Search Results (119)

Background and Objectives: Resistance to immune checkpoint inhibitors (ICIs) reduces treatment efficacy in 40–65% of patients. The ability to predict this at the outset of therapy could help optimise treatment selection and improve patient survival. The aim of this study was to identify factors associated with primary resistance to PD-1 inhibitors in metastatic melanoma and discover predictive markers. Materials and Methods: This retrospective study involved 110 patients with non-uveal metastatic melanoma treated with PD-1 inhibitors from 2016 to 2023. Demographic, clinical and haematological data were collected. LASSO regression was utilised to identify the best markers. Bootstrap resampling was performed for internal validation and to overcome overfitting. Results: Primary resistance occurred in 44.6% of the patients. The factors associated with resistance included elevated platelet-to-lymphocyte ratio (PLR), the presence of acral/mucosal melanoma, BRAF mutant disease, low globulin levels and ≥3 metastatic sites. An evaluation of the predictive capability of these variables showed robust discrimination, with an area under the receiver operating characteristic curve of 0.831. Conclusions: This study identified the key predictors of primary resistance to PD-1 inhibitors to be PLR, globulin levels, metastatic burden and melanoma subtype. These identified parameters may guide the early prediction of primary resistance to PD-1 inhibitors. Future work should externally validate the model and further explore robust strategies to overcome resistance. Full article

Background/Objectives: Borderline personality disorder (BPD) is a psychiatric disorder characterized by emotional instability, impulsive behavior, and impaired interpersonal relationships. It is associated with a high prevalence of childhood trauma and neurobiological changes. This study aimed to compare ophthalmologic parameters, namely, optic nerve sheath diameter, intraocular pressure, and dry eye, in patients with BPD with healthy controls and to investigate the relations between these parameters and childhood trauma. Methods: This study included 51 female patients with BPD between the ages of 18 and 35 years, who were not using psychotropic medication, and 51 healthy controls matched for age and educational level. Optic nerve sheath diameter, intraocular pressure, and tear break-up time were measured, and trauma history was evaluated using the Childhood Trauma Questionnaire-Short Form. Independent t-test and Pearson correlation analysis were used in statistical analyses. Results: Patients with BPD were found to have significantly higher mean optic nerve sheath diameter scores (left: 3.94 ± 0.43, right: 3.97 ± 0.47) compared with healthy controls (left: 3.76 ± 0.44, right: 3.78 ± 0.45) (p < 0.05). The groups showed no significant difference in intraocular pressure and dry eye parameters (p > 0.05). A significant positive correlation was noted between emotional abuse scores and the optic nerve sheath diameter of the left eye in patients with BPD (p < 0.05; r = 0.364). Conclusions: An increased optic nerve sheath diameter may be a potential peripheral biomarker reflecting chronic stress or changes in intracranial physiology in patients with BPD. This increase is particularly associated with a history of emotional abuse. Ophthalmological parameters may contribute to understanding the neurobiological basis of BPD and serve as peripheral biomarkers or indicators of neurobiological changes. Full article

This study investigated the effects of probiotic supplementation on performance, egg quality, antioxidant capacity, gut morphology, fecal microbiota, and bone morphology in Lohmann Brown laying hens aged 44 weeks over a 16-week period. Ninety-six hens were randomly divided into control and probiotic groups (n = 48 each). The probiotic group received probiotic supplement containing Lactobacillus acidophilus KUEN 1607 and Pediococcus acidilactici KUEN 1608 via drinking water at 0.5%. Probiotic supplementation significantly improved feed conversion ratio (FCR), eggshell strength and thickness, and albumen quality (p < 0.001) and reduced the incidence of cracked and shell-less eggs (p < 0.05). Yolk and serum cholesterol levels decreased (p < 0.001), and antioxidant parameters improved, along with elevated serum IgG (p < 0.001). Histological analysis showed an increased ratio of villus height to crypt depth (p < 0.001) in the jejunum, indicating enhanced intestinal health. Fecal samples revealed increased Lactobacillus spp. and reduced coliform counts (p < 0.001), suggesting improved gut microbiota balance. While bone volume and surface area showed no significant difference, 3D geometric morphometric analysis identified subtle shape changes in long bones, especially the femur and tibiotarsus. These findings demonstrate that the selected probiotic combination supports nutrient utilization, egg quality, gut integrity, immune status, and skeletal health, offering a sustainable strategy to enhance productivity and welfare in laying hens. Full article

