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SUMMARY OBJECTIVE: The aim of this study was to analyze the performance of ChatGPT in the generation of new systematic review ideas in urooncology. METHODS: In September 2024, we requested ChatGPT Version 4.0 to generate 10 systematic review ideas in general urooncology and also 10 ideas for each of the four subcategories: bladder cancer, prostate cancer, renal cell carcinoma, and testicular cancer. We utilized PubMed and Scopus to examine 50 ideas to determine whether prior systematic reviews had addressed them. Novelty was defined as a topic without prior systematic review. RESULTS: ChatGPT generated 30% original systematic review ideas, with 15 out of 50 being novel. The novelty rate for general urooncology was 50%. The rates for subcategories were 10% for both bladder and prostate cancer, 50% for renal cell carcinoma, and 30% for testicular malignancies. Approximately 10% of general research concepts external to systematic reviews were novel. CONCLUSION: ChatGPT performed very well in producing creative, apt, and partially viable systematic review ideas in urooncology. Although human judgment is still required to determine feasibility and create proposals with better accuracy, ChatGPT and other large language models can be useful aids while designing research, especially for dynamic and information-heavy disciplines such as urooncology.

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SUMMARY OBJECTIVE: The aim of this study was to compare serum levels of endocan, human epididymis protein 4, sialyl-Tn antigen, and neopterin between women with endometrial cancer and asymptomatic healthy controls, and to explore their discriminatory performance in this case–control setting and clinicopathological associations. METHODS: Prospective case–control study of 133 women with endometrial cancer and 65 healthy controls. Serum biomarkers were measured before treatment by enzyme-linked immunosorbent assays. Discrimination was evaluated using the area under the receiver operating characteristic curve with optimal cut-offs. RESULTS: Endocan levels were significantly higher in endometrial cancer patients than in controls (p<0.001), with an area under the curve of 0.758. Serum human epididymis protein 4 was also elevated in patients (p<0.001), with an area under the curve of 0.702. Neopterin and sialyl-Tn did not differ significantly between groups. Endocan and human epididymis protein 4 were higher in women with lymphovascular space invasion (both p<0.05); however, these associations did not remain significant after correction for multiple comparisons. CONCLUSION: Serum endocan and human epididymis protein 4 were elevated in endometrial cancer patients compared to asymptomatic healthy controls. Neopterin and sialyl-Tn showed no discriminatory value in this setting. Our findings should be interpreted as exploratory and require validation in clinically relevant cohorts.

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SUMMARY OBJECTIVE: The aim of the study was to determine the prevalence of insomnia and identify associated sociodemographic and clinical factors among individuals aged 80 years and older. METHODS: This descriptive cross-sectional study was conducted between October and November 2025 in the Advanced Age Unit of Elazığ City Hospital, Turkey. A total of 419 participants aged ≥80 years were enrolled. Sociodemographic and clinical data were collected using a structured questionnaire. The presence and severity of insomnia were assessed using the Insomnia Severity Index. An Insomnia Severity Index score ≥8 was accepted as indicative of insomnia. RESULTS: The prevalence of insomnia was 38.2%. Insomnia was significantly more frequent among women compared with men (p=0.010). Low economic status was associated with a higher rate of insomnia (p=0.033). A history of falls, hypertension, diabetes, and polypharmacy showed significant associations with insomnia (all p<0.05). Insomnia Severity Index score demonstrated a positive correlation with the number of chronic diseases (r=0.487; p<0.001) and the number of medications used (r=0.455; p<0.001). CONCLUSION: Insomnia is common among individuals aged 80 years and older and is associated with female gender, low economic status, polypharmacy, multiple chronic diseases, and a history of falls. Insomnia in older adults should not be considered a normal part of aging, but a manageable condition that affects overall well-being. Routine sleep assessment and management of underlying risk factors should be integral components of geriatric care.

