Evaluation of the Left Ventricular Myocardium Using Layer-Specific Strain Analysis in Adolescent Athletes Performing High-Intensity Interval Training.

High-intensity interval training (HIIT) has been demonstrated to be an efficient way of improving physical performance in adolescent athletes compared to conventional training modalities. The objective of this study was to evaluate the impact of HIIT on the myocardial function of adolescent athletes, specifically focusing on left ventricular (LV) function, using conventional echocardiography and layer-specific strain (LSS) analysis. A total of 19 male adolescent athletes (with mean age of 16.83 ± 1.29 years) participating in various football clubs were recruited for this study. During the course of 8 weeks, these adolescent male athletes engaged in HIIT program centered around running. Upon completion of HIIT program, a treadmill exercise test was conducted. Subsequently, conventional and LSS echocardiography were conducted to acquire the evaluation of LV myocardial function. Interventricular septum thickness and ventricular mass index were significantly increased post high-intensity interval training (p < 0.005). After the HIIT, the treadmill exercise test demonstrated a significant increase in test duration and metabolic equivalent compared to the pre-training values (p < 0.005). Post high-intensity interval training, LSS analysis revealed significantly improved LV circumferential strain values in the basal and mid-segments of the left ventricle when compared to the pre-training measurements (p < 0.005). The implementation of high-intensity interval training led to an enhancement of circumferential LSS in the LV, indicating a favorable physiological adaptation and improved efficiency of the myocardium.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units.

INTRODUCTION AND OBJECTIVES: Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS: Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS: The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION: RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION: RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

The Relationship Between the Age of First Acute Coronary Syndrome Episode and Internal Migration.

OBJECTIVE: It has been shown that migration has an increasing effect on the risk of cardiovascular events. However, these studies are mostly related to international migration. There are very few studies on the relationship between internal migration and cardiovascular disease. The aim of the current study was to evaluate the effect of internal migration on the age of the first acute coronary syndrome episode. METHODS: The study was designed as a cross-sectional, observational study that enrolled 1261 consecutive patients diagnosed with the first episode of acute coronary syndrome between 2014 and 2020. Patients born and living in Antalya were included in the nonimmigrated group, and those born in another city in Türkiye and settled to live in Antalya were included in the immigrated group. The effect of internal migration and other risk factors on the age of the first acute coronary syndrome was calculated by regression analysis. RESULTS: Immigrants were younger than nonimmigrants at the time of acute coronary syndrome (55.4 ± 10.7 years vs. 60.0 ± 13.36 years, P < 0.001). Linear regression analysis showed that migration is an independent risk factor for acute coronary syndrome at an earlier age (-2.07, P < 0.001). The socioeconomic status of the migrant group was not lower than the nonimmigrant group. CONCLUSIONS: Internal migration may be a risk factor associated with acute coronary syndrome at an earlier age when compared to nonimmigrants. This finding needs to be tested in multicenter epidemiological studies.

COMPARISON OF LAPAROSCOPIC AND OPEN PYELOPLASTY IMPACT ON COMFORT AND SUCCESS: A RETROSPECTIVE, SINGLE CENTER STUDY.

Ureteropelvic junction obstruction causes hydronephrosis and may lead to renal parenchymal damage unless timely diagnosed and treated. Although open pyeloplasty is still the gold standard, it needs to be compared with new techniques. In this study, we compared laparoscopic and open pyeloplasty. Data on 113 patients who had undergone surgery between 2008 and 2014 were evaluated retrospectively. Thirty-nine patients had undergone laparoscopic pyeloplasty, and 74 had undergone open pyeloplasty. Ultrasonography was performed at 3 months and scintigraphy at 6 months postoperatively. Parameters such as the length of surgery, need for analgesics, length of hospital stay, complications, and success rates were compared. When compared to open pyeloplasty (mean 9.8 dexketoprofen 50 mg IV dose), the need for an analgesic was significantly lower in the laparoscopic pyeloplasty (mean 4.5, paracetamol 15 mg/kg IV dose) group (p<0.05). The length of hospital stay was also shorter in the laparoscopic pyeloplasty group (mean 4.0 days) than in the open pyeloplasty group (mean 7.3 days) (p<0.05). This study demonstrated that laparoscopic pyeloplasty could be safely used in the treatment of ureteropelvic junction obstruction with a lower need for analgesics and a shorter length of hospital stay than with open pyeloplasty.