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article

Background/Objectives: Malnutrition is a common problem in children with cerebral palsy (CP). The aim of this study was to investigate the suitability and diagnostic performance of mid-upper arm circumference (MUAC) z-score in diagnosing wasting in children with CP, and its impact on diagnostic accuracy when evaluated concomitantly with additional clinical factors (birth weight, history of phototherapy). Methods: This single-center, cross-sectional study included 83 children with CP, aged 6 months–17 years, followed-up in our clinic. Anthropometric measurements (MUAC, Body Mass Index (BMI)) and clinical data (birth weight, history of phototherapy, Gross Motor Function Classification System (GMFCS)) were prospectively collected. Wasting was defined according to the BMI z-score ≤ −2 criteria. The diagnostic performance of MUAC z-score was evaluated by Receiver Operating Characteristic (ROC) analysis. The contribution of additional covariates was examined using logistic regression analysis and the backward elimination method. Results: MUAC z-score alone demonstrated good discrimination in diagnosing wasting with an Area Under the Curve (AUC) value between 0.805 and 0.821, but its sensitivity was limited (67.0%). No statistically significant difference was found in diagnostic performance between MUAC measurements of the right arm, left arm, and the unaffected arm (p > 0.050). In logistic regression analysis, MUAC z-score (p = 0.001), birth weight (p = 0.014), and a history of phototherapy (p = 0.046) were found to be significantly associated with wasting malnutrition. The simplified model including these variables yielded an AUC value of 0.876. Conclusions: MUAC z-score is a usable tool for wasting malnutrition screening in children with CP. Although its sensitivity is limited when used alone, its diagnostic accuracy increases when evaluated concomitantly with additional clinical factors such as birth weight and a history of phototherapy. This combined approach may offer clinicians a more robust tool for the early diagnosis and management of wasting malnutrition in children with CP. Full article

This paper presents the design and implementation of a high-efficiency, full silicon carbide (SiC)-based center-tapped phase-shifted full-bridge (PSFB) converter for NiCd battery charging applications in railway systems. The converter utilizes SiC MOSFET modules on the primary side and SiC diodes on the secondary side, resulting in significant efficiency improvements due to the superior switching characteristics and high-temperature tolerance inherent in SiC devices. A nanocrystalline-cored center-tapped transformer is optimized to minimize voltage stress on the rectifier diodes. Additionally, the use of a nanocrystalline core provides high saturation flux density, low core loss, and excellent permeability, particularly at high frequencies, which significantly enhances system efficiency. The converter also compensates for temperature fluctuations during operation, enabling a wide and adjustable output voltage range according to the temperature differences. A prototype of the 10-kW, 50-kHz PSFB converter, operating with an input voltage range of 700–750 V and output voltage of 77–138 V, was developed and tested both through simulations and experimentally. The converter achieved a maximum efficiency of 97% and demonstrated a high power density of 2.23 kW/L, thereby validating the effectiveness of the proposed design for railway battery charging applications. Full article

Fish is important for human health due to its high nutritional value. However, it is prone to spoilage due to its structural characteristics. Traditional freshness assessment methods, such as visual inspection, are subjective and prone to inconsistency. This study proposes a novel, cost-effective hybrid methodology for automated three-level fish freshness classification (Day 1, Day 2, Day 3) by integrating single-wavelength laser reflectance data with deep learning-based image features. A comprehensive dataset was created by collecting visual and laser data from 130 mackerel specimens over three consecutive days under controlled conditions. Image features were extracted using four pre-trained CNN architectures and fused with laser features to form a unified representation. The combined features were classified using SVM, MLP, and RF algorithms. The experimental results demonstrated that the proposed multimodal approach significantly outperformed single-modality methods, achieving average classification accuracy of 88.44%. This work presents an original contribution by demonstrating, for the first time, the effectiveness of combining low-cost laser sensing and deep visual features for freshness prediction, with potential for real-time mobile deployment. Full article