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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between inflammatory mediators (tumor necrosis factor-alpha, interleukin-6, and interleukin-10), oxidative stress parameters, and obstetric-neonatal outcomes in maternal blood of pregnant patients with multiple sclerosis and healthy pregnant patients, and to identify biomarkers that may be useful in predicting relapse in pregnant patients with multiple sclerosis. METHODS: This prospective, single-center study was conducted at Ankara City Hospital between July 2024 and May 2025 and included a total of 72 patients: 36 pregnant women diagnosed with multiple sclerosis and 36 healthy pregnant women as the control group. The patients with multiple sclerosis were further divided into two groups: those who experienced relapses during pregnancy and those who did not. Clinical and demographic data, biochemical tests (interleukin-6, interleukin-10, tumor necrosis factor-alpha, total antioxidant status, and total oxidant status), and obstetric and neonatal outcomes were recorded. Data were analyzed statistically using SPSS 22.0, and appropriate statistical tests and correlation analyses were applied. RESULTS: Levels of interleukin-6, interleukin-10, tumor necrosis factor-alpha, total oxidant status, and total antioxidant status were significantly higher in patients with multiple sclerosis compared to controls (p<0.01). These parameters were even more elevated in patients who experienced relapses. Receiver operating characteristic analysis demonstrated that cut-off values of 237.8 pg/mL for tumor necrosis factor-alpha and 1.75 for interleukin-6/interleukin-10 provided high sensitivity and specificity in predicting multiple sclerosis relapse. CONCLUSION: Inflammatory and oxidative stress markers were elevated in pregnant women with multiple sclerosis, and tumor necrosis factor-alpha levels and the interleukin-6/interleukin-10 ratio were identified as potential biomarkers for predicting disease relapse.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the prevalence and characteristics of hearing loss among infants referred after newborn hearing screening in a tertiary referral center in Türkiye and to examine its association with demographic and clinical risk factors. METHODS: A retrospective study was conducted at SBÜ Gülhane Training and Research Hospital between January 2021 and December 2024, including 1,322 infants referred after newborn hearing screening due to either a "refer" result or the presence of risk factors despite passing automated auditory brainstem response. Relevant risk factors were analyzed. RESULTS: Hearing loss was detected in 92 infants (7.0%), including 3.3% with unilateral and 3.7% with bilateral loss. By severity, the distribution was mild (2.8%), moderate (0.8%), moderately severe (0.3%), and profound (1.5%). While most infants with unilateral loss did not receive amplification, bilateral cases showed higher rates of hearing aid (28.6%) and cochlear implant (14.3%) use. Family history of hearing loss was the only factor significantly associated with device adoption (p<0.05). CONCLUSION: The prevalence of hearing loss in referred infants was higher than in population-based studies and aligned with findings in high-risk groups. Differences in device use between unilateral and bilateral cases highlight the importance of parental counseling. Strengthening follow-up and family awareness is crucial to improving early intervention outcomes, particularly in infants without a family history.

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SUMMARY OBJECTIVE: Postpartum depression is a common mood disorder. Orexin-A, a hypothalamic neuropeptide involved in regulating arousal, stress response, and emotional processes, is implicated in major depressive disorder. The aim of this study was to assess plasma orexin-A levels in women with postpartum depression and to explore its potential biological involvement in postpartum depression. METHODS: A prospective controlled pilot trial was conducted at two hospitals between April 1, 2024, and June 30, 2025. In total, 60 postpartum women were included: 30 women with postpartum depression, defined as Edinburgh Postpartum Depression Scale ≥13 and confirmed by psychiatric evaluation, and 30 age- and parity-matched healthy controls (Edinburgh Postpartum Depression Scale <13, no psychiatric diagnosis). Venous blood samples were collected 1 month after delivery, and plasma orexin-A was measured. Demographic, obstetric, and clinical characteristics were recorded. RESULTS: The groups were comparable in terms of demographic and obstetric characteristics. Mean plasma orexin-A levels were significantly lower in women with postpartum depression compared to controls (65.2±10.8 vs. 79.9±6.4 pg/mL, p=0.021). Orexin-A levels were positively correlated with maternal age (r=0.328, p=0.011) but were not associated with parity, body mass index, neonatal parameters, or family history. CONCLUSION: This preliminary clinical evidence demonstrates that plasma orexin-A levels are reduced in women with postpartum depression, independent of major demographic or obstetric factors. The findings support orexin-A as a potential biomarker and therapeutic target in postpartum depression. Larger longitudinal studies are needed to confirm causality and investigate orexin-based interventions.

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SUMMARY OBJECTIVE: Chronic venous disease is a highly prevalent condition with significant morbidity. Although there is a well-documented predominance of chronic venous disease among women, the differences in surgical treatment based on sex, especially in low- and middle-income countries, are not well understood. The aim of this study was to investigate these disparities within Brazil's public healthcare system. METHODS: This cross-sectional study analyzed all varicose vein surgeries (n=1,114,625) performed in the public sector from 2007 to 2024. Data were extracted from the national open database (Sistema de Informações HospitalaresDepartamento de Informática do Sistema Único de Saúde (Department of Informatics of the Unified Health System). We compared demographics, procedural and mortality rates, age at surgery, length of hospital stays, and patterns of travel for surgery between the sexes. RESULTS: Women constituted most of the procedures (80.5%). Men underwent bilateral surgery at a significantly older median age than women (49 vs. 47 years, p<0.01). Men were more likely to travel between cities (38.89 vs. 37.22%, p<0.01), while women traveled more between states (0.35 vs. 0.39%, p<0.021). Mortality rates were low for both sexes, but higher for men (0.0197 vs. 0.0023%, p<0.01). CONCLUSION: This study reveals significant gender disparities in the surgical treatment of varicose veins in Brazil, extending beyond mere prevalence to include differences in the age at which intervention occurs and geographic access patterns. The findings suggest that biological factors alone cannot account for these disparities, highlighting that healthcare-seeking behaviors, mortality rates, and structural inequities also play a crucial role. Further qualitative research is needed to elucidate the underlying motivations for these differences and to guide the development of more equitable healthcare policies.

