Sürdürülebilir Kalkınma Amaçları

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• MakaleAçık Erişim2026/r/gumushane/15845
  Association of Serial Intra-Abdominal Pressure Measurements with Renal Outcomes and Mortality in Critically Ill Adults

  Öztürk, Ayse Sari; Konur, Kamil; Kara, Ekrem

  Background/Objectives: Intra-abdominal hypertension (IAH) is a common but under-recognized condition in critically ill patients and is associated with adverse outcomes, particularly acute kidney injury (AKI) and mortality. However, the prognostic value of intra-abdominal pressure (IAP) remains incompletely defined. This study aimed to evaluate the association between IAP levels and clinical outcomes, and to determine its prognostic significance in intensive care unit (ICU) patients. Methods: This prospective cohort study included adult patients admitted to the ICU between 2024 and 2025. Serial IAP measurements were performed using the transvesical method on days 0, 1, 3, 5, and 7. Demographic, clinical, and laboratory data, along with severity scores (SOFA and APACHE II), were recorded. Patients were followed for 90 days. Primary outcomes were AKI and 90-day mortality. Statistical analyses included regression models, survival analysis, and ROC curve analysis. Results: The prevalence of IAH was 54%. IAH was significantly associated with advanced age, male sex, higher body mass index, increased comorbidity burden, sepsis, positive fluid balance, and higher disease severity scores. Patients with IAH had a significantly higher frequency of AKI occurrence and increased mortality. IAP levels positively correlated with serum urea and creatinine levels. Serial IAP measurements, particularly on days 5 and 7, showed progressively improved predictive performance for mortality. Survival analysis revealed significantly reduced survival in patients with IAH. Conclusions: IAH is highly prevalent in critically ill patients and is strongly associated with renal dysfunction and mortality. Serial IAP measurements may provide useful prognostic information in critically ill patients; however, these findings require validation in larger studies.

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• Derleme MakaleAçık Erişim2026/r/gumushane/13803
  Intersection of Precision Nutrition and Bladder Cancer: A Narrative State-of-the-Art Review of Potential Applications and Challenges

  Koçak, Tevfik; Özbek, Yağmur Demirel; Bodur, Mahmut; Yeşil, Süleyman; Ağagündüz, Duygu

  Bladder cancer (BC) is a biologically heterogeneous tumor affected by genetic, metabolic, environmental, and lifestyle factors. Recent research indicates that nutrition can change the way urothelial cancer forms by affecting inflammation, oxidative stress, cellular energy, and the epigenome. It can also change the risk of BC and how well treatment works. Simultaneous progress in precision nutrition (PN) and nutriomic profiling—encompassing nutrigenomics, nutrigenetics, nutriepigenetics, metabolomics, and microbiome science—presents novel options to tailor dietary regimens beyond universal guidelines. In this review, we consolidate existing knowledge regarding the nutritional factors influencing BC, outline pertinent principles of PN for BC prevention and survival, and explore how urine proteomics and molecular subtyping facilitate the integration of PN into precision oncology. Our review examines the methodological, bioinformatic, biomarker, and clinical translation challenges that impede the implementation of PN in BC management; these challenges include the need for validated nutritional biomarkers with mechanistic endpoints, interoperable data platforms, and rigorously designed clinical trials. Finally, we emphasize future prospects for PN-guided medical nutrition therapy and dietary models during and after systemic treatment recovery. We propose research priorities that will facilitate the integration of PN-informed individualized dietary plans with medical and surgical approaches in BC treatment, aiming to decrease the costs associated with expensive or excessively aggressive treatment methods, thereby supporting long-term survival care. This review seeks to establish a conceptual framework for the integration of PN into BC management by delineating the opportunities and challenges, hence promoting hypothesis-driven research in a promising yet underexplored domain.

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• MakaleYayıncıda açık erişim2025/r/gumushane/10521
  Could Different Doses of Dexmedetomidine Be as Effective as Amifostine Against Radiotherapy-Induced Liver Injury in Rats? Evidence from Mitotic, Apoptotic, Oxidative, and Neurogenic Insights

  Beyazal Polat, Hatice; Yilmaz, Hamit; Demir, Kasim; Kilinc, Kagan; Gülhan, Belemir; Rakici, Sema Yilmaz; Tumkaya, Levent

