OBJECTIVE: This study investigates the impact of leadership support, organizational culture and digital transformation on em-ployee satisfaction, employee motivation, patient satisfaction, organizational learning capacity and innovative performance in the dental sector. Employee and patient satisfaction is critical to improve service quality and ensure a sustainable healthcare system. Leadership support promotes job satisfaction and motivation, while organizational culture supports collaboration and commu-nication. Digital transformation increases operational efficiency, streamlines workflows and improves patient satisfaction. The study aims to provide theoretical and practical insights into health management and organizational development in dental clinics.
METHODS: A quantitative research design was used involving 300 participants from dental clinics in Istanbul. Data were collected through questionnaires and analyzed using SPSS software. Statistical methods including factor, correlation and regression analyses were applied to test the hypotheses. The study examined the relationships between leadership, organizational culture, digital transformation and their effects on the dependent variables.
RESULTS: The results show that leadership support significantly increases employee satisfaction, motivation, patient satisfaction, innovative performance, and organizational learning capacity. In addition, organizational culture and digital transformation showed positive but statistically insignificant effects on these variables. While digital transformation increased operational efficiency, it did not significantly affect employee motivation or patient satisfaction. The findings emphasize the importance of leadership in driving innovation and improving service quality in dental clinics.
CONCLUSION: Leadership significantly promotes employee and patient satisfaction, employee motivation, organizational learning and innovative performance. Organizational culture contributes positively to the dependent variables, but its effects are less pronounced. Digital transformation positively affects patient satisfaction. The study underlines the need for effective leadership strategies and the integration of digital technologies to improve dental service outcomes. These findings provide valuable guidance for developing management strategies in dentistry. Future research should investigate the long-term effects of digital transformation and innovative technologies on satisfaction, motivation and organizational performance.

OBJECTIVE: It was aimed to compare the prognostic risk factors and multidisciplinary treatments affecting mortality in acute mesenteric ischemia (AMI).
METHODS: We retrospectively analyzed 111 patients treated for acute mesenteric ischemia between January 2012 and January 2023. Patients were divided into 2 groups as alive and dead for early survey (postoperative 28 days). The characteristics of the two groups were compared and the factors affecting early mortality were investigated. Factors affecting the presence of perioperative ischemia, the length of ischemia, the length of the resected bowel, and the length of the remaining small bowel from the ligament of Treitz were investigated. The results of different treatment processes were analyzed.
RESULTS: The mean age was 71.67, years with 64 (57.6%) males and 47 (42.3%) females. Early mortality rate was 47.7%. Envas was applied to 9 (8.1%) patients. EnvasSurg to 19 (17.1%) patients. Surg to 71 (64%) and SurgEnvas to 12 (10.8%) patients during the treatment process. Preoperative D-dimer (p=0.013). lactate (p=0.006). creatine (p=0.001). LAR (p=0.031) were significantly different between the groups when compared according to the treatment process. The resected bowel length was significantly less in patients who underwent EnvasSurg compared to the other groups (p=0.002), CCI (p=0.041), D-dimer (p=0.016), lactate (p<0.001), creatine (p<0.001), LAR (p<0.001) and ischemia length (p<0.001) were found to be significantly different between the groups.
CONCLUSION: The prognosis can be predicted with serum-based blood tests and indicators at the time of diagnosis, and organ loss and prognosis can be changed with the selected treatment process.

OBJECTIVE: Only few cases of intratesticular varicocele (ITV) have been reported in the literature, mostly as single cases or a case series. In this study, we aimed to describe the topographic distribution of ITVs in the testicular parenchyma and the correlation between ITV accompanying extratesticular varicocele (ETV) and age.
METHODS: Approximately 10,537 patients with scrotal pain and swelling who visited our hospital between August 2014 and May 2020 and underwent scrotal colour Doppler ultrasonography were included in this study. Of these patients, 2285 had ETV, and the remaining patients (n=8252) had other testicular pathologies such as acute-chronic torsion, testicular mass, orchitis, significant testicular atrophy, or isolated extratesticular varicocele, and were thus excluded from the study. Among the 2285 patients, only 20 had ITV.
RESULTS: Of the 20 patients with ITV, 2 had isolated ITV, and the remaining had ITV accompanying ETV, of whom only one had a right ETV. One patient had left testicular atrophy accompanying an isolated ITV. Among the ITV cases, subcapsular ITV was the most common (n=13), followed by central ITV (n=4) and subcapsular and hilar ITV (n=3). The patients’ ages ranged from 18 to 30 years.
CONCLUSION: ITV is a rare clinical entity that occurs only in young men, with most cases accompanying ETV. ITV is generally peripherally located in the testicular parenchyma. In this study, no correlations were found between ITV, ETV, and age. As in this study, testicular atrophy is rarely observed in patients with ITV. No studies have presented ITV cases with spermiogram analysis results. Thus, the effect of ITV on male reproductive fertility is still unknown, and further study on this topic is needed.

