Search Results (50)

Background/Objectives: Although anti-Müllerian hormone (AMH) is a strong biomarker of ovarian reserve and oocyte pools, it is unknown whether high AMH levels can be a reliable predictor of oocyte quality, ovulation, and embryo quality. We aimed to determine whether there is any AMH threshold value that can be used to predict treatment success in women with clomiphene citrate (CC) resistance or failure in polycystic ovary syndrome (PCOS). Methods: This retrospective cohort study included 93 infertile women with PCOS who had been previously diagnosed with CC failure or CC resistance between May 2017 and June 2018. Prior to treatment, AMH concentration was measured in all women. The participants were divided into 2 groups according to their conception after ovulation induction (OI) and intrauterine insemination (IUI). At the end of a one-year period, the medical files were assessed retrospectively. Those with and without pregnancy were compared in terms of treatment protocols, infertility periods, laboratory parameters and AMH levels. Results: Clinical and biochemical characteristics of 36 pregnant women were compared with those of 57 non-pregnant women. The results showed that the pregnant group had significantly shorter infertility periods and longer ovarian stimulations than the non-pregnant group (p < 0.05). Serum AMH levels > 4.5 ng/mL can predict OI and IUI outcome in this specific patient population, with a sensitivity of 56% and a specificity of 69%. Multivariate logistic regression analysis showed that only AMH was identified as an independent predictor of pregnancy [OR = 1.151 (95% CI: 1.034–1.280), p = 0.010]. Conclusions: Serum AMH may serve as an adjunct predictor of OI and IUI outcomes in infertile women with PCOS who failed to conceive after ≥3 cycles of CC. However, its predictive value appears to be context-dependent and should be interpreted cautiously in clinical practice. Given the distinct clinical characteristics of this patient population, individualized treatment strategies and consideration of earlier alternative therapeutic approaches may be warranted to optimize reproductive outcomes. Full article

The aim of this study was to comparatively evaluate echotextural and hemodynamic changes in the corpus luteum (CL), uterus, and uterine artery, together with serum progesterone (P4) concentrations, using B-mode and Doppler ultrasonography between days 5 and 21 post-insemination in pregnant and non-pregnant cows. Twelve clinically healthy Brown Swiss cows were enrolled and allocated into a cyclic non-inseminated group (n = 6) and an inseminated group (n = 6). Ultrasonographic examinations and progesterone measurements were performed daily during the post-insemination period, and pregnancy was confirmed on day 30. Echotextural parameters (mean gray value and homogeneity) were obtained from the corpus luteum and uterus using B-mode ultrasonography. Doppler ultrasonography was used to assess corpus luteum vascular parameters and uterine artery blood flow, and serum progesterone concentrations were measured at each examination. Corpus luteum mean gray value showed a significant time effect (p < 0.001). For Corpus luteum area and perfusion area, both the time effect and the group × time interaction were significant (p < 0.001), and marked differences between pregnant and non-pregnant cows were observed on days 19, 20, and 21 (p < 0.05). Serum progesterone concentrations also differed significantly between groups on days 20 and 21. In conclusion, changes in corpus luteum area and perfusion area were associated with early pregnancy-related differences and may represent earlier functional ultrasonographic indicators compared with uterine artery Doppler parameters and progesterone concentrations alone. These findings may have practical implications for herd management by potentially enabling differentiation between pregnant and non-pregnant cows approximately 1–2 days earlier than serum progesterone measurements. Full article

Environmental factors motivate migration across the globe, calling for better planning. Although the US experienced such movements during the COVID-19 pandemic, literature on population mobility and outcomes for receiving communities in the US is scarce. We use a mixed-methods case study approach to explore the COVID-era population movement trends in the US Northeast (NE) Region and their outcomes for receiving communities to draw lessons for strategic regional planning aiming to achieve sustainable and equitable outcomes of disaster-induced movements. Utilizing the Statistics of Income data and focus group data collected from 27 local experts in 22 rural counties of NE, which experienced the highest relative numbers of in-movers between 2016 and 2020, the findings revealed the top receiving counties were predominantly rural areas where urbanites moved from within NE. This movement challenged the housing market and services, disproportionately burdening socioeconomically disadvantaged groups in receiving communities. The COVID-19 experience opened a window of opportunity for regional planning to prepare desirable outcomes of such mobilities by addressing existing issues in receiving communities while incorporating pulse and slow population movements into the agenda. The right policy timing and communication among communities are keys to building trust and ensuring integration of newcomers into receiving communities. Full article

