Purpose: Metastatic hormone-sensitive prostate cancer requires accessible biomarkers for better prognostication. This study investigated the prognostic value of the alkaline phosphatase-to-albumin ratio (APAR) in metastatic hormone-sensitive prostate cancer survival risk stratification. Methods: We retrospectively analyzed 128 metastatic hormone-sensitive prostate cancer patients treated at a single institution between January 2015 and January 2025. A cut-off of 2.92 for the alkaline phosphatase-to-albumin ratio was determined via receiver operating characteristic analysis. Overall survival was assessed using Kaplan-Meier methods and multivariable Cox regression adjusting for standard prognostic factors, including tumor volume and Gleason score. Results: Patients with an alkaline phosphatase-to-albumin ratio of 2.92 or higher had significantly shorter overall survival compared to those with a ratio lower than 2.92 (log-rank p<0.001). In multivariable analysis, an alkaline phosphatase-to-albumin ratio of 2.92 or higher remained an independent predictor of poor overall survival (Hazard Ratio 3.26, 95% Confidence Interval 1.76-5.97; p<0.001), alongside Eastern Cooperative Oncology Group performance status (ECOG PS). Conclusion: The alkaline phosphatase-to-albumin ratio is an inexpensive, accessible marker that independently predicts survival in metastatic hormone-sensitive prostate cancer. APAR should be interpreted as a supportive, complementary marker alongside established clinical parameters such as ECOG PS, Gleason grade, and metastatic burden rather than as a standalone determinant. It holds promise for early risk stratification, though prospective validation is warranted
Purpose: Systemic amyloidosis encompasses a spectrum of protein misfolding disorders that result in amyloid deposition and organ dysfunction. Amyloid A (AA) amyloidosis, typically secondary to chronic inflammatory diseases, remains an important cause of renal morbidity. Therefore, the aim of this study was to evaluate factors associated with renal replacement therapy and mortality in patients with systemic amyloidosis. Materials and Methods: This retrospective single-center cohort study included 79 patients with biopsy-proven systemic amyloidosis diagnosed between 2010 and 2016. Demographic, clinical, and laboratory data were analyzed to identify factors associated with renal replacement therapy (RRT) and overall survival. Amyloid subtypes were determined by histopathology and immunohistochemistry. Results: Of the 79 patients, 62 (78.5%) had AA amyloidosis and 17 (21.5%) other types. The mean age was 55.8 +/- 15.8 years, and 53.2% were female. The median observation duration was 36 months. The kidneys were the most frequently involved organ (75.6%), and nephrotic syndrome was present in 50%. RRT was required in 33.8%, and overall mortality was 43%. Patients with AA amyloidosis were younger (p=0.047) and had higher creatinine and inflammatory markers (p<0.05). In multivariate Cox analysis, baseline serum creatinine (HR=1.20, 95% CI1.11-1.30, p<0.001) and proteinuria (HR=1.10, 95% CI1.01-1.20, p=0.031) were independently associated with RRT requirement. Older age was independently associated with mortality, with a 5% increase in risk per year of age (HR=1.05, 95% CI 1.01-1.09, p=0.006). Conclusion: In this cohort of systemic amyloidosis, where AA amyloidosis predominated, renal involvement was frequent and emerged as a major determinant of clinical outcomes. Baseline renal function and proteinuria are key associated factors of progression to RRT, while age remains the main determinant of overall survival.
Purpose: Bladder ischemia-reperfusion (I/R) injury leads to tissue damage through oxidative stress, inflammation, and cellular dysfunction. Cardamom (Elettaria cardamomum) has shown protective effects on various tissues thanks to its antioxidant and anti-inflammatory properties. However, its effects on bladder I/R injury have not been adequately investigated. The aim of this study was to evaluate the biochemical and histopathological protective effects of cardamom extract on bladder I/R injury. Materials and Methods: Wistar albino rats were allocated into three groups: I/R, sham and cardamom treatment group. The I/R group underwent 30 minutes of ischemia followed by 30 minutes of reperfusion. The cardamom group received 50 mg/kg of cardamom extract via gavage 24 hours before the I/R process. Bladder tissues were collected for biochemical analysis of oxidative stress markers (MDA, SOD, CAT) and histopathological examination. Results: In the cardamom treatment group, MDA levels were significantly lower, and SOD and CAT enzyme activities were significantly higher compared to the I/R group (p < 0.05). Histopathological analysis showed prominent inflammation, edema, and disruption of epithelial integrity in the I/R group, while the cardamom group exhibited notably reduced tissue damage and better-preserved epithelial integrity. Conclusion: Cardamom extract exhibited a protective role in bladder I/R injury by alleviating oxidative stress and inhibiting inflammatory responses. Further clinical studies are needed to better understand the bladder-protective effects of cardamom.
Purpose: This study aimed to investigate the effects of exercise on circulating microRNA expression and clinical outcomes in patients with rheumatoid arthritis. Materials and Methods: This prospective non-randomized interventional study included 30 RA patients (18-60 years) and 30 age-and sex-matched healthy controls. The RA group completed an 8-week supervised exercise program consisting of stretching, strengthening, and walking exercises. Pain , disease activity, functional status, and health-related quality of life were evaluated before and after the intervention. Circulating levels of miRNA-145, miRNA-146a, miRNA-155, and miRNA-16 were measured using real-time PCR. Results: After the exercise program, significant improvements were observed in pain, functional status, disease activity, and health-related quality of life (p<0.05). Circulating miRNA analysis showed a trend toward reduced expression after exercise. miRNA-145 demonstrated the largest change between pre-and post-exercise measurements, but this difference did not remain statistically significant after Bonferroni correction. No significant changes were observed for miRNA-146a, miRNA-155, or miRNA-16. No correlations were found between clinical improvements and miRNA expression changes Conclusion: Exercise was associated with improvements in clinical outcomes in RA patients, while molecular changes in circulating miRNAs were modest and exploratory.
Purpose: Quality management systems in healthcare services are developing within a multi-layered structure through general management standards, sector-specific adaptations, and accreditation frameworks. This study examines ISO 9001, ISO 15224, ISO 7101, the European Foundation for Quality Management Excellence Model, and healthcare-specific accreditation systems (such as standards developed by he Joint Commission International and the T & uuml;rkiye Health Care Quality and Accreditation Institute in terms of scope, conceptual orientation, clinical risk management, performance measurement, and external evaluation mechanisms. Material and Methods: The research used the qualitative document analysis method. Relevant standard texts and official documents were evaluated through thematic content analysis. Results: The results show that ISO 9001 provides a process architecture for quality management independent of the sector; ISO 7101 is a quality management system for healthcare organizations; ISO 15224 integrates clinical risk management into the core of the system; and accreditation systems in healthcare contain more detailed and operational clinical requirements. The EFQM model, on the other hand, offers a governance framework that provides a perspective on organizational maturity and sustainable performance rather than being a compliance-based certification standard. Conclusion: The study demonstrates that these systems are complementary, not contradictory, and that they create a layered quality architecture in healthcare organizations.
