INTRODUCTION: Migraine is a common neurological disorder that leads to significant morbidity. In recent years, it has been suggested that migraine may be associated with depression and sleep disturbances. The aim of this study was to evaluate the relationship between migraine, depression, and sleep quality.
METHODS: A total of 194 patients with migraine who presented to the neurology outpatient clinic of Afyonkarahisar University of Health Sciences and 90 healthy volunteers were compared. All participants completed the beck depression inventory (BDI) and the Pittsburgh sleep quality index (PSQI), and demographic as well as clinical data were recorded.
RESULTS: The study included 194 patients with migraine (68.3%) and 90 healthy controls (31.7%). Among migraine patients, 143 (73.7%) were female, while 66 (73.3%) of the control group were female. Mean age was 37.73±13.17 years in the migraine group and 38.01±12.50 years in the control group, with no significant difference between groups (p=0.946 for gender and p=0.746 for age). BDI and PSQI scores were significantly higher in the migraine group compared to the control group (p<0.001). Furthermore, the prevalence of chronic disease and smoking was higher, whereas alcohol consumption was lower, among individuals with migraine.
DISCUSSION AND CONCLUSION: Our findings demonstrate that depression and sleep disturbances are common in patients with migraine, supporting the notion that migraine is a complex disorder associated with psychiatric comorbidities. In clinical practice, routine evaluation of psychological status and sleep quality is essential in the management of migraine.

INTRODUCTION: Coronary slow flow (CSF) is increasingly interpreted as a functional abnormality of the coronary microcirculation and has been associated with metabolic imbalance and unfavorable cardiovascular profiles. Recently proposed metabolic markers, including the atherogenic index of plasma (AIP) and the triglyceride–glucose (TyG) index, have attracted attention as easily applicable indicators that reflect atherogenic lipid burden and insulin resistance. Nevertheless, evidence comparing the relationship between these indices and CSF remains scarce.
METHODS: In this retrospective analysis, 132 patients diagnosed with CSF by coronary angiography and 175 individuals with normal coronary flow were evaluated. CSF was identified using corrected thrombolysis in myocardial infarction (TIMI) frame count measurements. AIP, TyG, and modified TyG (Mod-TyG) indices were derived from fasting biochemical data. Associations with CSF were examined using correlation analysis, receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression models.
RESULTS: Patients with CSF demonstrated significantly higher AIP and TyG values, whereas Mod-TyG did not differ between the groups. AIP demonstrated the most robust correlation with corrected TIMI frame count values, particularly concerning the left anterior descending artery. ROC analysis revealed a better discriminative ability for AIP than TyG (AUC 0.685 vs. 0.634), whereas Mod-TyG was non-discriminatory. In the multivariate analysis, AIP and TyG remained independent predictors of CSF, along with smoking and hypertension.
DISCUSSION AND CONCLUSION: Lipid-driven atherogenic burden appears to play an important role in CSF. Among the evaluated indices, AIP demonstrated the strongest discriminative performance and the closest association with flow delay, supporting its potential clinical utility in CSF assessment.

INTRODUCTION: Online search engines have increasingly become important tools for accessing health-related information. This study aimed to evaluate global public interest in sarcopenia over the past decade using Google Trends (GT).
METHODS: Ten sarcopenia-related terms commonly used in physical medicine and rehabilitation – elderly, muscle mass, muscle quality, muscle strength, physical performance, sarcopenia, aging, body composition, muscle, and disability – were analyzed using GT. Searches were conducted in English with the “All categories,” “Web search,” and “Worldwide” filters applied. The 10-year study period (September 7, 2015–September 8, 2025) was divided into two consecutive 5-year periods. Relative search volumes for each term were compared between these periods.
RESULTS: Search interest in all ten terms increased significantly during the second 5-year period (p<0.001). These findings demonstrate increasing global search interest in sarcopenia and a broader set of related concepts associated with muscle health, aging, and physical function, potentially reflecting changes in online health information-seeking behavior.
DISCUSSION AND CONCLUSION: Global online interest in sarcopenia and related terms has increased substantially in recent years. Developing evidence-based online educational content that incorporates frequently searched terms may facilitate access to reliable health information and support efforts aimed at the prevention and early recognition of sarcopenia.

