Samsun University

Aim: This study aimed to identify bacterial pathogens causing chronic obstructive pulmonary disease (COPD) exacerbations and asthma attacks by evaluating nasopharyngeal swabs tested by polymerase chain reaction (PCR) and simultaneous sputum cultures from hospitalized patients, and to assess the contribution of PCR to causative agent identification. Materials and methods: Patients hospitalized with COPD exacerbations or asthma attacks from September 2022 to May 2023 were included. Bacterial pathogens were evaluated using PCR on nasopharyngeal swab samples, with simultaneous sputum culture results recorded. Analyzed pathogens included Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Bordetella pertussis, Legionella pneumophila, and Chlamydia pneumoniae. Frequencies of pathogens detected by PCR and culture were compared. Results: The study included 911 patients. Nasopharyngeal swabs and simultaneous sputum cultures were obtained from 448 patients with COPD exacerbations and 127 patients with asthma attacks. In COPD exacerbations, H. influenzae was detected in 52 (8.7%) patients and S. pneumoniae in 32 (5.3%) by PCR, compared to 2 (0.4%) and 3 (0.7%) patients by sputum culture, respectively. In asthma attacks, H. influenzae was detected in 20 (6.5%) patients and S. pneumoniae in 11 (3.5%) patients by PCR, with S. pneumoniae detected by sputum culture only in 1 (0.8%) patient. H. influenzae and S. pneumoniae were significantly higher in COPD exacerbations and asthma attacks using PCR (p<0.05). Conclusion: PCR may detect bacterial pathogens in COPD exacerbations and asthma attacks more effectively than sputum culture within the context of this study.

Background and Aim Nanoplastics (NPs), formed by the degradation of plastic materials, are ubiquitous substances with potential negative effects on various ecosystems and organisms. This article aims to investigate toxicological and biochemical NP accumulation in testicular tissue of rats and explore its potential effects on male reproductive health. Methods Our study was conducted on the control (sham) group and two experimental groups receiving 25 mg/kg NPs (LNp) and 50 mg/kg NPs (HNp). Five male rats in each group were administered fluorescent NPs via gavage for one month. At the end of the experiment, testicular tissues were removed, and NPs accumulation, oxidative stress and testicular inflammation were investigated histopathologically and biochemically. Results NPs accumulation was detected in the testicular tissue of LNp and HNp groups. Immature sperm cells and vacuolization were observed, suggesting that spermatogenesis was adversely affected. Oxidative stress was found to be increased in testicular tissue. Toll-like receptor 7 (TLR7) gene expression was evaluated, and inflammation was found to be statistically significant (p < 0.05). Conclusion In conclusion, continuous intake of nanoplastics can lead to their accumulation in testicular tissue, impairing testicular function and potentially causing infertility. Given their increasing presence in the environment, nanoplastics pose significant risks to male reproductive health, necessitating further research and regulatory action to minimize exposure.

KBG syndrome is a rare autosomal dominant disorder caused by ANKRD11 variants, characterized by distinctive craniofacial features, short stature, skeletal anomalies, and neurodevelopmental impairment. Regional studies, particularly from underrepresented populations, are essential to broaden the clinical and molecular spectrum of the syndrome. We retrospectively analyzed the clinical, molecular, and anthropometric data of 23 Turkish individuals with molecularly confirmed KBG syndrome. Molecular analyses included whole exome sequencing, clinical exome sequencing, and targeted gene panels. Variants were classified according to ACMG guidelines, and phenotypic features were systematically assessed using standardized criteria. Eighteen distinct ANKRD11 pathogenic or likely pathogenic variants were identified, including eight novel variants, predominantly located in exon 9. Short stature (height SDS < –2) was documented in 30.4% of patients. Intellectual disability was observed in 82.6%, and behavioral anomalies in 52.2% of the cohort. Craniofacial dysmorphism, including long philtrum, triangular facial shape, and macrodontia, was prominent. No genotype–phenotype correlation could be established. This study expands the mutational landscape of ANKRD11 and underscores the clinical variability of KBG syndrome in a Turkish cohort. Our findings emphasize the importance of integrating molecular and detailed clinical evaluations for early diagnosis, especially in diverse populations with limited prior representation.