Objective: To evaluate the clinical and biochemical differences between pediatric patients with suspected foreign body aspiration (FBA) who had foreign bodies detected on bronchoscopy and those who did not. Methods: Patients undergoing bronchoscopy for suspected FBA were retrospectively divided into two groups: Group 1 (n = 59), with confirmed foreign body; Group 2 (n = 50), without foreign body. Age, blood gas parameters (pCO₂, pO₂, SpO₂), and type and localization of foreign bodies were recorded and statistically compared. Results: The mean age was significantly lower in Group 1 (24.63 ± 12.32 months) than in Group 2 (37.12 ± 32.98 months; p = 0.014). Group 1 had significantly higher pCO₂ levels (41.24 ± 13.37 mmHg vs. 31.53 ± 6.44 mmHg; p < 0.001) and lower pO₂ levels (45.78 ± 12.18 mmHg vs. 53.98 ± 13.24 mmHg; p = 0.001). Oxygen saturation values showed no significant difference between groups (p = 0.19). Among confirmed cases, foreign bodies were located in the right bronchial system (56%), left bronchial system (41%), and trachea (3.4%). Conclusions: Children diagnosed with FBA were younger and exhibited greater abnormalities in blood gas parameters compared to those without FBA. While bronchoscopy remains essential for the definitive diagnosis and treatment of suspected FBA, our findings suggest that these results may play a significant role in reducing unnecessary bronchoscopies. Full article

Background/objectives: The study aimed to present cases of malignant struma ovarii from seven centers in Türkiye and evaluate them within the context of the existing literature. Methods: We retrospectively analyzed clinical data from 17 patients treated at seven centers, focusing on clinical features, surgical management, pathology, thyroid function, adjuvant treatment, and outcomes. Additionally, a literature review including eight studies with 178 patients was conducted. Results: The mean age of patients was 44.7 years, with a mean tumor size of 9.2 cm. Elevated Ca 125 was found in 33.3% of patients, while thyroid function abnormalities and hyperthyroidism signs were rare. Pelvic pain and menstrual irregularities were common presenting symptoms. A total of 16 patients (94.1%) had unilateral tumors. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and unilateral salpingo-oophorectomy were the most frequent surgical approaches. Histopathology predominantly showed classical papillary thyroid carcinoma (13 patients, 76%). All patients were FIGO stage I, with no metastasis. Thyroidectomy was performed in seven patients, identifying two concurrent thyroid cancers. Four patients received adjuvant radioactive iodine therapy. During a median follow-up of 43 months, no deaths and one recurrence were observed. The literature review showed a diagnosis age ranging 43–53 years and papillary thyroid carcinoma as the most common subtype. Thyroidectomy and RAI treatment were selectively applied. Among the reported studies, recurrence occurred in 7 of 76 patients (9.2%), while 5-year disease-free and overall survival rates exceeded 94% and 100%, respectively. BRAF mutations were uncommon. Conclusions: Malignant struma ovarii is a rare tumor with a favorable prognosis when diagnosed early and managed appropriately. Full article

Background/Objectives: Myotonic dystrophy type 1 (DM1) is a multisystem disorder that affects the central nervous system. Despite previous studies, blood-based biomarkers have not been sufficiently characterized. This study investigated plasma neurofilament light chain (NfL), phosphorylated tau (p-tau181), amyloid-β (Aβ42/40), and glial fibrillary acidic protein (GFAP) in a Japanese cohort with DM1 to assess their potential as biomarkers. Methods: Forty patients with genetically confirmed DM1 were enrolled in this study. Plasma NfL, p-tau181, Aβ42/40, and GFAP were quantified using single-molecule array technology. Clinical and genetic variables, including age, CTG repeat size, Mini-Mental State Examination (MMSE) score, modified Rankin Scale (mRS) score, and creatine kinase levels, were analyzed for correlations. Results: NfL and p-tau181 were significantly elevated in patients with DM1 compared with controls, with 95% exceeding the p-tau181 cut-off. NfL was moderately correlated with age, age at onset, and mRS, and no significant associations were observed between p-tau181 and other biomarkers, although a correlation was noted with serum creatine kinase. Conclusions: These findings support that NfL is a marker of disease severity in DM1 and identified plasma p-tau181 as a potential novel biomarker. While the mechanisms underlying the increased p-tau181 levels remain unclear, they may reflect DM1-related pathologies in the brain and possibly in skeletal muscle. Study limitations include a small sample size and lack of age-matched controls, highlighting the need for longitudinal validation. This study demonstrates the utility of NfL and suggests that p-tau181 is an emerging biomarker for DM1, supporting future work toward biomarker-guided monitoring and therapeutic evaluation. Full article