INTRODUCTION: Xanthelasma palpebrarum (XP) has been increasingly recognized as a potential cutaneous marker of systemic metabolic and vascular disorders. The ankle–brachial index (ABI) is a simple, non-invasive tool for detecting subclinical atherosclerotic burden. This study aimed to investigate the association between xanthelasma and ABI.
METHODS: In this single-center, descriptive cross-sectional study, 121 participants were evaluated. Patients with clinically diagnosed xanthelasma formed the study group, while age- and sex-matched individuals without xanthelasma served as controls. Demographics, cardiovascular risk factors, body mass index (BMI), and laboratory parameters were recorded. ABI was measured using a handheld Doppler device, with values ≤0.90 indicating peripheral artery disease and ≥1.30 suggesting medial arterial calcification.
RESULTS: Patients with xanthelasma had significantly higher BMI (31.8±6.4 vs. 28.7±4.1 kg/m²; p=0.002), low-density lipoprotein (LDL) cholesterol (144.7±50.2 vs. 129.2±37.1 mg/dL; p=0.046), Homeostasis Model Assessment of İnsulin Resistance (4.54±5.22 vs. 2.90±2.66; p=0.025), and free thyroxine levels (p=0.001), whereas serum 25-hydroxy Vitamin D was lower (p=0.014). ABI values were higher in the xanthelasma group (1.41±0.21 vs. 1.28±0.18; p<0.001). The prevalence of ABI ≥1.30 was significantly greater (65.6% vs. 45.0%; p=0.023). Logistic regression revealed that xanthelasma increased the risk of medial arterial calcification by 2.3-fold (odds ratio: 2.33; 95% confidence interval: 1.12–4.85).
DISCUSSION AND CONCLUSION: XP is associated with obesity, insulin resistance, elevated LDL cholesterol, and increased prevalence of ABI ≥1.30, consistent with medial arterial calcification. These findings suggest that xanthelasma may serve as a non-invasive cutaneous marker of metabolic derangements and subclinical atherosclerotic burden. ABI measurement could represent a valuable adjunct in the evaluation of patients with xanthelasma. Larger multicenter prospective studies are required to validate these associations.

INTRODUCTION: Minimally invasive direct coronary artery bypass (MIDCAB) is an established alternative to full sternotomy for isolated left anterior descending (LAD) revascularization. However, the impact of preoperative biological heterogeneity on early postoperative recovery in homogeneous beating MIDCAB cohorts remains unclear. This study aimed to identify latent preoperative phenotypes using unsupervised machine learning and to evaluate their association with early perioperative outcomes.
METHODS: This retrospective single-center study included consecutive patients undergoing isolated beating MIDCAB with left internal mammary artery (LIMA) to LAD grafting between August 2020 and May 2025. Emergency and redo cases were excluded. Preoperative variables (age, ejection fraction, hemoglobin, creatinine, C-reactive protein, and smoking exposure) were analyzed using Gower distance and k-medoids clustering. The optimal number of clusters was determined by silhouette analysis. Early outcomes included operative time, intensive care unit (ICU) stay, and hospital length of stay. Cluster stability was assessed using bootstrap resampling and the adjusted Rand index (ARI).
RESULTS: Forty-five patients were included. Three preoperative phenotypes were identified. Age, hemoglobin, creatinine, and smoking exposure varied across clusters, whereas ejection fraction and C-reactive protein did not differ significantly. No significant differences were observed in operative time (p=0.5099), ICU stay (p=0.1166), or hospital stay (p=0.2538). Bootstrap validation demonstrated moderate stability (mean ARI=0.43).
DISCUSSION AND CONCLUSION: Unsupervised machine learning identified distinct biological phenotypes in patients undergoing isolated beating MIDCAB; however, early postoperative outcomes were comparable across groups. Larger studies are needed to assess long-term clinical implications.

