E-ISSN: 2587-0351 | ISSN: 1300-2694
Van Medical Journal - Van Med J: 33 (1)
Volume: 33  Issue: 1 - 2026
1. Cover

Pages I - III

LETTER TO EDITOR
2. Comments on “Postoperative Analgesic Efficacy of Modified-Thoracoabdominal Nerves Block Through Perichondrial Approach and Transversus Abdominis Plane Block in Patients Undergoing Open Hysterectomy with Bilateral Salpingo-Oophorectomy”
Uğur Serkan Çitilcioğlu
doi: 10.5505/vmj.2026.59454  Pages 1 - 2
Abstract |Full Text PDF

ORIGINAL ARTICLE
3. Fighting Beyond the Colon: Early Surgical Outcomes of Urinary System Involvement in Locally Advanced Colorectal Cancer
Ferit Aydin, Emre Tunç
doi: 10.5505/vmj.2026.22043  Pages 3 - 7
INTRODUCTION: Locally advanced colorectal cancers (LACRCs) frequently invade adjacent organs, most commonly the urinary bladder and ureters, requiring multivisceral en bloc resections. Genitourinary involvement complicates the surgical approach and often necessitates collaboration with multiple surgical disciplines. This study evaluates the clinical characteristics and early postoperative outcomes of patients undergoing surgery for LACRC with urinary system invasion by a single surgical oncology team.
METHODS: This retrospective study included 23 patients who underwent en bloc resection for LACRC with concurrent urinary system involvement at......between January 2023 and January 2025. Surgical procedures included partial cystectomy, ureteral resection, and ureteroneocystostomy. Clinical, demographic, and pathological data were collected, and postoperative complications were analyzed.
RESULTS: Of the 23 patients, 65.2% were female, with a mean age of 65.2 ± 7.2 years. The most common procedure was ureteroneocystostomy (56.5%). Open surgery was performed in 56.5% of cases, and 52.2% received neoadjuvant therapy. R0 resection was achieved in 95.7% of patients. Postoperative complications included wound infections (65.2%), ileus (43.5%), and urinary infections (17.4%). Urinary anastomotic leakage occurred in one patient. No reoperations were required, and 1-year mortality was 4.3%.
DISCUSSION AND CONCLUSION: En bloc resection of LACRC with genitourinary invasion can be safely and effectively performed by a dedicated surgical oncology team, achieving high R0 resection rates and acceptable complication rates. These findings highlight the feasibility of single-team management in specialized centers. However, larger multicenter studies are warranted to confirm long-term outcomes and improve patient selection and perioperative care.

4. Induction of Proinflamatuar Response by Pseudomonas aeruginosa Lipopolyssaccharide in Human Bronchial Epithelial Cells: Insights into Airway Inflammation
Ayşegül Yılmaz, Utku Yaka
doi: 10.5505/vmj.2026.29981  Pages 8 - 13
INTRODUCTION: Pseudomonas aeruginosa (P. aeruginosa) is a major opportunistic pathogen associated with chronic respiratory infections, particularly in individuals with compromised lung function such as those with cystic fibrosis, bronchiectasis, or ventilator-associated pneumonia. The airway epithelium serves as a primary site for host-pathogen interaction and actively contributes to innate immune responses via the production of proinflammatory cytokines. This study aimed to evaluate the dose-dependent and temporal effects of P. aeruginosa lipopolysaccharide (LPS) on inflammatory gene expression and cytokine secretion in BEAS-2B bronchial epithelial cells.
METHODS: BEAS-2B cells were treated with increasing concentrations of P. aeruginosa LPS, and the optimal non-toxic dose was determined. Subsequently, cells were stimulated with 100 µg/mL LPS and harvested at 12, 24, 48, and 72 hours to assess the mRNA expression levels of IL-6, TNF-α, and IFN-γ using qRT-PCR. Cytokine secretion into the culture medium was quantified by ELISA.
RESULTS: Stimulation with P. aeruginosa LPS significantly increased the expression and secretion of proinflammatory cytokines in a time-dependent manner. The highest levels of IL-6, TNF-α, and IFN-γ secretion were observed at 48 hours post-stimulation (p < 0.05), indicating a delayed but robust inflammatory response.
DISCUSSION AND CONCLUSION: These findings demonstrate that P. aeruginosa LPS elicits a marked proinflammatory response in human bronchial epithelial cells, highlighting the pivotal role of the epithelium in airway inflammation. The BEAS-2B cell line provides a valuable in vitro model for dissecting early immune responses to bacterial pathogens in the respiratory tract.