Background and Objectives: The clinical value of HER2-low breast cancer (BC), defined by immunohistochemistry (IHC) scores of 1+ or 2+/ISH-negative without HER2 amplification, remains unclear in the neoadjuvant setting. This study aimed to determine whether HER2-low and HER2-zero tumors differ in pathological complete response (pCR) rates and disease-free survival (DFS) among early-stage breast cancer patients undergoing neoadjuvant chemotherapy (NAC). Materials and Methods: We retrospectively analyzed 134 early BC patients treated with NAC between 2017 and 2023. Patients were categorized as HER2-zero (IHC 0) or HER2-low (IHC 1+ or 2+/ISH–). The primary endpoint was total pCR (tpCR); secondary endpoints included breast (bpCR), nodal (npCR), and radiologic complete response (rCR), alongside DFS analysis stratified by hormone receptor (HR) status. Results: Of the cohort, 91 patients (67.9%) were HER2-zero and 43 (32.1%) were HER2-low. There was no statistically significant difference in tpCR (26.4% vs. 27.9%, p = 0.852), bpCR (28.6% vs. 30.2%, p = 0.843), npCR (37.4% vs. 32.6%, p = 0.588), and rCR (23.1% vs. 30.2%, p = 0.374) between HER2-zero and HER2-low groups. DFS did not significantly differ between HER2-zero and HER2-low groups overall (p = 0.714), nor within HR-positive (p = 0.540) or TNBC (p = 0.523) subgroups. Conclusions: HER2-low tumors demonstrated similar pathological responses and survival outcomes compared to HER2-zero tumors. While a HER2-low status does not appear to define a distinct biological subtype in early BC, it remains a relevant classification for emerging HER2-targeted therapies, needing further investigation in prospective studies. Full article

Major Depressive Disorder (MDD) is a chronic mental disorder characterized by anhedonia, loss of desire, guilt, suicidal thoughts, and appetite changes. It is reported that individuals with MDD resort to binge eating to escape from negative feelings. In this study, we aimed to determine the relationship between binge eating behavior and the concept of psychological pain associated with emotions such as shame, guilt, and anger in individuals with MDD. We conducted the study in the Psychiatry Outpatient Clinics of Balcalı Hospital, Çukurova University Faculty of Medicine. The sample consisted of 147 individuals with MDD without psychotic symptoms and 128 healthy controls with sociodemographic characteristics similar to the MDD group. We administered a sociodemographic data form, the Hamilton Depression Rating Scale (HDRS), Psychache Scale (PS), Tolerance for Mental Pain Scale-10 (TMPS-10), Barratt Impulsiveness Scale (BIS-11), and Eating Disorder Examination Questionnaire (EDE-Q-13). Eighty-two (55.7%) of the patients with MDD were diagnosed with binge eating disorder (BED). In the group of MDD patients with BED comorbidity, the EDE-Q-13 total, binging subscale, and HDRS scores were significantly higher than those of the other groups (p < 0.05 for each group), with large to very large effect sizes (e.g., EDE-Q-13 binging d = 1.04; HDRS d = 1.91; PS d = 1.22). There was no significant difference between the MDD groups (with and without BED) regarding the BIS and BIS subscales’ subscores, PS, and TMPS scores. For participants with MDD, there was a significant same-directional correlation between EDE-Q-13 binging, HDRS, BIS, and PS scores (p < 0.05 for each), with moderate to strong effect sizes (EDE-Q-13 binging and HDRS: r = 0.398, p < 0.001; binging and PS: r = 0.273, p < 0.001; binging and BIS: r = 0.233, p = 0.005; binging and TMPS-10: r = –0.257, p = 0.002). Additionally, a negative correlation was observed between TMPS and the scores for EDE-Q-13 binging, HDRS, BIS, and PS. A linear regression analysis indicated that depression severity and BMI were the strongest predictors of binge eating behavior (R² = 0.243; f² = 0.32). Based on our results, we concluded that the presence of binge eating behavior in patients with MDD is associated with more severe depressive symptoms, psychological pain, impulsivity, and lower tolerance to psychological pain. The finding that binge eating behavior was most strongly associated with depression severity and body mass index (BMI) supports the notion that binge eating behavior is a maladaptive attitude. Longitudinal studies comparing individuals with different BMIs in different clinical samples are needed to confirm our results. Full article