Cytokine Profile in Patients With Maturity-onset Diabetes of the Young (MODY).

BACKGROUND/AIM: High-sensitivity C-reactive protein (hs-CRP) is used in the differential diagnosis of maturity-onset diabetes of the young (MODY)-3, but other inflammatory markers have not been investigated in MODY patients. We aimed to compare the serum levels of anti-inflammatory and proinflammatory cytokines between MODY patients and healthy subjects and show the inflammatory features in MODY subtypes. PATIENTS AND METHODS: Thirty patients with clinically suspected MODY and 34 healthy controls were included in this study. Next-generation sequencing (NGS) was used for the molecular diagnosis of MODY subtypes. Serum levels of cytokines were measured using a multiplexed cytokine assay and hs-CRP concentration was determined by the immunoturbidimetric assay. RESULTS: The hs-CRP levels were higher in both NGS-confirmed (MODY, n=17) (p=0.009) and NGS-unconfirmed (non-MODY, n=13) patients (p<0.001) than those in controls. However, IL-1ß (p=0.001), IL-6 (p=0.018), IL-31 (p=0.003), TNF-α (p<0.001), and sCD40L (p=0.007) levels of MODY patients and IL-1ß (p=0.002), IL-31 (p<0.001), IL-22 (p=0.018), and sCD40L (p=0.039) levels of non-MODY patients were lower than those of controls. While hs-CRP levels were lower in MODY3 patients than non-MODY3 patients (p=0.009), IL-17A (p=0.006) and IL-23 (p=0.016) levels for the first time in this study were found to be higher in patients with MODY3 than in patients with other MODY subtypes (p<0.05). CONCLUSION: MODY patients had lower serum levels of the proinflammatory cytokines IL-1ß, IL-6, TNF-α, IL-31, and sCD40L compared to healthy controls. High IL-17A and IL-23 levels along with low hs-CRP levels may be potential markers to distinguish MODY3 from other MODY subtypes.

Long-term impacts of different dialysis modalities on right ventricular function in patients with end-stage renal disease.

BACKGROUND: Right ventricular dysfunction is a major cause of heart failure and mortality in end-stage renal disease patients. Scarce data is available regarding the comparison of echocardiographic right ventricular function in end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis (PD). The aim of the study was to evaluate the long-term impacts of different dialysis modalities on right ventricular function assessed by conventional echocardiography, in end-stage renal disease patients with preserved left ventricular function. METHODS: The study included 120 patients grouped as follows: PD (n = 40), HD with arterio-venous fistula (n = 40), and healthy control subjects (n = 40). Conventional echocardiography was performed on all patients. A classification of right ventricular function was defined in HD patients by using tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index (RV-MPI), fractional area change (FAC), and tricuspid lateral annulus systolic velocity (Sa) values. Correlation analysis was performed by using the right ventricular dysfunction score, clinical, and echocardiographic parameters. RESULTS: The mean age of the study population was 51.9 ± 13.1 years and 47.5% were females. TAPSE and Sa velocity were found to be significantly lower and RV-MPI was significantly higher in patients undergoing HD, compared with control and PD patients. Logistic regression analysis showed that HD treatment was an independent risk factor for developing right ventricular dysfunction. CONCLUSION: RV function was impaired in patients undergoing HD compared with patients on PD.

A Novel Modification of Ureteral Reimplantation (Combined Technique) in Pediatric Patients: A Preliminary Case Series.

BACKGROUND: In this video, we present a new open ureteral reimplantation approach (combined technique) with preliminary results from 32 renal units. MATERIAL AND METHODS: Written informed consent was obtained from the parents of the patients. We used a suprapubic Pfannenstiel incision to reach the bladder. After preparation of the ureters with the guidance of the vesicoureteral reflux surgery principle, they were moved from the bladder to the extravesical area. A submucosal tunnel was created above and below the old hiatus with reference to the old hiatus site. The required submucosal tunnel length is adjusted to be 2/3 above the old hiatus and 1/3 below the old hiatus. The ureters were carried down through the submucosal tunnel using a right-angle clamp and fixed to the bladder with 5/0 polyglactin sutures, step by step, respectively. RESULTS: A total of 22 patients (9 females/13 males) with a median age of 7 (min: 2and max: 15) years were operated on using the combined technique. There were 16 cases with vesicoureteral reflux and 6 cases with unilateral obstructive megaureter. The success rate was found to be 100% for vesicoureteral reflux and 83.3% for primer obstructed megaureter. When we focus on the number of ureters, the overall success rate was found to be 97%. CONCLUSION: The vertical angulation or kinking of the ureter at the entrance to the bladder can be prevented in this modification. New orifice localization is close to the normal position. Short tunnel length is out of the question in this modification. We think that with potential surgical advantages, a novel combined technique can be used in ureteral reimplantation.