Background/Objectives: Penile urethral stricture is a therapeutically challenging condition that significantly impacts quality of life and is often managed initially with urethral dilation or internal urethrotomy. However, both techniques are associated with high recurrence rates, limited long-term efficacy, and potential adverse effects, particularly in the penile urethra. Urethroplasty remains the gold standard but is invasive and not suitable for all patients. Optilume, a paclitaxel-coated balloon, combines mechanical dilation with localized drug delivery to reduce recurrence rates and the need for re-intervention. This study evaluated its effectiveness in patients with penile urethral strictures. Methods: A retrospective, multicenter study was conducted at two German clinics. Eight male patients (mean age 59) with symptomatic penile urethral strictures underwent Optilume treatment. Symptom severity was assessed using the International Prostate Symptom Score (IPSS) and quality of life (QoL) scores before and after treatment. The primary endpoint was symptom improvement, while the secondary endpoint was the need for reintervention. Patients were followed for a median of 16.5 months. Statistical analyses included Wilcoxon signed-rank and Mann–Whitney U tests. Results: The median IPSS improved from 25.5 to 5.0 and QoL scores from 4.5 to 1.0 after treatment (p < 0.01 for both). No patients required reintervention during follow-up. The subgroup analysis showed slightly better outcomes in patients without prior interventions, although differences were not statistically significant. The stricture length did not correlate with treatment response. Conclusions: Optilume significantly reduces urinary symptoms and improves QoL in penile urethral strictures, and the absence of re-interventions during follow-up underscores its durable mid-term success. It offers a minimally invasive alternative to urethroplasty, particularly for patients seeking symptom relief with a shorter recovery time and no hospital stay or general anesthesia. These preliminary findings suggest that Optilume may be a promising minimally invasive option for selected patients. Larger, controlled studies are warranted to validate these results and refine patient selection criteria. Full article

Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns in this population. Objectives: This study aimed to evaluate the effects of a synchronous telerehabilitation program—designed to support post-surgical recovery in individuals with adolescent idiopathic scoliosis (AIS)—on trunk muscle endurance, trunk flexibility, functional capacity, pain severity, perception of appearance, and quality of life. Methods: Thirty-two individuals with AIS, who had undergone surgery 6 months to 2 years prior, were randomly assigned to either an intervention group or a control group. The intervention group participated in a supervised telerehabilitation program twice weekly for eight weeks, while the control group received no exercise intervention. All outcome measures were assessed before and after the intervention. Results: The telerehabilitation group demonstrated significant improvements across all outcome measures compared with the control group (p < 0.05). Post-intervention, the telerehabilitation group had superior trunk muscle endurance, flexibility, and quality-of-life scores, as well as reduced pain intensity (p < 0.05). However, no significant differences were observed between the groups in functional capacity or perception of appearance (p > 0.05). Conclusions: A supervised telerehabilitation program initiated six months after surgery can effectively improve trunk muscle endurance, flexibility, pain intensity, and quality of life in individuals with AIS. These findings emphasize the value of structured post-surgical rehabilitation and raise awareness of the potential benefits of remotely delivered exercise programs in this population. Full article

Background: Cardiovascular diseases are the leading cause of global mortality, with 80% of coronary heart disease in patients over 65. Understanding aging cardiovascular structures is crucial. Photon-counting computed tomography (PCCT) offers improved spatial and temporal resolution and better signal-to-noise ratio, enabling texture analysis in clinical routines. Detecting structural changes in aging left-ventricular myocardium may help predict cardiovascular risk. Methods: In this retrospective, single-center, IRB-approved study, 90 patients underwent ECG-gated contrast-enhanced cardiac CT using dual-source PCCT (NAEOTOM Alpha, Siemens). Patients were divided into two age groups (50–60 years and 70–80 years). The left ventricular myocardium was segmented semi-automatically, and radiomics features were extracted using pyradiomics to compare myocardial texture features. Epicardial adipose tissue (EAT) density, thickness, and other clinical parameters were recorded. Statistical analysis was conducted with R and a Python-based random forest classifier. Results: The study assessed 90 patients (50–60 years, n = 54, and 70–80 years, n = 36) with a mean age of 63.6 years. No significant differences were found in mean Agatston score, gender distribution, or conditions like hypertension, diabetes, hypercholesterolemia, or nicotine abuse. EAT measurements showed no significant differences. The Random Forest Classifier achieved a training accuracy of 0.95 and a test accuracy of 0.74 for age group differentiation. Wavelet-HLH_glszm_GrayLevelNonUniformity was a key differentiator. Conclusions: Radiomics texture features of the left ventricular myocardium outperformed conventional parameters like EAT density and thickness in differentiating age groups, offering a potential imaging biomarker for myocardial aging. Radiomics analysis of left ventricular myocardium offers a unique opportunity to visualize changes in myocardial texture during aging and could serve as a cardiac risk predictor. Full article