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SUMMARY INTRODUCTION: The global burden of peripheral artery disease is increasing worldwide. A subset of 5% of these patients ultimately reach the final stage with trophic defects, a condition clinically defined as critical limb-threatening ischemia. Revascularization remains the paramount treatment modality offering the greatest potential for limb preservation. We investigated whether performing direct revascularization according to the angiosome concept significantly influences (i) the superior healing of ischemic defects, (ii) optimized limb salvage rates, and (iii) reduced patient mortality in a cohort treated with femoropopliteal bypass. METHODS: This rigorous prospective clinical cohort study processed data from 143 patients after femoropopliteal bypass procedures performed at the AGEL Ostrava Vítkovice Hospital between January 2016 and December 2021—all patients presented with critical limb-threatening ischemia, specifically Fontaine stage IV. We employed advanced statistical methods, including Kaplan-Meier survival analysis and the Cox regression model, to evaluate the effect of direct revascularization versus indirect revascularization on primary outcomes: defect healing, limb salvage, and patient mortality. RESULTS: Statistical analysis robustly confirmed a statistically significant benefit of direct revascularization on (i) defect healing (p=0.02), (ii) limb salvage (p=0.02), and (iii) patient mortality (p=0.04). Specifically, direct revascularization significantly reduced amputation rates and improved overall survival compared to indirect revascularization. CONCLUSION: Despite the controversies in the literature and the absence of dedicated, large-scale, English-language published studies focusing specifically on the application of the angiosome concept in femoropopliteal bypasses, we demonstrated a statistically significant benefit of direct revascularization on defect healing, limb salvage, and mortality in this specific patient cohort. This evidence suggests that the angiosome concept extends its predictive power proximally to the femoropopliteal bypass targets. Practical application: In patients with critical limb-threatening ischemia, where the indication for femoropopliteal bypass is rendered borderline due to advanced local findings (high-risk Wound, Ischemia, and foot Infection classification) or severe overall comorbidity status, surgical intervention should be preferentially reserved for scenarios guaranteeing direct revascularization, as patients derive minimal benefit from non-targeted indirect revascularization in high-risk settings.

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SUMMARY OBJECTIVE: Familial Mediterranean fever, an autoinflammatory disease, is characterized by recurrent stereotypic febrile attacks associated with an inflammatory syndrome. Malondialdehyde, a lipid peroxidation marker, and soluble transferrin receptor, a key regulator of cellular iron homeostasis, are important markers associated with ferroptosis. The aim of this study was to investigate the levels of these markers in children with familial Mediterranean fever in remission. METHODS: The study included 30 pediatric familial Mediterranean fever patients in remission who were being monitored in the hospital and 30 healthy children. Malondialdehyde and soluble transferrin receptor levels were analyzed using enzyme-linked immunosorbent assay. Malondialdehyde and soluble transferrin receptor levels were compared between groups. Correlation analyses were also performed separately for each group to assess the relationship between these two parameters. RESULTS: Serum amyloid A, erythrocyte sedimentation rate, and creatinine levels were higher and hematocrit levels were lower in the familial Mediterranean fever group compared to the control. No significant difference was found in malondialdehyde and soluble transferrin receptor levels between the two groups. There was a positive correlation between malondialdehyde and soluble transferrin receptor levels in both groups (familial Mediterranean fever r=0.803, control r=0.599). CONCLUSION: Although there was no significant difference in mean malondialdehyde and soluble transferrin receptor levels between children with familial Mediterranean fever in remission and a healthy control group, the high correlation coefficient between these two parameters in familial Mediterranean fever patients suggests a possible link between iron imbalance and oxidative stress in the pathophysiology of the disease. These findings highlight the need for larger, multicenter studies, including patients in the exacerbation phase, to better elucidate the role of ferroptosis in familial Mediterranean fever.

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SUMMARY OBJECTIVE: The temporomandibular joint is anatomically and neurologically associated with the cervical spine. The aim of this study was to investigate the impact of temporomandibular disorder on neck awareness, cervical sensorimotor performance, and pain sensitivity, including pressure pain threshold, pressure pain tolerance, and temporal summation. METHODS: In this observational, cross-sectional study, the diagnostic criteria for temporomandibular disorders were used to evaluate temporomandibular disorder. Trial registered as NCT06558318. Participants were divided into two groups based on temporomandibular disorder presence: a temporomandibular disorder group (n=25) and an asymptomatic control group (n=25). Neck awareness was evaluated using the Fremantle Neck Awareness Questionnaire, while cervical sensorimotor performance was assessed using the "joint position error test" for both the global cervical region and the isolated upper cervical region, measured separately with a cervical range of motion device. Pain pressure threshold, pain pressure tolerance, and temporal summation were measured using a mechanical pressure algometer. RESULTS: No significant differences were found between the temporomandibular disorder and control group in pain-related parameters (p>0.05). Neck awareness was significantly impaired in the temporomandibular disorder group (p<0.001), although the joint position error tests showed no significant differences (p>0.05). CONCLUSION: The presence of temporomandibular disorder did not affect pain sensitivity in the cervical region. While sensorimotor performance was not impaired in either the global or the isolated upper cervical region, neck awareness was affected in the temporomandibular disorder group. This suggests that neck awareness in patients with temporomandibular disorder should be considered in clinical evaluation and management.