5. Does Frequency Of Demodicosis Increase With Using Topical Drug And Cosmetics In Facial Dermatoses?
Ilknur Yorğun Özdemir, Zeynep Tas Cengiz, Gokturk Dere, Ömer Çalka, Hasan Yılmaz, Hatice Uce Ozkol
doi: 10.5505/vmj.2026.88319  Pages 14 - 24
INTRODUCTION: This study aims to investigate whether topical drugs and cosmetic products in dermatological diseases in the facial area increase Demodex infestation and to determine the associated risk factors.
METHODS: This cross-sectional study included 193 patients with facial involvement and 102 healthy volunteers who applied to the dermatology outpatient clinic between January 2014 and December 2015. Demographic data, topical medication use, cosmetic product preferences, and facial cleansing habits were recorded. Demodex spp. samples were obtained from five face areas by the standard superficial skin biopsy method, and microscopic examination was performed.
RESULTS: The mean age of Demodex positive patients (36.84±16.4 years) was significantly higher than negative patients (29.84±13.46 years). Demodex positivity was higher in males (64.9%) than females (44.7%) (p=0.008). Among the diseases, the highest Demodex positivity was found in seborrhoeic dermatitis (70%) and rosacea (66.25%) (p=0.005). Among topical products, the highest Demodex positivity was observed in corticosteroid users (70.37%) and the lowest in tetracycline users (18.18%). In multivariate analysis, male gender (OR=2.27), increasing age (OR=1.38/decad), high body weight (OR=1.17/5kg), rosacea (OR=3.62), seborrheic dermatitis (OR=4.28), topical corticosteroid use (OR=3.87), and face washing with water only (OR=2.31) were determined as independent risk factors.
DISCUSSION AND CONCLUSION: Topical corticosteroids, sunscreens, and moisturisers have been shown to increase Demodex infestation in facial dermatological diseases. A strong positive correlation was found between disease severity and Demodex density. Non-irritating cleansing products should be recommended for patients with facial dermatological diseases.

6. Anesthesia Strategies and Patient Outcomes in Deep Brain Stimulation Surgery
Esra Turunc, Bahriye Binnur Sarıhasan
doi: 10.5505/vmj.2026.49469  Pages 25 - 30
INTRODUCTION: This study aims to evaluate the anesthesia management strategies employed in deep brain stimulation (DBS) surgery for movement disorders, focusing on patient comfort, surgical conditions, and the effect on electrophysiological monitoring.

METHODS: A retrospective analysis was conducted on the data of 166 patients who underwent DBS surgery for movement disorders at xxx between January 2011 and December 2021. The patients were categorized based on the anesthesia approach used: local anesthesia throughout the procedure, local anesthesia during electrode placement followed by general anesthesia during battery insertion, and general anesthesia for the entire procedure. Data were collected on demographics, comorbidities, anesthesia types, drug usage, surgical procedures, and 30-day postoperative mortality.
RESULTS: The study included 166 patients, with 97 males (58.5%) and 69 females (41.5%). The majority of patients were classified as American Society of Anesthesiologists (ASA) II (86%). The mean surgical duration was 235 minutes. Comorbidities included Parkinson's disease (57.8%), hypertension (18%), and diabetes mellitus (11.4%). DBS was primarily performed for tremor (78.9%). Anesthesia management included sedation with dexmedetomidine, remifentanil, and propofol in patients receiving local anesthesia. General anesthesia involved remifentanil, propofol, and muscle relaxants. No respiratory complications occurred, and all patients were transferred to the service without incident.
DISCUSSION AND CONCLUSION: Anesthesia management in DBS surgery is critical for optimizing patient comfort and maintaining intraoperative electrophysiological integrity. While both local anesthesia and general anesthesia are used, careful monitoring and the choice of appropriate anesthetic agents are essential to minimize complications and ensure the success of the procedure.