INTRODUCTION: Metabolic reprogramming is a defining feature of colorectal cancer, and amino acid metabolism constitutes a major functional axis supporting proliferation, stress tolerance, and treatment resistance. We aimed to compare the intracellular free amino acid profile of human colon tumor-116 (HCT-116) colon cancer cells with that of normal colon cells (CCD) using a targeted metabolomics workflow.
METHODS: Cells were cultured under standard conditions. Free amino acids were quantified by liquid chromatography-mass spectrometry/mass spectrometry using multiple reaction monitoring following derivatization with a commercial kit, based on a modified protocol previously described by Celik et al. Data preprocessing (median normalization, log10 transformation, and Pareto scaling) and statistical analyses were performed in MetaboAnalyst 6.0. Group comparisons used a two-sample t-test with Benjamini-Hochberg false discovery rate correction. Multivariate analyses (principal component analysis [PCA] and partial least squares-discriminant analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment/topology analyses were conducted.
RESULTS: PCA demonstrated clear metabolic separation between HCT-116 and CCD cells, with PC1 explaining 91.1% of total variance. Differential analysis indicated selective yet pronounced changes: taurine and phosphoethanolamine were increased, whereas citrulline, cystine, and thiaproline were decreased in HCT-116 cells. KEGG pathway analysis highlighted significant enrichment of valine/leucine/isoleucine biosynthesis, one-carbon pool by folate, arginine biosynthesis, and glycine/serine/threonine metabolism.
DISCUSSION AND CONCLUSION: HCT-116 cells exhibited pronounced reprogramming across redox-related (cystine/taurine), membrane phospholipid intermediate (phosphoethanolamine), and one-carbon/arginine-linked metabolic networks. This study supports hypothesis generation for testing targetable vulnerabilities, including the xCT/SLC7A11 axis and key one-carbon metabolic nodes.

INTRODUCTION: Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms with heterogeneous biological behavior. Identifying simple, accessible prognostic biomarkers could improve risk stratification. We aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and triglyceride–glucose (TyG) index in pNETs patients.
METHODS: This retrospective study included 47 patients with pNETs diagnosed through endoscopic ultrasound-guided fine-needle aspiration/biopsy between January 2012 and December 2024. Patients were grouped as insulinoma (n=10) or non-functional pNETs (n=37). Tumor characteristics, laboratory parameters, inflammatory markers, and TyG index were analyzed. Survival analyses were performed using Kaplan–Meier curves, and the prognostic cutoff value of NLR was assessed by receiver operating characteristic (ROC) analysis.
RESULTS: The median age was 61 (47–66) years, and insulinoma patients tended to be younger (46 [27–65]) than non-func-tional pNETs (62 [53–66]; p=0.122). Tumor size was smaller in insulinomas (14 [11.5–20] mm vs. 20 [15.5–37.5] mm; p=0.019). TyG index was significantly lower in insulinoma patients (4.50±0.30 vs. 4.80±0.36; p=0.018), but no association was observed between TyG and tumor grade, size, metastasis, or survival. Median NLR and PLR were significantly higher in expired patients compared to survivors (NLR: p=0.003; PLR: p=0.006), while LMR was not significant. ROC analysis demonstrated NLR as a strong predictor of mortality, especially in non-functional pNETs (area under the curve = 0.892, p=0.003; cutoff=2.39; sensitivity 100%; specificity 71%). Furthermore, multivariable Cox proportional hazards regression analysis revealed that metastasis (hazard ratio [HR]: 7.636, 95% confidence interval [CI]: 1.313–44.405, p=0.024) and NLR (HR: 2.248, 95% CI: 0.973–1.294, p=0.048) were independent predictors for overall survival.
DISCUSSION AND CONCLUSION: NLR and PLR are potential independent prognostic biomarkers in pNETs, particularly in non-functional tumors. TyG index showed no significant prognostic value in this cohort. Further prospective studies are required to validate these findings.