OBJECTIVE: To investigate the relationship between nutrition literacy (NL) of mothers and physical growth and development, dietary diversity and quality, and vitamin levels of their children aged 24-59 months.
METHODS: A cross-sectional survey-based study was conducted at well-child outpatient clinic. Eighty-eight mother-child pairs included. Mother’s Evaluation Instrument of Nutrition Literacy for Adults (EINLA) scores and child anthropometric z-scores, age when reaching six gross motor milestones, dietary diversity and the Mediterranean Diet Quality Index scores, and serum vitamin A, B1, B2, B12, C, D, and E levels were measured. Two independent groups comparison statistics and Spearman rank correlations were performed.
RESULTS: Thirty-four mothers (38.6%) had borderline and 54 mothers (61.4%) had adequate NL level. The percentages of wasted and acutely malnourished children were higher in the borderline NL group (17.6% vs. 1.9%, p=0.005 and 14.7% vs. 1.9%, p=0.030, respectively). There was no significant correlation between maternal EINLA score and child motor skill acquisition, dietary diversity, or serum vitamin status (p>0.05). There was a correlation between maternal EINLA score and child dietary quality score (r=0.218, p=0.041).
CONCLUSION: Increasing NL of mothers may be a step toward improving the dietary quality of children and reducing the burden of child undernutrition.

OBJECTIVE: Scleroderma has a wide range of clinical manifestations due to vasculopathy, autoimmunity, altered endothelium function, and abnormal fibrosis, which are accused in the pathogenesis of the disease. The aim of this study is to shed light on the pathogenesis of the disease in childhood via dermal immunohistochemical analysis of the cases.
METHODS: A single-blind clinical trial is conducted with evaluation of the tissue samples obtained from patients. The samples are stained with PAS, hematoxylin and eosin, E-Cadherin, Connective tissue growth factor (CTGF), Tunnel, and staining
for Transforming growth factor beta 1 (TGF-β1) and evaluated by light microscopy. In addition, both TGF-β1 level and mRNA expression analyses in plasma and tissue samples from patients are performed. A total of 15 patients (systemic, n=8 or localized; n=7) were enrolled in the study.
RESULTS: The mean age of onset of the disease was 9.2±1.2 years, and the mean age of diagnosis was 15.3±3.2 years. Antinuclear antibody (ANA) titer was between 1/160–1/640 in all patients with systemic sclerosis. There was no ANA positivity in patients with localized scleroderma. A total of 22 tissue samples (15 diseased tissues, 7 healthy tissues) were examined. Histopathological examination has shown that two clinically different subgroups have different characteristics at the tissue level.
CONCLUSION: TGF-β1 levels, which play a fundamental role in the pathogenesis of the disease, are found in both plasma and skin have been shown high. This elevation was found particularly in patients with systemic scleroderma to be more pronounced. Also, in patients with localized scleroderma, skin fibroblasts have been shown to limit the pathologic response.

OBJECTIVE: The cardiopulmonary exercise test (CPET), which is used as the gold standard in the evaluation of exercise capacity in patients with chronic heart failure (CHF), is not always possible to perform in clinics and field tests are preferred. The aim of this study was to determine the effectiveness of the symptom-limited stair climbing test (SLSCT) in patients with CHF.
METHODS: Thirty-one patients (mean age: 65.52±7.57 years) with New York Heart Association (NYHA) Classification stage II-III CHF were included. Exercise capacity was assessed by SLSCT, 6-minute walk test (6MWT), and CPET. Predicted peak oxygen consumption (VO2peak), heart rate (HR), blood pressure (BP), and left ventricular ejection fraction (LVEF), pulmonary functions were measured.
RESULTS: The predicted VO2peak calculated from SLCT was significantly higher than that of 6MWT and CPET (p<0.05). On analyzing the HR changes, SLSCT increased HR by more than 6MWT and less than CPET (p<0.05). There were significant correlations between the predicted VO2peak values by SLSCT and LVEF, BMI (Body Mass Index), FEV1 (Forced Expiratory Volume in One Second), and FVC (Forced Vital Capacity), predicted VO2peak of CPET (r=0.36-0.55, p≤0.05).
CONCLUSION: SLSCT was found to be effective and easy to use in assessing exercise capacity in CHF patients. Compared with 6MWT, SLSCT gives better results in determining the clinical status and hemodynamic responses of the patients. SLSCT can be an alternative method for assessing exercise capacity in the absence of CPET.