7. Intrauterine Transfusion for Parvovirus B19–Related Fetal Anemia: A Comparative Cohort Study of Hydropic and Non-Hydropic Outcomes
Ruken Dayanan, Dilara Duygulu Bulan, Merve Ayas Özkan, Betul Tokgöz, Sevki Celen
doi: 10.5505/vmj.2026.42275  Pages 31 - 39
INTRODUCTION: To evaluate the efficacy and safety of intrauterine transfusion (IUT) in fetuses with parvovirus B19–related anemia, and to compare prenatal, procedural, and neonatal outcomes between hydropic and non-hydropic presentations.
METHODS: This retrospective cohort included 41 pregnancies with confirmed fetal parvovirus B19 infection managed between December 2022 and December 2024 in Department of perinatology Ankara Etlik City Hospital. Fetuses were stratified based on the presence of hydrops. MCA Doppler values, transfusion parameters, hematologic response, and perinatal outcomes were compared between hydropic (n=29) and non-hydropic (n=12) groups.
RESULTS: IUT was performed in 18 fetuses (14 hydropic, 4 non-hydropic). The median gestational age at first IUT was 26 weeks in hydropic and 27 weeks in non-hydropic cases (p=0.513). Pre-transfusion hemoglobin was significantly lower in hydropic fetuses (4.7 vs. 8.2 g/dL, p=0.010), while post-transfusion levels did not differ significantly (p=0.670). MCA-PSV values were significantly higher in hydropic cases (median 1.67 vs. 1.35 MoM, p=0.049) and showed significant improvement following transfusion. Fetal pH values increased after IUT, although this change was not statistically significant. No procedure-related fetal deaths occurred. Minor complications were observed in 21.4% of hydropic and 25% of non-hydropic fetuses. Live birth was significantly less frequent in hydropic fetuses (48.2% vs. 83.3%, p=0.044), and perinatal mortality was higher (37.9% vs. 16.7%, p=0.047).
DISCUSSION AND CONCLUSION: Intrauterine transfusion is a safe and effective treatment for parvovirus B19–related fetal anemia. Although hydropic fetuses remain at elevated risk, timely transfusion—guided by MCA Doppler surveillance—can significantly improve survival and reduce perinatal morbidity.

8. Association Between Age-Related Cataract and Knee Osteoarthritis: a Comparative and Correlational Study Focusing on Disease Severity
Ulku Demir, Halit Öcal, Emre Şenköy
doi: 10.5505/vmj.2026.32559  Pages 40 - 44
INTRODUCTION: There are several common features between age-related cataract and knee osteoarthritis. Both disorders are associated with serum immunoglobulin E levels, connective tissue growth factor, and oxidative stress. Musculoskeletal disorders have been identified as the most common comorbidities in patients with age-related cataract, with knee osteoarthritis being the most frequent. Therefore, the authors aimed to further investigate this association, considering the severity of these disorders.
METHODS: In this study, data from 350 knee joints and 350 eyes were analyzed. The severity of knee osteoarthritis was assessed radiographically using the Kellgren-Lawrence (KL) grading system. The severity of cataracts was evaluated based on the degree of opacification, using the Lens Opacities Classification System III.
RESULTS: Cataract grades were significantly lower in KL grade 0 compared to other grades for cortical cataract and posterior subcapsular cataract. Additionally, cataract grades were significantly lower in KL grade 1 compared to grades 3 and 4 for posterior subcapsular cataract. There were significant positive correlations between knee osteoarthritis grades and the grades of nuclear cataract (r = 0.121, p = 0.024), cortical cataract (r = 0.137, p = 0.010), and posterior subcapsular cataract (r = 0.215, p = 0.001).
DISCUSSION AND CONCLUSION: There is a significant relationship between age-related cataracts and knee osteoarthritis in terms of disease severity. Beyond their association with aging, these two conditions may share common pathophysiological features. This study may provide new insights into the mechanisms underlying age-related cataracts and knee osteoarthritis.