INTRODUCTION: In this study, we aimed to demonstrate the relationship between player demographic characteristics (age, gender, etc.) or playing preferences (court preference, grip position, backhand type, etc.) and injuries in tennis players.
METHODS: The questionnaire created to study and to investigate the relationship between injuries and these parameters was answered by 198 people who play tennis at club level, play tennis at professional level, or are tennis coaches.
RESULTS: In our study, it was found that the incidence of ankle injuries among female tennis players was statistically significantly higher than among male players. In addition, it was found that elbow injuries were more common among players aged 40 and older and that this association was statistically significant. A significant association was identified between grip type and elbow injuries, with elbow injuries observed more frequently in players using the continental and western grips. In contrast, no statistically significant association was found between grip type and wrist or hand/finger injuries. Similarly, no significant association was found between court preference and training frequency and the incidence of injuries.
DISCUSSION AND CONCLUSION: This study examined the relationships between demographic characteristics and playing preferences and injury patterns among tennis players. In particular, it was determined that grip position is associated with elbow injuries, ankle injuries are more common among female players, and advanced age is a significant factor in elbow injuries. These findings may contribute to the development of targeted injury prevention strategies for tennis players.

INTRODUCTION: Electrolyte monitoring is essential in pediatric intensive care units (PICUs), where rapid clinical decisions are frequently required. Blood gas analyzers (BGAs) provide fast, bedside results; however, their agreement with central laboratory analyzers (CLAs) remains a matter of debate, particularly in pediatric populations. To evaluate the correlation, agreement, and clinical interchangeability between electrolyte measurements obtained from a BGA and a CLA in pediatric intensive care patients.
METHODS: In this retrospective study, PICU patients with simultaneous BGA and CLA electrolyte measurements were included. Sodium, potassium, and chloride values obtained from the two methods were compared. Correlation analysis was performed using Spearman’s test, and agreement was assessed using Bland–Altman analysis. Predefined clinical acceptability limits were applied. Subgroup analysis was conducted based on acid–base status.
RESULTS: A total of 1,923 paired measurements were analyzed. Significant correlations were observed between BGA and CLA for sodium (ρ=0.656), potassium (ρ=0.794), and chloride (ρ=0.714) (all p<0.001). However, Bland–Altman analysis demonstrated wide limits of agreement for all parameters, with a substantial proportion of measurements falling outside predefined clinical acceptability limits. Subgroup analysis showed slightly stronger correlations in patients with acidosis, whereas sodium correlation was lower in the alkalosis group. Despite these variations, limits of agreement remained similar across acid–base subgroups.
DISCUSSION AND CONCLUSION: Although BGA electrolyte measurements show significant correlation with central laboratory results, the wide limits of agreement indicate that the two methods are not reliably interchangeable in clinical practice. While BGA provides rapid and clinically valuable information, confirmation with central laboratory measurements is recommended, particularly before making critical treatment decisions.

INTRODUCTION: The objective of the study is to evaluate clinical outcomes and demographic characteristics of patients undergoing decompressive craniectomy for cerebral complications following cardiothoracic surgery or endovascular procedures.
METHODS: This single-center retrospective study included 96 patients who underwent decompressive craniectomy between July 2016 and June 2025. Among these, 37 patients who required decompressive craniectomy due to hemorrhage and/or infarction following cardiothoracic surgery or endovascular procedures were included. Demographic characteristics, preoperative midline shift, post-operative craniectomy size, and modified Rankin Scale scores at discharge were analyzed.
RESULTS: The mean age of the 37 patients was 61.2±13.9 years. During follow-up, 81.1% of the patients died. The mean age of survivors was significantly lower than that of non-survivors (p=0.010). No statistically significant association was found between clinical outcome and sex, pre-operative midline shift, or post-operative craniectomy size. Firth penalized logistic regression analysis identified age as the only variable independently associated with mortality (p=0.006). This association remained significant after exclusion of the single pediatric patient in sensitivity analysis (p=0.024).
DISCUSSION AND CONCLUSION: Mortality remains high in patients undergoing decompressive craniectomy for cerebral complications following cardiothoracic surgery or endovascular procedures. Age was identified as the only independent predictor of mortality.

