Aim: Despite advances in early detection and surgical de-escalation strategies in breast cancer, accurately predicting sentinel lymph node involvement (SLNI) among patients with T1 disease remains a clinical challenge, particularly in those with unfavorable histologic subtypes. In this context, this study aimed to examine clinical factors related to pathological SLNI among patients with T1 early-stage breast cancer (ESBC) and unfavorable histologic subtypes. Methods: This retrospective analysis included 128 patients with clinically node-negative T1 ESBC and unfavorable histology who underwent surgery between January 2010 and December 2020. Clinicopathological and preoperative laboratory parameters were analyzed. To identify the independent risk factors associated with SLNI, logistic regression analyses were performed. Results: Thirty-six (28.1%) patients were SLNI-positive, and 92 (71.9%) were SLNI-negative. In univariate analysis, the presence of lymph nodes with a thickened cortex on preoperative ultrasonography (p=0.016), lymphovascular invasion (LVI) (p=0.002), larger tumor size (p=0.002), and higher neutrophil levels (p=0.046) were significantly associated with SLNI positivity. SLNI-positive patients also demonstrated significantly lower serum albumin levels (p=0.002), while monocyte levels exhibited a tendency toward lower values (p=0.064). In multivariate analysis, serum albumin levels (p=0.015), neutrophil count (p=0.031), monocyte count (p=0.035), and LVI (p=0.040) remained independently associated with SLNI. Conclusion: Selected clinicopathological and inflammatory parameters were independently associated with SLNI in patients with T1 ESBC and unfavorable histology and may help identify patients at higher risk of nodal involvement.
Aim: Iron deficiency anemia remains a common global health problem, particularly affecting women owing to reproductive and nutritional factors. This study aims to assess the use of iron preparations, their side-effect profiles, and their impact on treatment adherence among women in T & uuml;rkiye. Methods: This study was designed as a cross-sectional analytical study between October 1 and November 30, 2023. A total of 270 female patients receiving iron replacement therapy for at least one month were included in the study. A structured 20-item questionnaire was used to collect data on demographic characteristics, iron preparations, side effects, and treatment adherence. Data were analyzed using descriptive statistics, chi-square tests, t-tests, and binary logistic regression to identify predictors of treatment discontinuation. Results: Nausea was the most frequently reported cause of medication discontinuation (84.0%) and of switching (73.4%). Iron (III) polymaltose complex was associated with the highest rates of side effects (55.6% reported dyspeptic complaints) and treatment discontinuation (88.9%). The tablet formulation substantially increased the risk of treatment discontinuation by approximately ninefold overall and by about 5.6 fold due to side effects. Each additional year of age increased the odds of discontinuation by 10.4% (odds ratio 1.104; 95% confidence interval 1.062-1.146; p<0.001). Non pregnant women experienced higher rates of side effects, treatment discontinuation (47.2% vs. 30.9%), and medication changes (38.9% vs. 25.3%) than pregnant women (p=0,007; p=0.018). Conclusion: These findings support the need for personalized treatment strategies that consider factors such as age, pregnancy status, and formulation type to improve adherence and minimize treatment discontinuation.
Aim: Endometrial hyperplasia, particularly when accompanied by atypia, is considered a well-established precursor of endometrial carcinoma. Yes-associated protein 1 (YAP1), a key effector of the Hippo signaling pathway, plays a crucial role in the regulation of cell proliferation, apoptosis, and tissue homeostasis and has been implicated in tumorigenesis. The present study aimed to investigate whether YAP1 protein expression in endometrial hyperplasia with and without atypia differs from that in normal endometrial tissue. Methods: This retrospective observational case-control study included 122 patients: 41 cases of endometrial hyperplasia with atypia, 41 cases of endometrial hyperplasia without atypia, and 40 controls with normal endometrial histology. Immunohistochemical analysis was performed on formalin-fixed, paraffin-embedded tissue sections using a YAP1 polyclonal antibody. Staining localization (nuclear and/or cytoplasmic), intensity, and distribution were evaluated semi-quantitatively. Statistical comparisons among the three groups were performed using parametric or nonparametric tests according to the distribution characteristics of the variables. Results: No statistically significant differences were observed among the study groups in terms of YAP1 staining localization, intensity, or distribution. Both nuclear and cytoplasmic expression patterns were comparable in endometrial hyperplasia with and without atypia and in control tissues. Conclusion: Yes-associated protein 1 protein expression did not differ significantly between precancerous endometrial lesions and normal endometrium. These findings suggest that YAP1 activation may represent a later molecular event in endometrial carcinogenesis rather than an early alteration during precursor stages. Further prospective studies integrating molecular and functional analyses are warranted to clarify the precise role of YAP1 in the progression from benign to malignant endometrial pathology.