9. Cerebellar and Vermian Morphometry in Cadaveric Specimens: Reference Data for Posterior Fossa Approaches
Ufuk Erginoglu, Abdurrahman Aycan
doi: 10.5505/vmj.2026.43765  Pages 45 - 54
INTRODUCTION: The cerebellum, with the vermis central to posture and gait, is critical for posterior fossa and fourth ventricular surgery, where millimetric accuracy ensures safety. However, reference morphometric data remain inconsistent, particularly for vermian depth and proportional indices. This study aimed to establish reproducible cadaveric reference values through volumetric, linear, and proportional analyses.
METHODS: Twenty-five formalin-fixed adult cerebellums were analyzed using volumetric displacement and standardized linear measurements. Proportional ratios were derived, and statistical comparisons were performed between hemispheres and across vermian levels.
RESULTS: The right hemisphere was larger than the left in both volume (69.04 ± 4.56 vs 67.12 ± 4.39 mL, p < 0.001) and width (49.00 ± 3.07 vs 47.08 ± 3.29 mm, p = 0.011), with asymmetry indices of 1.41% and 2.02%. Volume correlation was strong (r = 0.893, p < 0.001). Global shape ratios were stable, with height related to anteroposterior length (r = 0.456, p = 0.022). Vermian dimensions were consistent (length 25.14 ± 2.49 mm; uvular width 14.88 ± 2.09 mm) and showed no significant rostrocaudal depth variation. Regression revealed scaling, with vermis length predicted by anteroposterior length (β = 0.560, R² = 0.553, p < 0.001) and an inverse relation between anteroposterior length and uvular depth (β = –0.169, R² = 0.248, p = 0.011).
DISCUSSION AND CONCLUSION: These findings establish cadaveric reference values for the cerebellum and vermis, confirm mild right-sided asymmetry, and reveal stable proportions with coordinated scaling, including an inverse relationship between anteroposterior cerebellar elongation and uvular depth, thereby refining radiological interpretation and surgical planning.

10. Coexistence and Correlation of Adenomyosis, DIE and Ovarian Endometrioma Size: Insights from MR
Hande Özen Atalay, Muhammet Selman Söğüt, Üzeyir Kalkan, Afak Durur Karakaya
doi: 10.5505/vmj.2026.93585  Pages 55 - 60
INTRODUCTION: The coexistence of ovarian endometriomas, adenomyosis, and deep infiltrating endometriosis (DIE) is frequently observed in endometriosis. This study aimed to investigate the relationship between endometrioma size and the presence of adenomyosis and DIE on pelvic MRI, as well as the association between adenomyosis and DIE, and to assess whether endometrioma size could serve as a marker for these conditions.
METHODS: This retrospective single-center study included 118 women with ovarian endometriomas who underwent pelvic MRI between January 2019-January 2023. The presence of adenomyosis and DIE was recorded based on standardized MRI criteria. The largest endometrioma diameter was measured for each patient. Statistical analyses included Kruskal–Wallis tests for group comparisons, point-biserial correlations to assess the relationship between endometrioma size and adenomyosis/DIE, and Chi-square tests to evaluate the association between adenomyosis and DIE.
RESULTS: Ovarian endometrioma size was not significantly associated with adenomyosis or DIE. Median endometrioma diameters did not differ significantly between patients with and without adenomyosis or DIE (all p>0.05). In contrast, there was a strong association between adenomyosis and DIE: adenomyosis was present in 27 of 74 women with DIE (36.5%) compared with only 4 of 44 women without DIE (9.1%). Chi-square testing confirmed this relationship (p=0.001), and symmetric measures indicated a moderate positive correlation (r=0.301, p=0.001).
DISCUSSION AND CONCLUSION: Ovarian endometrioma size does not appear to predict adenomyosis or DIE; however, the coexistence of adenomyosis and DIE is significant and clinically relevant. Identification of adenomyosis on MRI should prompt careful evaluation for concurrent DIE, as this combination may reflect a more severe endometriosis phenotype.

