Reimbursement of Lung Cancer in Turkey: A 10‐Year Single Center Study

ABSTRACT Objective and Background Lung cancer is the most common carcinoma reported worldwide. The burden of lung carcinoma on healthcare has been reported in many countries, while a real‐life report within Turkey has yet to be published. This study aims to present the available results from a tertiary center specializing in pulmonology. Methods The study's population consisted of 199.112 patient admissions, which were reimbursed under the national healthcare system. After exclusion criteria, 4.991 patients were evaluated in the study. The patient's demographic data, malignancy types, diagnostic methods for lung carcinoma type and staging, and treatment modalities were recorded. Results The average healthcare expenditure during the treatment duration was 4289.4 (± 3739.4) USD, and the median was 3219.9 USD. The average expenditure was higher for male patients (3260 to 2977 USD, p  = 0.003). Survivors had an overall lower healthcare expenditure than the non‐survivor group (2865 to 4230 USD). Patients with locally advanced disease classification also had a higher expenditure on other stages ( p  < 0.001). This was not present in SCLC, as those diagnosed with SCLC had the most expenditure at the limited stage ( p  < 0.001). Carcinoid tumors had the least expenditure compared to other subtypes at limited and advanced stages ( p  < 0.001). SCLC had the highest expenditure requirement at the limited stage ( p  < 0.001). At the locally advanced stage, large cell carcinoma, SCC, and adenocarcinoma were the subtypes requiring the highest expenditure ( p  < 0.001). Conclusion The parameters affecting overall cost were age, gender, stage, and malignancy subtype. The healthcare expenditure was also affected by the difficulty of diagnosis, with the non‐diagnostic patient group having an overall higher cost. A longer duration of hospitalization and treatment given on an inpatient basis also contributed to a higher cost of care.

Assessment of Guidewire‐Induced Deviation in Fractional Flow Reserve: Impact of Lesion Morphology and Pressure Guidewire Malposition

ABSTRACT Coronary artery disease (CAD) is one of the leading causes of mortality worldwide. Fractional flow reserve (FFR) is a diagnostic metric for evaluating ischemic coronary stenoses, necessitating invasive pressure measurements using a guidewire during maximal hyperemia. The stenosis morphology and the presence of a guidewire influence coronary hemodynamics, warranting further investigation to improve FFR accuracy. This study systematically examines the effect of a pressure guidewire on FFR across different stenosis morphologies under clinically relevant boundary conditions (BCs). Six idealized models of coronary stenosis were developed, representing area stenoses (AS: percentage reduction in the cross‐sectional area) of 64%, 75%, 84%, and 91%, based on the dimensions of the left anterior descending (LAD) artery. Computational fluid dynamics (CFD) simulations were conducted using coronary BCs validated against both in vivo and in silico data in the literature. Guidewire‐induced FFR deviation (dFFR) exhibited a linear correlation with the blockage ratio—guidewire area relative to minimum lumen area—with deviations exceeding 0.04 for AS greater than 80%. dFFR values were comparable for AS of 64% and 75% across different shapes, but shape‐related variation increased (> 0.02) at AS of 84% and 91%. Lesion length (LL) significantly influenced FFR based on morphology: a threefold increase in LL reduced FFR by 0.06 in crescent‐shaped stenosis, while having minimal impact in the fully eccentric circular case (AS 84%). However, dFFR remained largely unaffected by LL. Finally, the effects of guidewire malposition on dFFR were negligible in non‐circular stenoses (< 0.01) but considerable in circular stenoses (> 0.04 for AS 84%).

Modulation of mechanosensitive genes during embryonic aortic arch development

Abstract Background Early embryonic aortic arches (AA) are a dynamic vascular structures that are in the process of shaping into the great arteries of cardiovascular system. Previously, a time‐lapsed mechanosensitive gene expression map was established for AA subject to altered mechanical loads in the avian embryo. To validate this map, we investigated effects on vascular microstructure and material properties following the perturbation of key genes using an in‐house microvascular gene knockdown system. Results All siRNA vectors show a decrease in the expression intensity of desired genes with no significant differences between vectors. In TGFβ3 knockdowns, we found a reduction in expression intensities of TGFβ3 (≤76%) and its downstream targets such as ELN (≤99.6%), Fbn1 (≤60%), COL1 (≤52%) and COL3 (≤86%) and an increase of diameter in the left AA (23%). MMP2 knockdown also reduced expression levels in MMP2 (≤30%) and a 6‐fold increase in its downstream target COL3 with a decrease in stiffness of the AA wall and an increase in the diameter of the AA (55%). These in vivo measurements were confirmed using immunohistochemistry, western blotting and a computational growth model of the vascular extracellular matrix (ECM). Conclusions Localized spatial genetic modification of the aortic arch region governs the vascular phenotype and ECM composition of the embryo and can be integrated with mechanically‐induced congenital heart disease models.