Background: Brain metastasis (BM) is observed in approximately 1–4% of cases involving metastatic colon cancer and is almost invariably associated with extracranial dissemination. The occurrence of isolated intracranial disease in the absence of systemic metastases is, therefore, exceedingly rare. Case presentation: We report a 74 year-old female who presented with new-onset focal seizures 18 months after curative surgery for stage IIIC sigmoid adenocarcinoma. The F18 FDG PET/CT scan revealed increased F18 FDG uptake in an 18x19 mm hyperdense lesion located in the right temporal lobe, accompanied by a substantial edematous region in the surrounding area (SUV max:8.0) but no abnormal F18 FDG accumulation elsewhere, confirming isolated BM. Brain MRI revealed a 28x30 mm contrast-enhancing lesion in the right temporal lobe with vasogenic edema. The patient underwent gross-total resection followed by adjuvant stereotactic radiosurgery (SRS, 18 Gy single fraction). Histopathology showed metastatic moderately-differentiated colon adenocarcinoma (CK20+, CDX-2+, CK7+, P53+). Post-operative capecitabine plus bevacizumab was given for six cycles. At 12-month follow-up the patient remains disease-free on surveillance MRI and F18 PET/CT. Conclusion: This case illustrates the diagnostic value of F18 FDG PET/CT in excluding extracranial disease and supports an aggressive local-therapy strategy (surgery ± SRS) for solitary kolon adenocarsinoma BM, which may confer prolonged survival.

This study examines the combination of overhang constraints and Reliability-Based Topology Optimization (RBTO) in additive manufacturing (AM). AM offers intricate component production but faces challenges due to support structures. Incorporating overhang constraints in topology optimization enables self-supporting structures. RBTO addresses uncertainties in design variables to enhance reliability. This research investigates build direction parameter solutions using deterministic and RBTO algorithms. Topological properties, compliance, sensitivity, and density filters are assessed, alongside optimization techniques like Method of Moving Asymptotes (MMA) criterion and Optimality Criteria (OC). In numerical experiments on the MBB beam, the AM-RBTO algorithm reduced 3D printing time by approximately 18.3% and improved structural performance by lowering the objective function value by 1.85% compared to conventional RBTO. Results contribute to merging overhang constraints and RBTO in AM topology optimization, improving design by considering uncertainties. The study enhances computational efficiency and stability in optimizing build direction parameters, offering valuable insights for future AM applications.

Background and aim Transthyretin cardiac amyloidosis (ATTR) is a debilitating condition characterized by the accumulation of misfolded transthyretin (TTR) amyloid fibrils in the myocardium, resulting in restrictive cardiomyopathy and heart failure. Although Tc-99m-pyrophosphate (PYP) cardiac amyloidosis scintigraphy (CAS) has transformed the non-invasive diagnosis of ATTR, existing imaging protocols predominantly utilize anterior-posterior (AP) planar projections, which are susceptible to limitations due to anatomical overlap and extracardiac activity. The aim of this study was to explore the diagnostic utility of left anterior oblique (LAO) imaging in Tc-99m-PYP CAS for enhancing the identification and characterization of myocardial amyloid deposits. Materials and methods A retrospective analysis was conducted on 152 patients who underwent Tc-99m-PYP CAS. Static images were obtained from both AP and LAO projections at 1 and 3 hours following Tc-99m-PYP administration. Semi-quantitative assessment was conducted utilizing heart-to-contralateral (H/CL) ratio measurements, and the results were correlated with echocardiographic parameters, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and visual amyloidosis grading. Multivariate logistic regression was employed to identify independent predictors of PYP positivity, while receiver operating characteristic (ROC) curve analysis was utilized to assess diagnostic performance. Results LAO imaging exhibited significantly higher H/CL ratios compared to AP imaging at both time points (p < 0.001), indicating enhanced of myocardial tracer uptake. Among patients with PYP-positive scans, the 1-hour LAO H/CL ratio emerged as a robust independent predictor of amyloidosis (OR = 14.1, 95% CI: 3.31–60.10, p < 0.001), surpassing the predictive value of the 3-hour measurement (OR = 7.1, 95% CI: 1.80–28.13, p < 0.001). Bland-Altman analysis revealed a systematic bias towards higher uptake values in LAO projections compared to AP projections, with a mean difference of 39% H/CL. ROC analysis demonstrated superior sensitivity for 1-hour LAO imaging (80.4%) relative to 3-hour imaging (60.9%), suggesting that early-phase LAO projections enhance diagnostic accuracy and may facilitate more efficient scan protocols. Conclusion This pilot investigation provides novel systematic evidence that LAO imaging enhances diagnostic accuracy in Tc-99m-PYP CAS for ATTR by reducing extracardiac interference. These preliminary findings also suggest that 1-hour LAO imaging could optimize CAS protocols and may ultimately decrease the need for invasive biopsy particularly in borderline cases. This innovation holds promise for advancing early ATTR detection and streamlining clinical decision-making. Further validation through prospective multicenter studies is required to confirm these observations and standardize LAO integration into clinical practice.