INTRODUCTION: Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder that is frequently encountered in childhood, arising from immune-mediated impairment of pancreatic β-cell function. Th1 responses are predominantly associated with autoimmune mechanisms within T helper (Th) cell subsets, while Th2 responses are primarily involved in allergic diseases. The balance between Th1 and Th2 pathways may reflect a potential inverse relationship between autoimmune and atopic conditions. Therefore, this study aimed to assess the prevalence of atopy among children and adolescents with T1DM.
METHODS: This study included 30 children diagnosed with T1DM and 100 healthy children. The presence of atopy was assessed using the International Association of Asthma and Allergies in Childhood questionnaire. In addition, atopy indicators included physician-confirmed diagnoses, serum total immunoglobulin E (IgE) concentrations, and peripheral eosinophil counts.
RESULTS: The prevalence of atopy, serum IgE levels, and eosinophil counts were similar between the diabetic and control groups.
DISCUSSION AND CONCLUSION: Our findings indicate no significant or directional association between T1DM and atopic diseases in children, with comparable prevalence rates observed between patients and healthy controls. These results suggest that the relationship is complex and multifactorial, extending beyond the traditional Th1/Th2 paradigm and likely involving multiple immunological and environmental mechanisms.

INTRODUCTION: Myocarditis is an important cause of morbidity and mortality in children. This study aimed to evaluate whether the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a recently proposed systemic inflammatory index, can serve as an early predictor of adverse outcomes in pediatric myocarditis.
METHODS: This retrospective study included patients aged >1 month and <18 years who were followed in our clinic between January 1, 2022, and March 1, 2025. Patients were classified as having fulminant myocarditis (requiring inotropic support or extracorporeal membrane oxygenation) or non-fulminant myocarditis. HALP scores measured within the first 6 h of admission were compared between groups.
RESULTS: A total of 155 children (109 boys; median age 12 years) were included, of whom 38 (24.5%) had fulminant myocarditis. Fulminant cases showed significantly lower left ventricular ejection fraction (LVEF) (median 29%, interquartile range [IQR] 24–37) compared with non-fulminant patients (53%, IQR 45–60; p<0.001). N-terminal pro-brain natriuretic peptide levels were markedly higher in the fulminant group (35,596 pg/mL, IQR 18,166–55,419) than in the non-fulminant group (288 pg/mL, IQR 96–1,458; p<0.001). The HALP score was significantly lower in fulminant myocarditis (2.91, IQR 2.18–3.60) compared with non-fulminant cases (5.62, IQR 4.44–7.11; p<0.001). In receiver operating characteristic analysis, HALP demonstrated excellent discrimination for fulminant myocarditis (area under the curve 0.926; 95% confidence interval 0.874–0.972), with an optimal cut-off of <3.78 (sensitivity 85%, specificity 90%).
DISCUSSION AND CONCLUSION: Lower HALP scores and reduced LVEF were independent predictors of fulminant myocarditis. HALP, an easily calculated biomarker derived from routine laboratory parameters, may support early identification of children at risk for a fulminant course.

