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Objective. Interleukin-35 (IL-35), an interleukin-12 (IL-12) cytokine family member, is shown to be a potent immunosuppressive and anti-inflammatory cytokine. Inducible regulatory T cells (Tregs) produce IL-35 that mediates the immune inhibitory function of Tregs. Growing evidence revealed that upregulation of IL-35 expression may play a critical role in the prevention of autoimmune diseases in various experimental autoimmunity models and vice versa. Hashimoto’s thyroiditis (HT) is considered to be a Treg cell-related autoimmune disease with loss of self-tolerance. Methods. One hundred-twenty eight subjects, newly diagnosed hypothyroid HT patients [56 overt (Group 1), 72 subclinical hypothyroid (Group 2)] and 38 healthy controls (Group 3) were enrolled in the study. The levels of serum IL-35 were determined by enzyme-linked immunosorbent assay (ELISA). Results. Serum IL-35 levels were lower in the HT group when compared with subclinical HT group [304.5 (834.6) pg/ml vs. 636.1 (1542.0) pg/ml, p=0.004] and control cases [304.5 (834.6) pg/ml vs. 1064.7 (2526.8) pg/ml, p<0.001]. Serum IL-35 levels were inversely associated with thyroid stimulating hormone (TSH; rs=-0.396, p<0.001) and anti-thyroid peroxidase antibodies (TPOAb; rs=-0.571, p<0.001) in whole group. Serum IL-35 were negatively associated with TSH (rs=-0.264, p=0.003) and TPOAb (rs=-0.735, p<0.001) in patients with Hashimoto’s thyroiditis (Group 1 + Group 2). Conclusion. The results suggest that IL-35 may play a role in the pathogenesis of HT.

Both practitioners and academics often frown on pragmatic and opportunistic reuse. Large organizations report that structured reuse methods and software product lines are often the way to go when it comes to efficient software reuse. However, opportunistic that is, nonstructured reuse has proven profitable for small to medium-sized organizations. Here, we describe two start-ups that have opportunistically and pragmatically developed their products, reusing functionality from others that they could never have built independently. We demonstrate that opportunistic and pragmatic reuse is necessary to rapidly develop innovative software products. We define pragmatic reuse as extending software with functionality from a third-party software supplier that was found without a formal search-and-procurement process and might not have been built with reuse in mind. We define opportunistic reuse as extending software with functionality from a third-party software supplier that wasn't originally intended to be integrated and reused.

Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department. Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient’s clinical course was complicated by a stroke. The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisciplinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway interventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome management in the emergency department.

Background: The excessive accumulation of fat tissue in obesity is the source of chronic low-level inflammation and causes future dysmetabolic and cardiovascular disorders. Removal of this excessive fat tissue with the aid of bariatric surgery (BS) techniques, such as sleeve gastrectomy, may reverse adverse inflammatory outcomes. The aim of this study is to investigate the impact of sleeve gastrectomy on inflammatory markers, specifically endocan, IL-6, and CRP, in individuals with obesity. Methods: Thirty-two patients with class 3 obesity and class 2 obesity + comorbidities were enrolled in the study. Clinical characteristics including age, comorbidity, body mass index (BMI), waist, and hip circumferences of the participants were noted before and 3 months after sleeve gastrectomy. Blood samples were collected during those periods to assess biochemical features such as serum endocan, interleukin-6 (IL-6), C-reactive peptide, fasting insulin, glycosylated hemoglobin A1c levels, and lipid panel. A statistical package program was used for the analysis of those parameters, and p<0.05 was accepted as significant at a 95.0% confidence interval. Results: BMI reduced from 43.55[+ or -]6.78 to 36.16[+ or -]6.14 kg/m2 within 3 months following BS (p<0.001). Preoperative serum endocan, IL-6, and CRP levels were correlated with BMI, and in line with BMI reduction, their serum levels decreased after BS (p<0.05). HOMA-IR also reduced after BS, and both in the pre and post-BS periods correlated with BMI, IL-6, endocan, and CRP levels (p<0.05). The mean total body weight loss was 20.4% within 3 months post-BS. Conclusion: BS techniques are effective in weight loss and reversing the inflammatory processes caused by obesity. Serum endocan, IL-6, and CRP levels are promising markers for describing obesity-related inflammation and objectively checking the alleviation of inflammation following BS. Keywords: bariatric surgery, endocan, interleukin-6, sleeve gastrectomy, weight loss