Aim: Hospital security staff encounter specific occupational stressors, such as irregular work hours, exposure to violence, and crises, but research on their mental health remains limited. This study aimed to examine the association between psychological symptom severity and sleep quality, job satisfaction, work schedule, and psychiatric history among hospital security personnel. Methods: A cross-sectional study was performed with 115 hospital security personnel from May 1, 2025, to July 1, 2025. All security workers completed structured questionnaires. The assessment tools included the Minnesota Satisfaction Questionnaire, the Pittsburgh Sleep Quality Index, and the Symptom Checklist-90-Revised (SCL-90-R). Participants’ sociodemographic data were recorded. Spearman correlation analysis was used to examine associations between continuous variables. Multiple linear regression analysis was performed to determine variables that were independently associated with SCL-90-R scores. Results: Significant differences in psychological symptoms were not found across demographic groups, work schedules, or psychiatric history. Correlation analysis revealed a significant negative association between job satisfaction and psychological distress (r=-0.253, p=0.006). Multiple linear regression analysis demonstrated that job satisfaction was independently associated with SCL-90-R scores (B=-0.004, 95% confidence interval: -0.007 to -0.001, p=0.031), whereas sleep quality (p=0.310), age (p=0.299), gender (p=0.130), and work schedule (p=0.965) showed no statistically significant association. Sleep quality, age, gender, work schedule, and other variables showed no significant predictive value. Conclusion: Job satisfaction was the only variable independently associated with psychological well-being among hospital security personnel, independent of traditional occupational stressors such as shift work and sleep quality. These findings suggest that organizational interventions targeting job satisfaction may be associated with improved mental health outcomes in this population.
Aim: Considering that systemic inflammatory indicators may insufficiently represent localized gastric inflammation in juvenile populations, chronic Helicobacter pylori(H. pylori) infection is associated with persistent gastric inflammation, which may influence systemic inflammatory parameters in children. This study aimed to investigate whether the C-reactive protein/albumin ratio (CAR) was associated with the severity of histopathological gastritis and H. pyloricolonization density in H. pylori-positive children. Methods: This retrospective cross-sectional study included 121 children aged 1-18 years who underwent upper gastrointestinal endoscopy for dyspeptic symptoms and were diagnosed with H. pyloriinfection. Gastritis severity, activity, and H. pylori colonization density were graded according to the modified Sydney classification system. The association between the CAR and histopathological parameters was analyzed. Results: The study included 121 pediatric patients (mean age +/- standard deviation: 14.49 +/- 2.83 years), of whom 66% were female. No statistically significant association was observed between the CAR and chronic gastric inflammation grade, gastric inflammatory activity grade, or H. pylori colonization density grade (p=0.735, p=0.287, and p=0.318, respectively). Although the median CAR was higher in patients with severe H. pylori colonization than in those with mild or moderate colonization, this difference did not reach statistical significance (p=0.744). Conclusion: The findings indicate that the CAR is not associated with histopathological severity or colonization density of H. pylori in children and does not reflect the histopathological severity in pediatric H. pylori gastritis.