Precision Diagnosis of Maturity-Onset Diabetes of the Young with Next-Generation Sequencing: Findings from the MODY-IST Study in Adult Patients.

Maturity-onset diabetes of the young (MODY) is a highly heterogeneous group of monogenic and nonautoimmune diseases. Misdiagnosis of MODY is a widespread problem and about 5% of patients with type 2 diabetes mellitus and nearly 10% with type 1 diabetes mellitus may actually have MODY. Using next-generation DNA sequencing (NGS) to facilitate accurate diagnosis of MODY, this study investigated mutations in 13 MODY genes (HNF4A, GCK, HNF1A, PDX1, HNF1B, NEUROD1, KLF11, CEL, PAX4, INS, BLK, ABCC8, and KCNJ11). In addition, we comprehensively investigated the clinical phenotypic effects of the genetic variations identified. Fifty-one adult patients with suspected MODY and 64 healthy controls participated in the study. We identified 7 novel and 10 known missense mutations localized in PDX1, HNF1B, KLF11, CEL, BLK, and ABCC8 genes in 29.4% of the patient sample. Importantly, we report several mutations that were classified as "deleterious" as well as those predicted as "benign." Notably, the ABCC8 p.R1103Q, ABCC8 p.V421I, CEL I336T, CEL p.N493H, BLK p.L503P, HNF1B p.S362P, and PDX1 p.E69A mutations were identified for the first time as causative variants for MODY. More aggressive clinical features were observed in three patients with double- and triple-heterozygosity of PDX1-KLF11 (p.E69A/p.S182R), CEL-ABCC8-KCNJ11 (p.I336, p.G157R/p.R1103Q/p.A157A), and HNF1B-KLF11 (p.S362P/p.P261L). Interestingly, the clinical effects of the BLK mutations appear to be exacerbated in the presence of obesity. In conclusion, NGS analyses of the adult patients with suspected MODY appear to be informative in a clinical context. These findings warrant further clinical diagnostic research and development in different world populations suffering from diabetes with genetic underpinnings.

Reversal of metabolic syndrome with weight loss decreases epicardial fat more than weight loss alone in women with obesity.

OBJECTIVE: In this study, we aimed to investigate the impact of weight loss with diet and exercise on echocardiographically measured epicardial fat thickness (EFT) in women with obesity and whether the change in EFT can be different between the groups whose metabolic syndrome (MetS) status has changed or remained the same with weight loss. METHODS: Seventy four women with obesity who were scheduled for a one-year weight reduction (WR) program were prospectively enrolled in the study. Anthropometric, laboratory, clinical, and echocardiographic parameters were assessed at baseline and after one year for twenty eight women who completed the program and had weight reduction. At the end of one year, all the participants were divided into two groups on the basis of whether their MetS status had changed or remained the same. RESULTS: Body mass index was significantly reduced from 37.17±5.94 to 31.61±5.55 kg/m2 (p<0.001) after the one-year WR program. A significant reduction in EFT was noted after weight loss compared with baseline measurements (0.51±0.15 cm to 0.39±0.14 cm, p=0.001). The decrease in EFT was significantly higher in the patient group with reversal of MetS than in the group whose MetS status did not change with weight loss (0.16±0.68 cm vs. 0.09±0.07 cm, p=0.018, respectively). Reversal of MetS was found to be an independent predictor of the change in EFT. CONCLUSION: Long-term, sustained weight loss can significantly reduce echocardiographic EFT, and EFT can be used as an indicator of metabolic profile for WR interventions in women with obesity.

Association between obesity grade and the age of the first acute coronary syndrome: Prospective observational study.

