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PurposeThis study aimed to examine the diagnostic value of IL-6, thiol–disulfide homeostasis, complete blood count and inflammatory biomarkers in the prediction of acute appendicitis in children.MethodsThe study was designed as a prospective and controlled study in children—the study was conducted at a tertiary referential university hospital between May 2020 and April 2021. Patients were divided between study groups and one control group (CG): 1: confirmed acute appendicitis group (AAP); 2: perforated appendicitis group (PAP); and 3: non-specified abdominal pain (NAP). The age and gender of the patients were determined. The following listed laboratory parameters were compared between groups: TOS: total oxidative status, TAS: total antioxidant status, OSI: oxidative stress index, TT: total thiol, NT (µmol/L): native thiol, DIS: disulfide, IL-6: interleukin 6, TNF-a: tumor necrosis factor-alpha, WBC: white blood cell, NEU: neutrophil, NEU%: neutrophil percentage, LY: lymphocyte, LY%: lymphocyte percentage, PLT: platelet, MPV: mean platelet volume NLR: neutrophil lymphocyte ratio, CRP: C-reactive protein, LCR: lymphocyte CRP ratio, and serum lactate.ResultsThe TOS level of the PAP group was found to be significantly higher than that in the AAP, NAP and control groups (p = 0.006, < 0.001 and p < 0.001). TAS, TT, and NT levels in the PAP group were significantly lower than those in the AAP, NAP and control groups. OSI was significantly higher in the PAP group than in the other groups. The TT and NT levels of the NAP group were both similar to those of the control group. Serum DIS level was similar between the AAP and PAP groups, AAP and NAP groups, and NAP and control groups. Serum IL-6 and TNF-α levels were found to be significantly higher in the PAP group compared to those in all groups. The WBC, NEU, and NEU% values were found to be significantly higher in the PAP group than those in the NAP and control groups, while LY and LY% values were found to be significantly lower. PAP and AAP groups were found to be similar in terms of WBC, NEU, LYM, NEU%, and LYM% values. PLT and MPV values and serum lactate values did not show a significant difference between the groups. NLR was similar in the AAP and PAP groups. A significant increase in CRP versus a decrease in LCR was detected in the PAP group compared to that in the AAP group. Multivariate analysis demonstrated that only IL-6 has significant estimated accuracy rates as 80% for the control group, 78.8% for AAP, 96.9% for PAP, and 81.6% for NAP.ConclusionRather than AAP, PAP caused significantly higher oxidative stress (increased TOS and OSI), and lower antioxidation capacity (decreased TT and NT). IL-6 levels can provide a significant stratification. Nevertheless, simply detecting WBC or CRP is not enough to distinguish the specific pathology in acute appendicitis and related conditions.

Introduction/BackgroundThe aim of the study was to evaluate site of splenic metastases and ıts affect on survival in advanced stage epithelial ovarian cancer.MethodologyThis retrospective study was done in Baskent University School of Medicine, Ankara, Turkey. We evaluated 182 patients who underwent splenectomy as a part of primary cytoreductive surgery between 2008–2018 Besides we invastegated 2,3 and 5 year overall survival rates.ResultsMedian age was 61 years (27–81),Median lenght of stay was 13 days (4–87 days). 40 (21,7%) patients had paranchimal and 144 (78,3%) had non paranchimal (Hilar or capsular) metastases,Median overal survival was 27 months and 31 months respectively(p=0,6).ConclusionSplenectomy in primary cytoreductive surgery is an effective intervention to achive R0 resection in advanced stage EOC However site of splenic metastases has no impact on short term and long term overall survival.DisclosureNothing to disclose.Abstract EP773 Table 1Median Overall Survival rates According to site of Splenic Metastases Site of Metastases Number Median Overall Survival (Months) 2 year OS 3 Year OS 5 year OS p value Paranhimal 40 27 62% 41% 23,5% 0,6 Non-Paranchimal 142 31 60% 44% 26%