Aim: Systemic immune-inflammatory indices have recently been investigated as potential biomarkers in several inflammatory and autoimmune diseases. This study aimed to investigate the symptom-based diagnostic value of the systemic immuno-inflammatory index (SII) and the systemic immunoresponsive index (SIRI) in patients with Hashimoto's thyroiditis (HT). Methods: The medical records of 169 patients who presented to our clinic between January 2023 and June 2023 were retrospectively reviewed. Demographic and laboratory parameters including age, gender, drug use, thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (Anti-TPO), Anti-Tg, platelet (PLT), neutrophil, lymphocyte, monocyte, SIRI, and SII values were analyzed. SII and SIRI indices were calculated using standard formulas based on complete blood count parameters. The association between inflammatory indices and symptom status was evaluated using correlation and logistic regression analyses. Results: Spearman's rho correlation analysis showed that the correlation between symptom positivity and Anti-TPO was significant (r=0.203; p<0.01). The correlation of symptom positivity with age, gender, drug usage, TSH, anti-Tg, PLT, neutrophil, lymphocyte, monocyte, SIRI, and SII was not statistically significant. Binary logistic regression analysis showed that the effects of gender, drug usage, age, SIRI, and SII on symptom positivity were not statistically significant. Although the effects of SIRI and SII on symptom positivity were not significant, the effect of Anti-TPO was significant (B=0.002; p<0.01). Conclusion: Neither SIRI nor SII had diagnostic value in patients with HT based on symptoms. Therefore, clinical evaluations based on the SIRI and SII indicators for monitoring disease progression and morbidity in cases of HT may not provide reliable information for symptom-based clinical evaluation.
Aim: We aimed to evaluate how modifiable risk factors influence these relationships and to better understand the drivers of early cognitive changes in regional tau burden in the medial temporal lobe (MTL) versus the neocortex (NEO) during the preclinical stages of Alzheimer’s disease (AD). Methods: In this cross-sectional study, 447 participants in the A4 study (anti-amyloid treatment in asymptomatic AD) underwent tau-positron emission tomography-standardized uptake value ratio evaluations. Cognitive abilities were assessed using the Preclinical Alzheimer’s Cognitive Composite (PACC). Depression, anxiety, and lifestyle factors were analyzed using t-tests, chi-square tests, and multiple linear regression models. Results: The tau-positive cohort was notably older (p=0.002) and significantly more likely to carry APOE4 (p<0.001). Tau-positive groups demonstrated poorer cognitive performance. Negative correlations between tau accumulation and cognitive performance for PACC and its components, with tauMTL/tauNEO associated with worse outcomes. Females were associated with better objective performance but worse informant-reported function, suggesting an early loss of self-awareness. Higher education was protective; depression was linked to decreased memory and executive function, whereas anxiety showed no association. Conclusion: Regional tau pathology is robustly associated with functional decline detectable by informants prior to clinical emergence. The significant interaction between tau and modifiable factors such as depressive symptoms underscores the importance of multifaceted, informant-based assessments in preclinical AD screening.
Aim: Despite increasing interest in wet cupping therapy (WCT), its effects on cardiac autonomic regulation have not been sufficiently investigated. In this context, we aimed to investigate whether WCT affects cardiac autonomic function in healthy individuals. Methods: This study was designed as a prospective single-arm interventional pre-post study in which 24-hour rhythm Holter (RH) recordings were obtained before and after WCT between August 2, 2022, and December 31, 2022. Time-domain measures were used to assess heart rate variability (HRV). 50 healthy volunteers were included in the study. Before the WCT, nurses in the cardiology outpatient clinic Holter room attached 24-hour RHs to the participants; the RHs were removed after 24 hours, before the WCT was applied in the traditional and complementary medicine department. After the WCT procedure, the 24-hour RH was immediately reattached to the healthy participants in the Holter room and removed 24 hours later. Results: No statistical difference was found between the two groups in the following parameters: standard deviation of NN intervals index (95% CI: -2.815-2.245, t=-0.226, p=0.822), SDSD (z=-1.238, p=0.216), NN50 (z=-1.725, p=0.085), RMSSD (z=-1.048, p=0.295), pNN50 (z=-0.104, p=0.917) and triangular index (z=-1.355, p=0.176). Conclusion: To the best of our knowledge, studies evaluating HRV parameters using 24-hour Holter monitoring before and after WCT are limited. When HRV parameters were compared before and after WCT, no statistically significant differences were observed between the two groups. More studies are needed with a larger number of healthy volunteers and with repeated WCT procedures.
