Turkish Journal of Medical Sciences最新文献

This review synthesizes current knowledge on the molecular mechanisms regulating brown, white, and beige adipose tissues, with particular emphasis on the browning process of white adipose tissue. Rather than considering adipose tissue as a passive energy reservoir, this review underscores its active role as a dynamic endocrine and metabolic organ. Brown and beige adipose tissues, recognized for their thermogenic capacity and contribution to energy expenditure, have emerged as promising therapeutic targets for the treatment of obesity, type 2 diabetes, and related metabolic disorders. The review draws upon recent findings on adrenergic signaling, transcription factors, exosomal microRNAs, and other novel regulatory pathways for the creation of a cohesive framework. Particular attention is paid to how environmental, physiological, and molecular cues, such as exposure to cold, exercise, gut microbiota, and exosomal communications, converge on common pathways to influence thermogenesis and browning. By highlighting these interrelated mechanisms, the review not only summarizes recent advances in the field, but also clarifies their interconnected implications for metabolic regulation and potential therapeutic interventions.

Background/aim: Nonalcoholic fatty liver disease (NAFLD) is a metabolic disease that is commonly observed in individuals with obesity. The present study investigates the irisin and adropin levels of sera in preobese or obese adults with NAFLD.

Materials and methods: Included in the study were 89 patients who were categorized into four groups: Group 1: 25 normal-weight individuals without NAFLD (Control group); Group 2: 17 preobese or obese individuals without NAFLD; Group 3: 24 preobese or obese individuals with Grade 1 NAFLD; and Group 4: 23 preobese or obese individuals with Grade 2-3 NAFLD. The demographic details of all participants were recorded. Abdominal ultrasonography and anthropometric assessments were conducted. Serum adropin and irisin levels were determined using the Enzyme-Linked Immunosorbent Assay (ELISA) method.

Results: Serum adropin and irisin levels were lower in Groups 3 and 4 than in Group 1 (between the all groups; p = 0.006, p = 0.001, respectively), but were comparable between Groups 3 and 4. Furthermore, the atherogenic index of Group 1 was lower than that of Group 4 (p < 0.001). Among the hemogram parameters, the red cell distribution width value was higher in Group 3 than in Group 1 (p = 0.031).

Conclusion: Serum adropin and irisin levels decrease in the presence of NAFLD, regardless of disease severity, which may play a role in the development and exacerbation of NAFLD in preobese and obese individuals.

Background/aim: Impairments in spatiotemporal gait characteristics have been observed in patients with chronic obstructive pulmonary disease (COPD). However, arm swing characteristics-a fundamental component of gait that play a key role in maintaining gait stability and energy efficiency-have been largely overlooked. This study aimed to investigate the spatiotemporal characteristics of gait, together with arm swing patterns, in patients with COPD.

Materials and methods: A total of 20 patients with COPD (aged 40-65 years) and 20 age- and sex-matched healthy controls (HC) participated in this cross-sectional study. Spatiotemporal gait characteristics and arm swing data were recorded using a motion capture system equipped with eight near-infrared cameras during a 6 min walk.

Results: Stride and step length, step time and width, gait speed, and cadence were similar between the groups (p > 0.05). The swing phase ratio was higher in patients with COPD, whereas the gait cycle and stance phase ratios were higher in the HC (p < 0.05). The magnitude and total angular displacement of arm swings were similar between the groups (p > 0.05). In patients with COPD, the right and left arm swings were similar across both the flexion-extension and abduction-adduction axes (p > 0.05), whereas significant right-left differences were observed in the HC group (p < 0.05). Posture quality was significantly poorer in patients with COPD (p < 0.05). The types and presence of scapular dyskinesia were similar between the groups (p > 0.05).

Conclusion: Due to postural impairments and disease-related compensatory adaptations, a more abducted and symmetrical arm swing pattern was observed in patients with COPD. An asymmetrical arm swing pattern was observed in the HC group. These results highlight the importance of assessing and addressing upper extremity movements within rehabilitation programs to optimize gait efficiency and functional mobility.

Background/aim: Moltkia coerulea, a medicinal plant traditionally used for its neuroprotective properties, contains diverse phenolic compounds. However, its mechanisms of action in neuroinflammation remain unclear. We hypothesized that extracts of M. coerulea may protect microglial cells from lipopolysaccharide (LPS)-induced oxidative stress and apoptosis by modulating reactive oxygen species (ROS) and caspase-3 activity.

Materials and methods: Aqueous and methanol extracts (5-50 μg/mL) were tested in BV-2 microglial cells. Cell viability was assessed by MTT assay, while ROS generation and caspase-3 activity were measured using fluorescence-based kits. The effective concentration (10 μg/mL) was selected for mechanistic assays based on viability data and previous studies. The phenolic profile of the plant extracts was determined by liquid chromatography with tandem mass spectrometry (LC/MS/MS).

Results: Both extracts improved cell survival, reduced ROS levels, and attenuated caspase-3 activation in LPS-treated BV-2 cells. LC/MS/MS analysis identified chlorogenic acid, rosmarinic acid, vanillin, and rutin as predominant in the methanolic extract, while chlorogenic acid and rutin were most abundant in the aqueous extract; all are associated with antioxidant and antiapoptotic potential.