BACKGROUND: The study evaluates how obesity grade is associated with age during the first acute coronary syndrome (ACS) and examines the effect of cardiovascular (CV) risk factors and the age of first ACS in patients with severe obesity. METHODS: We enrolled consecutive patients diagnosed with first episode of ACS between 2014 and 2019, and categorized them by body mass indices (BMI). Severe obesity was defined as BMI ≥35 kg/m2. Independent variables affecting the age of first ACS were examined by linear regression analysis. RESULTS: A total of 1005 patients (mean age, 57.5 ± 12.3 years; 19.3% female) were included. Approximately 6% and 12% of obese patients and normal weight patients had no other risk factors. Patients with ACS with severe obesity were younger than those with ACS in the grade-I obesity, overweight, and normal-weight groups (52.8 ± 9.9 vs. 55.3 ± 10.9, 56.8 ± 11.4, and 61.4 ± 14.2, respectively, p < 0.001). BMI had a strong, inverse linear relationship with earlier age of first ACS. The number of patients with no risk factors was significantly high in normal-weight individuals compared with patients with severe obesity (11.6% vs 5.6%, p = 0.037). After adjusting for CV risk factors, patients with overweight, grade-I obesity, and severe obesity may experience first ACS sooner than those with normal-weight by 3.9, 6.1, and 7.7 years, respectively (p < 0.001). However, males and females with severe obesity without CV risk factors experienced the first ACS episode 16 and 22 years later than those with the highest number of risk factors, respectively. CONCLUSION: Patients with severe obesity experience first ACS episode 7.7 years earlier than those with normal-weight. Absence of CV risk factors in people with obesity can improve the potential negative effect of obesity on the ACS age. TRIAL REGISTRATION: NCT04578964, 08 October 2020.

Which children are at risk of developing overactive bladder in early adulthood even if lower urinary tract symptoms improve during childhood?

OBJECTIVES: To evaluate more comprehensively the presence of an association between childhood lower urinary tract symptoms and development of adulthood overactive bladder, to determine the group at most risk of overactive bladder in adulthood, and to assess its effects on daily life. METHODS: A total of 264 patients who were followed up for lower urinary tract symptoms in childhood between 2000 and 2005 were included in this retrospective, cohort study. After a median period of 20 years, these patients with a median current age of 29 (27-35) years were re-evaluated and divided into two groups: those currently with overactive bladder (n = 102, 23.0%), and those without overactive bladder (n = 162, 36.5%). In addition, 180 age-matched overactive bladder patients without a history of childhood lower urinary tract symptoms (n = 180, 40.5%) were included. The primary endpoint was to determine which children are at higher risk of adulthood overactive bladder. The secondary endpoint was to evaluate the effect of history of childhood lower urinary tract symptoms on quality of life in adulthood. The eight-item Overactive Bladder questionnaire, the Pittsburgh Sleep Quality Index, and the Short-Form 36-item Health Survey were administered to all participants. Voiding Dysfunction Symptom Score was evaluated according to childhood medical records. RESULTS: Overactive bladder in adulthood was observed in 38.6% of patients recovering from childhood lower urinary tract symptoms. They had worse overactive bladder symptom scores and quality of life than those without childhood lower urinary tract symptoms (P < 0.001). Voiding Dysfunction Symptom Score ≥13 (odds ratio 2.54), daytime incontinence (odds ratio 2.01), holding maneuvers (odds ratio 1.82), nocturnal enuresis (odds ratio 1.75) in the pediatric period, and recovery age from all these symptoms of ≥12 years (odds ratio 1.95) were the most unfavorable determinants of development of adulthood overactive bladder. CONCLUSIONS: Our findings show that children with the above characteristics are at risk of developing overactive bladder later in their lives even if their symptoms improve in childhood.

Investigation of Scavenger Receptor Class B Type I gene variants in patients with coronary heart disease with a history of early myocardial infarction.

OBJECTIVE: The scavenger receptor class B type 1 (SR-BI, SCARB1), which is a high-density lipoprotein (HDL) receptor that mediates selective cholesteryl ester uptake, plays an important role in reverse cholesterol transport. This study investigated the distribution of polymorphic variants of the SR-BI gene in patients with coronary heart disease (CHD) with a history of early myocardial infarction (MI) at an early age and their effects on their serum lipid levels. METHODS: SR-BI rs5888(T>C), rs4238001(C>T), and rs10846744(G>C) were analyzed in 100 male patients with CHD with a history of MI (MI+) who were younger than 50 years and 89 male control subjects without MI history (MI-) using real-time polymerase chain reaction (PCR) and mutant-allele-specific PCR techniques. RESULTS: SR-BI rs4238001 common-CC genotype was found to be more frequent in patients with MI+ than in control subjects (MI-; odds ratio 4.046, p<0.001). The rs10846744 rare-C allele showed a significant association with increased total cholesterol (p=0.014) and triglyceride (p=0.009) levels in the MI+ CHD group. Logistic regression analysis confirmed that there may be an association between the rs4238001-CC genotype (p=0.002), smoking (p=0.026), and MI+ CHD in the presence of other risk factors associated with CHD, whereas haplotype analysis confirmed that patients with MI+ CHD (rs5888-C, rs10846744-G, and rs4238001-C alleles) and CCC (rs5888-C, rs10846744-C, and rs4238001-C alleles) haplotypes were highly frequent (p<0.01 and p=0.027, respectively). CONCLUSION: These results indicated that SR-BI gene variants show different distribution in patients with MI+ CHD compared with that in MI- control subjects, and these variants may have effects in favor of dyslipidemia.