Aim: Public-private partnership (PPP) hospitals have been increasingly implemented in T & uuml;rkiye to improve healthcare infrastructure and patient comfort. Coronary artery bypass grafting (CABG) is a high-risk surgical procedure frequently associated with significant preoperative anxiety, which may influence perioperative outcomes. This study aimed to compare preoperative anxiety levels and patient satisfaction among CABG patients treated at both a public hospital and a PPP-operated hospital with similar clinical capacity. Methods: A total of 2,201 patients who underwent isolated CABG between April 2016 and July 2024 were included in a retrospective analysis. Patients were divided into two groups: alethe [public hospital group (PHG), n=1.110] and the [PPP hospital group (PPPHG), n=1.091]. Patients using antidepressant or anxiolytic medications or whith known psychiatric disorders were excluded. Preoperative anxiety was assessed using the Beck Anxiety Inventory (BAI), and patient satisfaction was evaluated using the Patient Satisfaction Questionnaire Short Form (PSQ-18) and patient satisfaction were assessed using the BAI and the PSQ-18, respectively. Continuous and categorical variables were compared using Student's t-test and chi 2 test, respectively. Results: Overall patient satisfaction scores did not differ significantly between the two groups. However, preoperative anxiety levels were significantly lower in the PPPHG compared with the PHG (BAI: 9.3 +/- 4.1 vs. 17.8 +/- 6.4; p<0.001). Higher anxiety levels were associated with previous percutaneous coronary intervention, chronic obstructive pulmonary disease, divorced or widowed marital status, and lower socioeconomic status. Conclusion: While patient satisfaction with medical care was similar in both hospital models, CABG patients treated in the PPP hospital experienced significantly lower preoperative anxiety. Hospital environment and organizational characteristics may influence psychological well-being independently of clinical care quality.
Aim: Percutaneous nephrostomy (PN) is a well-established method for urgent decompression in stone-related urinary obstruction; however, post-procedural sepsis remains a significant concern. This study aimed to determine the incidence and risk factors for sepsis following PN in patients with stone-related urinary tract obstruction who did not have pre-existing sepsis. Methods: This retrospective observational cohort included patients who underwent PN for stone-related urinary tract obstruction. Patients were classified as non-septic (n=290) or septic (n=18) based on postoperative (post-op) sepsis. Demographic, clinical, laboratory, microbiological, and radiological parameters were analyzed. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of post-op sepsis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative performance of the prediction model. Results: Three hundred and eight patients were included; 18 (5.9%) developed post-op sepsis. Patients with post-op sepsis had significantly higher preoperative (pre-op) body temperature, white blood cell count and neutrophil count, C-reactive protein (CRP) levels, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index. Bacterial growth in nephrostomy catheter cultures and perirenal fat stranding were more frequent in the sepsis group. Multivariable analysis identified elevated body temperature, higher pre-op neutrophil count, increased pre-op CRP, and bacterial growth in nephrostomy catheter cultures as independent predictors of post-op sepsis. ROC curve analysis showed an area under the curve (AUC) of 0.925 for the prediction model, while body temperature, pre-op CRP, and neutrophil count had AUCs of 0.777, 0.750, and 0.746, respectively. Conclusion: Percutaneous nephrostomy relieves urinary tract obstruction but may also lead to serious complications such as sepsis. An increased body temperature, a high pre-op neutrophil count, a high pre-op CRP level, and bacterial growth in nephrostomy catheter cultures were all independent predictors, and the prediction model showed excellent discrimination.
Aim: Sarcopenia and Parkinson's disease (PD) share pathophysiological mechanisms that may synergistically accelerate functional decline. This study aimed to investigate the relationship between sarcopenia risk and functional mobility in patients with PD and to compare the clinical and demographic characteristics of patients with low and high sarcopenia risk. Methods: This cross-sectional study enrolled 29 patients with idiopathic PD between October and December 2025. Sarcopenia risk was assessed using the SARC-F questionnaire (cut-off >= 4) and functional mobility using the Timed Up and Go (TUG) test. Disease severity was staged using the Hoehn-Yahr (H-Y) scale. Spearman rank correlation, the Mann-Whitney U test, and independent t-tests were applied; normality was evaluated using the Kolmogorov-Smirnov test. Results: Of 29 participants (mean age 70.59 +/- 12.61 years), 65.5% were classified as high sarcopenia risk. The high-risk group was significantly older (75.42 vs. 63.00 years; p=0.008) and had more advanced H-Y staging (2.37 vs. 1.50; p=0.005). Timed Up and Go time was significantly longer in the high-risk group (27.58 vs. 18.30 seconds; p=0.018). SARC-F score correlated strongly with TUG time (r=0.709, p<0.001) and moderately with H-Y stage (r=0.440, p=0.016). Conclusion: Sarcopenia risk is highly prevalent in PD and is strongly associated with disease severity and impaired functional mobility. Combined SARC-F and TUG screening may facilitate early identification of at-risk patients to guide targeted rehabilitation interventions.