INTRODUCTION: Catheter-related bloodstream infections (CRBSIs) remain a major cause of morbidity and mortality in intensive care units (ICUs), despite advances in infection control practices. Monitoring long-term trends in infection rates and pathogen distribution is essential for evaluating the effectiveness of preventive strategies and guiding empirical treatment. The present study aimed to evaluate temporal trends in CRBSI incidence and changes in the distribution of causative micro-organisms in an ICU over an 11-year period (2015–2025).
METHODS: This retrospective, single-center study was conducted in the ICUs of Tokat State Hospital, Türkiye, between January 1, 2015, and December 31, 2025. CRBSI rates were calculated as the number of infections per 1,000 catheter-days using aggregated annual surveillance data. Temporal trends in infection rates and microbial distribution were analyzed using joinpoint regression, and annual percent change (APC) values were calculated.
RESULTS: Over the 11-year study period, CRBSI rates demonstrated a statistically significant decreasing trend, with an overall APC of −21.81% (p<0.05). Klebsiella pneumoniae showed a significant decrease during 2015–2017 (APC: −47.83%, p<0.001), followed by an increase during 2017–2022 (APC: +25.01%, p<0.001) and a subsequent decrease during 2022–2025 (APC: −34.21%, p<0.001). Acinetobacter baumannii increased significantly during 2015–2020 (APC: +21.20%, p<0.001) and decreased during 2020–2025 (APC: −31.34%, p<0.001). Candida spp. demonstrated a marked increase during 2015–2021 (APC: +46.10%, p<0.001), followed by a non-significant trend thereafter (APC: −2.50%, p=0.570). Other pathogens, including Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, and enterococci, showed no statistically significant temporal changes.
DISCUSSION AND CONCLUSION: CRBSI rates significantly decreased over the study period, reflecting improvements in infection control practices. However, pathogen-specific trends revealed dynamic and heterogeneous patterns, particularly among Gram-negative bacteria and Candida spp. Continuous surveillance and adaptive infection control strategies are essential to sustain reductions in infection rates and to address evolving microbial patterns.

INTRODUCTION: To compare the clinical, laboratory, and obstetric characteristics of multiple pregnancies conceived through assisted reproductive technology (ART) and spontaneous conception (SC) that resulted in second-trimester abortion or stillbirth.
METHODS: This retrospective study was conducted at a tertiary research hospital between January 2019 and December 2024. Multiple pregnancies complicated by abortion or stillbirth occurring between 14 and 28 weeks of gestation were included in this study. Singleton and higher-order multiple pregnancies, as well as pregnancies complicated by pregestational diabetes mellitus or chronic hypertension, were excluded from the study. Patients were grouped according to the mode of conception (ART vs. SC). Demographic characteristics, obstetric history, clinical signs, laboratory findings, and progesterone use were compared between the groups.
RESULTS: A total of 64 women were included, comprising 30 ART-conceived and 34 spontaneously conceived multiple pregnancies. Maternal age, gestational age at pregnancy loss, history of vaginal delivery, and history of abortion were similar between the groups (all p>0.05). White blood cell counts and rates of positive vaginal cultures did not differ significantly. However, median C-reactive protein levels were significantly higher in the ART group than in the SC group (9.25 vs. 1.33 mg/dL; p=0.001). Progesterone use was significantly more frequent in ART-conceived pregnancies than ART-conceived pregnancies (90% vs. 21%, p=0.001). No significant differences were observed in the rates of vaginal bleeding, pelvic pain, membrane rupture, or cervical dilatation.
DISCUSSION AND CONCLUSION: Second-trimester abortion and stillbirth in multiple pregnancies showed largely similar clinical and obstetric characteristics, regardless of the mode of conception. Elevated inflammatory markers in ART-conceived pregnancies may indicate distinct underlying mechanisms and warrant further investigation in larger prospective studies.