A Novel Record of Brown Hyaena ( Parahyaena brunnea ) in Zinave National Park, Mozambique

ABSTRACT Globally, large carnivores face significant threats and have lost substantial portions of their historical range. The Brown Hyaena ( Parahyaena brunnea ), one of four Hyaenidae species, has a global population estimated at fewer than 10,000 individuals and the species is of conservation concern. Its population size in Mozambique remains unknown. Zinave National Park (Zinave) in Mozambique is undergoing recovery following the impacts of a prolonged civil war, which severely depleted its wildlife populations. Recently, however, the park has seen the return of large carnivores, both naturally (Spotted Hyaena; Crocuta crocuta , Leopard; Panthera pardus , and Lion; Panthera leo ) and reintroduced (Spotted Hyaena and Leopard) inside the sanctuary. During September 2023 to September 2024, through the establishment of a permanent camera trap grid and the periodic placement of camera traps on carcasses to monitor scavenger activity, the first images of Brown Hyaenas were recorded in Zinave. This provides evidence of their presence in an area not previously considered within the species extant range. This study highlights the importance of long‐term biodiversity monitoring, both inside and outside protected areas, using complementary methods such as active search efforts and camera trapping. These approaches are critical for documenting rare and cryptic species, species range shifts and generating essential data to guide effective conservation strategies.

Exploring heart failure prevalence and dimensions: A comprehensive NT‐proBNP study in high‐risk primary care patients

Abstract Introduction Early detection of heart failure (HF), particularly in asymptomatic individuals, is essential for timely intervention. This study aimed to determine the prevalence of HF among high‐risk individuals in primary care using N‐terminal probrain natriuretic peptide (NT‐proBNP) screening. Methods A prospective cohort of 874 participants aged ≥40 years with at least one HF risk factor but no prior HF diagnosis was analysed. NT‐proBNP levels were measured, and all participants underwent comprehensive cardiac evaluations, including laboratory tests, electrocardiography and echocardiography. Results The mean age of the cohort was 62.5 ± 9.1 years, and 51.9% were female. Based on ACC/AHA HF staging, 69.1% of participants were classified as Stage A, 21.9% as Stage B and 9.0% as Stage C. Elevated NT‐proBNP levels were detected in 84.8% of Stage B and 100% of Stage C patients. Among Stage C patients, 92.4% had HF with preserved ejection fraction (HFpEF). NT‐proBNP levels correlated positively with left atrial volume index ( r  = 0.273, P  < 0.001), left ventricular mass index ( r  = 0.207, P  < 0.001), E/e′ ratio ( r  = 0.182, P  < 0.001) and estimated systolic pulmonary artery pressure ( r  = 0.124, P  < 0.001), while showing a negative correlation with estimated glomerular filtration rate ( r  = −0.222, P  < 0.001). Conclusions A significant proportion of high‐risk individuals in primary care had undiagnosed HF, particularly Stage B (pre‐HF) and early symptomatic Stage C HF. The predominance of HFpEF highlights the need for targeted management. NT‐proBNP screening is a valuable tool for early identification and risk stratification, especially for detecting Stage B HF, where it serves as an effective standalone method in the absence of imaging.