The aim of this work is to conduct a numerical analysis on a battery thermal management system (BTMS) that utilizes liquid cooling and is equipped with a cold plate. The system is specifically designed for a 2 × 6 format of a 18650 cylindrical Li-ion battery pack (BP). In order to analyze cooling performance of the BTMS, three distinct cold plate setups of the BTMS and varying volume flow rates (0, 0.1, 0.25, 0.5, 0.75, and 1 l/min) are utilized at a fixed discharge rate of 2C. The initial setup, denoted as Setup I, pertains to the implementation of symmetrical cooling. The subsequent setup, referred as Setup II, involves the utilization of asymmetrical cooling. Lastly, the third setup, designated as Setup III, encompasses both asymmetrical cooling and the incorporation of an aluminum block. Numerical analyses are performed with the ANSYS Fluent software. The study involves comparing of these setups in terms of the pressure drop throughout the cold plate, the greatest temperature difference between the cells, the hot spot temperature within the BP, the cooling efficacy as well as the energy density of the BP. The findings indicate that there is a negative correlation between flow rate and both hot spot temperature and the greatest temperature difference within the BP. Nevertheless, once the flow rate reaches 0.5 l/min, any subsequent increase in flow rate does not appear to significantly impact the cooling performance. Furthermore, it is observed that the pressure drop exhibits a positive correlation with the flow rate. Hence, it can be concluded that flow rates ranging from 0.25 to 0.5 l/min are seen to be the most favorable for these BTMS setups. When comparing the BTMS setups, it can be concluded that Setup III is the optimal setup, particularly when considering factors such as the hot spot temperature and the greatest temperature difference within the BP.

Objective We introduce a novel intervention for posterolateral knee pain termed the Biceps Femoris Short Head (BiFeS) Block, which targets the articular branches innervating the posterolateral aspect of the joint. We describe a two-part proof-of-concept study to validate the BiFeS block: A cadaveric study evaluating injectate spread and a retrospective case series assessing analgesic efficacy. Methods In the cadaveric study, 25 mL of dye solution was applied at the interface between the BiFeS and the lateral supracondylar line of the femur following bone contact. For the retrospective cases, we present five patients with posterolateral knee pain following total knee arthroplasty (TKA) who underwent a BiFeS block with 25 mL of 0.25% bupivacaine. Results In all cadaveric specimens, a distinct dye spread was observed deep to the BiFeS, extending both medial and lateral to the lateral supracondylar line and along the facies poplitea. In all specimens, the superior lateral genicular nerve and the lateral branch of the nerve to the vastus intermedius were stained. The anterior branch of the common fibular nerve was stained in 2 out of 6 specimens where it could be identified. In the clinical cases, the median(IQR) NRS score decreased from 6.5(6–7) pre-block to 3(2–3) post-intervention. Conclusion Our preliminary data demonstrate that the BiFeS block achieves complete blockage of the posterolateral knee capsule. This technique may serve as a complementary, motor-sparing regional anesthesia method, particularly for postoperative pain management following TKA. Advantages include a low risk of complications, avoidance of vascular and neural structures, feasibility in the supine position.

Background : Artificial intelligence is rapidly transforming the healthcare sector by supporting advanced decision making, diagnostic tools, and personalized medicine. However, most medical curricula, especially in developing countries and at newly established institutions, have not fully adapted to these technological advances. Understanding medical students' knowledge, attitudes, and expectations is crucial for designing effective education strategies and preparing future physicians for the digital transformation of healthcare. Objective : This study evaluated the knowledge, awareness, attitudes, and educational expectations of medical students regarding the integration of artificial intelligence and digital health technologies into medical education. It also explored students’ perceptions of the ethical and practical implications of artificial intelligence in clinical practice. Methods : A descriptive, cross-sectional survey was conducted among first- to fourth-year medical students at Samsun University Faculty of Medicine in Turkey. Data were collected using an online questionnaire covering demographics, self-assessed digital literacy, knowledge and awareness of artificial intelligence, attitudes toward artificial intelligence-based educational tools, and open-ended suggestions for improving the curriculum. Descriptive statistics, chi-square tests, and Kruskal–Wallis tests were used for analysis. Results : Of 235 eligible students, 198 completed the survey. One hundred twenty were randomly selected for analysis. Most students described their digital literacy as moderate or low. Interest in artificial intelligence and digital health was higher among junior students but declined in later years. While positive attitudes toward artificial intelligence integration were common, actual knowledge and independent learning were limited. Conclusion : Medical students in a newly established Turkish medical school show high motivation and positive attitudes toward artificial intelligence integration, despite limited knowledge and self-efficacy. There is an urgent need for comprehensive, ethical, and context-appropriate artificial intelligence curricula to prepare future physicians for digital healthcare.

