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Background and Objectives: Fibrosis stage is the key histopathological determinant of liver-related outcomes in metabolic dysfunction-associated steatohepatitis (MASH); however, a reliable noninvasive method for predicting fibrosis stage remains an unmet need. This study aimed to develop an accurate, practical, and noninvasive tool for identifying “at-risk MASH patients”. Materials and Methods: Fifty-six patients with biopsy-confirmed MASH were prospectively enrolled and categorized into fibrosis stages using the NASH-CRN system. In addition to anthropometric and biochemical parameters, seven serum fibrosis biomarkers were evaluated across fibrosis stages. Binary logistic regression analysis was used to construct a scoring model for predicting ≥F2 fibrosis. The diagnostic performance of the proposed model was compared with established noninvasive tests (NITs) and magnetic resonance elastography (MRE) for detecting both ≥F2 and ≥F3 fibrosis. Results: The total metabolic syndrome score was the only variable that significantly distinguished between F1 and F2 stages (p = 0.039). Among the biomarkers, matrix metalloproteinase-1 (MMP-1) showed a significant difference across fibrosis groups (p = 0.009). The AST/ALT ratio was the most robust predictor for differentiating ≥F3 (p < 0.001). A scoring model integrating the total metabolic syndrome score, MMP-1, and AST/ALT ratio demonstrated superior diagnostic accuracy for identifying ≥F2 (AUROC 0.88, 95% CI 0.79–0.97) compared to other NITs and MRE, and strong performance for detecting ≥F3 (AUROC 0.95, 95% CI 0.90–1.00). Conclusions: Total metabolic syndrome score and MMP-1 are promising candidates for future approaches. Combining total metabolic syndrome score, MMP-1, and AST/ALT ratio might detect ≥F2 in MASH with higher diagnostic accuracy than other NITs and MRE.

Cirrhosis has been reported as an important risk factor for death in coronavirus disease 2019 (COVID-19) disease. In this study, we aimed to investigate the effects of COVID-19 on the natural course of cirrhosis before and after starting vaccination. The cirrhosis patients in our cohort ( : 140; median age:56; 71 female) were included in this study. The median MELD (Model For End-stage Liver Disease) score was 11 (6-25) and CCI (Charlson Comorbidity Index) score was 4 (1-11). In total, 85 had CTP (Child-Turcotte-Pugh)-A, 44 had CTP-B and 11 had CTP-C cirrhosis. The course of COVID-19 in this patient group was evaluated before and after COVID-19 vaccination. Between March 2020 and January 2021, 36 of the 140 cirrhosis patients had developed COVID-19. Cirrhosis (+)/COVID-19 (+) and Cirrhosis (+)/COVID-19 (-) groups did not differ in terms of age, CCI and MELD-Na scores, or gender. There were six deaths in the Cirrhosis (+)/COVID-19 (+) group and five in the Cirrhosis (+)/COVID-19 (-) group [6/36 (16.6%) vs. 5/104 (4.8%); : 0.03]. Patients who died were older, had higher CCI and MELD-Na scores, and lower albumin levels. Having had COVID-19 [6.45 (1.43-29.4); : 0.015], higher MELD-Na score [1.35 (1.18-1.60); : 0.001] and higher CCI score [1.65 (1.14-2.39); : 0.008] were found to be independent predictors of mortality. After effective vaccination started in Turkey, only 11 of the remaining 129 patients developed COVID-19, and only one patient died, who was unvaccinated. In our cirrhotic cohort, COVID-19 disease was associated with 16% mortality in the pre-vaccination period. COVID-19 vaccination prevents serious illness and death due to COVID-19 in cirrhotic patients.

Objective: To compare diffusion tensor imaging (DTI) findings of the normal-appearing white matter (NAWM) and corpus callosum (CC) in patients with clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) and a healthy control (HC) group.Materials and Methods: The CIS (n = 10), RRMS (n = 29), and HC (n = 13) groups were evaluated by DTI in this retrospective study. Mean diffusion (MD) and fractional anisotropy (FA) maps as well as MD and FA measurements were made from the corpus callosum genu (CCG), corpus callosum splenium (CCS), and NAWM areas from the frontal, parietal, occipital and temporal lobes.Results: The mean FA values of the NAWM in the temporal lobes were bilaterally lower in both the CIS and RRMS groups than in the HC group. However, no difference was found between the CIS and RRMS groups. In addition, the CIS group had lower FA values in the CCG, whereas the RRMS group had lower FA values in the CCS compared with the HC group. The MD values were significantly different in the CCG between the RRMS and HC groups.Conclusion: DTI contributes to detecting early changes in the NAWM and CC in patients diagnosed with CIS and RRMS. Additionally, DTI can aid in the follow-up care and management of these patients.