Introduction: Patients in intensive care units (ICU) are 5-7 times more susceptible to infection than other groups, which increases the prevalence of hospital-acquired infections and associated sepsis accounting for 60% of deaths. Gram-negative bacteria are the most common source of urinary tract infections that cause morbidity, mortality, and sepsis in the ICU. The aim of this study is to detect the most commonly grown microorganisms and antibiotic resistance in urine cultures in the intensive care units of our tertiary city hospital, which has more than 20% of the ICU beds in Bursa By this way, we suppose that we will contribute to surveillance studies in our province, our country. Methodology: Patients who were admitted to Bursa City Hospital adult ICU for various reasons between 15.07.2019 and 31.01.2021 and had growth in urine cultures were retrospectively screened. The urine culture result, growing microorganism, antibiotic used, and resistance status were recorded and analyzes were performed according to hospital data. Results: Gram-negative growth was observed in 85.6% (n = 7707), gram-positive growth in 11.6% (n = 1045), and candida fungus growth in 2.8% (n = 249). Resistance to at least one antibiotic in urine cultures was observed for Acinetobacter (71.8), Klebsiella (51%), Proteus (47.95%), Pseudomonas (33%), E. coli (31%) and Enterococci (26.75%), respectively. Discussion: Developing a health system leads to longer life expectancy, longer intensive care treatment, and more frequent interventional procedures. In terms of being a resource for empirical treatments, early initiation of empirical treatments to control the urinary tract infection disrupts the patient's hemodynamics and increases mortality and morbidity.

Background: Nutrition status prior to conception and during pregnancy and infancy seems to have an influence on the disease risk in adulthood (early nutrition/developmental programming). We aimed to review the current knowledge on the role of micronutrients in early nutrition programming and its implications for healthcare. Summary of Findings: Globally and even in high-income countries where a balanced diet is generally accessible, an inadequate maternal micronutrient status is common. This may induce health problems in the mother and foetus/newborn both immediately and in later life. Pregnant women and those who may become pregnant should aim to achieve a satisfactory micronutrient status from a well-balanced diet, and where necessary from additional supplements. Key Messages: We emphasise the need for a call to action for healthcare providers and policymakers to better educate women of child-bearing age regarding the short- and long-term benefits of an appropriate micronutrient status. The role of micronutrient status in early nutrition programming needs to be emphasized more to address the still limited awareness of the potential long-term health repercussions of suboptimal micronutrient supply during pregnancy.

Introduction Iron deficiency anemia (IDA) is a common health problem. The hepcidin hormone is the main regulator of systemic iron balance. The body responds to IDA by decreasing hepcidin. This study investigated how different iron supplementation regimens affect hepcidin levels in women with IDA. 87 female participants aged 18–45 years with hemoglobin < 10 g/dL and serum ferritin < 20 ng/ml were assigned to receive iron therapy every other day, once daily, or twice daily. Hemogram, serum iron, serum iron binding capacity, ferritin, hepcidin, and C-reactive protein values were measured at baseline and on the 15th and 90th days of treatment in all groups. On the seventh day, no significant difference was found between the once-daily and twice-daily groups ( p  = 0.42) in reticulocyte counts. By the 15th day, hemoglobin and MCV levels showed significant improvement in the twice-daily group compared to the other groups ( p  < 0.01). At the third month, ferritin levels were significantly higher in the twice-daily group compared to the every-other-day and once-daily groups ( p  = 0.03). No significant differences were observed in hepcidin levels at three months across all groups. The study concludes that twice-daily iron supplementation results in the most significant hematological improvements but with increased gastrointestinal side effects. These findings underscore the importance of tailoring iron dosing schedules to individual patient needs. In cases where rapid haemoglobin response is required, twice-daily dosing may provide superior results. Conversely, once-daily dosing may be preferred if tolerable anemia can be maintained. Every other day dosing, although associated with fewer side effects and better tolerability, may not provide adequate support for erythropoiesis.