Pharyngocutaneous fistula is the most common complication after total laryngectomy and increases morbidity by prolonging hospital stay. Factors such as history of radiotherapy, tumor size, anemia and diabetes are effective in its development. Treatment options include conservative and surgical methods. A 72-year-old man underwent total laryngectomy and right neck dissection for advanced laryngeal cancer. Pharyngocutaneous fistula developed on postoperative day 5. Initially, local intervention and nasogastric feeding were performed, but the defect progressed. On postoperative day 30, repair was performed with a pectoralis major myocutaneous flap. The fistula recurred because the patient did not follow the recommendations. Subsequently, a successful reconstruction was achieved with supraclavicular full-thickness skin graft and deltopectoral flap. Pharyngocutaneous fistula is a common and difficult to manage complication after total laryngectomy. Early detection and appropriate treatment approach reduces morbidity. For reconstruction of large defects, myocutaneous flaps and double-layer repair with full- thickness skin grafting are effective. In this case, the fistula was completely healed with a successful reconstruction and the patient was able to switch to oral feeding.

Background Extended interval dosing (EID) of natalizumab (NTZ) every 6 weeks may reduce adverse events while maintaining efficacy. This study compared the effectiveness and safety of EID versus standard interval dosing (SID) in relapsing–remitting multiple sclerosis (RRMS) patients, focusing on treatment adherence and its impact on clinical and radiological outcomes. Methods This retrospective study involved 80 patients with RRMS from seven clinics: 52 received SID (300 mg every 4 weeks), and 28 received EID (300 mg every 6 weeks). Clinical and radiological disease activity, treatment adherence, and adverse events were assessed. Results The SID and EID groups differed significantly in sex distribution (78.8% female in SID vs. 46.4% in EID, p = 0.007), but median age was similar (32 vs. 36 years, p = 0.209). Clinical and radiological worsening rates were similar between the groups, with no significant differences (combined worsening: 9.6% in the SID group vs. 17.9% in the EID group, p = 0.308; radiological worsening: 5.8% in the SID group vs. 7.1% in the EID group, p = 1.00; clinical worsening: 9.6% in the SID group vs. 10.7% in the EID group, p = 1.00). Adherence rates were comparable across both dosing regimens, and no significant differences were observed in terms of treatment discontinuation. No progressive multifocal leukoencephalopathy cases were reported. Conclusion Both SID and EID provide comparable efficacy and safety profiles, with similar adherence rates. Despite the observed sex distribution imbalance, additional analyses confirmed no significant sex‐ or group‐related differences in baseline disability or clinical worsening, strengthening the interpretation that EID preserves efficacy. Findings should still be interpreted with caution due to the study's retrospective nature and limited sample size.

Aim This study aimed to determine the important features and cut‐off values after demonstrating the detectability of cirrhosis using routine laboratory test results of chronic hepatitis C (CHC) patients in machine learning (ML) algorithms. Methods This retrospective multicenter (37 referral centers) study included the data obtained from the Hepatitis C Turkey registry of 1164 patients with biopsy‐proven CHC. Three different ML algorithms were used to classify the presence/absence of cirrhosis with the determined features. Results The highest performance in the prediction of cirrhosis (Accuracy = 0.89, AUC = 0.87) was obtained from the Random Forest (RF) method. The five most important features that contributed to the classification were platelet, αlpha‐feto protein (AFP), age, gamma‐glutamyl transferase (GGT), and prothrombin time (PT). The cut‐off values of these features were obtained as platelet < 182.000/mm³, AFP > 5.49 ng/mL, age > 52 years, GGT > 39.9 U/L, and PT > 12.35 s. Using cut‐off values, the risk coefficients were AOR = 4.82 for platelet, AOR = 3.49 for AFP, AOR = 4.32 for age, AOR = 3.04 for GGT, and AOR = 2.20 for PT. Conclusion These findings indicated that the RF‐based ML algorithm could classify cirrhosis with high accuracy. Thus, crucial features and cut‐off values for physicians in the detection of cirrhosis were determined. In addition, although AFP is not included in non‐invasive indexes, it had a remarkable contribution in predicting cirrhosis. Trial Registration Clinicaltrials.gov identifier: NCT03145844