A SERS Substrate Based on Ultrasonic Stacking of Nanopowders on Thermoplastics

ABSTRACT Surface‐enhanced Raman spectroscopy (SERS) is often considered as a versatile tool for high‐sensitive detection of low concentrations of analytes. Typically, gold or silver patterned surfaces, namely the SERS substrates, are utilized to amplify Raman signal. However, most SERS substrates require microfabrication processes based on costly infrastructures. In this paper, we propose a simple yet effective scheme for fabricating SERS substrates on thermoplastics. The process involves ultrasonically stacking nanopowders on thermoplastic substrate via a stencil. We showed that gold surfaces on polymethly methacrylate (PMMA) substrates could be fabricated by ultrasonic means in less than 10 s by using a benchtop ultrasonic welder. We investigated the effect of process parameters, namely the pressure and the vibration time, on the surface topography and SERS performance. The results show that the process is mainly controlled by the vibration time, such that at moderate vibration times (~ 5 s), uniformly rough surfaces could be repeatably achieved. Fabricated samples were tested for SERS performance using 5,5′‐ditiobis (2‐nitrobenzoic acid) (DTNB) as the Raman reporter. We showed that the substrates fabricated under 2.7 MPa pressure and 5 s vibration time yielded comparatively low relative standard deviations (RSD) of SERS intensity—6.12% for point‐to‐point variation and 6.73% for batch‐to‐batch variation—along with an enhancement factor (EF) of 1.28 × 10 5 . The performance of the SERS substrates, considering RSD and EF, indicates that the proposed fabrication method could be a promising alternative for SERS based sensing applications.

AI‐Driven Personalized Nutrition: Integrating Omics, Ethics, and Digital Health

ABSTRACT Personalized nutrition (PN) aims to prevent and manage chronic diseases by providing individualized dietary guidance based on genetic, metabolic, and lifestyle data. Artificial intelligence (AI) has become a key enabler in PN by analyzing large‐scale, multiomics datasets in obesity, diabetes, cardiovascular, and gastrointestinal disorders, where digital twins and health knowledge graphs support personalized interventions. Current findings demonstrate that AI models can guide microbiome‐based dietary interventions, and support obesity management, thereby extending the scope of conventional nutritional strategies as supported by deepened bibliometric analyses. This study highlights the global increase in AI‐based PN studies, accelerated by digital health demands and the COVID‐19 pandemic, and the expansion of traditional nutrition strategies through machine learning approaches with the integration of microbiome‐based models and omics. However, challenges such as algorithmic bias, limited generalizability, and data privacy remain. To overcome these issues, diverse datasets, explainable AI approaches, and standardized multicenter validation protocols are proposed. These steps are critical for transforming AI‐supported PN from a conceptual potential into a fair, reliable, and clinically applicable structure. The growing consensus in the literature highlights that AI can support individual and societal health goals by transforming nutrition science through predictive, adaptive, and ethically based approaches.

The Furan Fatty Acids 11M5 and 11D5 Can Act as Activators of Human Peroxisome Proliferator‐Activated Receptor Gamma

ABSTRACT Furan fatty acids (FuFA) are a minor class of fatty acids in food that are characterized by a furan ring within the alkyl chain. Furan fatty acids have strong antioxidant properties but their biological functions remain largely elusive. Using molecular docking combined with biomolecular validation, we investigated the regulatory activities of the key furan fatty acids 9M5, 11M5, and 11D5 on human nuclear receptors, including PPARγ, LXR, PXR, FXR, and HNF4α. Using computational methods, 11M5 and 11D5 and to a lesser extend 9M5 were predicted to bind to PPARγ. The activation of both PPARγ1 and PPARγ2 was confirmed in human HEK293T cells and structure‐activity experiments revealed that this was dependent on the furan fatty acid backbone. In summary, our data provide novel insights into the biological activities of furan fatty acids in human cells and indicate that activation of peroxisome proliferator‐activated receptor gamma underlies their beneficial health effects. These findings establish a clear mechanistic basis, supported by the inactivity of related compounds, and we are confident that future expanded studies will further confirm this mechanism.

Does Adding TENS to Pelvic Floor Rehabilitation Effect on Urodynamics and Clinical Results in Children With Spina Bifida?

ABSTRACT Introduction Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice. Materials and Methods Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR ( n  = 14), TENS was used in addition to this therapy in Group PFR + T ( n  = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated. Results Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 ± + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 ± 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS ( p  < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 ± 58.069 cmH2O to 58.077 ± 39.872 cmH2O) ( p  < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups. Discussion PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients. Conclusion Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence‐related quality of life.

Global Pediatric Pulmonology Alliance recommendations to protect all infants against respiratory syncytial virus with prophylactic monoclonal antibodies