INTRODUCTION: Digital platforms increasingly influence how patients obtain information about cardiovascular imaging. Differences between professional terminology and patient search language, together with the growing role of YouTube, may shape awareness of coronary computed tomography angiography (CCTA). This study examined cross-country trends in CCTA awareness and the influence of linguistic patterns and video-based information sources on patient-provider communication.
METHODS: Google Trends was used to retrieve monthly relative search volumes for curated medical and colloquial CCTA-related terms across Türkiye, the United States, the United Kingdom, France, and Germany from 2011 to 2025 on Web and YouTube. Baseline-to-endpoint growth, the linguistic gap ratio (LGR), and platform correlations were evaluated. Trends were analyzed using the Mann–Kendall test.
RESULTS: Web search interest increased significantly in all countries (p<0.05). The United States showed mature-market growth (+238.4%), whereas Türkiye showed rapid emerging-market expansion (+4,115.1%). Western markets showed a pronounced linguistic gap (LGR 9.83–13.30), whereas Türkiye showed a hybrid pattern (LGR 0.83) with strong correlation between medical and colloquial searches (r=0.85). YouTube growth exceeded web growth in most regions.
DISCUSSION AND CONCLUSION: Public engagement with CCTA is increasingly driven by colloquial terminology and video-based information seeking. Recognizing these regional patterns may improve patient communication and optimize pre-test workflow.

INTRODUCTION: The aim of this study is to evaluate the 5-year publication outcomes of oral presentations presented at the National Turkish Orthopedics and Traumatology Congresses between 2015 and 2019.
METHODS: Abstract books of the National Turkish Orthopedics and Traumatology Congresses held between 2015 and 2019 were reviewed. Only oral presentations were included. Subsequent full-text publications were identified through systematic searches of PubMed and Google Scholar using presentation titles and author names. Publications appearing within 5 years after the congress were recorded. Identified articles were classified according to journal indexing status, quartile ranking, and impact factor. Time to publication was calculated relative to the congress year.
RESULTS: A total of 1677 oral presentations were evaluated. Of these, 772 (46.0%) were published as full-text articles within 5 years, including publications in both nationally indexed and internationally indexed journals. Publication rates differed significantly across congress years (p=0.002). Among the published articles, 464 (60.1%) appeared in Science Citation Index Expanded (SCIE)-indexed journals. Most publications occurred within the first 2 years after presentation. Quartile analysis demonstrated a predominance of Q2 and Q3 journals, whereas Q1 publications constituted a smaller proportion. The mean impact factor of SCIE publications varied by year, with the highest average observed in 2017.
DISCUSSION AND CONCLUSION: Nearly half of the oral presentations presented at the National Turkish Orthopedics and Traumatology Congresses between 2015 and 2019 progressed to full-text publication within 5 years. The majority of these publications appeared in internationally indexed journals, while a smaller proportion were published in nationally indexed journals, indicating that oral presentations at the national congress contribute meaningfully to the orthopedic literature.

INTRODUCTION: The aim of this study was to develop and temporally validate a multimodal machine learning model for classifying clinically relevant flare-related activity during the 90 days preceding the index visit in patients with inflammatory bowel disease (IBD).
METHODS: This retrospective cohort study included 345 adults with IBD in clinical remission or with mild disease activity who underwent routine ileocolonoscopy at a tertiary referral center between December 2025 and March 2026. Demographic, clinical, laboratory, endoscopic, histopathological, and patient-reported data were extracted from electronic medical records for the 90-day pre-index period. The primary outcome was a composite of treatment intensification due to symptomatic worsening, IBD-related hospitalization, or IBD-related surgery during that period. Least absolute shrink-age and selection operator regression was used for feature selection in a development cohort (n=242). Three algorithms – regularized logistic regression, random forest, and eXtreme Gradient Boosting (XGBoost) – were evaluated in a temporally distinct validation cohort (n=103) using area under the receiver operating characteristic curve (AUROC), calibration metrics, and decision curve analysis.
RESULTS: Flare-related activity was identified in 76 of 345 patients (22.0%). In the validation cohort, the multimodal XGBoost model showed the best discriminative performance, with an AUROC of 0.84 (95% confidence interval [CI], 0.77–0.91), sensitivity of 78.0%, specificity of 73.8%, positive predictive value of 55.3%, and negative predictive value of 89.1%. The multimodal model outperformed unimodal models (clinical-only AUROC 0.66, laboratory-only 0.71, endoscopic-only 0.74, and histology-only 0.69) and a baseline clinical model (AUROC 0.73). Calibration was good (Brier score 0.15), and decision curve analysis demonstrated net benefit across clinically relevant thresholds.
DISCUSSION AND CONCLUSION: A multimodal model integrating routinely collected data demonstrated good performance in classifying recent flare-related activity in IBD and outperformed single-modality approaches in a temporally distinct validation cohort. External validation is required before clinical implementation.