Aim: Vascular surgery is among the surgical procedures associated with the highest cardiac morbidity and mortality because the surgical stress response is pronounced in individuals with cardiogenic risk factors. The aim of this study is to evaluate the effect of epidural anesthesia on the surgical stress response during major vascular surgery. Methods: Two groups (epidural group (EG), n=15; control group, n=15) were formed in the cardiovascular surgery operating room by prospective randomization. Hemodynamic fluctuations and visual analog scale (VAS) pain scores were monitored. The primary endpoint was defined as the change in N-terminal-proBNP (NT-proBNP) levels on postoperative day two compared with preoperative measurements. Troponin-I, changes in blood flow, pain scores, and sevoflurane use were secondary endpoints. Results: Sevoflurane consumption was lower in EG, whereas fluid volume was higher. >= 11 tachycardia attacks were more frequent in CG, and >= 11 decreases in mean arterial pressure were seen (33.3% vs. 0%; p=0.042). VAS was lower in favor of EG (Day-1: 4.33 +/- 0.98 vs. 5.27 +/- 0.70, p=0.011; Day-2: 1.67 +/- 1.13 vs. 2.13 +/- 0.64, p=0.041). No difference in NT-proBNP/troponin-I levels was observed between groups. Conclusion: In vascular surgery, epidural anesthesia can reduce hemodynamic fluctuations and early postoperative pain while limiting the rise in NT-proBNP. Biomarker findings are hypothesis-generating owing to methodological constraints and necessitate validation through studies with larger sample sizes.
Aim: Childbirth self-efficacy is a critical psychological variable that influences birth outcomes and maternal well-being; however, its exact predictors among nulliparous women remain underinvestigated. This research aimed to outline variables that affect self-efficacy for vaginal delivery among nulliparous women, with a specific interest in the effects of birth belief systems. Methods: This cross-sectional observational study was conducted between February and July 2025 among nulliparous women receiving prenatal care. Validated measures, such as the Birth Beliefs Scale (medical process and natural process subscales) and the Self-efficacy Regarding Vaginal Birth Scale, were used for data collection. Predictors of vaginal birth self-efficacy were determined using hierarchical multiple regression and structural equation modeling. Results: Two hundred and eighty nulliparous women were included in the study. Self-efficacy was negatively related to medical process beliefs (b=-0.168, p<0.01) but positively related to natural process beliefs (b=0.154, p<0.01). The regression model accounted for 18.7% of the variance in self-efficacy [F(6,273)=10.47, p<0.001]. Other important predictors were planned delivery approach, pregnancy experience rating, education level, and spousal support. Conclusion: Birth belief systems are the first psychological predictors of vaginal birth self-efficacy in women in their first pregnancy. To help prevent low self-efficacy, healthcare providers should consider adopting screening procedures to identify women whose belief patterns are linked to low self-efficacy.
