Towards an intraoperative engineering of osteogenic and vasculogenic grafts from the stromal vascular fraction of human adipose tissue

Grafts generated by cultivation of progenitor cells from the stromal vascular fraction of human adipose tissue have been proven to have osteogenic and vasculogenic properties in vivo. However, in vitro manufacture of such implants is challenged by complex, impractical and expensive processes, and requires implantation in a separate surgery. This study investigates the feasibility of an intraoperative approach to engineer cell-based bone grafts with tissue harvest, cell isolation, cell seeding onto a scaffold and subsequent implantation within a few hours. Freshly isolated adipose tissue cells from a total of 11 donors, containing variable fractions of mesenchymal and endothelial progenitors, were embedded at different densities in a fibrin hydrogel, which was wrapped around bone substitute materials based on beta-tricalcium phosphate (ChronOS), hydroxyapatite (Engipore), or acellular xenograft (Bio-Oss). The resulting constructs, generated within 3 hours from biopsy harvest, were immediately implanted ectopically in nude mice and analysed after eight weeks. All explants contained blood vessels formed by human endothelial cells, functionally connected to the recipient's vasculature. Human origin cells were also found within osteoid structures, positively immunostained for bone sialoprotein and osteocalcin. However, even with the highest loaded cell densities, no frank bone tissue was detected, independently of the material used. These results provide a proof-of-principle that an intraoperative engineering of autologous cell-based vasculogenic bone substitutes is feasible, but highlight that - in the absence of in vitro commitment--additional cues (e.g., low dose of osteogenic factors or orthotopic environmental conditions) are likely needed to support complete osteoblastic cell differentiation and bone tissue generation.

The effect of chronic pelvic pain scoring on pre-term delivery rate

A total of 57 pregnant women, who were admitted to the outpatient clinic having high visual analogue scale (VAS) and a history of chronic pelvic pain before pregnancy, were evaluated with the international pelvic pain assessment form (IPPAF). Gynaecological disorders, pain at ovulation, dysmenorrhoea, level of cramps with period and suspicion of endometriosis were determined to be higher in the pre-term group (p < 0.05). Regarding urological disorders, pain when the bladder was full, pain with urination, a positive answer to the question, 'Does your urgency bother you?' and suspicion of interstitial cystitis were also determined to be higher in the pre-term group (p < 0.05). Thus, the total IPPAF scores were significantly higher in the pre-term group (p < 0.05). The pregnant women with a higher total IPPAF score before pregnancy may thus have a higher probability of pre-term labour.

Real-world data on direct oral anticoagulants in BCR::ABL1-negative myeloproliferative neoplasms (MPNs): a multicenter retrospective study on behalf of scientific subcommittee on MPNs for Turkish society of hematology

BCR::ABL1-negative myeloproliferative neoplasms (MPNs) pose a substantial risk of thrombosis, leading to significant morbidity and mortality. Anticoagulant therapy, historically based on vitamin K antagonists (VKAs), has limitations in preventing recurrent thrombotic events and managing bleeding complications. Direct oral anticoagulants (DOACs) offer a potential alternative with improved pharmacokinetics and compliance. However, evidence on DOAC efficacy and safety in MPNs remains limited, necessitating further investigation. In this multicenter retrospective study in Türkiye, we assessed real-world usage patterns and outcomes of DOACs in MPN patients. Data from 220 patients with PV, ET, or PMF receiving DOACs or VKAs for thrombosis or nonvalvular atrial fibrillation (NVAF) were collected from medical records. Thrombotic events and bleeding episodes were documented based on ISTH criteria. DOACs were used in 126 patients as first-line anticoagulant therapy or following VKAs. Ninety-four patients were on VKAs, of which 83 as a first-line treatment. There were eight thromboses (6.3%) seen in 126 DOAC patients, and similarly, seven episodes (9.4%) of thrombosis were observed in 94 patients using VKA. Major bleeding occurred in seven patients (5.6%) on DOAC and 3 (3.2%) in VKA. Thrombotic and bleeding risks were comparable between DOACs and VKAs (p = 0.708 and p = 0.158, respectively). The incidence rate of thrombosis in the VKA group is 1.1% and in the DOAC group is 1.9%. The incidence of major bleeding in the VKA group is 0.6% and 1.6% in the DOAC group. To the best of our knowledge, our study included the largest number of MPN patients to date, comparing DOACs with VKA in terms of both efficacy and safety, which suggests DOACs as promising alternatives to VKAs for managing thrombotic risk in MPNs with manageable toxicity. Despite the limitations of retrospective studies, DOACs' benefits in terms of efficacy and compliance warrant further investigation through prospective trials. Individualized treatment decisions should consider patient-specific factors, emphasizing collaborative efforts between specialists to optimize DOAC therapy in patients with MPNs. Comparable efficacy and safety between DOACs and VKAs were observed in MPN patients.