11. The Norepinephrine Transporter Gene SLC6A2 Variant Is Associated with Essential Hypertension
Egemen Akgün, Ahmet Karagöz, Fadime Mutlu Içduygu, Aysegul Cebi, Mehmet Alkanat, Ebru Alp
doi: 10.5505/vmj.2026.30316  Pages 61 - 67
INTRODUCTION: The norepinephrine transporter, encoded by SLC6A2, terminates sympathetic signaling. The rs7194256 (C/T) 3′UTR variant has been implicated in altered NET regulation, yet evidence in essential hypertension and Turkish populations is limited.
METHODS: We conducted a hospital-based case–control study including 308 adults (153 essential hypertension; 155 normotensive controls). rs7194256 was genotyped by PCR – Restriction fragment length polymorphism analysis. Associations with hypertension (logistic regression) and with clinical/echocardiographic traits (linear regression) were tested under genotype (3-level), dominant (CT+TT vs CC), and additive (per-T-allele) models. Hardy–Weinberg expectations were met in controls (p=0.76) and in cases (p=0.93).
RESULTS: Genotype frequencies (CC, CT, and TT) were 54.9%, 38.6%, and 6.5% in cases, and 68.4%, 29.0%, and 2.6% in controls, respectively. Under the dominant model, CT+TT carriers had higher odds of hypertension than CC (adjusted OR 2.00, 95% CI 1.14–3.52, p=0.016). For individual genotypes, adjusted ORs were 1.90 (1.05 – 3.44, p=0.035) for CT vs CC and 2.86 (0.79–10.33, p=0.109) for TT vs CC. The T allele frequency was 25.8% in cases vs 17.1% in controls, with an adjusted allelic OR=1.84 (1.18–2.85, p=0.012). Systolic blood pressure differed across CC/CT/TT (adjusted p=0.028) and was higher in CT+TT vs CC (adjusted p = 0.029). Diastolic blood pressure showed an overall genotype association (adjusted p=0.035) but was not significant in the dominant model (p=0.096). Arterial stiffness indices and echocardiographic parameters showed no significant associations after adjustment.
DISCUSSION AND CONCLUSION: In this Turkish population, the SLC6A2 rs7194256 T allele is associated with essential hypertension and relates more strongly to systolic than diastolic phenotypes.

12. Effects of Dapagliflozin on miRNA Expression and Microalbuminuria in Diabetic Nephropathy
Deniz Yıldız Pehlivan, Mirza Yuksel, Hamit Yıldız
doi: 10.5505/vmj.2026.15870  Pages 68 - 75
INTRODUCTION: To investigate the effects of dapagliflozin on micro-ribonucleic acid expression profiles in diabetic nephropathy patients and evaluate potential correlations between micro-ribonucleic acid levels and microalbuminuria.
METHODS: This retrospective study examined 52 patients with diabetic nephropathy receiving dapagliflozin therapy. Serum samples were collected at baseline and day 60 of treatment. Micro-ribonucleic acid-lethal-7a, micro-ribonucleic acid-25 and micro-ribonucleic acid-130b expression levels were analyzed using real-time polymerase chain reaction. Clinical parameters, including glucose, lipid profile, and microalbuminuria, were evaluated.
RESULTS: Dapagliflozin treatment significantly reduced glucose, hemoglobin A1c, triglycerides, and urinary microalbumin levels (all p<0.05). Significant increases were observed in miRNA-lethal-7a and miRNA-130b expression levels (p<0.01), while miRNA-25 showed moderate elevation (p<0.05). However, no significant correlation was found between changes in miRNA levels and microalbuminuria reduction.
DISCUSSION AND CONCLUSION: Dapagliflozin therapy significantly modulates specific miRNA expression profiles while improving glycemic control and reducing microalbuminuria in diabetic nephropathy patients. The observed elevations in miRNA-lethal-7a, miRNA-25, and miRNA-130b levels suggest their potential utility. While these findings provide novel insights into dapagliflozin's molecular effects beyond sodium-glucose cotransporter-2 inhibition larger longitudinal studies are needed to establish definitive relationships between miRNA alterations and clinical outcomes in diabetic nephropathy management.