  Background/Objectives: Radiotherapy (RT) induces oxidative stress and structural damage in solid tissues, including the liver. This study aimed to investigate the histological and immunohistochemical effects of dexmedetomidine (DEX) and amifostine on their potential protective and regenerative properties against liver injury induced by radiation therapy. Methods: This study consisted of five randomized groups: control, RT, RT-D100, RT-D200, and RT-A (Amifostine). A total of 100 mu g/kg DEX, 200 mu g/kg DEX, and 200 mu g/kg amifostine were administered before radiotherapy as per the experimental design. After RT, liver specimens were analyzed for histological alterations, including periportal and perisinusoidal fibrosis, vacuolization, and pyknotic nuclei. Furthermore, immunohistochemistry investigations were conducted to evaluate apoptosis, mitosis, oxidative stress, and neural regeneration in non-neuronal liver tissue following radiotherapy and subsequent treatment. Results: The control group's liver tissue exhibited standard histological architecture, whereas the RT group displayed severe cellular degeneration, periportal and perisinusoidal fibrosis, cytoplasmic vacuolization, and an increase in pyknotic nuclei. The apoptotic index was markedly reduced in the RT-D100 and RT-D200 groups relative to the RT group. Furthermore, caspase-3 immunoactivity was negligible in the control group, while a significant increase was observed in the RT group. The administration of amifostine significantly increased GAP-43 levels. Conclusions: DEX mitigates RT-induced hepatic injury chiefly through antioxidant and anti-apoptotic pathways, whereas amifostine promotes hepatic regeneration by modulating GAP-43.

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• MakaleAçık Erişim2025/r/gumushane/10632
  Low Serum and Urine Fetuin-A Levels and High Composite Dietary Antioxidant Index as Risk Factors for Kidney Stone Formation

  Icer, Mehmet Arif; Koçak, Tevfik; Icer, Yusuf; Kocyigit, Emine; Agagündüz, Duygu; Gezmen-Karadag, Makbule; Yesil, Suleyman; Budán, Ferenc

  Background: Fetuin-A prevents the precipitation of hydroxyapatite in supersaturated solutions of calcium and phosphate; however, its relationship with nephrolithiasis has yet to be clarified. The aim of this study was to investigate the protective and predictive roles of serum and urine fetuin-A levels in nephrolithiasis and their relationships with the composite dietary antioxidant index (CDAI). Methods: This study involved 75 adult patients with kidney stone disease and 71 healthy adults without kidney stone disease in the control group. Participants had specific anthropometric measurements taken, and three-day food records were kept. The CDAI was calculated by summing six standard antioxidants, including vitamins A, C, and E, manganese, selenium, and zinc, representing participants' antioxidant profile. In addition to some analyzed serum and urine parameters of the participants, fetuin-A levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Results: In patients with kidney stones, both serum and urine fetuin-A levels (676.3 +/- 160.14 ng/mL; 166.6 +/- 128.13 ng/mL, respectively) were lower than in the control group (1455.6 +/- 420.52 ng/mL; 2267.5 +/- 1536.78 ng/mL, respectively) (p < 0.00001). In contrast, the CDAI was higher in patients with kidney stones compared to those without kidney stones (p < 0.001). Besides, several dietary parameters had significant positive correlations with serum and/or urinary fetuin-A. Conclusions: The present study suggests that serum and urinary fetuin-A levels may serve as protective factors against kidney stones and could potentially be used as predictive markers for the development of nephrolithiasis. Furthermore, our results suggest that the CDAI above a certain level may increase the risk of stone formation and that some dietary parameters may affect the levels of this biomarker in serum and urine.

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• MakaleAçık Erişim2024/r/gumushane/16303
  The Association Between Glycemic Variability and Mortality in Critically Ill Patients: A Multicenter Prospective Observational Study

  Emgin, Omer; Yavuz, Mehmet; Sahin, Adem; Günes, Murat; Eser, Mustafa; Yavuz, Tunzala; Kökalan, Damla; Ergün, Bisar; Rollas, Kazim; Çakirgöz, Mensure Yilmaz

  Background: Glycemic variability (GV) is a prevalent and significant condition observed in critically ill patients. This study aimed to investigate the relationship between early glycemic variability parameters and 28-day mortality in critically ill patients. Methods: A multicenter, prospective, and observational study was performed at five tertiary intensive care units (ICUs) in Turkey. All patients who had more than six blood glucose level (BGL) measures per 24 h were included. The parameters of GV including the SD, MGL, MGD (the difference between the maximal and minimal glucose level), and the CV (the percentage of SD to the MGL) in the first 24 h were recorded. Results: A total of 578 eligible patients were enrolled in the study, of whom 43.6% were women. The mean age of the patients was 68.09 +/- 16.62 years. Overall mortality was 31.5% (n = 182). The glycemic parameters of the CV, SD, and MGD were significantly higher in the non-survivor group than in the survivor group (p = 0.040, 0.006, and 0.002, respectively). The multivariate logistic regression analysis revealed that the CV (OR 1.023; 95% CI 1.004-1.042; p = 0.017) was an independent factor that increased mortality. Spearman's rho correlation analysis revealed a strong (r:0.871) and statistically significant correlation (p < 0.001) between the CV and MGD. Conclusions: The CV calculated within the first 24 h of ICU admission is independently associated with 28-day mortality. The MGD is correlated with the CV and is maybe a practical tool to predict increased risk of mortality at the bedside. However, further studies are needed to establish the independent association of the MGD with mortality.

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