Comparison of epicardial fat thickness between metabolically healthy and unhealthy obese women.

OBJECTIVE: Epicardial adipose tissue is suggested to play an important role in the progression of metabolic syndrome (MetS). There is not enough evidence regarding the relationship between echocardiographically measured epicardial fat thickness (EFT) and metabolic health status in women with equal obesity. In this study, we aimed to compare the echocardiographically measured EFT between metabolically healthy and unhealthy obese women with similar body mass index (BMI) and waist circumference (WC) values. METHODS: A total of 90 women (mean age 51.7±8.6 years) with BMI ≥30 kg/m² were enrolled in the study. EFT was measured with transthoracic echocardiography in all participants. The patients were then classified into two groups; metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). EFT and clinical and biochemical parameters were compared between the two groups. RESULTS: Among the study participants, 46 (51.1%) patients were included in the MHO group. The groups were not different with respect to age, WC, waist to hip ratio, and BMI. The mean value of EFT was 5.53±1.42 mm in patients with MUO and 4.80±1.54 mm in patients with MHO with a statistically significant difference (p=0.022). EFT, fasting insulin, and vitamin D were found as independent variables associated with MUO in obese women. CONCLUSION: This study demonstrates that EFT is increased in women with MUO, regardless of BMI and waist circumference, than in women with MHO.

Monogenic Childhood Diabetes: Dissecting Clinical Heterogeneity by Next-Generation Sequencing in Maturity-Onset Diabetes of the Young.

Diabetes is a common disorder with a heterogeneous clinical presentation and an enormous burden on health care worldwide. About 1-6% of patients with diabetes suffer from maturity-onset diabetes of the young (MODY), the most common form of monogenic diabetes with autosomal dominant inheritance. MODY is genetically and clinically heterogeneous and caused by genetic variations in pancreatic ß-cell development and insulin secretion. We report here new findings from targeted next-generation sequencing (NGS) of 13 MODY-related genes. A sample of 22 unrelated pediatric patients with MODY and 13 unrelated healthy controls were recruited from a Turkish population. Targeted NGS was performed with Miseq 4000 (Illumina) to identify genetic variations in 13 MODY-related genes: HNF4A, GCK, HNF1A, PDX1, HNF1B, NEUROD1, KLF11, CEL, PAX4, INS, BLK, ABCC8, and KCNJ11. The NGS data were analyzed adhering to the Genome Analysis ToolKit (GATK) best practices pipeline, and variant filtering and annotation were performed. In the patient sample, we identified 43 MODY-specific genetic variations that were not present in the control group, including 11 missense mutations and 4 synonymous mutations. Importantly, and to the best of our knowledge, the missense mutations NEUROD1 p.D202E, KFL11 p.R461Q, BLK p.G248R, and KCNJ11 p.S385F were first associated with MODY in the present study. These findings contribute to the worldwide knowledge base on MODY and molecular correlates of clinical heterogeneity in monogenic childhood diabetes. Further comparative population genetics and functional genomics studies are called for, with an eye to discovery of novel diagnostics and personalized medicine in MODY. Because MODY is often misdiagnosed as type 1 or type 2 diabetes mellitus, advances in MODY diagnostics with NGS stand to benefit diabetes overall clinical care as well.

Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study.

PURPOSE: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.

The Effect of Exercise on Life Quality and Depression Levels of Breast Cancer Patients.