Background/Objectives: Ovarian germ cell tumors are rare, and determining prognostic factors is crucial for individualizing management strategies. We aimed to determine an optimal neutrophil-to-lymphocyte ratio (NLR) cut-off value for predicting survival outcomes in malignant ovarian germ cell tumors, and to evaluate the prognostic significance of NLR in these tumors. Methods: This retrospective cohort study included women diagnosed with malignant ovarian germ cell tumors who underwent surgery at Istanbul University-Cerrahpasa between 2000 and 2024. Patients with benign tumors; incomplete follow-up; inaccessible data; history of hematological or rheumatic diseases; inflammatory conditions such as diabetes mellitus, asthma, or renal failure; as well as those with acute/chronic infections or sepsis were excluded. Data collected included demographic characteristics, surgical and pathological findings, chemotherapy details, disease progression, survival outcomes, and laboratory values at preoperative, postoperative, and post-chemotherapy time points. The NLR was calculated and compared for overall survival and disease-free survival. Results: The study included 44 patients with a pathologically confirmed diagnosis of malignant ovarian germ cell tumors. The NLR cut-off value for survival prediction was determined as 3.69 using the ROC curve. The effect of preoperative NLR on overall survival was found to be significant. The median overall survival was significantly lower in the group with NLR ≥ 3.69 (153.2 months) compared to the group with NLR < 3.69 (234 months) (p = 0.010). However, there was no statistically significant difference in median disease-free survival between the NLR ≥ 3.69 group (159.3 months) and the NLR < 3.69 group (215 months). Conclusions: The preoperative NLR was found to have a significant impact on overall survival but not on disease-free survival. A cut-off value of 3.69 can be used to assess short survival time. Full article

Background and Objectives: Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention in order to preserve erectile function and penile length. This study aims to evaluate the management of recurrent ischemic priapism in sickle cell disease (SCD) patients in an endemic region and compare it with ischemic priapism of other etiologies. Materials and Methods: Patients admitted to our hospital with a diagnosis of priapism between January 2010 and June 2024 were retrospectively reviewed. The patients were divided into two groups: ischemic priapism due to SCD and ischemic priapism due to other etiologies. Patient characteristics, treatment management, and the need for penile prosthesis (PP) were compared. Results: A total of 40 ischemic priapism patients were included in the study; 20 of them had SCD and the other 20 had priapism cases due to different etiologies. In the SCD priapism group, the rate of comorbidity and previous history of priapism were significantly (p < 0.05) higher than in the other etiologies of priapism group. Similarly, in the SCD priapism group, the hospital admission time and the rate of fibrosis findings in MRI (magnetic resonance imaging) were significantly (p < 0.05) higher than in the other priapism groups. The PP implantation rate in the SCD priapism group was found to be significantly (p < 0.05) higher than in the other priapism group. Conclusions: This study highlights the importance of early intervention and patient awareness in SCD-related ischemic priapism, recommending educational programs to improve symptom recognition and prevent complications. Full article

Background: The purpose of this systematic review was to investigate the clinical outcome measures, either in separation or in conjunction with the Cobb angle, that were employed in randomized controlled trials to evaluate posture and spinal deformity. Methods: The PubMed, PEDro, OVID, and Scopus electronic databases were used to search for published articles from January 2004 to May 2024. All the searches included English language studies. Keywords were determined as “scoliosis, exercise, physical activity, brace, bracing, conservative treatment, rehabilitation, physiotherapy and physical therapy”. Results: The most commonly used clinical evaluation parameters other than the Cobb angle in the studies were the ATR and surface topography measurements. The most commonly used assessment methods were POTSI asymmetry assessment performed with measurements made on photographs, the WRVAS, a deformity perception assessment evaluated with different photographs, and the SRS-22 scale, a disease-specific quality of life assessment. Conclusions: New developments in the treatment of scoliosis have brought about alternative measurement techniques that offer a more comprehensive view of patient outcomes. As a result of the review of the literature, it has emerged that radiation-free, valid, and reliable multidimensional evaluations should be performed in follow-up and treatment efficacy evaluations after initial diagnosis in adolescent idiopathic scoliosis. Full article