OBJECTIVE: Osteoarthritis (OA) is a prevalent and disabling joint condition that affects millions worldwide, particularly in the knee joint, and it presents limited therapeutic options. Platelet-rich plasma (PRP) and hyaluronic acid (HA) have emerged as promising intra-articular treatments. This study aimed to compare the effects of single-dose PRP and HA on pain, functionality, and stiffness in patients with knee OA over a 12-week follow-up period.
METHODS: A retrospective analysis was conducted on 64 patients who underwent single-dose intra-articular HA or PRP treatment for knee OA between December 2021 and June 2022. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Patient satisfaction was evaluated using a Likert scale. Appropriate statistical analyses were performed to compare treatment outcomes and p<0.05 was considered statistically significant.
RESULTS: Both PRP and HA treatments led to significant improvements in pain, functionality, and stiffness over the 12-week follow-up period. VAS pain scores decreased significantly in both groups, but a greater reduction was observed in the HA group. Additionally, the HA group exhibited superior improvement in the WOMAC physical function score at the 4-week mark (p=0.047).
CONCLUSION: This study is another novel contribution to the growing literature on treatment of PRP and HA treatments for knee OA, where we highlighted the potential benefits of single-dose HA in alleviating pain and enhancing physical function.

OBJECTIVE: Achalasia is a movement disorder of the esophagus that continues with chest pain, dysphagia, weight loss, regurgitation of undigested foods, recurrent aspiration and night cough.
METHODS: Weight loss, presence of dysphagia, presence of retrosternal pain and regurgitation were recorded before POEM treatment and preoperative Eckardt Score was calculated and recorded. Patients were recorded at the 6th month after POEM treatment recording weight loss, dysphagia presence, retrosternal pain and regurgitation presence and calculating postoperative Eckardt score.
RESULTS: The change between the postoperative and preoperative values of the patients was calculated as ∆ value. As a result of the examination, no significant difference was found between the values ∆weight loss, ∆dysphagia, ∆retrosternal pain, ∆regurgitation and ∆Eckardt score and gender variable (respectively, p=0.112; p=0.412; p=0.619; p=0.171; p=0.092). Postoperative weight loss, dysphagia, retrosternal pain, regurgitation and Eckardt score values were found to be lower than preoperative values. (respectively, p<0.001;p<0.001; p<0.001; p<0.001; p<0.001).
CONCLUSION: Peroral endoscopic myotomy treatment is an effective treatment method with its being more reliable, lower complication risk, being less invasive and with postprocedural and clinical results.

OBJECTIVE: The primary objective of our meticulously designed study is to thoroughly investigate and delineate the extent to which individuals afflicted with seborrheic dermatitis, particularly those exhibiting facial manifestations of this dermatological condition, experience significant psychological distress that may adversely impact their self-perception as measured by the Social Appearance Anxiety Scale (SAAS), while simultaneously comparing these findings against a group of healthy individuals serving as controls.
METHODS: In the framework of our research, we meticulously recruited a sample comprising 120 individuals diagnosed with seborrheic dermatitis characterized by facial involvement, whose ages ranged from 18 to 65 years, alongside 118 healthy control participants who were strategically matched for key demographic variables, including age, gender, and educational attainment to ensure the integrity of our comparative analysis. Both the patient participants and the healthy controls underwent a systematic administration of a range of validated psychometric tools, particularly the SAAS and the Hospital Anxiety and Depression (HAD) scale. Further, the Dermatology Life Quality Index (DLQI) and Visual Analog Scales (VAS) were exclusively utilized for the subset of individuals within the patient population.
RESULTS: Through comprehensive statistical analysis, the mean scores acquired from the Social Appearance Anxiety Scale (SAAS) for the patient and control groups were 52.10 and 21.35 points, respectively. Accordingly, it was concluded that the average SAAS score observed in the patient group was substantially higher than that recorded in the control group, with a p-value of less than 0.01 reflecting a statistically significant observation.
CONCLUSION: The presence of seborrheic dermatitis lesions located on visible areas of the skin engenders a notable degree of anxiety among affected individuals, primarily stemming from concerns regarding their physical appearance. This investigation underscores the critical need for individuals experiencing such dermatological manifestations to receive holistic treatment that addresses their psychiatric and dermatological needs.