13. Diagnosis and Treatment of Choledochal Cysts: A Single-Center Experience
Serhat Binici, Fırat Aslan, Iklil Eryılmaz, Veysel Tahiroğlu, Muhammed Berkcan Bingöl, Ahmet Burak Cicek, Burhan Beger, Kemal Ayengin
doi: 10.5505/vmj.2026.44227  Pages 76 - 82
INTRODUCTION: Choledochal cysts are rare congenital biliary malformations with a lifelong malignancy risk. Although prenatal ultrasonography and MRCP have improved early diagnosis, total cyst resection with biliary reconstruction remains the definitive treatment for Type I cysts. This study evaluates the clinical features, surgical approach, and short- to mid-term outcomes of Type I choledochal cysts in a single center.
METHODS: Nine patients operated between 2015 and 2025 were retrospectively reviewed. All had Todani Type I cysts and underwent open total cyst resection with Roux-en-Y hepaticojejunostomy. Data on demographics, clinical presentation, imaging, postoperative complications, liver function, and follow-up were analyzed. Follow-up included clinical assessment and ultrasonography at 1, 3, and 12 months.
RESULTS: Median age was 12 years (IQR 8–15); 55.6% were female. Diagnosis was made by ultrasonography alone in 66.7% of cases, with MRCP added in 33.3%. Median hospital stay was 6 days, with no sex-based difference. Postoperative morbidity was 11.1%; one patient developed a low-output hepaticojejunostomy leak, resolving conservatively by the third month. No other significant complications occurred. Patients with elevated preoperative liver function tests showed marked postoperative improvement. At 12 months, no strictures, recurrence, or late complications were detected, and clinical status remained stable.
DISCUSSION AND CONCLUSION: Open total cyst resection with Roux-en-Y hepaticojejunostomy is safe and effective for Type I choledochal cysts, providing low morbidity, biochemical improvement, and recurrence-free short- to mid-term outcomes. MRCP complements ultrasonography in anatomical assessment. Given the persistent malignancy risk, risk-stratified long-term follow-up is essential. Larger multicenter prospective studies are needed to optimize surgical timing, approach, and long-term outcomes.

14. MEFV Mutations And Clinical Findings in Patient With Familial Mediteranean Fever: The Emergency Department Experiences
Murat Toprak, Mehmet Resit Oncu
doi: 10.5505/vmj.2026.74946  Pages 83 - 89
INTRODUCTION: We examined emergency department utilization patterns by identifying the characteristics of FMF cases in the emergency department and analyzing the relationship between genotype-related characteristics and clinical findings.
METHODS: One hundred and thirty-five patients with FMF were evaluated. The present study included adult Turkish patients (≥18 years old) who had been diagnosed according to the Tel Hashomer and Livneh criteria. A comprehensive data set encompassing demographic and clinical information was meticulously compiled for the entire patient cohort from the clinic's database and medical records.
RESULTS: A total of 135 patients (81 [60%] female/54 [40%] male) with FMF were included to study. The mean age was 28.19±9.71 years and the disease duration was 6.62±5.38 years. The most common allele freuquency was identified as M694V, present in 36 (26.5%) patients. The other mutations were listed as R202Q (14%), M680I (5.9%), E148Q (8.4%) and V726A (12.5%) respectively. While patients with M694V gene mutations have more severe clinical symptoms (constipation, fatigue, erysipelas-like erythema, scrotal pain, appendicitis surgery), E148Q and V726A gene mutations shows milder clinical symptoms. A correlation was identified between M694V and appendectomy, arthritis/arthralgia, and constipation.
DISCUSSION AND CONCLUSION: Abdominal pain and fever was the most frequent symptom. M694V, E148Q, R202Q, M680I, and V726A were the most common mutations in FMF patients. Appendectomy, arthritis/ arthralgia and constipation were significantly correlate in patients with M694V mutations.