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SUMMARY OBJECTIVE: The aim of this study was to determine whether adenomyosis is an independent prognostic factor in cervical cancer using integrated survival analysis and machine-learning models. METHODS: This retrospective cohort study included 131 patients with early-stage cervical cancer treated surgically between 2008 and 2020. Patients were stratified by the presence (n=28) or absence (n=103) of adenomyosis based on final histopathology. Kaplan-Meier curves and log-rank tests assessed overall survival. Independent prognostic factors were identified through multivariate Cox regression and logistic regression analyses, supplemented by machine-learning decision tree modeling to evaluate variable importance and model performance. RESULTS: Women with adenomyosis had no significant differences in tumor size, histology, depth of stromal invasion, lymphovascular space invasion, parametrial involvement, lymph node metastasis, or International Federation of Gynecology and Obstetrics 2018 stage. Kaplan-Meier analysis demonstrated shorter overall survival in the adenomyosis group (median overall survival 31.3 vs. 64.8 months, log-rank p=0.045). Multivariate Cox regression identified age, tumor size, International Federation of Gynecology and Obstetrics stage III, histologic grade, lymphovascular space invasion, parametrial infiltration, and vaginal involvement as independent determinants of overall survival (all p<0.05). Adenomyosis status did not retain prognostic significance after adjustment (HR 0.91, p=0.818). Decision tree models corroborated these findings, with International Federation of Gynecology and Obstetrics stage and tumor size emerging as the most influential predictors of survival and recurrence. CONCLUSION: Although adenomyosis was associated with shorter overall survival in univariate analysis, it did not function as an independent prognostic factor after adjustment for established clinicopathological variables in both multivariate Cox regression and machine-learning decision tree models. These findings indicate that prognostic stratification in cervical cancer should remain guided by tumor burden, stage, and histopathological risk factors.

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SUMMARY OBJECTIVE: Hemodynamically significant patent ductus arteriosus is a frequent problem in preterm neonates and may impair systemic and organ-specific oxygenation. Near-infrared spectroscopy provides a non-invasive tool to evaluate regional tissue oxygenation. The aim of this study was to investigate the effects of pharmacological closure therapy on cerebral, renal, and mesenteric tissue oxygenation in preterm neonates diagnosed with hemodynamically significant patent ductus arteriosus. METHODS: This prospective observational study was conducted in a tertiary neonatal intensive care unit between September 2021 and November 2024. Twenty-four preterm infants (24–34 weeks’ gestational age) with hemodynamically significant patent ductus arteriosus confirmed by transthoracic echocardiography were enrolled. Paracetamol treatment was given in cases where ibuprofen was contraindicated. Patients who underwent medical patent ductus arteriosus closure were divided into two groups: ibuprofen and paracetamol groups. Specific regional tissue oxygen saturation and fractional tissue oxygen extraction in three regions were monitored continuously using near-infrared spectroscopy for 72 h before and after medical treatment. Echocardiographic and hemodynamic parameters were recorded. RESULTS: While patent ductus arteriosus closure was achieved in 46% of cases with medical treatment, a significant reduction in patent ductus arteriosus diameter was achieved in 29% of cases. Ibuprofen was superior to paracetamol in reducing patent ductus arteriosus diameter. Mesenteric regional tissue oxygen saturation also improved significantly at 24–48 h in the ibuprofen group (p=0.01), while cerebral and renal oxygenation remained unchanged (p>0.05). CONCLUSION: Our findings revealed that ibuprofen therapy improved hemodynamic stability and mesenteric oxygenation in preterm neonates with hemodynamically significant patent ductus arteriosus. Although we showed in our study that there was no significant change in cerebral and renal oxygenation of hemodynamically significant patent ductus arteriosus with ibuprofen treatment, more comprehensive studies showing the changes with near-infrared spectroscopy are needed.

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SUMMARY OBJECTIVE: The aim of this study was to determine the relationship between postpartum depression, dyadic coping strategies, and relationship satisfaction. METHODS: This study was designed as a descriptive cross-section. The study was conducted in 10 Family Health Centers in Southern Turkey. The study included 285 mothers who were registered to these Family Health Centers and who had babies aged 1–12 months. Interviews with mothers were held in a private room at the Family Health Centers between June 1, 2022, and June 1, 2023, and the data were collected in this room. Data were collected using a personal information form, the Dyadic Coping Inventory, the Relationship Assessment Scale, and the Edinburgh Postnatal Depression Scale. RESULTS: In the study, we found that 28.4% (n=81) of the mothers had postpartum depression. It was found that mothers with postpartum depression had significantly lower self-dyadic coping behaviors, and their partners had lower dyadic coping behaviors and lower joint dyadic coping behaviors than those of mothers without postpartum depression (p<0.05). The relationship satisfaction of mothers with postpartum depression was significantly lower than that of mothers without postpartum depression (p<0.05). As a result of the regression analysis, the mother's self-dyadic coping behaviors, partner's dyadic coping with stress, and relationship satisfaction were found to be significant risk factors for postpartum depression (p<0.01). CONCLUSION: In conclusion, mothers with poor dyadic coping strategies and low relationship satisfaction were more likely to experience postpartum depression.