Numerous ground-based observatories are using small sized ground telescopes for scientific research purposes. The telescopes that are available on the market have three main problems. These issues can be listed as: positioning repeatability, tuning requirement according to different wind speeds for different seasons, and the mass changing via different scientific equipments added to the telescope. This study is aimed at resolving these issues for ground based small alt-azimuth telescopes. Establishing of a set and forget system is performed by designing an adaptive controller. Motor dynamics are taken into consideration for a realistic mathematical model. The Wind-Gust model that consists of a sum of sinusoidal disturbances with unknown phase, amplitude and frequency is used for the wind model. The purposed controller cancels the disturbance effects on the plant while operational positioning and also the makes the plant insensitive to mass changes. The Lyapunov approach is utilised when proving the asymptotic stability. The proposed controller’s success is illustrated with thorough numerical evaluation.

This study aimed to determine the effectiveness of adding a simple questionnaire related to musculoskeletal system to routine outpatient examination to detect undiagnosed axial and peripheral arthropathy in patients with inflammatory bowel disease (IBD). A musculoskeletal symptom questionnaire was given to all patients with IBD during their follow-up examinations between January 2020 and November 2021. The DETAIL questionnaire consisting of six questions about the musculoskeletal system was administered by asking the patients with IBD. All patients who answered yes to at least one of these questions were directed to specialists in the rheumatology department to undergo a detailed examination. The patients who were diagnosed with rheumatological disease after further investigation were recorded. Patients with a known diagnosis of rheumatological disease were excluded from the study. There were 333 patients with IBD included in the study. Of these patients, 41 (12.3%) had a previously diagnosed rheumatological disease and were excluded from the evaluation. Of the remaining 292 patients (147 with ulcerative colitis, 139 with Crohn's disease and six with indeterminate colitis; mean age 42 years), 67 (23%) answered yes to at least one of the questions and were referred to a rheumatology consultation. Rheumatological examination was completed in 52 patients. As a result of the evaluations, 24 patients (8.2%) were diagnosed with enteropathic arthritis (14 axial, 9 peripheral, and 1 axial plus peripheral). Patients with newly diagnosed enteropathy had a lower median disease age than patients without enteropathy. The DETAIL questionnaire is an effective and easy tool for identifying missed cases of SpA in patients with IBD.

Aim In this study, it was aimed to explore the prognostic factors in patients who received selective internal radiation therapy for hepatocellular cancer. Materials and methods A retrospective evaluation was made of 28 (24 male, 4 female, mean age 65.4 ± 6.8 years) hepatocellular cancer patients who received selective internal radiation therapy with Y-90 resin microspheres. Using Cox proportional hazards regression analysis, the relationship between age, gender, MELD score, serum albumin and AFP levels, number of liver lesions, size of the largest lesion, absence of 18 F-FDG uptake, maximum standardized uptake value and overall survival times was analyzed. Results Treatment was applied to the right lobe in 22 and both in 6 patients. Mean treatment dose was 1.5 ± 0.2 GBq. Number of liver lesions were 1, <5 and multiple in 16, 5 and 7 patients, respectively, and the mean size of the largest lesion was 41.5 mm (min–max 15–160 mm). While 18 F-FDG uptake was seen in 24 patients, liver lesions were hypometabolic in 4 patients. Mean SUV max of liver lesions was calculated as 5.3 ± 0.3. During the mean 17.8 (min–max 2–39) months follow-up period, 19 patients died. Median survival time was computed as 18 ± 5 months (95 % CI 8.1–27.8). Age ( p  = 0.04), serum AFP level ( p  = 0.03) and size of the largest lesion ( p  = 0.02) had a significant negative effect on survival according to the Cox proportional hazards regression analysis. Conclusion Age, serum AFP level and the size of the largest liver lesion have a negative significant effect on survival of hepatocellular cancer patients who received selective internal radiation therapy.

The development of additive manufacturing (AM) technologies has significantly advanced fabrication capabilities, yet achieving optimal surface quality and mechanical properties in end-use products is challenging. The primary objective of this study is to improve specific characteristics of 3D-printed components by employing a chemical post-processing technique including acetone. This technique is specifically applied to acrylonitrile butadiene styrene (ABS) material, utilizing a customized mechanical cold-vapor system. A complete investigation was undertaken to assess the effects of treatment on many factors, such as temperature, solvent volume, and exposure duration, on the tensile strength, physical dimensions, and mass of the ABS samples. Acetone post-processing has notably improved tensile strength, influenced by treatment duration and temperature and has led to dimensional changes such as a slight length reduction and increases in width and thickness. Furthermore, the mass of the samples exhibited variability upon acetone treatment, which was shown to be dependent on both the ambient temperature and the duration of solvent exposure. The tensile strength was assessed under various conditions, showing a significant enhancement at higher temperatures and longer exposure times. These results, demonstrating smoother surfaces and a tensile strength increase of up to 20% at 65 °C, underscore the efficacy of our techniques in modifying the mechanical and physical properties of 3D-printed ABS components. This innovative approach provides valuable insights into the relationship between post-processing conditions and ABS properties, enriching the body of knowledge in AM technology.