15. In Vitro Evaluation of the Combined Effects of Rosmarinic Acid and 5-Fluorouracil in Prostate Cancer Cells
Ceren Sumer, Ceren Sari, Saniye Koç Ada, Burcu Yucel
doi: 10.5505/vmj.2026.25238  Pages 90 - 96
INTRODUCTION: Prostate cancer is the most common malignancy in men. Despite therapeutic advances, drug resistance remains a major challenge, and many patients progress to castration-resistant prostate cancer (CRPC). This study aims to investigate the combined effects of rosmarinic acid (RA), a polyphenolic compound, and 5-FU, a conventional chemotherapeutic agent, on DU145 prostate cancer cells.
METHODS: Cell viability was assessed at various doses for RA and 5-FU to determine the IC50, IC30, and IC10 values. For combination studies, IC30 dose was selected, and the effects of the treatments were evaluated using MTT assays, colony formation assays, scratch healing assays and acridine orange/ethidium bromide staining assays.
RESULTS: Monotherapy with RA and 5-FU demonstrated a dose-dependent inhibitory effect on cell viability. The combination of both agents at their IC30 concentrations produced a statistically significant and combined inhibition of colony formation and cell motility compared to the single-agent and control groups. Furthermore, combined treatment induced more pronounced changes in characteristic cell morphology associated with apoptosis and necrosis than monotherapy groups.
DISCUSSION AND CONCLUSION: This study presents preliminary findings on the combined effects of rosmarinic acid with 5-fluorouracil. The combination significantly suppressed cell viability, colony formation capacity, and motility in CRPC cells in vitro and increased apoptosis- and necrosis- associated cell death compared to single treatments. In conclusion, these in vitro results suggest that combining the chemotherapeutic agent 5-FU with the natural compound RA may enhance treatment efficacy and represent a promising strategy for managing castration-resistant prostate cancer.

16. Relationship Between Arterial Stiffness and Immature Granulocyte, Delta Neutrophil Index, and Systemic Immune-Inflammation Index in Hemodialysis Patients
İlyas Öztürk, İbrahim Halil Bilen, Orcun Altunoren
doi: 10.5505/vmj.2026.90377  Pages 97 - 103
INTRODUCTION: Several inflammatory markers are thought to be potential predictors of disease progression and mortality in end-stage renal disease. In the present study, for the first time in the literature, we aimed to assess the potential association between newly described inflammatory markers immature granulocyte (IG), delta neutrophil index (DNI), and systemic immune-inflammation index (SIII) and arterial stiffness (AS) in hemodialysis (HD) patients.
METHODS: Medical records of HD patients undergoing outpatient clinic were retrospectively reviewed. A single-cuff arteriograph device was used to measure AS. IG and DNI levels were determined using a specific automated hematology analyzer. SIII was calculated using the formula: (neutrophil count × platelet count) / lymphocyte count.
RESULTS: A total of 117 patients were enrolled, with a mean age of 53.6±14.5 years; 55.6% were male and 44.4% were female. Correlation analysis showed that pulse wave velocity (PWV) was strongly correlated with age, body mass index, and systolic blood pressure; positively correlated with IG and DNI; and negatively correlated with serum albumin levels. When the effect of age was eliminated in the partial correlation analysis, the relationship between PWV and inflammation markers disappeared. Regression analysis revealed that the most important determinants of PWV were age and diastolic blood pressure (DBP).
DISCUSSION AND CONCLUSION: In HD patients, PWV an indicator of arterial stiffness demonstrates an age-dependent relationship with novel inflammatory markers such as IG and DNI. These routinely obtainable hematological parameters may provide useful insight into cardiovascular risk assessment in this population.

