information; however, the level of knowledge and confidence decreases to intermediate and, in some cases, low levels with questions at fundamental and intermediate levels of knowledge. This decrease was clearly observed among topics related to the nature of radiation, the origin of radiation, radiation protection, and radiation applications. Our findings demonstrate conclusively that the public and medical professionals in Oman have limited knowledge in this field; therefore, appropriate measures must be implemented. Full article

The rise in emerging viral outbreaks has intensified the need for novel antiviral therapies and highlighted the untapped potential of natural products. Influenza viruses, particularly avian strains, continue to evolve rapidly, yet the antiviral properties of Jordan’s native plants remain largely unexplored. This study focused on avian influenza and screened twelve endemic plant species, using ethanol to selectively extract polar phytochemicals likely to interact with the hydrophilic active site of neuraminidase (NA). Among these, Arbutus andrachne leaf and fruit extracts emerged as potent in vitro inhibitors of recombinant N9 neuraminidase, a key enzyme in influenza replication, with IC₅₀ values of 31.6 µg/mL and 32.9 µg/mL, respectively. LC-MS analysis identified hyperoside as the major shared flavonoid in both extracts, which may contribute to the observed inhibitory activity. These findings support the potential of A. andrachne as a natural source for herbal preparations with antiviral activity. Full article

Heatwaves are among the most significant climate extremes affecting Egypt, with direct impacts on human health, energy demand, water resources, and overall thermal comfort. Although several previous studies have examined heatwave characteristics in Egypt, most have relied on station-based or localized analyses, limiting the understanding of national-scale patterns and recurrence behavior. To address this gap, this study provides a comprehensive national-scale assessment of the spatiotemporal characteristics of heatwave occurrences across Egypt from 1990 to 2023 using daily maximum and minimum temperatures derived from the ERA5 reanalysis dataset. Daytime and nighttime heatwaves were defined using the 90th percentile temperature thresholds and a minimum duration of three consecutive days. This made it possible to study their frequency, duration, severity, seasonal distribution, and how often they happened again. The results demonstrate that heatwaves happen more often and with more severity in late July and August. This is especially true for nighttime heatwaves. These findings indicate that daily baseline temperatures in Egypt have been rising steadily since 2010. Nighttime heatwaves show a notable increase in frequency and persistence, indicating a sustained rise in baseline temperatures and reduced nocturnal cooling. By providing the first long-term, spatially consistent national-scale heatwave assessment over Egypt, this study contributes to a more comprehensive understanding of extreme temperature behavior under ongoing climate change. Full article

Egypt generally experiences a hot and arid climate, with rainfall primarily confined to the northern coast during winter season. However, on 31 May 2025, Alexandria experienced an unusual late-spring convective storm that was associated with heavy rainfall, strong winds, intense lightning, and localized hail. This rare event caused temporary disruptions to urban life and underscored the growing vulnerability of coastal cities to short-duration, high-intensity precipitation events occurring outside the climatological rainy season. This study investigates the atmospheric mechanisms underlying this event through a comprehensive synoptic and dynamic analysis of pressure systems, wind fields, and temperature structures extending from the surface to the 200 hPa level. Particular emphasis is placed on the role of moisture convergence and upper-level dynamical forcing in triggering the rapid development of deep convection. Furthermore, the influence of anomalous large-scale circulation patterns on storm initiation and intensification is systematically examined. Improved understanding of these processes provides valuable insight into off-season convective activity over the southeastern Mediterranean and enhances forecasting capability, risk assessment, and early warning strategies for similar extreme events in the region. Furthermore, the influence of anomalous large-scale circulation patterns on storm initiation and intensification is quantitatively assessed to clarify their contribution to the event’s development. A deeper understanding of these processes offers critical insight into the mechanisms governing off-season convective activity over the southeastern Mediterranean and strengthens forecasting skill, risk assessment frameworks, and early warning systems for comparable extreme events in the region. Full article