Breast cancer continues to be a devastating disease worldwide, highlighting the critical need for new and effective treatments. Schiff bases are increasingly being used as powerful medications for a number of disorders. The current investigation concentrates on the synthesis and characterization of an alkynes allied Schiff bases 4(a–c) through spectroscopic techniques, i.e., IR, NMR (¹H and ¹³C), and mass spectrometry. The 3D structures of Schiff bases 4(a–c) were elucidated through single‐crystal X‐ray diffraction technique. Herein, we report the photophysical, biological, and computational study of newly synthesized Schiff bases. The synthesized compounds were investigated for their cationic chemosensing activities, which showed the high selectivity of Schiff base 4b towards Sn²⁺ ion over other metallic cations. The LOD values for Sn²⁺ from absorption and emission spectroscopy were found to be 0.7333 × 10⁻⁶ M and 0.1675 × 10⁻⁷ M, respectively, and the binding affinity was confirmed by the association constant values of 0.3244 × 10⁶ M⁻¹ and 0.0902 × 10⁷ M⁻¹ as depicted in the B–H plot and Stern–Volmer plot, respectively. The 1:1 stoichiometry was confirmed through the Job's plot, and binding modes between ligand 4b and Sn²⁺ were investigated using ¹H NMR and FTIR spectroscopic techniques. Schiff bases investigated biologically exhibited potent cytotoxicity, characterized by favorable EC50 values (μM). In order to further explore the biological aspects of these compounds, molecular docking was carried out. The resulting binding energy of −8.38 kcal/mol suggested potential interactions, leading to the investigation of their antibreast cancer effects.

In this study, the ordered flow shop scheduling problem, which is in the class of NP-hard optimization problems, is considered. This problem is used especially to increase the efficiency and prevent delays in the production process. The problem was first identified in the literature during the 1970s. The main objective of this study is to develop an efficient and fast method to overcome the complexity of this problem. For this purpose, the ordered flow shop scheduling problem is explained in detail and a robust meta-heuristic method is proposed. First of all, a genetic algorithm is developed by considering Smith’s convexity criterion. While performing operations such as crossover and mutation in the genetic algorithm, the pyramid structure is integrated to ensure that the solution has certain symmetry. The developed method is compared with other methods, such as the Nawaz–Enscore–Ham (NEH), pair insert, and iterated local search (ILS) methods. In order to increase the reliability of the results, the Pyramid Structure Adapted Tabu Search (PSA-TS) algorithm is also developed. The results are validated by statistical analysis using the Wilcoxon signed-rank test and Friedman test. The proposed genetic algorithm outperforms the methods with which it is compared. To the best of the authors’ knowledge, there is no other method in the literature that preserves the pyramid structure in the ordered flow shop scheduling problem. Therefore, this study is expected to make a significant contribution to the literature in this respect.

Neurofibromatosis Type 1 is a genetic disorder resulting in RAS pathway activation. As a result, risk of developing both benign and malignant neoplasms is higher, compared with the general population. Plexiform neurofibromas are benign tumors of the peripheral nerve sheath affecting 40%–50% of patients with neurofibromatosis Type 1. Cervical‐parametrial plexiform neurofibroma is a very rare neoplasm. Here we present the ninth case in the literature. A 37‐year‐old woman presented with chronic pelvic pain and a pelvic mass that was 73 × 33 mm in size. Most of the mass was located between the proximal vagina‐cervix and the bladder. It was infiltrating the bilateral parametrium and the pararectal tissues. There was hydronephrosis on the right side and her right kidney was atrophic. The tumor would likely also cause obstruction on the left side. We performed a type B radical hysterectomy, right salpingo‐oophorectomy, left salpingectomy, cystoscopy, left ureterorenoscopy, and left ureteral double‐j catheterization, in addition to resection of the tumor, which was located between the cervix and bladder. She was followed for 11 months without any tumor relapse. The left kidney remained normal in the follow‐up period. To our knowledge, this is the first publication reporting the neurofibromatosis Type1 mutation c.7615 + 6 T>C as a pathogenic variant. In this case, we showed that plexiform neurofibromas and neurofibromatosis should be taken into account, when a pelvic mass adjacent to the uterine cervix is diagnosed, particularly if the tumor tends to accompany the peripheral nerve tracts. Surgical treatment of cervical‐parametrial plexiform neurofibromas is recommended in certain circumstances and a multidisciplinary approach may help to determine the optimal management.