Tıp Fakültesi

The role of lipid-derived indices in patients with MASLD in Turkey: a nationwide, multicenter cross-sectional study

2026-06-26T14:13:58Z

The role of lipid-derived indices in patients with MASLD in Turkey: a nationwide, multicenter cross-sectional study Şahin, Cem; Solmaz, İhsan To investigate the role of lipid-derived indices-the monocyte-to-HDL cholesterol ratio (MHR), visceral adiposity index (VAI), atherogenic index of plasma (PAI), and cardiometabolic index (CMI)-in determining hepatic steatosis and fibrosis among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) across Turkey. This nationwide, multicenter, retrospective cross-sectional study included 14,322 individuals from 44 internal medicine clinics in 31 provinces of Turkey. Anthropometric, clinical, and biochemical data were collected, and Participants were classified as MASLD (+) if ultrasonographic hepatic steatosis was present in the setting of >= 1 cardiometabolic risk factor according to current EASL-EASD-EASO guidelines; individuals without ultrasonographic steatosis were classified as MASLD (-). FIB-4 scores were calculated to assess the risk of advanced hepatic fibrosis. Cardiometabolic risk factors included obesity (BMI >= 25 kg/m & sup2; or increased waist circumference), type 2 diabetes mellitus, hypertension, impaired fasting glucose, and dyslipidemia as defined by international guidelines. The relationships between MHR, VAI, PAI, CMI, and MASLD presence and fibrosis severity were analyzed via nonparametric statistical tests. MASLD was detected in 10,836 participants (75.7%). The VAI, PAI, and CMI were significantly greater in the MASLD (+) group than in the MASLD (-) group (p < 0.001 for all), whereas the MHR was not significantly different (p = 0.453). Among MASLD (+) patients, 1,214 (11.2%) had high FIB-4 scores (>= 1.3; >= 2.0 if > 65 years) yet none of the lipid indices correlated significantly with FIB-4 levels. In multivariable logistic regression analysis restricted to MASLD-positive individuals, none of the lipid-derived indices were independently associated with high FIB-4 risk after adjustment for metabolic covariates. A weak negative correlation was observed only between FIB-4 score and the MHR (r=-0.030, p = 0.002). VAI, PAI, and CMI are significantly associated with hepatic steatosis in MASLD, suggesting their potential role as supportive, noninvasive markers in identifying individuals at increased risk of MASLD. However, these indices are not reliable predictors of advanced hepatic fibrosis risk based on FIB-4. The combination of these tools with other noninvasive fibrosis assessment tools may increase diagnostic accuracy in MASLD management.

Is the Prognostic Nutritional Index a Predictor of Urolithiasis?

2026-06-26T12:47:36Z

Is the Prognostic Nutritional Index a Predictor of Urolithiasis? Dereköylü, Engin; Çoşkun, Çağrı; Aydın, Uğur; Tarım, Kayhan Objective: Prognostic nutritional index (PNI) is a parameter that reflects nutritional status and inflammation. It is calculated from serum albumin and lymphocyte count. Our study investigated whether PNI has a predictive value in urolithiasis. Materials and Methods: Data of patients who applied to A & gbreve;r & imath; Training and Research Hospital with renal colic between January 2017 and December 2024 were retrospectively examined. Three hundred forty-eight patients were included in the stone group and 627 patients were included in the control group. Patients' age, gender, smoking, hypertension, and diabetes history, body mass index, hemoglobin level, glomerular filtration rate (GFR), blood urea nitrogen, uric acid levels, sodium, potassium, calcium, white blood cell count (WBC), neutrophil count, lymphocyte count, albumin, neutrophil/lymphocyte ratio (NLR), and PNI levels were compared. Results: No statistically significant difference existed between the demographic data and the patients' comorbidities. In the stone patients group and the control group, mean GFR was 88.04 [standard deviation (SD): 13.21], 93.90 (SD: 13.17); mean WBC was 8910 (SD: 1629), 8268 (SD: 1562); mean neutrophil count was 6040 (SD: 1416), 4933 (SD: 1283); mean lymphocyte count was 2070 (SD: 879), 2535 (SD: 944); mean NLR was 3.62 (SD: 2.1), 2.34 (SD: 1.41); PNI was 30.73 (SD: 6.85), 53.66 (SD: 6.94) (p<0.001, all). Conclusion: PNI value was lower in stone patients than in the control group. PNI may be a parameter predicting stone formation. Additionally, the predictive value can be strengthened with the NLR value.