Background and Objectives: To evaluate pregnancy outcomes and transthoracic echocardiographic (TTE) findings during the antenatal and postpartum periods in women with repaired Tetralogy of Fallot (ToF) who delivered at Çukurova University Faculty of Medicine, Balcalı Hospital, between 2011 and 2025 and to interpret these findings in the context of the 2025 European Society of Cardiology (ESC) recommendations. Materials and Methods: This single-center retrospective cohort study undertaken between 2011 and 2025 included 11 pregnant women with surgically repaired ToF. Maternal demographic characteristics, obstetric outcomes, mode of delivery, neonatal outcomes, and antenatal TTE parameters were recorded. Cardiac measurements obtained during pregnancy were compared with postpartum TTE findings performed 3–6 months after delivery to assess pregnancy-related cardiac adaptation and recovery. Results: A total of 11 pregnancies in women with repaired ToF were analyzed. Nine pregnancies resulted in live births, while one ended in missed abortion at 9 + 2 weeks and one in intrauterine fetal demise at 34 + 2 weeks. Among live births, the mean gestational age was 36 + 2 weeks and the mean birthweight was 2865 g, with a preterm delivery rate of 55.6%. Cesarean section was performed in 70% of cases, while 30% delivered vaginally. During pregnancy, the mean left ventricular ejection fraction was 62.6%, and residual tricuspid regurgitation was the most frequently observed echocardiographic finding. Postpartum TTE evaluations indicated that echocardiographic parameters were largely stable over the observation period, with no numerical change and no clear evidence of deterioration in ventricular function or progression of valvular regurgitation. Conclusions: Despite successful surgical repair, pregnancy may still pose potential risks for women with ToF, underscoring the importance of individualized, multidisciplinary management. In this cohort, pregnancy appeared to be generally well-tolerated when care was provided in accordance with contemporary ESC recommendations. The observation of preserved ejection fraction and overall stable right ventricular function in the early postpartum period suggests that favorable maternal cardiac adaptation may be achievable in carefully selected patients. Early postpartum echocardiographic assessment may be useful for identifying functional changes and informing structured long-term follow-up strategies. Full article

Background: Poly(ADP-ribose) polymerase (PARP) inhibitors have been established as a first-line maintenance therapy in advanced epithelial ovarian cancer (EOC) following platinum-based chemotherapy. While phase III trials have demonstrated significant progression-free survival (PFS) benefits with olaparib and niraparib, real-world data remain limited. Methods: This retrospective, multicenter real-world study included 179 patients with newly diagnosed epithelial ovarian treated with first-line maintenance olaparib or niraparib across 33 centers in Türkiye between January 2014 and March 2025. Clinical, pathological, and molecular data—including BRCA (Breast Cancer Susceptibility Gene) mutation status, origin, and variant classification—was collected. The primary endpoint was PFS, and secondary endpoints included overall survival (OS) and safety. Survival outcomes were analyzed using Kaplan–Meier methods. Results: Of 179 patients, 110 received olaparib and 69 received niraparib. BRCA mutations were present in 88.3% of patients, while 11.7% had unknown HRD status. Median follow-up was 16.5 months, and median PFS was not reached. Estimated PFS rates for the overall cohort were 91.0% at 6 months, 83.0% at 12 months, and 64.0% at 24 months. In the olaparib cohort, BRCA-mutant patients demonstrated PFS rates of 89%, 78%, 73%, and 64% at 6, 12, 18, and 24 months, respectively. In the niraparib cohort, corresponding PFS rates among BRCA-mutant patients were 87% at 6 months and 75% at 12 months. Patients harboring pathogenic BRCA variants experienced longer PFS compared with those with likely pathogenic variants. Any-grade adverse events occurred in 73.7% of patients, and grade 3–4 events in 29.6%, with hematologic toxicities predominating. Dose interruptions were more frequent with niraparib, while treatment discontinuation rates were low in both groups. No cases of myelodysplastic syndrome or acute myeloid leukemia were observed. Conclusions: In this large multicenter real-world cohort, first-line maintenance therapy with olaparib and niraparib provided durable PFS benefit in patients with advanced EOC, particularly among those with pathogenic BRCA mutations, confirming their effectiveness and manageable safety profiles in routine clinical practice. Full article