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SUMMARY OBJECTIVE: Cystoscopy, biopsy, and urine cytology are gold standards for the diagnosis and surveillance of bladder carcinoma. Bladder washings, obtained via cystoscopy or by catheterization, are common in routine cytology practice, whereas voided urine is evaluated less frequently. The aim of this study was to perform a comparative cytologic assessment of voided urine and bladder washing specimens in patients with bladder carcinoma. METHODS: In this prospective study, second-morning voided urine and bladder washing samples were obtained from 75 patients with histologically confirmed bladder carcinoma over a 3-year period. Samples were re-evaluated cytologically according to the Paris system. RESULTS: Bladder washing cytology showed higher sensitivity (81 vs. 62%) and the correlation coefficient (0.617 vs. 0.487), compared to voided urine cytology. CONCLUSION: While bladder washing cytology showed superior diagnostic performance with a higher area under the curve and sensitivity in this cohort, voided urine cytology remains a valuable non-invasive alternative despite its lower sensitivity.

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SUMMARY OBJECTIVE: Early pregnancy loss is a frequent reproductive health problem. Systemic inflammatory markers derived from complete blood count—neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic inflammatory index—may reflect the inflammatory status present at clinical presentation. The aim of this study was to compare these indices between spontaneous abortion and threatened abortion. METHODS: This retrospective cross-sectional study included 146 women evaluated between January 2022 and April 2025. Patients were classified as spontaneous abortion (n=67) or threatened abortion (n=79) based on clinical and ultrasonographic findings. neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic inflammatory index were calculated from complete blood counts. Group comparisons were performed using the Student's t-test or the Mann-Whitney U test. Blood samples were obtained at presentation, when the diagnosis of spontaneous abortion or threatened abortion had already been established; therefore, markers reflected concurrent inflammatory status rather than pre-diagnostic levels. RESULTS: The groups were similar regarding age, body mass index, gravida, parity, and gestational age (all p>0.05). Compared with threatened abortion, spontaneous abortion patients had significantly higher white blood cell and neutrophil counts, neutrophil-to-lymphocyte ratio, C-reactive protein, and systemic inflammatory index (all p<0.05). Although platelet-to-lymphocyte ratio values were numerically higher in the spontaneous abortion group, the difference was borderline and not statistically significant (p=0.058). CONCLUSION: Spontaneous abortion is associated with a stronger systemic inflammatory profile at presentation. Elevated systemic inflammatory index, neutrophil-to-lymphocyte ratio, and C-reactive protein levels reflect concurrent inflammation rather than definitive predictive or causal relationships.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive value of immunonutrition-based indices (Hemoglobin, Albumin, Lymphocyte, Platelet score, prognostic nutritional index, and C-reactive protein–albumin–lymphocyte index) for latency duration and neonatal outcomes in preterm prelabor rupture of membranes. METHODS: This retrospective cohort study included 145 singleton pregnancies diagnosed with PPROM between 24 and 34 weeks. Patients were categorized by latency duration (≤48 vs. >48 h), and subgroup analyses used thresholds of 72 h, 96 h, and 7 days. Maternal, laboratory, and neonatal characteristics were compared. Logistic regression adjusted for parity and gestational age evaluated associations between indices and latency. RESULTS: Hemoglobin, Albumin, Lymphocyte, Platelet, prognostic nutritional index, and C-reactive protein–albumin–lymphocyte values showed no significant differences across latency groups (all p>0.05). Only respiratory distress syndrome was more frequent in the short-latency group (p=0.005). CONCLUSION: Immunonutrition indices remained stable across latency durations, highlighting the predominance of localized inflammatory and structural mechanisms in preterm prelabor rupture of membranes pathophysiology.

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SUMMARY OBJECTIVE: The aim of this study was to examine the effects of midwife-led continuity education on fear of childbirth, mode of delivery, and postpartum trauma among primiparous women. METHODS: A single-blind randomized controlled trial was conducted at Adana City Hospital, Turkey, between December 2023 and November 2024. Ninety-two primiparous pregnant women were enrolled and randomized to an intervention group (n=46) or a control group (n=46). Inclusion criteria were age 18–35 years, singleton low-risk pregnancy, Turkish literacy, and no medical or obstetric contraindications to vaginal birth. Women with high-risk pregnancies, psychiatric disorders, systemic diseases, or prior structured childbirth education were excluded. The intervention group received a four-module education program based on the Midwife-Led Continuity of Care Model, while the control group received routine antenatal care. RESULTS: Baseline childbirth fear scores were comparable between groups. Following the intervention, mean childbirth fear scores were lower in the intervention group than in the control group. One month postpartum, mean City Birth Trauma Scale scores were 5.43±5.69 in the intervention group and 22.93±9.92 in the control group. Vaginal birth occurred in 69.6% of women in the intervention group compared with 24.4% in the control group. Among women who had vaginal births, postpartum fear scores remained lower in the intervention group. CONCLUSION: Midwife-led continuity education is associated with reduced fear of childbirth, lower postpartum trauma symptoms, and higher vaginal birth rates among primiparous women. These findings support the integration of continuity-based midwifery education into routine maternity care.