OBJECTIVE: This study aims to evaluate the changes in posterior segment parameters that affect visual prognosis in patients with central retinal vein occlusion (CRVO).
METHODS: This retrospective study included 58 eyes of 58 CRVO patients. Best-corrected visual acuity (BCVA), intraocular pressure, central macular thickness (CMT), hyperreflective foci (HRF), ellipsoid zone (EZ) loss, disorganization of retinal inner layers (DRIL), intraretinal cystic changes, posterior vitreous detachment (PVD), and macular superficial and deep vascular density (VD), as well as superficial and deep foveal avascular zone (FAZ) areas, were assessed at baseline and 3 months follow-up after treatment. The treatments (intravitreal injections and laser) received were recorded.
RESULTS: The mean age was 63.02±9.91 years, 37 (63.8%) were female, and 39 (67.3%) were classified as having non-ischemic CRVO. The mean baseline BCVA was 0.64±0.85 logMAR; at 3 months, it improved to 0.39±0.65 logMAR (p<0.001). The mean baseline CMT was 478.9±82.6 µm, and at 3 months, it reduced to 288.56±72.39 µm (p<0.001). At baseline, HRF in 31% of eyes, EZ disruption in 44.8% of eyes, DRIL in 17.2% of eyes, intraretinal cysts in 55.2% of eyes, and PVD in 43.1% of eyes. A significant decrease in BCVA was observed in patients with EZ loss (p<0.001), while the presence of intraretinal cysts had significant impact on CMT (p=0.007). Furthermore, a statistically significant neg-ative correlation was observed between foveal and superior VD in both the superficial and deep capillary plexus (SCP, DCP) and changes in BCVA (logMAR). In contrast, a positive correlation was found between superficial FAZ area and BCVA (logMAR). Additionally, a statistically significant positive correlation was noted between foveal VD in both the SCP and DCP and changes in CMT.
CONCLUSION: The study emphasizes the importance of structural and vascular changes in predicting functional outcomes and suggests the utility of optical coherence tomography (OCT) and OCT angiography in early visual prognosis and treatment planning.

OBJECTIVE: Elective splenectomy is often performed due to hematological diseases. In this study, we aimed to investigate the splenectomy procedures performed in our clinic under emergency and elective conditions by analyzing the surgical techniques applied, surgical indications, and the clinical and demographic data of the patients, while seeking to discuss this subject, which holds a significant place in general surgical practice, in light of current literature.
METHODS: Patients who underwent splenectomy surgery in the general surgery clinic of a tertiary care hospital between September 2016 and September 2024 were included in the study. Clinical and demographic data of the patients were collected retrospectively through the hospital information management system records.
RESULTS: The mean age of 89 patients included in the study was 41.0±18.8 years (18-76 years). The male/female ratio was 1.3/1. The most common indication for splenectomy was trauma (38.2%). This was followed by mass (29.2%), splenomegaly (14.6%), and immune thrombocytopenic purpura (ITP) (14.6%). Of the patients, 62.9% underwent open surgery, while 37.1% were operated on using the laparoscopic technique. Of the patients, 57.3% underwent elective surgery, while emergency surgery was planned for 42.7%.
CONCLUSION: While splenectomy is a life-saving intervention in emergency conditions, it has become the most important treatment in some hematological diseases. Firstly, accurate surgical indication and the selection of an appropriate surgical technique tailored to the patient are of critical importance. There are still controversial issues in the current literature regarding the indications for splenectomy and the surgical technique to be applied.

OBJECTIVE: The role of magnesium in glucose homeostasis, its effects on glycemic control and the causal relationship between them have been the subject of many studies. In this direction, in our study, we aimed to investigate the relationship between serum magnesium (Mg) levels and hemoglobin A1c (HbA1c) and insulin resistance.
METHODS: Based on their HbA1c levels, 305 participants were split into 3 groups: 121 were in the control group, 85 were in the prediabetes group, and 99 were in the diabetes group. Serum magnesium levels were measured in these three groups. The correlation between Mg and fasting plasma glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) was also investigated. In addition, patients’ demographic data, blood pressure, smoking habits and basic biochemical data were also included in the analysis.
RESULTS: There was a significant statistical difference in terms of serum magnesium levels among all the groups (p<0.001). A strong negative correlation was found between serum magnesium levels and HbA1c (r=-0.316, p<0.001). There was also a weak negative relationship between Mg and serum fasting glucose, insulin, and HOMA-IR (r=-0.167 p=0.004, r=-0.167 p=0.003, and r=-0.198 p=0.001, respectively).
CONCLUSION: We observed a statistically significant negative correlation between serum magnesium levels and HbA1c in our study. According to this finding, it would be useful to assess magnesium levels in patients with high HbA1c levels. However, due to conflicting results among studies investigating the relationship between magnesium, glycemic control and insulin sensitivity with increasing interest, more comprehensive, prospective studies with longer follow-up periods are needed.