The effects of hormone therapy on ischemia modified albumin and soluble CD40 ligand levels in obese surgical menopausal women

PURPOSE

To determine the effects of hormone therapy (HT) on ischemia modified albumin (IMA) and soluble (s)CD40 ligand in obese surgical menopausal women.

MATERIALS AND METHODS

A total of 52 obese surgical menopausal women with a body mass index (BMI) > 30 kg/m2 were admitted to the study. Twenty-seven women received estradiol hemihydrate two mg and 25 did not receive any menopausal therapy. At baseline and after three and six months of treatment, IMA and sCD40 ligand levels were measured.

RESULTS

There were no significant differences among the groups for any variables at baseline. No difference in change in the serum sCD40L levels was found in obese surgical menopausal women after three and six months of HT. Serum IMA levels were statistically lowered in obese women with HT after six months of treatment.

CONCLUSION

HT may have a beneficial reduction in IMA levels in obese surgical menopausal women.

Psychometric Properties of the Depression Anxiety Stress Scales (DASS-42 and DASS-21) in Patients with Hematologic Malignancies

Background/Objectives: Patients with hematologic malignancies undergo prolonged, intensive treatments involving frequent hospitalizations and experience debilitating side effects. Consequently, they are at increased risk of developing symptoms of depression, anxiety, and stress, which can undermine their quality of life. However, there is a scarcity of instruments validated for the simultaneous assessment of depression, anxiety, and stress within hematologic cancer populations. The aim of this study is to examine the construct validity, convergent and discriminant validity, and reliability of the Depression Anxiety Stress Scales (DASS-42 and DASS-21) among hematologic cancer patients. Methods: We collected data from 452 hematologic cancer patients across three studies. Results: Confirmatory factor analyses indicated that the theoretical correlated three-factor model and bifactor model for DASS-42 and DASS-21 responses were sufficient to explain the underlying factor structure of the scales in hematologic cancer patients. However, the bifactor model for DASS-42 and DASS-21 fit better with the data compared to the theoretical correlated three-factor model. In addition, we found the correlated three-factor model and the bifactor structure to exhibit scalar measurement invariance across gender for DASS-42 and DASS-21. DASS-42 and DASS-21 subscales demonstrated weak to strong negative correlations with measures of psychological well-being (happiness, well-being, life satisfaction) and strong positive correlations with measures of similar constructs (depression, anxiety, and stress), thereby supporting their convergent and discriminant validity with theoretically and empirically expected correlations with external criteria. The reliability analyses demonstrated that both DASS-42 and DASS-21 subscales exhibited strong internal consistency and test-retest reliability when assessing symptoms of depression, anxiety, and stress among patients with hematologic malignancies. Moreover, the item-scale convergent and discriminant validity analyses demonstrated that items exhibited higher corrected item-total correlations with their intended subscales than with other subscales across the DASS-42 and DASS-21, providing evidence for the distinct measurement properties of each subscale. Conclusions: The findings suggest that the DASS-42 and DASS-21 are psychometrically robust instruments for use in Turkish hematologic cancer patients.