Objective: This study aimed to examine the demographic characteristics and working conditions of neurology specialists working in Türkiye and to determine the factors that play a role in neurologists’ resignations.Materials and Methods: This study was designed as a multiple-choice survey. The study included 472 neurology specialists who were actively practicing in clinics. The data collected through the questionnaire were analyzed.Results: Most (78.2%) of neurologist work in public hospitals, while 15.7% work in private hospitals, 3.6% work in foundation hospitals, and 2.5% work in private practices. 70.1% of the participants examine 41 or more patients per day. 37.7% of neurologists take on-call duty for ten or more days per month. 93.8% think their payment is not at a deserved level. 70% of the participants (n = 328) reported experiencing verbal violence. The rate of those who reported being exposed to mobbing is 62.5% (n = 295). 56% of the participants (n = 264) frequently feel burned out or depressed. Only 10% of them are satisfied with their working conditions. We used Logistic regression analysis to investigate factors for resigning. Accordingly, exposure to verbal or physical violence (P = 0.033), working in a particular institution (P = 0.038), and the number of emergency shifts affect the likelihood of resignation (P = 0.046). The probability of resigning for lecturers is significantly lower (OR: 0.05). The likelihood of resigning for those who report earning less than what they deserve is about 16 times higher than those who feel they are adequately paid.Conclusion: The workload of neurology specialists is high. Neurologists have a high rate of exposure to violence and low job satisfaction. The workload of physicians varies significantly across different units and regions and is unequally distributed. To increase job satisfaction among healthcare workers and prevent physician migration, there is a need to improve working conditions, distribute workload and resources more equally among units.

Hepatitis D is the most severe form of chronic viral hepatitis. Treatment guidelines recommend 1 year of peginterferon alfa, which is effective in 25–30% of patients only. Whether prolonged therapy with peginterferon alfa-2a for 96 weeks and combination therapy with tenofovir disoproxil fumarate (TDF) would increase hepatitis D virus (HDV) RNA suppression is unknown. We aimed to explore whether prolonged treatment of HDV with 96 weeks of peginterferon would increase HDV RNA response rates and reduces post-treatment relapses. We did two parallel, investigator-initiated, multicentre, double-blind randomised, controlled trials at 14 study sites in Germany, Greece, Romania, and Turkey. Patients with chronic HDV infection and compensated liver disease who were aged 18 years or older were eligible for inclusion. All patients were HBsAg positive for at least 7 months, anti-HDV positive for at least 3 months, and HDV-RNA positive at the local laboratory at the screening visit. Patients were ineligible if alanine aminotransferase levels were higher than ten times above the upper limit of normal and if platelet counts were lower than 90 000 per μL, or if they had received interferon therapy or treatment with a nucleoside and nucleotide analogue within the preceding 6 months. Patients were randomly assigned by blinded stratified block randomisation (1:1) to receive 180 μg of peginterferon alfa-2a weekly plus either TDF (300 mg once daily) or placebo for 96 weeks. The primary endpoint was the percentage of patients with undetectable HDV RNA at the end of treatment assessed by intention to treat. The trials are registered as NCT00932971 and NCT01088659. Between June 24, 2009, and Feb 28, 2011, we randomly assigned 59 HDV RNA-positive patients to receive peginterferon alfa-2a plus TDF and 61 to receive peginterferon alfa-2a plus placebo, including 48 (40%) patients with cirrhosis to the two treatment groups (23 in the peginterferon alfa-2a plus TDF group and 25 in the peginterferon alfa-2a plus placebo group). The primary endpoint was achieved in 28 (48%) of 59 patients in the peginterferon alfa-2a plus TDF group and in 20 (33%) of 61 patients in the peginterferon alfa-2a plus placebo group (odds ratio 1·84, 95% CI 0·86–3·91, p=0·12). We recorded 944 adverse events (459 in the peginterferon alfa-2a plus TDF group and 485 in the peginterferon alfa-2a plus placebo group). The most common adverse events were haematological, behavioural (eg, fatigue), musculoskeletal, influenza-like syndromes, and psychiatric complaints. Addition of TDF resulted in no significant improvement in HDV RNA response rates at the end of treatment. These findings highlight that alternative treatment options are needed for hepatitis D. The HepNet Study-House (a project of the German Liver Foundation founded by the German Liver Foundation, the German Ministry for Education and Research, and the German Center for Infectious Disease Research), Hoffmann-La Roche, and Gilead Sciences.