Background and Objectives: Primary prostatic stromal sarcoma is an exceptionally rare urological malignancy, constituting less than 0.1% of all prostatic cancers. It poses a significant clinical challenge due to its aggressive behavior and poor prognosis. Materials and Methods: We report the case of a 34-year-old male who presented with nonspecific lower urinary tract symptoms, including dysuria and increased urinary frequency. The initial diagnostic workup, including digital rectal examination and Magnetic Resonance Imaging (MRI), revealed a lobulated lesion within the prostate. A transurethral resection (TUR) was performed for diagnostic purposes, and histopathological examination revealed a “malignant mesenchymal tumor”. The patient underwent a laparoscopic radical prostatectomy. The pathology report confirmed the diagnosis of prostatic stromal sarcoma. The postoperative follow-up, including systemic CT and MRI, showed no evidence of recurrence or metastasis thus far. Results: Multidisciplinary management is essential for optimizing treatment outcomes in all urologic malignancies; however, it becomes particularly challenging and crucial in rare cases such as primary prostatic stromal sarcoma. In our case, the patient benefited from a coordinated approach involving urology, pathology, and oncology, underscoring the importance of collaborative care for rare and aggressive tumors like this. This case highlights the importance of early detection, complete surgical excision, and consideration of adjuvant therapies, given the aggressive nature of the disease. The role of novel therapeutic strategies, including immunotherapy and targeted therapies, is also discussed in the context of metastatic sarcomas. Conclusions: This case underscores the critical need for a comprehensive, multidisciplinary approach to managing primary prostatic stromal sarcoma. Ongoing research on innovative therapies offers hope for improved outcomes in metastatic stages. Full article

This study presents two novel frameworks, termed a quasi-modular b-metric space and a non-Archimedean quasi-modular b-metric space, and various topological properties are provided. Using comparison and simulation functions, this paper rigorously proves several fixed point theorems in the non-Archimedean quasi-modular b-metric space. As a useful application, it also establishes Ulam–Hyers stability for the fixed point problem. Finally, this study concludes with a unique solution to a non-linear fractional differential equation, making a substantial contribution to the discipline. Full article

Raptors (Accipitriformes, Falconiformes and Strigiformes) are important for ecological niches as bioindicators and an apex predator; however, their global populations have continuously decreased due to human activities, habitat loss and contagious diseases. Avian malaria that may cause the negative impact on raptors’ health may also contribute to the declining of raptor populations. This study reported malaria’s molecular prevalence and genetic diversity in wild-caught and rehabilitated raptors in the Kasetsart University Raptor Rehabilitation Unit. In total, 109 raptors from 18 provinces of Thailand were classified into two groups, which included 78 diurnal raptors (DIRs) in Accipitriformes and 31 nocturnal raptors (NORs) in Strigiformes. Each ethylenediaminetetraacetic (EDTA) blood sample (0.5–1 mL) was tested through haematological analyses and polymerase chain reaction (PCR)-based detection to assess parasites’ health impacts. Amplicons of PCR positive samples were analysed for a nucleotide sequencing and phylogenetic relationships. The overall prevalence of avian malaria was low at 3.67% (4/109) (95% CI: 1.44–9.06%), with a prevalence of 3.86% (3/78) (95% CI: 1.32–10.70%) in DIRs and 3.23% (1/31) (95% CI: 1.32–10.70%) in NORs. Most of the infected samples were from southern Thailand. This suggested that the raptors in humid habitats are more vulnerable to the malarial infection, which was likely associated with vector and parasite abundance. Clinical appearances and haematological examinations demonstrated that raptors could tolerate the infection and only became asymptomatic and subclinically infected. This study is the first report of the infection of avian malaria in Cinerous Vulture, Himalayan Vulture and Barred Eagle Owl in Thailand, providing baseline information in preparedness for the disease diagnostic and further study of avian malaria in some endangered raptor species. Full article