Ankle mobility plays a critical role in dynamic stability and propulsion during fencing-specific actions. However, its relationship to performance metrics in young athletes remains unclear. This study aimed to investigate the relationship between ankle range of motion (ROM), acceleration, and jump height in pre-adolescent male fencers, as well as to examine bilateral differences in ankle mobility between the front and rear foot. Fifteen fencers (age 10.86 ± 0.91 years) were assessed for ankle ROM (dorsiflexion, plantar flexion, inversion, eversion) using a goniometer. Performance tests included a 7 m sprint lunge (acceleration) and countermovement jump. Significantly large correlations were observed between front and rear foot ankle plantar flexion range of motion and both acceleration (r = 0.625–0.628, p < 0.05) as well as vertical jump height (r = 0.579–0.647, p < 0.05). Rear foot ankle plantar flexion range of motion significantly predicted acceleration (r² = 0.335, p < 0.05) and jump height (r² = 0.418, p < 0.05). In contrast, no meaningful associations were found between dorsiflexion, inversion, or eversion range of motion and performance metrics. Additionally, bilateral comparisons revealed significantly greater dorsiflexion in the front foot ankle and greater eversion in the rear foot ankle (p < 0.05). Plantar flexion ROM is a key contributor to acceleration and jump capacity in youth fencers. Incorporating ankle mobility training may support physical development in this population. Full article

Background/Objectives: This systematic review and meta-analysis evaluated the effectiveness and the safety of transarterial radioembolization using Holmium-166 microspheres (Ho-166-TARE) for the treatment of primary and secondary liver tumors. The aim of the study was to offer a detailed analysis of clinical outcomes and the potential benefits of this innovative therapy. Methods: The study was conducted according to the PRISMA 2020 guidelines. The systematic search was performed in five databases in November 2023 and updated in June 2024. All 16 eligible studies were original research that evaluated Ho-166-TARE. The endpoints analyzed were disease control rate (DCR), overall survival (OS), progression-free survival (PFS), clinical and laboratory adverse events, healthy-liver- and tumor-liver-absorbed doses. The risk of bias was assessed using the MINORS checklist. Results: The pooled overall disease control rate (DCR) was 72% (95% CI, 46–89%); by mRECIST, it was 93% (95% CI, 71–99%); and by RECIST 1.1, it was 54% (95% CI, 22–83%) at 3-month follow-up. Overall survival (OS) at 3, 6, 12, and 30 months was 98%, 89%, 74%, and 39%, respectively. Severe clinical adverse events were minimal, although some patients showed elevated GGT levels and lymphocytopenia. Tumor-absorbed doses were nearly three times higher than those in healthy liver tissue. Conclusions: These findings suggest that Ho-166-TARE is a safe and effective locoregional treatment option for liver tumors, especially in cases where systemic therapy alone is insufficient or surgical resection is not feasible. Further studies are needed to investigate tumor-specific response, optimize dosimetry strategies, and establish standardized protocols for long-term outcome assessment. Full article

Recently, the electrification and automation of heavy-duty trucks has gained significant attention from both industry and academia, driven by new legislation introduced by the European Union. During a typical drive cycle, the mass of an urban service truck can vary substantially as waste is collected, yet most existing studies rely on a single controller with fixed gains. This limits the ability to adapt to mass changes and results in suboptimal energy usage. Within the framework of the EU-funded OBELICS and ESCALATE projects, this study proposes a novel control strategy for a semi-autonomous refuse truck. The approach combines a particle swarm optimization algorithm to determine optimal controller gains and a multiple model controller to adapt these gains dynamically based on real-time vehicle mass. The main objectives of the proposed method are to (i) optimize controller parameters, (ii) reduce overall energy consumption, and (iii) minimize speed tracking error. A cost function addressing these objectives is formulated for both autonomous and manual driving modes. The strategy is evaluated using a real-world drive cycle from Eskişehir City, Turkiye. Simulation results show that the proposed MMC-based method improves vehicle performance by $5.19\%$ in autonomous mode and $0.534\%$ in manual mode compared to traditional fixed-gain approaches. Full article

Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Materials and Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, and saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p = 0.7), but PRP outperformed both of the other groups in DASH and PRTEE scores, with the saline group performing the worst (p < 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p = 0.3 and p = 0.2, respectively). Conclusions: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes. Clinical Relevance: PRP offers a promising treatment option for lateral epicondylitis, with superior functional improvements over other commonly used injections. Radiological assessments of vascularity and SMI may not reliably predict clinical outcomes. Full article

This study presents a novel approach for the detection and severity assessment of pest-induced damage in maize plants, focusing on the Zyginidia pullula pest. A newly developed dataset is utilized, where maize plant images are initially classified into two primary categories: healthy and infected. Subsequently, infected samples are categorized into three distinct severity levels: low, medium, and high. Both traditional and deep learning-based feature extraction techniques are employed to achieve this. Specifically, hand-crafted feature extraction methods, including Gabor filters, Gray Level Co-occurrence Matrix, and Hue-Saturation-Value color space, are combined with CNN-based models such as ResNet-50, DenseNet-201, and EfficientNet-B2. The maize images undergo preprocessing and segmentation using Contrast Limited Adaptive Histogram Equalization and U2Net, respectively. Extracted features are then fused and subjected to Principal Component Analysis for dimensionality reduction. The classification task is performed using Support Vector Machines, Random Forest, and Artificial Neural Networks, ensuring robust and accurate detection. The experimental results demonstrate that the proposed hybrid approach outperforms individual feature extraction methods, achieving a classification accuracy of up to 92.55%. Furthermore, integrating multiple feature representations significantly enhances the model’s ability to differentiate between varying levels of pest damage. Unlike previous studies that primarily focus on plant disease detection, this research uniquely addresses the quantification of pest-induced damage, offering a valuable tool for precision agriculture. The findings of this study contribute to the development of automated, scalable, and efficient pest monitoring systems, which are crucial for minimizing yield losses and improving agricultural sustainability. Full article

Background and Objectives: Sarcopenia is frequently observed in cancer patients and is associated with short survival. In this study, the aim was to research the sarcopenia risk factors, the correlation of sarcopenia with inflammatory biomarkers, and the prognostic significance of sarcopenia and inflammation markers in patients with metastatic gastric cancer. Material and Method: The study included 177 patients diagnosed with metastatic gastric cancer attending Dokuz Eylül University Faculty of Medicine (DEUFM) Medical Oncology clinic from 2016 to 2022. The skeletal muscle area at L3 vertebral level was identified on abdominal computed tomography (CT) images, and the skeletal muscle index (SMI, cm²/m²) was calculated. Additionally, PLR, MLR, NLR, dNLR, SIRI, SII, PIV, PNI, CAR, and LAR were assessed among systemic inflammatory biomarkers. Cut-off values were determined with ROC curve analysis. Survival analyses were performed with the Kaplan–Meier method, and risk factors were investigated with Cox regression analysis. For all statistical analyses, p < 0.05 was accepted as significant. Results: Among patients, 71.8% were identified to have sarcopenia. Significant levels of difference were identified for median SIRI, NLR, MLR, PLR, SII, PNI, and dNLR values between patients with and without sarcopenia (p < 0.05). The sarcopenia risk was assessed between groups created according to the cut-off values for inflammation markers. Univariate regression analysis found that SIRI, PIV, NLR, MLR, PLR, SII, PNI, and dNLR were statistically significant (p < 0.05). Multivariate analysis identified SIRI and PNI as independent risk factors. For all patients, median overall survival was identified to be 12.4 ± 0.8 months (CI 95%, 10.8–13.9). For patients with sarcopenia, overall survival duration was 11.5 ± 0.8 months, while survival duration for patients without sarcopenia was 17.5 ± 4.6 months (p = 0.010). Elevation in the inflammatory biomarkers of SIRI, NLR, SII, LAR, and CAR and low PNI values appear to be associated with short survival (p < 0.05). Conclusions: In this study, sarcopenia was frequently observed in patients with metastatic gastric cancer and sarcopenia was associated with shorter survival. A significant correlation was observed between sarcopenia and inflammatory biomarkers, with SIRI and PNI identified to be independent risk factors for sarcopenia. Our study emphasizes the prognostic importance of sarcopenia and inflammatory markers for the management of patients with metastatic gastric cancer. Full article