Introduction/BackgroundRadical hysterectomy plus pelvic +- paraaortic lymhadenectomy is the first choice of treatment in early stage cervical cancer and adjuvant treatment is determined according to risk factors.High risk patients (positive surgical margine, positive parametrial invasion, lyph node invoılvement) recieve adjuvant chemoradiotherapy without a doubt.However adjuvant treatment in patients with intermadiate risk factors (tm size ≥4 cm,positive LVSİ and with deep stromal invasion) remains controversial. ESGO, ESTRO and ESP recomend adjuvant radiotheraphy to patients with these risk factors and also offer observation as an option especialy with an experienced team.MethodologyThis retrospective cohort study was carried out in Baskent University School of medicine Ankara, Turkey. All patietns underwent radical hysterectomy plus pelvic ±paraaortic lymhadenectomy, casese were included with negative lyph node, negative parametrial invasion and negative surgical margine. Patients with positive LVSİ and Deep stromal İnvasion or LVSİ and tm size ≥4 cm or DSİ and tm size ≥4 cm or only tm size ≥4 cm with minimum 24 months of follow up time were enrolled.Results The median age of patients were 50,4 years (23–80 y). 66 patients were treated only with surgery and 68 with adjuvant radiotheraphy after surgery. Total recurrence rates were 16,6% vs 23,5% respectively p=0,9. Besides each group had similar local recurrence rates.Five year DFS were 80,2% vs 78,2% in no adjuvant treatment and radiotheraphy group respectivelly p=0,25.Fİve year OS were 86% and 88% p=0,57. Having tumor size ≥4 cm was found to the only independent factor for recurrence HR 2,426 (1,123–5,239 with 95,0 Cİ).ConclusionNo further treatment after radical surgery for early stage cervical carcinoma with intermediate risk factors is a good option with same oncologic outcomes.DisclosureNothing to disclose.

Hereditary spastic paraplegias (HSPs) are a heterogenous group of rare neurodegenerative disorders that present with lower limb spasticity. It is known as complicated HSP if spasticity is accompanied by additional features such as cognitive impairment, cerebellar syndrome, thin corpus callosum, or neuropathy. Most HSP families show autosomal dominant (AD) inheritance. On the other hand, autosomal recessive (AR) cases are also common because of the high frequency of consanguineous marriages in our country. This study aimed to investigate the clinical and genetic aetiology in a group of HSP patients. We studied 21 patients from 17 families. Six of them presented with recessive inheritance. All index patients were screened for ATL1 and SPAST gene mutations to determine the prevalence of the most frequent types of HSP in our cohort. Whole exome sequencing was performed for an AD-HSP family, in combination with homozygosity mapping for five selected AR-HSP families. Two novel causative variants were identified in PLP1 and SPG11 genes, respectively. Distribution of HSP mutations in our AD patients was found to be similar to European populations. Our genetic studies confirmed that clinical analysis can be misleading when defining HSP subtypes. Genetic testing is an important tool for diagnosis and genetic counselling. However, in the majority of AR HSP cases, a genetic diagnosis is not possible.

Objective The value of genetic sonogram is controversial in low-risk population. The aim of our study was to compare the anxiety levels among women with high risk and low risk for fetal chromosomal/structural defects. Materials and methods A total of 115 consecutive pregnant women were included. The anxiety levels were assessed by the use of Turkish version of the standardized state-trait-anxiety-inventory. Before and after genetic sonogram, state and trait-anxiety was measured. Results The mean state anxiety score before genetic sonogram was statistically, significantly higher than the mean score after the examination. Before genetic sonogram, the mean state-anxiety score of the women with high risk for fetal chromosomal/structural defects was significantly higher than the mean score of women with low risk. Following genetic sonogram, although the anxiety scores decreased, the scores of women with high risk still remained significantly higher than the scores of women with low risk and the anxiety scores significantly further increased among women with a positive minor or major ultrasound finding. Conclusion Genetic sonogram presents an anxiety-inducing situation for the parents-to-be. The level of experienced anxiety was found to be proportional to the level of the perceived risk. Women with low risk for chromosomal/structural defects experienced lower anxiety than women with high risk. Following the examination, women with a negative result were found to have a significant reduction of anxiety and emotional relief whereas a positive test result led to a further increase in anxiety scores.