Examining posttraumatic growth among Turkish family caregivers of cancer patients

Cancer is a deadly disease that affects millions of people worldwide and is a source of great difficulty, stress, and trauma not only for patients but also for their caregivers. The physical and emotional suffering that patients experience by patients can lead their caregivers to cope with constant anxiety, sadness, and uncertainty. Moreover, during the cancer treatment process, caregivers must make a great effort to meet the needs of patients and support them. This situation may negatively affect the quality of life and psychological health of cancer patients' caregivers and may lead them to experience trauma. The aim of this cross-sectional study was to examine posttraumatic growth's relationship with age, the transformative power of suffering, and hope in family caregivers of cancer patients. Participants consisted of 314 Turkish family caregivers of cancer patients (73.2% women; Mage = 39.89 years) selected by using convenience sampling method. Participants answered a data collection tool consisting of a demographic information form, the Posttraumatic Growth Inventory, Trait Hope Scale, and Transformative Power of Suffering Scale. Data were analyzed using descriptive statistics, the Pearson product-moment correlation coefficient analysis, simple mediation analysis, and moderated mediation analysis. The results of this study revealed that hope mediated the association between the transformative power of suffering and posttraumatic growth in family caregivers of cancer patients, whereas age moderated this relationship. Psychosocial support programs for cancer caregivers could benefit from incorporating interventions that explore the transformative potential of suffering and cultivate hope. Tailoring these interventions to address the specific needs of different age groups may enhance their effectiveness. Future researchers should investigate the factors associated with posttraumatic growth in caregivers across diverse cultures, age ranges, and cancer diagnoses.

Consensus statement addressing controversies and guidelines on pediatric urolithiasis

PURPOSE

We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews.

METHODS

Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews.

RESULTS

Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15 years, and 4 with 6-10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement).

CONCLUSION

The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.

Frequency of respiratory function disorders among dental laboratory technicians working under conditions of high dust concentration

BACKGROUND AND OBJECTIVES

Dental laboratory technicians (DLTs) have much exposure to mineralogical dust that may have adverse effects on their lung health. The aim of our study was to investigate occupational dust exposure, and to determine the frequency of respiratory function disorders and radiologic abnormalities among DLTs.

MATERIALS AND METHODS

The study enrolled 94 DLTs who were exposed to dust in dental laboratories and 94 control subjects. Dust concentrations in the workplaces were measured.

RESULTS

The mean age of DLTs was 30.70 ± 9.84 years. No significant difference was found between the DLTs and the control groups for age or smoking status (p > 0.05). Spirometric values for the DLTs were found to be lower than the control group (p < 0.05). The mean working period for DLTs was 9.19±5.9 years. The pulmonary function test results for the DLTs showed that 65.9% had a normal pattern, 22.4% were restrictive, and 11.7% showed obstructive type pulmonary function disorder. Negative correlations were found between the working period time and Forced Expiratory Volume in 1 second in the DLTs (R = -0.675 p = 0.000). Negative correlations were also found between working period time and Forced Vital Capacity in the DLTs (R = -0.720 p = 0.000). All DLTs had chest X-rays and 16 (17%) of them showed radiological pneumoconiosis.

CONCLUSIONS

This study showed a negative association between level of respiratory function and working period in DLTs.

Effects of comorbidities associated with COVID-19 cases in Intensive Care Unit on mortality and disease progression

OBJECTIVE

The patient's age, gender and the presence of certain concomitant diseases have been reported to play a part in the course and progression of COVID-19 in the literature. In this study, we aimed to compare the comorbidities causing mortality in critically ill Intensive Care Unit (ICU)-patients diagnosed with COVID-19.

PATIENTS AND METHODS

The data as regards the COVID-19 cases followed up in the ICU were retrospectively reviewed. 408 COVID-19 patients with positive PCR test were included in the study. In addition, a subgroup analysis was performed in patients treated with invasive mechanical ventilation. While the primary aim of this study was to evaluate the difference in survival rates due to comorbidities in critical COVID-19 patients, we also aimed to assess the comorbidities in severely intubated COVID-19 patients in terms of mortality.