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SUMMARY OBJECTIVE: Type 2 diabetes mellitus is a chronic metabolic disorder characterized by insulin resistance and β-cell dysfunction, often coexisting with obesity. Obesity increases adipose tissue inflammation and oxidative stress, which may impair mitochondrial function and muscle metabolism. The aim of this study was to investigate the effects of obesity severity on oxidative stress biomarkers, exercise-related biomarkers, physical activity level, and sleep quality in individuals with type 2 diabetes mellitus. METHODS: This prospective observational study included 80 individuals aged 20–80 diagnosed with type 2 diabetes mellitus. Participants’ body mass index, physical activity assessed by the International Physical Activity Questionnaire-Short Form, and sleep quality assessed by the Pittsburgh Sleep Quality Index were recorded. Serum samples were analyzed for oxidative stress biomarkers (total antioxidant status, total oxidant status, malondialdehyde, and superoxide dismutase) and exercise-related biomarkers (irisin, Fibronectin Type III Domain-Containing Protein 5, Adenosine Monophosphate-Activated Protein Kinase, and leptin) using enzyme-linked immunosorbent assay methods. RESULTS: There were significant differences in irisin, Fibronectin Type III Domain-Containing Protein 5, Adenosine Monophosphate-Activated Protein Kinase, leptin, malondialdehyde, superoxide dismutase, total antioxidant status, and total oxidant status values according to body mass index levels (p<0.001). Overweight participants had higher irisin, Adenosine Monophosphate-Activated Protein Kinase, and Fibronectin Type III Domain-Containing Protein 5 levels, while leptin, malondialdehyde, and total oxidant status levels increased with obesity severity. Physical activity levels decreased as body mass index increased (p=0.016). No significant differences were observed in self-reported sleep quality parameters assessed by the Pittsburgh Sleep Quality Index across body mass index groups (p>0.05). CONCLUSION: Increasing obesity severity in individuals with type 2 diabetes mellitus is associated with elevated oxidative stress and decreased antioxidant defense, along with lower levels of exercise-related metabolic biomarkers. These findings highlight the importance of promoting regular physical activity and interventions targeting the irisin/Adenosine Monophosphate-Activated Protein Kinase pathway to reduce oxidative stress and improve metabolic health in obese diabetic individuals.

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SUMMARY OBJECTIVE: Essential hypertension is linked to increased maternal and perinatal risks. The aim of this study was to assess women with essential hypertension and poor obstetric history before conception to identify co-morbidities and placenta-related risk factors and to examine how preconception evaluation affects future pregnancy outcomes. METHODS: This retrospective cohort study involved women with poor obstetric history, with (n=25) or without (n=243) essential hypertension. Women were evaluated for co-morbidities and metabolic, immunological, inflammatory, and vascular/thrombotic risk factors. Subsequent pregnancies were then assessed for gestational outcomes. RESULTS: Higher levels of co-morbidity were found in the essential hypertension (+) group compared to high-risk controls (68 vs. 39.9%, p=0.013). Essential hypertension (+) women had significantly higher rates of chronic inflammatory diseases (28 vs. 5.8%, p=0.001) and carbohydrate metabolism disorders (44 vs. 10.3%, p<0.001) than in controls. Except for “APGAR<7” (p=0.016), we were unable to show any statistically significant differences between the study and control groups in terms of placenta-related obstetric complications and gestational outcomes in their forthcoming pregnancies due to necessary precautions and timely management of risk factors. CONCLUSION: Chronic inflammatory diseases and carbohydrate metabolism disorders, which are risk factors for both endothelial injury and placenta-related obstetric complications, are more frequently observed in pregnancies with essential hypertension. Preconception counseling is critical in reducing gestational complications.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the effect of mobile application-based musical tonalities delivered at different times of day on postoperative pain and analgesic consumption after orthopedic trauma surgery. METHODS: This randomized controlled study included 80 patients undergoing orthopedic trauma surgery at a university hospital. Tonalities (Rast, Nihavend, Neva) were delivered via an Android-based mobile application in the morning (T1), afternoon (T2), and evening (T3). Pain was assessed using the Numerical Rating Scale, and analgesic consumption was recorded. RESULTS: Baseline characteristics were largely comparable; however, body mass index (p=0.002) and marital status (p<0.001) differed between groups. Pain scores decreased significantly over time in both groups (p<0.001). After Bonferroni correction, baseline pain did not differ between groups, whereas post-intervention pain scores differed at all post-intervention time points (T1b, T2b, T3b; p<0.0083), with lower scores in the control group. Analgesic consumption did not differ significantly between groups (p>0.05). In robust regression analyses controlling for baseline Numerical Rating Scale, body mass index, and marital status, the intervention group showed significantly higher Numerical Rating Scale scores at all measurement times, and baseline Numerical Rating Scale was the strongest predictor of postoperative pain. CONCLUSION: Postoperative pain decreased over time in both groups, and baseline pain level was the strongest determinant of postoperative pain perception; no significant between-group difference was observed in analgesic consumption.