Çağdaş toplumda insanlar çeşitli ekonomik, sosyolojik· ve toplumsal zorluklar nedeniyle yüzyüze konuşma, iletişim kurma olanaklanndan giderek uzaklaşmaktadır. Tüketirnin her geçen gün artması, serbest piyasa ekonomisinin yaygınlaşması ile özellikle lüks tüketim maddeleri başta olmak üzere, pek çok üründe çeşitliliğe gidilmiştir. Bunun sonucu olarak da, gerek hizmet gerekse mal üreten işletmeler arasında kıyasıya bir rekabet oluşmuştur. Bu rekabet ortamı içinde, başta saydığımız nedenlerle yüzyüze iletişim kunna imkanı neredeyse olanıksız hale gelen üreticiler, hedef tüketici kitlelerine ürettikleri mal ve hizmetleri tanıtabilmek, onları kendi ürettikleri mal ve hizmetleri tercih etmeleri için ikna edebilmek amacıyla reklama başvurma yoluna gitmişlerdir. Bu çabalarında, gelişen teknoloji ve kitle iletişim araçları en büyük yardımcılan haline gelmiştir. Diğer bir anlatımla, modem kitle toplumu ve onun getirdiği bazı zorluklar ve zorunluluklar reklamın ve reklamcılığın oluşması, daha doğrusu gelişmesi için itici bir güç oluştunnuştur. Gelişen teknolojik ve ekonomik olanaklar, üretilen mal ve hizmetlerin pratikte birbirlerinden pek de farklı olmamasına, zaman zaman tamamen aynı özemikleri taşımalarına, zaman zaman ise çok ufak farklılıklar göstennelerine yol açmıştır. Bu da, mal ve hizmetlerin tanıtımı yapılırken hayali farklılıklann bulunup, bunların ön plana çıkanlmasına neden olmuştur. Bu hayali farlılılciann bulunup ön plana çıkarılması tek başına yeterli olmamış, bunlar hedef kitleye sunulurken insanlann bilinçaltına yerleşmiş bazı duygulanndan, beklentilerinden, özlemlerinden, çelişkllerinden, korkularından, kıskançlıklarından, kısacası sosyolojik ve psikolojik yapılarından yararlanılmıştır. Böylece bilinçaltına yerleşmiş olan bu duyguıar, insanların kendilerinin bile farkında olmadığı alışkanlıklar, değeıyargıları, hatta önyargıları, sunulan mal ve hizmetin hedef kitleye kabul ettirilmesinde en büyük yardımcı haline gelmişlerdir. Önceleri, bir mal veya hizmetin pıyasaya sürülmesi ve tanıtılması aşamalarında, reklam öncesi yapılan piyasa araştınnaları, tek başına yeterli gibi geliyordu. Ancak değişen ve gelişen toplum yapısı ve modern kitle toplumu üzerine yapılan incelemeler, günümüz insanının neyi neden istediğini çoğu zaman bilmediğini, özellikle alış veriş sırasında, bilinçaltındaki dürtüleri ile hareket ettiğini göstermiştir. İnsaıı1arın ifade ettikleri ile, gerçek düşüncelerinin ve yaptıklarının çoğu zaman birbirini tutmadığı, bunun nedeninin de bilinçaltındaki korkuları ve istekleri olduğu anlaşılmıştır. Sonuçta psikologlar, sosyologlar, araştırmacılar bu konuda geniş araştınnalar yapmaya başlamışlar, bilinçaltında gizli kalmış duygu, düşünce ve dürtüleri tesbit edebilmek amacıyla çeşitli analiz çalışmalannda bulunmuşlandır. Elde ettikleri sonuçlara göre, hedef kitlelerinin ekonomik, demografik, sosyolojik, psikolojik yapıları hakkında elde edilen bilgiler doğrultusunda hareket eden reklamcılar, özellikle son yıllarda, bu yönde çalışmalar sonucu oluşturulan reklamlarda çokça kullanılan göstergebilimin de yard11l11yla, başarılı kampanyalara imzalannı atmışlardır. Bu şekilde gerçekleştirilen reklamlar, bu tezin konusunu oluşturan \"bilinçaltına hitap edici reklamlar\" kapsamında ele alınmıştır. Buraya kadar yaptığımız açıklamalardan da anlaşılabileceği gibi tezin ana konusu \"Bilinçaltına Hitap Edici Reklamların Tüketici Davranışı Üzerine Etkisi\" dir. Burada bilinçaltı reklamdan söz ederken, J.A.C. Brown'ın 1994 basımı \"Beyin Yıkama\" adlı kitabının 156. sayfasında bahsedilen reklamdan biraz değişik bir tür ifade edimektedir. Jim Vicaıy isminde Amerikalı bir pazarlama uzmanının buluşu olan bilinçaltını hedef alan reklamda, bir fılmin oynatılması sırasında sinema perdesine projektörle \"Coca cola\" veya \"patlamış mısır yiyin\" yazıları belİrsizce yansıtılmış, sonuçta bu reklamın uygulandığı filmlerin oynatıldığı geceler sinemada Coca Cola ve patlamış mısır satışlarında belli bir oranda artış görüldüğü saptanınıştır. Görüldüğü gibi, burada reklamın sunumu gizlidir. Oysa bu tezin inceleme konusu olan bilinçaltına hitap eden reklamlann sunumu gizli değildir. İnsaıı1ar hangi fmnanın, hangi ürününün veya hizmetinin reklamını izlediklerinin farkındadırlar.