RESULTS

A statistically significant increase in mortality was observed in patients with underlying hematologic malignancy and chronic renal failure (p=0.027, 0.047). Body mass index value in the mortal group was significantly higher in both the general study group and subgroup analysis (p=0.004, 0.001).

CONCLUSIONS

Advanced age and comorbidities such as chronic renal failure and hematologic malignancy in COVID-19 patients are associated with poor survival prognosis in critically ill COVID-19 patients.

Evaluation of contraception methods in chronic myeloid leukemia patients: A Turkish multicenter study

BACKGROUND AND AIM

Chronic myeloid leukemia (CML) incidence has recently increased in younger individuals. With time, given the nature of the disease and available therapies, as well as the existing paucity and inconsistency of advice, worries about fertility have surfaced. With all these clear unknowns, we designed this study to raise awareness among both physicians and CML patients about whether male and female patients of childbearing age were using contraception at the time of diagnosis, and if so, which methods they were using. In this context, this study aimed to evaluate the contraception methods in patients with CML.

MATERIALS AND METHODS

Eighteen centres from Turkey participated in the study. Male and female patients of childbearing age diagnosed with chronic and accelerated phase CML between the years 2000 and 2024 were evaluated retrospectively.

RESULTS

Of the two hundred and thirty-two patients included, one hundred and twenty-five (53.9%) of these patients were female and 107 (46.1%) were male. At diagnosis, all female patients were in the childbearing age, and male patients were sexually active. The median age at diagnosis of the patients was 38 (range, 18-77) years. Eighty-six (68.8%) female patients were using any contraception method, while this was 53.2% (n = 57) among male patients.

CONCLUSION

In conclusion, since CML patients are diagnosed at an earlier age and the desire of these patients to have children, adequate information and evaluation should be provided regarding fertility and contraception issues, especially in female patients, from the moment of diagnosis.

Impact of CALR and JAK2V617F Mutations on Clinical Course and Disease Outcomes in Essential Thrombocythemia: A Multicenter Retrospective Study in Turkish Patients

Objective

In this study, we investigated the effects of calreticulin (CALR) and JAK2V617F mutational status on clinical course and disease outcomes in Turkish patients with essential thrombocythemia (ET).

Materials and Methods

Seventeen centers from Türkiye participated in the study and CALR- and JAK2V617F-mutated ET patients were evaluated retrospectively.

Results

A total of 302 patients were included, of whom 203 (67.2%) and 99 (32.8%) were JAK2V617F- and CALR-positive, respectively. CALR-mutated patients were significantly younger (51 years vs. 57.5 years, p=0.03), with higher median platelet counts (987x109/L vs. 709x109/L, p<0.001) and lower median hemoglobin levels (13.1 g/dL vs. 14.1 g/dL, p<0.001) compared to JAK2V617F-mutated patients. Thromboembolic events (TEEs) occurred in 54 patients (17.9%), 77.8% of which were arterial. Compared to CALR mutation, JAK2V617F was associated with a higher risk of thrombosis (8.1% vs. 22.7%, p=0.002). Rates of transformation to myelofibrosis (MF) and leukemia were 4% and 0.7%, respectively, and these rates were comparable between JAK2V617F- and CALR-mutated cases. The estimated overall survival (OS) and MF-free survival of the entire cohort were 265.1 months and 235.7 months, respectively. OS and MF-free survival durations were similar between JAK2V617F- and CALR-mutated patients. Thrombosis-free survival (TFS) was superior in CALR-mutated patients compared to JAK2V617F-positive patients (5-year TFS: 90% vs. 71%, respectively; p=0.001). Age at diagnosis was an independent factor affecting the incidence of TEEs.

Conclusion

In our ET cohort, CALR mutations resulted in higher platelet counts and lower hemoglobin levels than JAK2V617F and were associated with younger age at diagnosis. JAK2V617F was strongly associated with thrombosis and worse TFS. Hydroxyurea was the most preferred cytoreductive agent for patients with high thrombosis risk.