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SUMMARY OBJECTIVE: The aim of this study was to compare clinical outcomes, patient satisfaction, and postoperative complications between total mandibular inferior border circumferential osteotomy and T-shaped chin contouring combined with mandibular angle osteotomy, and to evaluate their surgical indications. METHODS: A retrospective analysis was conducted on 51 patients who underwent mandibular contouring between January 2018 and January 2022. According to the surgical technique, 21 patients were assigned to total mandibular inferior border circumferential osteotomy (Group I) and 30 to T-shaped chin contouring with mandibular angle osteotomy (Group II). Pre- and postoperative computed tomography images were analyzed to assess changes in chin width, height, offset, and facial proportions. Patient satisfaction and postoperative complications were also evaluated. RESULTS: Postoperative complications included lower lip numbness, hematoma, infection, and soft tissue ptosis, with no significant difference between the two groups (all p>0.05). Satisfaction rates were similarly high in both groups (mean scores: 4.58±0.42 vs. 4.72±0.56, p>0.05). However, Group I achieved a significantly greater chin width reduction and narrowing rate than Group II (p<0.01), with a smaller postoperative chin offset (p<0.01). Group I patients also showed improved facial symmetry and proportion, with no significant difference in postoperative chin-to-midface height ratio (p>0.05). CONCLUSION: Both techniques provide favorable aesthetic and functional results. Total mandibular inferior border circumferential osteotomy yields greater chin narrowing and better midline alignment, making it particularly suitable for patients with long, wide, or asymmetric lower faces seeking improved mandibular contour.

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SUMMARY OBJECTIVE: Gestational diabetes mellitus is a pregnancy complication associated with adverse maternal and neonatal outcomes. The aim of this study was to evaluate the hemoglobin-albumin-lymphocyte-thrombocyte, Aggregate Systemic Inflammation Index, Systemic Inflammatory Response Index, Systemic Immune-Inflammation Index, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio measured in the first trimester as early predictive biomarkers for gestational diabetes mellitus. METHODS: This retrospective cohort study included 588 pregnant women: 294 women with gestational diabetes mellitus and 294 matched controls. Demographic, obstetric, and first-trimester hematologic data were collected. RESULTS: Systemic Immune-Inflammation Index (p<0.001), neutrophil-lymphocyte ratio (p<0.001), and platelet-lymphocyte ratio (p<0.001) levels were significantly higher in those with gestational diabetes mellitus, while hemoglobin-albumin-lymphocyte-thrombocyte (p=0.001) and Aggregate Systemic Inflammation Index (p=0.020) levels were significantly lower than in those without gestational diabetes mellitus. Platelet-lymphocyte ratio (area under the curve=0.679; sensitivity 62.9%, specificity 63.3%) emerged as the strongest inflammatory marker for predicting gestational diabetes mellitus. Neutrophil-lymphocyte ratio (area under the curve=0.645) and Systemic Immune-Inflammation Index (area under the curve=0.610) demonstrated moderate discriminatory ability, whereas hemoglobin-albumin-lymphocyte-thrombocyte (area under the curve=0.422) and Aggregate Systemic Inflammation Index (area under the curve=0.444) showed weak diagnostic performance for gestational diabetes mellitus. In contrast, Systemic Inflammatory Response Index (area under the curve=0.466) and monocyte-lymphocyte ratio (area under the curve=0.475) were not significantly different between groups and lacked clinical relevance. CONCLUSION: Platelet-lymphocyte ratio, neutrophil-lymphocyte ratio, and Systemic Immune-Inflammation Index are promising biomarkers for early gestational diabetes mellitus prediction in the first trimester. These findings support the role of inflammation in gestational diabetes mellitus pathophysiology and highlight the value of routine hematologic markers in risk stratification.

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SUMMARY OBJECTIVE: The aim of this study was to describe early outcomes after neonatal modified Blalock-Taussig shunt and identify perioperative predictors of mortality in a tertiary congenital cardiac center. METHODS: In this retrospective cohort, 129 neonates with critical congenital heart disease who underwent modified Blalock-Taussig shunt were analyzed. Demographic, clinical, and perioperative variables were collected, and multivariate logistic regression was used to identify independent predictors of neonatal mortality. RESULTS: Overall neonatal mortality was 21.7%. Shunt failure occurred in 18.9% (24/127) of neonates transferred to the neonatal intensive care unit and was strongly associated with mortality (66.7 vs. 11.6%; p=0.001). Independent risk factors for neonatal mortality included lower gestational age (OR 0.82, 95%CI 0.72–0.94; p=0.004), preoperative inotropic support (OR 3.46; p=0.006), preoperative mechanical ventilation (OR 4.28; p=0.001), shunt failure (OR 5.12; p=0.001), and postoperative metabolic acidosis (OR 6.78; p=0.001). CONCLUSION: Neonates undergoing modified Blalock-Taussig shunt remain at high risk for postoperative complications and death. Preoperative hemodynamic instability, shunt failure, and postoperative metabolic acidosis are strong predictors of poor outcome. These findings support vigilant perioperative monitoring and individualized management strategies in neonatal modified Blalock-Taussig shunt candidates.