Conclusion: M. coerulea extracts alleviated LPS-induced apoptosis in BV-2 cells by reducing oxidative stress and caspase-3 activity. These findings suggest a potential neuroprotective role of phenolic compounds present in M. coerulea that may translate into beneficial effects in animal models and warrant further preclinical evaluation.

Background/aim: Telemedicine (TM) can overcome travel barriers in nonspecific neck pain (NNP), yet a comprehensive, physiatrist-supervised TM model has not been directly compared to standard in-clinic care. The aim of this study was to determine whether a video-based exercise and remote follow-up program is as effective as conventional follow-up in reducing pain and disability in NNP.

Materials and methods: This parallel-group randomized controlled trial (registered in ClinicalTrials.gov) included 68 adults (mean age = 40.52 years) with NNP who were randomly allocated 1:1 to the TM group (TG, n = 34) or control group (CG, n = 34). Both received identical exercises via prerecorded video (TG) or printed brochure (CG) to be performed for 3 months. TG visits were via video call; CG visits were in the clinic. Primary outcomes were pain measured by the visual analog scale (VAS) at baseline, day 15, month 1, and 3, and disability measured by the neck disability index (NDI) at baseline and month 3. Secondary outcomes were exercise adherence, patient satisfaction, and travel/time burden. Analyses followed the intention-to-treat principle using linear mixed models.

Results: Both groups achieved clinically important VAS reductions (TG: 6.56 to 3.02, CG: 6.44 to 2.96). The only between-group difference appeared at day 15, favoring CG (p = 0.038) and the group × time interaction was nonsignificant overall (p = 0.111). NDI improved similarly in both groups (p = 0.473). Adherence in TG and CG (67.90% and 71.21%, respectively) and satisfaction (4.25 and 4.42, respectively) were comparable. TG participants avoided a mean of 38.88 km/175.74 min of travel across 3 virtual visits.

Conclusion: A structured TM program with remote physiatrist follow-up matches conventional outpatient care in managing NNP. Larger, long-term studies should define optimal support and assess cost effectiveness across diverse populations.

Background/aim: This study primarily aimed to evaluate the preoperative awareness of nasal and facial anatomical deformities among patients scheduled for primary rhinoplasty. The secondary objective was to assess changes in patients' self-perception and aesthetic expectations regarding surgical outcomes following preoperative consultation with the surgeon.

Materials and methods: In this prospective cross-sectional study, 56 adult patients seeking primary aesthetic rhinoplasty at a tertiary care center were included. Each participant completed a 10-item anatomical evaluation form. An experienced rhinoplasty surgeon independently evaluated the same parameters. Additionally, participants completed a two-item visual analogue scale (VAS) questionnaire both before and after the preoperative consultation.

Results: Patients most frequently reported a nasal hump (91%), nasal deviation (89%), and a drooping nasal tip (77%) as their primary concerns. The surgeon most commonly identified a nasal hump (98%), tip ptosis (61%), and nasal deviation (59%). A significant discrepancy was observed between patient and surgeon evaluations of nasal deviation (p < 0.01), as well as in the recognition of extranasal aesthetic regions, particularly the cheek-midface (p = 0.04) and forehead-glabella (p < 0.01) areas. VAS scores for nasal appearance and expected surgical outcomes showed no significant change after the consultation (p = 0.184, p = 0.243).

Conclusion: Although there was general agreement between patients and the surgeon regarding nasal deformities, patient awareness of adjacent facial regions remained limited. Furthermore, preoperative counseling alone was insufficient to alter patients' self-perception or aesthetic expectations, highlighting the need for enhanced educational strategies in rhinoplasty planning.

Background/aim: Every year, hundreds of thousands of people worldwide suffer from traumatic spinal cord injury (tSCI), which causes irreversible damage, edema, and inflammation. Despite its devastating impact, no safe and effective medication is available. Edema formation is one of the earliest pathological events in tSCI, beginning within minutes after injury. Cytotoxic edema progresses to vasogenic edema, exacerbating irreversible damage. Our study aimed to investigate a therapeutic approach targeting cytotoxic edema in the acute phase of tSCI to improve treatment outcomes. Aquaporins (AQPs) are crucial in edema formation and tSCI pathogenesis. Vasopressin, also known as the antidiuretic hormone, modulates Aqp expression and translocation by initiating cell signaling via vasopressin 1a receptor (V1aR) and vasopressin 2 receptor (V2R). We investigated the effects of two V1aR and V2R antagonists (relcovaptan and tolvaptan, respectively) on edema formation and Aqp expression in tSCI.

Materials and methods: Transcriptome analysis was performed on male Sprague Dawley rats that were traumatized to determine the effect of relcovaptan and tolvaptan after tSCI. Gene set enrichment analysis and bioinformatics approaches identified critical genes and signaling pathways associated with the drug treatment.