Potential Late Effects of Early Pregnancy Night-Shift Exposure on Hofbauer Cells in Term Placentas: A Histological and Ultrastructural Study

2026-06-26T11:53:12Z

Potential Late Effects of Early Pregnancy Night-Shift Exposure on Hofbauer Cells in Term Placentas: A Histological and Ultrastructural Study Çetinavcı, Dilan; Elbe, Hülya; Yiğittürk, Gürkan; Sencar, Leman; Pirinçci, Fatih; Aydın, Hüsnü; Doğan, Kübranur Background Night shift work is considered an important environmental stressor with the potential to disrupt circadian rhythm and adversely affect placental structure and function during pregnancy. Materials and methods In this study, microscopic placental changes in pregnant women working regular daytime schedules (Group 1, n = 45) were compared with those of pregnant women who worked night shifts before pregnancy and during the first 24 weeks of gestation (Group 2, n = 45). Term placental samples were evaluated using hematoxylin and eosin (H&E) staining, along with immunostaining for phospho-BMAL1, CLOCK, and melatonin 1 A. Additionally, double immunofluorescence staining for CD68/CD163 and transmission electron microscopy analyses were performed. Results While the overall villous architecture remained largely preserved in both groups, the night-shift work group exhibited a higher frequency of microscopic lesions, including villous edema, abnormal vascularization, and hemorrhage. The mean histopathological damage score (MHDS) was significantly higher in group 2 (4.93 +/- 1.92) than in group 1 (2.29 +/- 1.10) (p < 0.001). Immunohistochemical analysis revealed significantly decreased expression of phospho-BMAL1, CLOCK, and melatonin receptor 1 A (MTNR1A) in group 2 (all p < 0.001). Immunofluorescence analysis revealed an increased number of CD68(+), CD163(+), and CD68(+)CD163(+) double-positive cells in group 2 (p < 0.005). Ultrastructural evaluation showed irregular microvilli and thickening/irregularity of the trophoblastic basal lamina in night-shift placentas. Conclusion In conclusion, night-shift work is associated with increased histopathological damage in the placenta, reduced circadian marker expression, and altered placental immune cell dynamics. Overall, these results indicate that circadian disruption related to night-shift work affects placental structure, molecular clock regulation, and immune microenvironment.

Prognostic Role of Inflammatory Indices and Real-World Outcomes in HER2-Positive Metastatic Breast Cancer Treated with Trastuzumab Emtansine

2026-06-26T08:48:47Z

Prognostic Role of Inflammatory Indices and Real-World Outcomes in HER2-Positive Metastatic Breast Cancer Treated with Trastuzumab Emtansine Güçlü Kantar, Taliha; Doğan, Tolga; Tanrıverdi, Özgür; Açıkgöz Yıldız, Bedriye Background and Objectives: Reliable pretreatment biomarkers to guide treatment selection in HER2-positive metastatic breast cancer (mBC) remain an unmet need. Systemic inflammatory indices derived from routine blood tests have emerged as accessible prognostic markers. This study evaluated the prognostic value of inflammation-based indices in patients with HER2-positive mBC treated with trastuzumab emtansine (T-DM1). Materials and Methods: In this retrospective single-center cohort study, 50 patients with HER2-positive mBC treated with T-DM1 in the second-line setting were analyzed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. ROC analysis assessed the prognostic performance of the CRP/albumin ratio (CAO), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Variables associated with PFS were further evaluated using multivariable Cox regression. Results: The median follow-up was 46 months. Median OS from initial diagnosis and median PFS from T-DM1 initiation were 96 and 7 months, respectively. Metastatic pattern (p = 0.010), CNS involvement at T-DM1 initiation (p = 0.025), liver metastasis (p = 0.041), and best radiologic response (p < 0.001) were associated with PFS. ROC analysis showed modest discrimination (CAO AUC 0.694, NLR 0.658, PLR 0.646, and SII 0.653). In multivariable analysis, best radiologic response to T-DM1 was strongly associated with progression risk and appeared to reflect treatment sensitivity rather than acting as a pretreatment predictor. Conclusions: T-DM1 provided meaningful disease control in this real-world cohort. Treatment response was the main determinant of progression, while baseline inflammatory markers offered modest complementary prognostic value. These findings may aid patient selection for T-DM1, particularly in settings with limited access to trastuzumab deruxtecan.