Aim: Accurate early risk stratification is essential for guiding disposition and monitoring decisions in community-acquired pneumonia (CAP) in the emergency department. We aimed to evaluate the prognostic performance of the PATHOS score and compare it with CURB-65 and A-DROP in predicting 30-day mortality in adult patients with CAP. Methods: This retrospective, single-center observational cohort study included consecutive adult patients (>= 18 years) presenting to the emergency department with CAP between January 1, 2019, and January 1, 2024. Patient data were obtained from the hospital's electronic medical record system using the International Classification of Diseases, Tenth Revision. CURB-65, A-DROP, and PATHOS scores were calculated based on the collected data. The ability of the PATHOS score to predict 30-day mortality was evaluated and compared with CURB-65 and A-DROP scores. Results: A total of 605 cases were included in the study. The overall 30-day mortality rate was 8.6%. In predicting 30-day mortality, the PATHOS score [area under the curve (AUC)=0.849] demonstrated better performance than CURB-65 (AUC=0.733) and A-DROP (AUC=0.780). A PATHOS score of >3 was identified as the optimal threshold for predicting 30-day mortality, with a sensitivity of 75.0%, a specificity of 86.8%, and a negative predictive value of 97.4%. Conclusion: Our findings indicate that the PATHOS score can serve as an effective tool in the clinical management of patients with CAP and contribute significantly to clinical decision-making.
Aim: Parental burnout is common among mothers of children with attention deficit hyperactivity disorder (ADHD); however, evidence regarding protective psychological factors is limited. This study aimed to examine mindful parenting and child symptom severity as determinants of burnout among mothers of children with ADHD. Methods: This cross-sectional study included mothers of 127 children diagnosed with ADHD. The Mindfulness in Parenting Questionnaire (MIPQ), Maslach Burnout Inventory (MBI), and Children and Adolescent Behavior Inventory were administered to the participants. Associations were examined using correlation analyses, followed by multiple linear regression models to identify the determinants of maternal burnout dimensions. Results: Mindfulness in Parenting Questionnaire-parental self-efficacy (MIPQ-PSE) and being in the moment with the child (MIPQ-BMC) were negatively correlated with depersonalization (MBI-DP) and emotional exhaustion (MBI-EE) and positively correlated with personal accomplishment (MBI-PA) (p<0.05). Hyperactivity-impulsivity and attention deficit were positively correlated with MBI-EE and MBI-DP, and negatively correlated with MBI-PA (p<0.05). Regression analysis showed that MIPQ-PSE negatively predicted MBI-EE and MBI-DP, whereas hyperactivity-impulsivity positively predicted them (p<0.05). Maslach Burnout Inventory-personal accomplishment was positively predicted by MIPQ-PSE and MIPQ-BMC and negatively predicted by attention deficit (p<0.05). Conclusion: Mindful parenting is associated with reduced maternal burnout. Interventions that promote mindfulness have the potential to mitigate burnout among mothers of children with ADHD.
Aim: Given the clinical importance of early risk stratification in patients with diabetic foot ulcers and the limited availability of simple and reliable biomarkers, there is a need for easily accessible parameters that can support clinical decision-making. Therefore, this study aimed to evaluate the association between the Prognostic Nutritional Index (PNI) and major amputation in patients hospitalized for diabetic foot ulcers. Methods: This retrospective observational study included patients with diabetic foot ulcers evaluated by the Diabetic Foot Board between January 2020 and August 2024, who were managed conservatively or underwent minor or major amputation. Demographic characteristics, comorbid diseases, and laboratory parameters—including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), HbA1c, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and PNI—were compared among groups. Multivariable logistic regression analysis was performed to identify independent factors associated with major amputation, and receiver operating characteristic curve analysis was used to assess the discriminative performance of PNI. Results: The study cohort consisted of 756 cases: 216 without amputation, 338 with minor amputation, and 202 with major amputation. Significant differences were observed between the amputation and non-amputation groups with respect to age, coronary artery disease, chronic heart failure, CRP, ESR, NLR, SII, and PNI. Age, ESR, CRP, and PNI were identified as independently associated with major amputation. Conclusion: The PNI reflects both immunological and nutritional status and is independently associated with major amputation in patients with diabetic foot ulcers.