Results: According to our results, tolvaptan was not suitable for the treatment of tSCI. On the other hand, relcovaptan had multiple positive effects. These include not only the positive effect on edema, which is achieved by suppression of Aqp1, Aqp4, and Aqp11 expression, but also immunoregulation, neuroprotection, neuroregeneration, and osmoregulation via activator protein-1 and galanin.

Conclusion: Our study suggests that clinical application of relcovaptan may be a promising treatment option for improving tSCI.

Background/aim: Subjective memory complaints (SMCs), defined as self-perceived declines in memory performance, are common among older adults and may serve as early indicators of neurocognitive impairment. Despite their clinical relevance, no previous studies have examined the prevalence and associated factors of SMCs in Türkiye.

Materials and methods: A total of 500 community-dwelling older adults were included in this retrospective, cross-sectional, observational study; all underwent a comprehensive geriatric assessment at a tertiary-level outpatient clinic. Participants with a mini-mental state examination score ≥27, independence in instrumental activities of daily living, and no diagnosis of mild cognitive impairment were assessed for SMCs. Sociodemographic characteristics, comorbidities, and medication use data were also collected. A logistic regression model was employed to identify independent predictors of SMCs.

Results: The median age of the participants was 76 years, and 64% were female. The prevalence of SMCs was 61.0%. Participants with SMCs had a lower educational level than those without SMCs, with median (interquartile range, 25-75) values of 5 (5-12) and 5 (5-16) years, respectively. Attainment of a university-level education was independently associated with a significantly lower likelihood of reporting SMCs (OR = 0.262, 95% CI: 0.116-0.588, p = 0.001). No other variables were significantly associated with the risk of SMCs after adjustment for covariates.

Conclusion: SMCs were highly prevalent among older adults in Türkiye. A university-level education was a significant protective factor against SMCs. Further prospective studies are warranted to gain a deeper understanding of the long-term effects of education level and other contributing factors on SMCs.

Background/aim: Acute gastrointestinal (GI) tract bleeding is a common and potentially life-threatening condition among patients presenting to emergency departments. In this study, we calculated AIMS65, Rockall, Glasgow-Blatchford Score (GBS), and Canada-United Kingdom-Australia (CANUKA) scores in patients with GI bleeding admitted to the emergency department and compared the sensitivity of these scoring systems in predicting the rates of admission to intensive care units and mortality. It is aimed to contribute to clinical practice and help determine an effective risk assessment tool in the management of patients with GI bleeding.

Materials and methods: The study was conducted with patients who were diagnosed with GI bleeding. The study was conducted retrospectively between 1 January 2020 and 31 December 2023. The data of the patients were obtained from the hospital automation system. Patients with missing data were excluded from the study. AIMS65, Rockall, GBS, and CANUKA scores of the patients were calculated and recorded separately.

Results: A total of 916 patients were included in our study. The median age was 70 years, and 62.3% of the patients were male. A total of 22.2% of the patients were hospitalized in the intensive care unit (ICU), and the in-hospital mortality rate was 0.9% (n = 8). According to the results of receiver operator characteristic (ROC) analysis of continuous measurements in terms of ICU hospitalization, the ability of the 4 scores to predict ICU hospitalization was statistically significant (p < 0.001). The CANUKA Score had the highest and best discriminative ability to predict ICU admission (area under the ROC curve [AUC] = 0.734). According to the results of ROC analysis of continuous measures in terms of mortality, the ability of AIMS65, CANUKA, and Rockall scores to predict mortality was statistically significant (p-values <0.001, <0.001, and 0.001, respectively).

Conclusion: The CANUKA Score had the best discriminative ability in predicting intensive care unit admission and the best discriminative ability in predicting mortality after the AIMS65 Score.

Background/aim: Research on the optical and surface properties of 3D-printed denture base materials is limited. This study investigated the effects of different beverages and denture cleansers on the color stability and surface roughness of conventional and digital denture bases.

Materials and methods: A total of 240 specimens were prepared using two digital (CAD/CAM milling and 3D printing) and two conventional (cold- and heat-polymerized) materials. The specimens were immersed in tea, coffee, and artificial saliva for 12 days. After immersion, specimens were cleaned with either sodium hypochlorite or a Corega effervescent tablet. Color changes and surface roughness were measured with a colorimeter and a profilometer, respectively. Statistical analyses were performed with ANOVA, t-tests, Kruskal-Wallis, and Wilcoxon tests depending on data distribution.

Results: 3D-printed resins exhibited greater discoloration in tea and coffee than in artificial saliva, whereas heat-polymerized and CAD/CAM-milled resins were more color stable. Corega generally reduced discoloration more effectively than NaOCl. Surface roughness increased significantly in 3D-printed and cold-polymerized resins after staining and selected cleansing procedures (p < 0.05), whereas heat-polymerized and CAD/CAM-milled materials maintained lower roughness values.

Conclusion: All materials showed clinically acceptable color changes (ΔE₀₀ ≤ 4.1). Heat-polymerized and CAD/CAM-milled resins demonstrated superior surface integrity, suggesting a lower risk of plaque accumulation. Cold-polymerized and 3D-printed resins were more susceptible to staining and increased roughness, underscoring the importance of careful material selection and customized hygiene recommendations to preserve denture esthetics and longevity.