OBJECTIVE: The aim of the study is to evaluate an established biomarker such as blood urea nitrogen (BUN)/Creatinine ratio in predicting upper gastrointestinal bleeding versus lower GI and stratify its severity. The aim of this study is to evaluate the diagnostic performance in clinical practice and predestination as a prognostic factor, including admission to an intensive care unit (ICU) or mortality rate for BUN/Creatinine ratio.
METHODS: A total of 300 patients controlled in our hospital between January 2022 and January 2024 were evaluated retrospectively due to hospitalization by acute GI bleeding. Gastroscopy and/or colonoscopy were used to stratify patients into the upper or lower GI bleeding group. Data included demographic information, clinical presentation history and vital signs, comorbidity status, medication use, clinical outcomes and laboratory tests including hemoglobin, hematocrit, urea, creatinine levels and so on. The BUN/Creatinine ratio was determined and correlated with site as well as severity of bleeding. Statistical techniques, such as logistic regression and receiver operating characteristic (ROC) analysis, were used to assess the diagnostic performance of the ratio and to choose a cut-off value.
RESULTS: Among the 300 patients, 215 (71.7% had upper GI bleeding, and 85 (28.3% had lower GI bleeding. Hematemesis and melena were significantly associated with upper GI bleeding, whereas hematochezia was more common in lower GI bleeding. Patients with upper GI bleeding had significantly higher BUN, urea, and BUN/Creatinine ratios, while hemoglobin and hematocrit levels were lower. The optimal BUN/Creatinine cut-off value of 23.3 demonstrated high sensitivity (89.3%) and specificity (94.1%) for distinguishing between upper and lower GI bleeding. Multivariate analysis revealed BUN/Creatinine ratio, hematochezia and endoscopic intervention as an independent predictor of bleeding location. Patients with BUN/Creatinine ratio >23.3 showed increased frequency of red blood cell transfusion, endoscopic intervention, and mortality.
CONCLUSION: The BUN/Creatinine ratio is a sensitive, noninvasive biomarker for distinguishing between upper and lower GI bleed and severity. Its introduction into clinical practice may enhance the decision process and patient care, especially in critical care contexts. Additional research is indicated to confirm these results and to define standardized cut-off values for wider use.

Endometriosis is an estrogen-dependent benign disease that generally affects women at childbearing age. Despite its high incidence, pathogenesis of endometriosis is poorly clarified. There are several theories explaining the mechanism of disease such as retrograde menstruation, coelomic metaplasia, vascular and lymphatic metastasis. While endometriosis has been described in many intra- and extra-abdominal organs including the ovaries, omentum, colon, liver, lungs and brain, parenchymal splenic endometriosis is a rare situation. In recent years, with reported cases, this rare condition came onto the scene. We also wanted to present our case and question the idea of splenic immunity against endometriosis according to current literature. From now on, splenic endometriosis can be thought of as a differential diagnosis for unidentified lesions of spleen.

REV-ERB α/β proteins play critical roles in circadian rhythm regulation and are considered to be specialized members of the nuclear receptor family. These so-called “orphan” proteins, whose endogenous ligands were initially unidentified, have become exogenously interferable through synthetic agents with the discovery of their endogenous ligands. This feature has made them an important target for clinical research in recent years. Unlike other nuclear receptors, the unique structure of REV-ERB proteins allows them to perform only transcription inhibition, which makes them even more intriguing. This review summarizes the structural features of REV-ERB α/β proteins and their role in the circadian cycle. We also discuss findings in the literature on the function of REV-ERB α/β proteins in the metabolic and immune systems, emphasizing their importance in these systems.

Retraction Notice

This article is retracted from publication by the decision of Editor-in-Chief, upon the authors’ request:

Samanci R, Ataoglu S, Ozsahin M, Ankarali H, Admis O. An investigation of serum irisin levels
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