INTRODUCTION: Metastatic bladder cancer (mBC) is associated with poor outcomes. Despite advances in immunotherapy and targeted agents, platinum-based chemotherapy remains a cornerstone of treatment in real-world practice. We aimed to identify pragmatic and readily available prognostic factors for risk stratification in patients with mBC.
METHODS: This retrospective multicenter study included 121 patients with mBC treated at two high-volume oncology centers. Clinicopathological and laboratory parameters at the time of metastatic diagnosis were analyzed. The primary endpoint was overall survival (OS).
RESULTS: The median age was 66 years, and 90% of patients were male. The most common metastatic sites were abdominal lymph nodes (71.9%), bone (52.9%), lung (41.3%), and liver (27.3%). On multivariable analysis, Eastern Cooperative Oncology Group Performance Status ≥2 (hazard ratio [HR] 1.80 (1.04–3.14), p=0.036), low hemoglobin (HR 1.67 (1.01–2.77), p=0.046), hypoalbuminemia (HR 2.08 (1.24–3.50), p=0.006), and leukocytosis (HR 2.26 (1.32–3.87), p=0.003) were independently associated with inferior OS.
DISCUSSION AND CONCLUSION: Poor performance status, low hemoglobin levels, hypoalbuminemia, and leukocytosis at metastatic diagnosis are independent predictors of worse survival. These simple, cost-effective parameters may support risk stratification and clinical decision-making, particularly in settings where access to novel therapies is limited.

INTRODUCTION: This study aimed to assess patient-perceived visual, auditory, and meteorological seizure triggers and examine their associations with ongoing seizure activity in adults with epilepsy.
METHODS: This single-center, cross-sectional study was conducted with 100 adults with epilepsy. We developed a structured researcher questionnaire, which was used to conduct face-to-face interviews and included 12 environmental stimuli. These were grouped as visual, auditory, and meteorological stimuli. Each stimulus was assessed using a 5-point Likert-type scale. These scores were assessed in relation to ongoing seizures. To understand the relationship between the perception of environmental stimuli and ongoing seizure activity, we performed multiple logistic regression analyses.
RESULTS: Sixty-one percent of participants (95% CI, 51.2–70.0%) reported at least one environmental stimulus as a trigger “sometimes or more often.” The most frequently reported stimuli were flashing lights (39%), bright sunlight (32%), sudden loud sounds (30%), and hot weather (30%). Participants with ongoing seizures had higher visual, meteorological, and total environmental trigger burden scores than those without ongoing seizures. Ongoing seizure activity was associated with the reporting of an external trigger (adjusted odds ratio [aOR]=9.93; 95% confidence interval [CI], 2.85–34.54; p<0.001). Each 5-point increase in the total environmental trigger burden score was associated with the occurrence of ongoing seizures (aOR=1.39; 95% CI, 1.02–1.88; p=0.035). Each additional ASM was independently associated with higher odds of ongoing seizure activity (aOR=2.36; 95% CI, 1.17–4.76; p=0.016).
DISCUSSION AND CONCLUSION: Many patients reported trigger stimuli when assessed in a structured manner. An increased environmental trigger load was shown to have an independent correlation with ongoing seizure activity. Therefore, a formal, structured assessment of environmental seizure triggers could provide additional information for routine epilepsy assessments. Prospective studies using validated assessment tools and objective exposure assessments are warranted to better define the possible clinical implications of these findings.