Aim: The clinical relevance of thyroid nodules in Graves’ disease (GD) remains controversial, particularly in iodine-deficient regions where both nodularity and thyroid cancer are more prevalent. This study aimed to compare clinical, biochemical, ultrasonographic, cytological, and pathological characteristics between nodular and non-nodular GD (non-NGD) to clarify the oncologic significance of nodularity. Methods: This retrospective observational cohort study included 160 patients who underwent total thyroidectomy for GD between June 2020 and July 2025 at an endocrine surgery center. Patients were classified according to preoperative ultrasonography (US) as nodular or non-NGD. Demographic features, thyroid autoimmunity markers, ophthalmopathy, fine-needle aspiration biopsy (FNAB)results, and final pathology were recorded. Multivariate logistic regression analysis was performed to identify independent predictors of nodularity. Results: Sixty-three patients (39.4%) had nodular GD (NGD), and 97 patients (60.6%) had non-NGD. Nodular patients were older and had higher body mass index (BMI) (both p<0.05), whereas thyroid-stimulating immunoglobulin and anti-thyroid peroxidase levels and ophthalmopathy were significantly higher in non-nodular patients. Fine-needle aspiration biopsy was more frequently performed in the nodular group (57.1% vs. 20.6%). Overall, papillary thyroid carcinoma (PTC) was diagnosed in 31.8% of the cohort, with a markedly higher prevalence in NGD (52.4% vs. 18.5%, p<0.001). Tumors in nodular patients were larger and more likely to exhibit lymphatic invasion. In multivariate analysis, age and BMI remained independent predictors of nodularity. Conclusion: In this surgically treated GD cohort, nodularity identifies a structural phenotype with substantially increased PTC risk, while non-NGD reflects an autoimmune-dominant phenotype. High malignancy rates across Bethesda categories and even in non-biopsied patients indicate the need for vigilant US surveillance and a low threshold for FNAB of suspicious or dominant nodules.
Aim: Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory disease of the breast, and its imaging findings may overlap with those of malignant non-mass enhancement (NME). This study aimed to investigate the performance of deep learning and machine learning models in differentiating IGM from malignant NME based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods: In this retrospective study conducted between January 2019 and March 2023, DCE-MRI findings of 30 patients with histopathologically confirmed IGM and of 33 patients with breast cancer presenting as NME were analyzed. The second dynamic phase of DCE-MRI (Dataset 1, 475 images) and the corresponding subtracted images (Dataset 2, 402 images) were used in this study. Datasets were sequentially split into 80% training and 20% testing sets to ensure a patient-level split. Image features were extracted using SqueezeNet and classified with a narrow neural network. Results: The mean age was significantly lower in the IGM group than in the NME group (41.3 +/- 11.3 vs. 52.2 +/- 11.4 years, p<0.001). For Dataset 1, the area under the curve was 0.997 in training and 0.870 in testing; for Dataset 2, the area under the curve was 0.998 in training and 0.807 in testing. Training accuracy was 0.984 (Dataset 1) and 0.978 (Dataset 2), whereas test accuracy was 0.811 (Dataset 1) and 0.704 (Dataset 2). Conclusion: The findings of this study suggest that deep learning shows significant promise for non-invasive differentiation of IGM from malignant NME on DCE-MRI, particularly in cases that are clinically indistinguishable.
Aim: Artificial intelligence (AI) applications are widely used to identify solutions to patients'problems. This study aims to evaluate the scientific validity of information that patients can access about human papillomavirus (HPV)-related topics using Chat-Generative Pre-Trained Transformer (ChatGPT). Methods: This study was conducted between July 1 and August 1, 2025. A physician developed a structured set of HPV-related questions. The responses generated by ChatGPT were independently evaluated by three clinicians with clinical experience in HPV management. Each response was rated using a five-point Likert scale based on accuracy and clinical relevance. Inter-rater reliability among reviewers was assessed using Cohen's kappa statistic. Results: The mean scores given by the reviewers for evaluating the accuracy of ChatGPT's answers to HPV-related questions were 4.9 +/- 0.3, 4.75 +/- 0.44, and 4.75 +/- 0.55, respectively. The percentages of correct scores assigned to ChatGPT by the reviewers were 90%, 75%, and 80%, respectively. The approximately equal percentages of correct and incorrect scores were 0, 0, and 5, respectively. The percentages of nearly correct scores were 10, 25, and 15, respectively. Conclusion: Chat-Generative Pre-Trained Transformer 4.0 demonstrated high efficacy in providing general information regarding HPV, with an 81.6% accuracy rate and a 90% near-accuracy rate. Incorporating AI tools into the facilitation of patient access to information could enhance learning processes. However, it is essential that these tools be continuously refined and utilized to complement rather than substitute for the critical judgment of medical professionals and patients.