Objective This study aimed to investigate the effect of progressive muscle relaxation exercises on the ability to cope with stress and anxiety level in caregivers of palliative care patients. Design The study was conducted as a single‐blind study with pretest–posttest randomised control group. Method The study was conducted between May 11 and July 22, 2021. The caregivers in the experimental group were asked to perform a total of 28 sessions of progressive muscle relaxation exercise for 30 min a day for 4 weeks. No interventions were made in the control group during the study. Data were collected using the ‘Caregiver Information Form,’ ‘State‐Trait Anxiety Inventory (STAI)’ and ‘Stress Coping Styles Scale (SCSS).’ Number and percentage, mean, standard deviation, Chi‐Square Test, independent groups t‐test, dependent groups t‐test, Mann–Whitney U Test, Wilcoxon Signed Rank Test and simple linear regression analysis were used to summarise the data obtained from the study. Results A total of 66 caregiver patient relatives, 33 in the experimental group and 33 in the control group, were included in the study. When the posttest mean scores of caregivers in the experimental and control groups were compared, it was found that the experimental group's STAI and negative SCSS subscale mean scores decreased compared to the control group's mean scores, while the positive SCSS subscale mean scores increased, and the difference was statistically significant (p < 0.05). It was found that the variable of progressive muscle relaxation exercise had a negative effect on anxiety (β = −0.962), helpless approach (β = −0.535) and submissive approach (β = −0.643), while it had a positive and significant effect on seeking social support (β = 0.765), self‐confident approach (β = 0.832) and optimistic approach (β = 0.493) (p < 0.001). Conclusion It was found that after progressive muscle relaxation exercises, the anxiety of caregivers of palliative care patients decreased, the use of positive stress coping methods increased and the use of negative stress coping techniques decreased. Patient or Public Contribution It is not necessary. Trial Registration ClinicalTrials.gov identifier: NCT04880941

Background and Objectives: This study focused on the impact of mental fatigue induced by motor imagery on upper limb function, an area with limited research compared to lower limb performance. It aimed to explore how diaphragmatic breathing exercises influence these effects. Materials and Methods: This study included 30 participants, and Group 1 participated in 12 sessions of diaphragmatic breathing exercises under the supervision of a physiotherapist; Group 2 did not receive any intervention. For all the participants, mental fatigue was induced with motor imagery before and after the intervention, and evaluations were performed before and after mental fatigue. Upper extremity functions were evaluated using isometric elbow flexion strength, hand grip strength, upper extremity reaction time and endurance, finger reaction time, the nine-hole peg test, shoulder position sense, light touch-pressure threshold, and two-point discrimination. Results: The study results showed that after mental fatigue, there was a decrease in isometric elbow flexion strength, nondominant hand grip strength, and nondominant upper extremity endurance, and an increase in nondominant tactile sensation (p < 0.05). No changes were found in two-point discrimination, nine-hole peg test time, and position sense on either side (p > 0.05). The effect of mental fatigue on isometric elbow flexion strength and nondominant grip strength showed significant improvement following diaphragmatic breathing exercises (p < 0.05). Conclusions: This study found that mental fatigue from motor imagery can impact elbow flexion, hand grip strength, upper extremity endurance, and tactile sensitivity. Breathing exercises may help improve strength parameters affected by mental fatigue. It is crucial to consider these effects on upper extremity functions in rehabilitation programs.