Nitric oxide ( NO ) participates in numerous biological processes, such as signalling in the respiratory system and vasodilation in the cardiovascular system. Many metal-mediated processes involve direct reaction of NO to form a metal–nitrosyl (M–NO), as occurs at the Fe 2+ centres of soluble guanylate cyclase or cytochrome c oxidase. However, some copper electron-transfer proteins that bear a type 1 Cu site (His 2 Cu–Cys) reversibly bind NO by an unknown motif. Here, we use model complexes of type 1 Cu sites based on tris(pyrazolyl)borate copper thiolates [Cu II ]-SR to unravel the factors involved in NO reactivity. Addition of NO provides the fully characterized S -nitrosothiol adduct [Cu I ](κ 1 -N(O)SR), which reversibly loses NO on purging with an inert gas. Computational analysis outlines a low-barrier pathway for the capture and release of NO . These findings suggest a new motif for reversible binding of NO at bioinorganic metal centres that can interconvert NO and RSNO molecular signals at copper sites. NO participates in numerous physiological processes of which many involve the reaction of NO with metalloenzymes to form a metal–nitrosyl (M–NO). Now, addition of NO to models of type 1 Cu sites has provided a fully characterized S -nitrosothiol adduct, [Cu I ](κ 1 -N(O)SR), that reversibly loses NO upon purging with an inert gas. These findings suggest a new motif for reversible binding of nitric oxide at bioinorganic metal centres.

IntroductionEarly and balanced replacement of blood products appears to be the key factor in improving outcomes of major bleeding patients including acute trauma, cardiac, obstetric and transplant surgery patients. Definitive clinical guidance regarding the optimal ratio of blood products, including those containing fibrinogen, is still lacking. Therefore, we tested the hypothesis that increasing the fibrinogen content to erythrocyte suspension ratio improves the mortality and functional outcomes of patients undergoing surgeries with expected major bleeding.Methods and analysisThe Approximate Dose-Equivalent of Fibrinogen-to-Erythrocyte Suspension (ADEFES) ratio is a multicentre, prospective, observational, cohort study of patients undergoing major surgical procedures with expected major perioperative bleeding (ie, requiring packed red blood cells (PRBC)>4U/24 hours). For 5U of cryoprecipitate and 1.5 U of fresh frozen plasma (FFP), the approximate dose-equivalent for fibrinogen is considered as 1 gram of fibrinogen. Association of the ADEFES ratio at 24 hours will be assessed on the primary objective, which will consist of the composite of 30-day all-cause mortality, 30-day bleeding-specific mortality and the ‘highly-dependent scores’ of Katz index of independence in activities of daily living.Ethics and disseminationThe study protocol was approved by the Ethics Committee of Ankara Bilkent City Hospital (approval no. E2-23-4265, dated 07 June 2023; Chair: Prof. Dr. F.E. Canpolat) and by the institutional review boards of all participating centres. The study will be conducted in accordance with the principles of the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, as well as in compliance with national regulations on data protection and Good Clinical Practice standards. Written informed consent will be obtained from all participants prior to inclusion in the study.The results of this study will be disseminated through peer-reviewed scientific journals, presentations at national and international conferences, and communication with relevant stakeholders including clinical practitioners and healthcare institutions. If applicable, study outcomes will also be shared via institutional newsletters and digital platforms to reach a broader audience in the medical community.Trial registration numberNCT06021184.