17. The Impact of Hemodynamic and Hematologic Markers on Postpartum Hemorrhage Risk in Hypertensive Pregnancies
Volkan Özgür Akbulut, Can Ozan Ulusoy, Aziz Kından, Ahmet Kurt, Ayse Gizem Yildiz, Gözde Başpınar Doğru, Hasan Altınsoy, Yaprak Engin-Ustun
doi: 10.5505/vmj.2026.17894  Pages 104 - 111
INTRODUCTION: This study aims to evaluate the predictive capabilities of traditional statistical and machine learning approaches in identifying postpartum hemorrhage (PPH) risk among hypertensive pregnancies, focusing on indicators such as hemoglobin, mean arterial pressure (MAP), and pulse rate. This will enable us to identify accessible and reliable predictors of PPH, thereby contributing to the early clinical decision-making process.
METHODS: Between 2016-2020, this retrospective case-control study was carried out at a tertiary center. Total of 64 cases with hypertensive disorders of pregnancy (HDP) were included, with 32 developing PPH and 32 serving as controls. To evaluate predictive value, hemoglobin, MAP, and pulse rate were analyzed using logistic regression and random forest models. Hyperparameter tuning was performed using GridSearchCV with 5-fold cross-validation. Model performance was evaluated using sensitivity, specificity, F1-score, accuracy, and area under receiver operating characteristic curve (AUC-ROC).

RESULTS: Hemoglobin levels were significantly lower (9.7 g/dL vs.11.9 g/dL, p=0.002), while MAP (103.0 mmHg vs.96.7 mmHg,p=0.002) and pulse rate (90.0 bpm vs.86.0 bpm,p=0.006) were significantly higher in the PPH group. Logistic regression demonstrated higher sensitivity (0.55 vs.0.44) and positive predictive value (0.83 vs.0.80) compared to the random forest model. However, the random forest model had a lower shrinkage value (-0.001 vs. -0.116), suggesting better generalizability. MAP ≥109.4 mmHg, pulse rate ≥97.6 bpm and hemoglobin level <9.23 g/dL were associated with a 94% probability of developing PPH.
DISCUSSION AND CONCLUSION: The findings indicate that monitoring hemoglobin, MAP and pulse rate may aid in recognizing PPH risk among HDP highlighting the importance of early risk assessment for enhancing maternal prognosis.

18. The Effect of Hypochlorous Obtained From Different Salts on Keratinocyte and Fibroblast Cells
Gülçin Abban Mete, Elvan Alkaya, Elif Önder, Doğukan Mutllu, Nazlı Çil, Ahmet Koluman, Şevki Arslan
doi: 10.5505/vmj.2026.69875  Pages 112 - 119
INTRODUCTION: Hypochlorous acid (HOCl) is a physiological molecule synthesised by neutrophils during phagocytosis and plays an active role in the destruction of all microorganisms. In general, HOCl has been demonstrated to function as an antiseptic and an agent that induces apoptosis or cell necrosis in cells, depending on the ambient concentration.The aim of this study was to examine the impact of sodium hypochlorite (NaOCI) and zinc hypochlorite (ZnOCI), derived from diverse chlorine salts, on cellular proliferation and migration in keratinocyte and fibroblast cell lines in vitro.
METHODS: The effects of different concentrations of NaOCl and ZnOCl on keratinocyte and fibroblast cell lines were compared using cell viability, colony formation and wound healing assays. In addition, the presence of apoptosis in the cells was determined using the tunel method.
RESULTS: The application of NaOCI and ZnOCI resulted in a notable enhancement in colony formation within keratinocyte cell lines, whereas this effect was not observed in fibroblast cell lines. In the fibroblast cell line, the application of NaOCI and ZnOCI was observed to result in the closure of the wound site. The keratinocyte cell line did not demonstrate a comparable effect. The application of NaOCI resulted in a notable reduction in apoptosis within the keratinocyte cell line, in comparison to the control group.
DISCUSSION AND CONCLUSION: NaOCL and ZnOCl increased colony formation in the keratinocyte cell line and enhanced wound healing in the fibroblast cell line. These hypochlorous acid derivatives were not superior to each other in terms of activity on cell lines.

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