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SUMMARY OBJECTIVE: The aim of this study was to determine the relationship between preoperative anxiety and postoperative pain and recovery index in patients undergoing laparoscopic abdominal surgery. METHODS: This study was descriptive and correlational. The study population consisted of 115 patients who underwent laparoscopic abdominal surgery in the General Surgery Department of a state hospital in Kocaeli. Permission to conduct the study was obtained from the institutions where the study was to be conducted, and ethical approval was obtained from the Scientific Research Ethics Committee of Kocaeli City Hospital. Data were collected using the Visual Analogue Scale pain scale, the Amsterdam Preoperative Anxiety and Information Score, the State–Trait Anxiety Inventory, and the Postoperative Recovery Index. RESULTS: A moderate, positive, and statistically significant correlation was found between State–Trait Anxiety Inventory-State Anxiety scores and Postoperative Recovery Index total scores. Furthermore, State–Trait Anxiety Inventory-State Anxiety scores were found to be significantly correlated with the subscales of the Postoperative Recovery Index. The correlations with these subscales were as follows: Physical Activities, Bowel Symptoms, General Symptoms, Desire/Urge, and Psychological Symptoms. CONCLUSION: It was concluded that as the preoperative anxiety level of patients undergoing laparoscopic abdominal surgery increased, they experienced difficulties in postoperative recovery and as the patients’ well-being decreased.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the demographic characteristics, prenatal findings, and outcomes of prenatally diagnosed congenital talipes equinovarus at a tertiary center. METHODS: A retrospective cohort study was conducted on 78 fetuses diagnosed with congenital talipes equinovarus between 2013 and 2023. Data on gestational age at diagnosis, laterality, associated anomalies, genetic results, and pregnancy outcomes were analyzed. RESULTS: The mean gestational age at diagnosis was 21±3.83 weeks. Congenital talipes equinovarus was bilateral in 60.3% of cases. Isolated congenital talipes equinovarus was present in 30.8% of cases, while 69.2% had associated anomalies, most commonly neural tube defects (32.6% of non-isolated cases). Of the 46 cases (59%) that underwent genetic analysis, 13 (28.3%) revealed abnormalities, representing 16.7% of the total cohort. Termination of pregnancy occurred in 59% of cases due to associated anomalies or genetic abnormalities. Thirty pregnancies resulted in live birth, with a prenatal diagnosis accuracy of 90%. The three false-positive cases were associated with oligohydramnios or early gestation. Postnatally, most live-born cases with confirmed congenital talipes equinovarus (77.8%) required serial casting and surgery. CONCLUSION: The prognosis for prenatally diagnosed congenital talipes equinovarus is excellent in isolated cases, supported by the absence of genetic abnormalities in this group. However, the high frequency of associated anomalies drastically alters prognosis, frequently leading to pregnancy termination and highlighting the critical need for comprehensive prenatal screening and multidisciplinary counseling.

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SUMMARY OBJECTIVE: The aim of this study was to compare the safety and effectiveness of the three-lobe and en-bloc techniques during the learning curve of holmium laser enucleation of the prostate. METHODS: We conducted a prospective, parallel-group, multicenter study that included patients who underwent holmium laser enucleation of the prostate between February and December 2024 at two tertiary urology departments. Patients with prostate volumes ≥80 cm3 scheduled for holmium laser enucleation of the prostate were alternately assigned (1:1) to either the three-lobe or en-bloc technique. Exclusion criteria included use of anticoagulants, prostate biopsy within the previous month, diagnosis of prostate cancer, or a history of pelvic surgery or radiotherapy associated with overactive bladder symptoms. The study evaluated the performance of a single surgeon at each center using either the three-lobe or en-bloc technique during their holmium laser enucleation of the prostate learning curve. Primary outcomes were enucleation time/efficiency and complications. Secondary outcomes included postoperative incontinence and functional outcomes. RESULTS: A total of 116 patients were enrolled in the study, with 60 in the three-lobe group and 56 in the en-bloc group. Patients in the en-bloc group were older than those in the three-lobe group (69.4 vs. 64.9 years, p=0.001). Body mass index and performance scores were comparable between groups. The mean prostate volume was 83.5 cm3 in the three-lobe group and 81.3 cm3 in the en-bloc group (p=0.732). No significant differences were observed in prostate volume or Prostate-Specific Antigen density. Short-term complication rates and postoperative urinary incontinence were similar between techniques. Operative and enucleation times were significantly shorter in the en-bloc group compared to the three-lobe group (86.1 vs. 107.4 min, p=0.042; 56.7 vs. 72.9 min, p=0.001, respectively). However, enucleation and morcellation efficiencies did not differ significantly. Other intraoperative parameters, as well as postoperative functional outcomes and uroflowmetry measurements, were comparable between the groups. CONCLUSION: The en-bloc technique demonstrated comparable safety and functional outcomes to the three-lobe technique but offered significantly shorter operative and enucleation times during the holmium laser enucleation of the prostate learning curve.