INTRODUCTION: The aim of this study is to determine the effects of aerobic and stretching exercises on quality of life and depression levels of breast cancer patients. METHODS: A total of 48 women (mean age 45.0±2.2 years) who were previously diagnosed with breast cancer and completed their treatment with no metastasis, were included in the study. Of these, 24 women who received the exercise program were assigned as the study group, while the remaining 24 women who did not receive the exercise program were assigned as the control group. The study group received a 12-week aerobic exercise program at the fitness club and home-based resistance exercise program designed by a sport scientist at the doctoral level. The control group was encouraged to maintain their normal level of physical activity and exercise habits throughout the study. The WHOQOL-BREF, EORTC-QLQ-C30 quality of life assessments and Beck depression inventory (BDI) were used to evaluate quality of life and the severity of depression before and after 12-week exercise programs. RESULTS: EORTC QLQ-C30 scoring showed that in the study group aerobic exercise positively impacted quality of life on the functional scales (physical p=0.001, role p=0.039, emotional p=0.031, social functioning p=0.010) and symptoms (fatigue p=0.001, pain p=0.001, sleep disturbance p=0.038 and financial impact p=0.015). WHOQOL-BREF assessment areas, (general p=0.001, physical p=0.02, mental p=0.001 and social health p=0.017) relationships also improved as a result of exercise. BDI showed that severity of depression in the study group decreased significantly (p=0.001). CONCLUSION: This study showed that aerobic and resistance exercises improved quality of life and decreased depression levels of women who previously received breast cancer treatments.
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What is the consistency between the results of needle biopsy and prostatectomy specimen pathology results? A pilot study

Background/aim: The aim of this study was to establish the relationship between the needle biopsy and the pathology result after radical prostatectomy administrated for prostate cancer. Materials and methods: We retrospectively analyzed 67 patients who had undergone radical prostatectomy from 2016 to 2019. All sur- geries and all biopsies were performed in the third author's urology department. Samples were collected through 12-core biopsy under local anesthesia. All specimens were studied in the pathology department of the third author's center. The results evaluated were needle biopsies' Gleason scores and prostatectomy specimens' Gleason scores. Results: Inclusion criteria were not having any neo-adjuvant treatment and being treated with surgery after needle biopsy. Gleason scores obtained from needle biopsies and prostatectomy specimens were evaluated. The comparison revealed that 39% of the tumors were undergraded, 7% were overgraded, and 54% had exact scoring in needle biopsies and prostatectomy specimens according to the detailed Gleason scoring as primary and secondary metrics. The patients were grouped into five categories according to the ISUP 2014 prostate cancer grading system. The relationship was strong with 64% of results staying in the same group after the operation; neverthe- less, the correlation remained weak based on the kappa coefficient. Conclusion: The information obtained from the needle biopsy is not a strong herald of the pathological result. Urologists should have awareness of this restraint when utilizing the needle biopsy's Gleason score in decision making and treatment planning.

Metabolic risk factors and the role of prophylaxis in pediatric urolithiasis.

Suppose that the recurrence in pediatric urolithiasis has a close relationship with metabolic abnormalities and is affected by residual burden and prophylaxis. If so, the recurrence rates could be reduced with effective surgery and appropriate prophylaxis. Here we retrospectively evaluate the metabolic risk factors data of 148 children who were operated on between January 2005 and March 2013 due to kidney stones. All patients underwent percutaneous nephrolithotomy (PCNL), and all were children. Thirteen children had a history of surgery performed to treat urological anomalies. Twenty-four-hour urine analysis, the residual status of surgery, BMI levels, and the number of metabolic abnormalities were noted. Only 18 (15%) of 122 patients without residual stones after PCNL had recurrence at follow-up whereas; nine (26%) of 26 patients with residual stones developed recurrence (p = 0.017). Recurrence was observed in 14 (16%) of 89 patients with a metabolic abnormality, and 13 (30%) of 44 patients with two or more metabolic abnormalities had recurrence at follow-up (p = 0.024). Those patients with no metabolic abnormalities did not develop recurrence. Stone recurrence was seen in six (8%) of 78 children who were given metabolic prophylaxis, compared to 21 (30%) of 70 patients who did not receive metabolic prophylaxis (p = 0.02). No stone recurrence was seen in nine children who were given Shohl's, whereas four (67%) of six patients who did not take Shohl's had recurrence (p = 0.022). Complete removal of stones by a suitable surgical method is essential to avoid recurrences. Detailed clinical and laboratory evaluations should be performed in children with urolithiasis. Appropriate specific prophylactic treatment (e.g., potassium citrate and Shohl's) and non-specific prophylactic treatment (e.g., avoiding animal proteins, salt, simple sugars, and increased water intake) should be given to prevent reformation of stones in patients with pediatric urolithiasis.