Tuberculosis and sarcoidosis can present with similar clinical and radiological features, especially intrathoracic lymphadenopathy, complicating differential diagnosis. This study explored the potential utility of QuantiFERON-TB Gold (QFT), serum High Mobility Group Box 1 protein (HMGB1), and microRNA-221 (miRNA-221) relative expression as biomarkers to aid in distinguishing tuberculosis-related intrathoracic lymphadenopathy (TBIL) from sarcoidosis-related intrathoracic lymphadenopathy (SAIL). The study included 27 patients with TBIL, 27 patients with SAIL, and 27 healthy controls. QFT results, serum HMGB1 levels, and miRNA-221 relative expression were measured and compared across groups using univariable and exploratory multivariable analyses. Significant differences were observed among the study groups for serum HMGB1 levels, miRNA-221 expression, and QFT results (p < 0.001). Both TBIL and SAIL patients had significantly higher HMGB1 levels compared with healthy controls, consistent with inflammatory activity. In contrast, miRNA-221 expression was significantly elevated in TBIL patients compared with both SAIL patients and controls. Exploratory analyses suggested a potential contribution of miRNA-221 to differentiating TBIL from SAIL, whereas the effects of HMGB1 and QFT were less pronounced after adjustment. The findings suggest that miRNA-221, alongside HMGB1 and QFT, may contribute to the differentiation of TBIL from SAIL, although validation in larger cohorts is necessary. Full article

This study looked at a fungal–cyanobacterial co-pellet system for cleaning up coffee waste and producing high-value polymers. Optimization focused on the pelletization process, waste removal efficiency, and biomass yield. Optimal conditions, including pH (6.5), glucose concentration (6 g/L), and shaking speed (130 rpm), achieved a maximum cyanobacterial immobilization efficiency of up to 97% on the fungal mycelium. Scanning electron microscopy (SEM) confirmed the formation of an integrated co-pellet structure, with fungal hyphae acting as a physical scaffold and extracellular polymeric substances (EPSs) enhancing cell–cell adhesion. The co-culture system exhibited superior performance compared to fungal (20.56 g/L) and algal (1.09 g/L) monocultures. It effectively removed major coffee effluent pollutants, achieving a significant reduction in total phenolic compounds (74.5%). Furthermore, the co-pellets displayed a remarkable final biomass yield (24.33 g/L) and high production of extracellular polymeric substances (EPSs) (5.28 g/L) and intracellular polymeric substances (IPSs) (3.84 g/L). The synergistic relationship was further confirmed by high nitrogen contents in the co-pellets (15.24%), which significantly surpassed that of the individual fungal biomass, suggesting interspecies nutrient transfer. Valuable glycerol-lipids were detected and identified in the fermentative broth of the co-culture confirming a highly efficient bioconversion process. Analyses revealed a targeted metabolic flow toward the accumulation of monoglycerides, notably monooleoylglycerol and monopalmitin, highlighting a powerful cooperative compatibility for producing high-value emulsifiers. Overall, these findings firmly establish the cyano-fungal co-pellet system as a robust and sustainable biorefinery approach for treating complex industrial wastewater while producing a high-quality, value-added biomass suitable for utilization as a biofertilizer or animal feed. Full article

Background: Postoperative cognitive dysfunction (POCD) is a common postoperative condition after neurosurgery, and in patients of advancing age, with far-reaching implications for recovery and quality of life. Current evidence points to the gut–brain axis as the main mechanism for the regulation of perioperative neuroinflammation and cognition. Objective: The aim of this review is to consolidate the existing evidence for perioperative gut microbiome dysbiosis in POCD, specifically in neurosurgical patients. Methods: A review of preclinical and clinical evidence on the gut microbiome, surgical stress, and cognitive recovery was conducted. Both mechanistic and therapeutic evidence were examined. Results: Surgery and anesthesia enhance gut microbial diversity, intestinal permeability, and systemic inflammation, thereby compromising neuroplasticity and the integrity of blood–brain barriers. Preclinical models show that interventions to reestablish microbial homeostasis with probiotics, prebiotics, or fecal microbiota transplantation decrease postoperative cognition. Clinical studies offer evidence supporting the associations between decreased short-chain fatty acid-producing bacteria and POCD risk. Randomized controlled trials have demonstrated that perioperative probiotics lower the incidence and markers of POCD. Multi-omic approaches to integrating microbiome, metabolome, and neuroimaging signatures are being engineered to discern recovery phenotypes prior to surgery. Conclusions: Perioperative gut microbiota are a modifiable target for the optimization of cognitive recovery from neurosurgery. The inclusion of microbiome treatments and diagnostics into standard surgical care pathways is one potential pathway to POCD minimization, but large randomized trials will be necessary to establish this. Full article