Izmir University

Inflammation is a crucial component of various stress-induced responses that contributes to the pathogenesis of major depressive disorder (MDD). Depressive-like behavior (DLB) is characterized by decreased mobility and depressive behavior that occurs in systemic infection induced by Lipopolysaccharide (LPS) in experimental animals and is considered as a model of exacerbation of MDD. We assessed the effects of melatonin on behavioral changes and inflammatory cytokine expression in hippocampus of mice in LPS-induced DLB, as well as its effects on NLR Family Pyrin Domain Containing 3 (NLRP3) inflammasome activation, oxidative stress and pyroptotic cell death in murine microglia in vitro. Intraperitoneal 5 mg/kg dose of LPS was used to mimic depressive-like behaviors and melatonin was given at a dose of 500 mg / kg for 4 times with 6 hour intervals, starting at 2 hours before LPS administration. Behavioral assessment was carried out at 24 hours post-LPS injection by tail suspension and forced swimming tests. Additionally, hippocampal cytokine and NLRP3 protein levels were estimated. Melatonin increased mobility time of LPS-induced DLB mice and suppressed NLRP3 expression and interleukin-1 (IL-1) cleavage in the hippocampus. Immunofluorescence staining of hippocampal tissue showed that NLRP3 is mainly expressed in ionized calcium-binding adapter molecule 1 (Iba1) -positive microglia. Our results show that melatonin prevents LPS and Adenosine triphosphate (ATP) induced NLRP3 inflammasome activation in murine microglia in vitro, evidenced by inhibition of NLRP3 expression, Apoptosis-associated speck-like protein containing a CARD (ASC) speck formation, caspase-1 cleavage and interleukin-1 (IL-1) maturation and secretion. Additionally, melatonin inhibits pyroptosis, production of mitochondrial and cytosolic reactive oxygen species (ROS) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling. The beneficial effects of melatonin on NLRP3 inflammasome activation were associated with nuclear factor erythroid 2–related factor 2 (Nrf2) and Silent information regulator 2 homolog 1 (SIRT1) activation, which were reversed by Nrf2 siRNA and SIRT1 inhibitor treatment.

BACKGROUND: Preclinical studies and results of a phase 2 trial of abiraterone and olaparib suggest a combined antitumor effect when the poly(adenosine diphosphate[ADP]-ribose) polymerase inhibitor olaparib is combined with next-generation hormonal agent abiraterone to treat metastatic castration-resistant prostate cancer (mCRPC). METHODS: We conducted a double-blind, phase 3 trial of abiraterone and olaparib versus abiraterone and placebo in patients with mCRPC in the first-line setting. Patients were enrolled regardless of homologous recombination repair gene mutation (HRRm) status. HRRm status was determined following enrollment by tumor tissue and circulating tumor DNA tests. Patients were randomly assigned (1:1) to receive abiraterone (1000 mg once daily) plus prednisone or prednisolone with either olaparib (300 mg twice daily) or placebo. The primary end point was imaging-based progression-free survival (ibPFS) by investigator assessment. Overall survival was among the secondary end points. RESULTS: At this planned primary analysis at the first data cutoff, median ibPFS was significantly longer in the abiraterone and olaparib arm than in the abiraterone and placebo arm (24.8 vs. 16.6 months; hazard ratio, 0.66; 95% confidence interval [CI], 0.54 to 0.81; P<0.001) and was consistent with blinded independent central review (hazard ratio, 0.61; 95% CI, 0.49 to 0.74). At this data cutoff, overall survival data were immature (28.6% maturity; hazard ratio, 0.86; 95% CI, 0.66 to 1.12; P=0.29). The safety profile of olaparib and abiraterone was consistent with the known safety profiles of the individual drugs. The most common adverse events in the abiraterone and olaparib arm were anemia, fatigue/asthenia, and nausea. CONCLUSIONS: At primary analysis at this first data cutoff, abiraterone combined with olaparib significantly prolonged ibPFS compared with abiraterone and placebo as first-line treatment for patients with mCRPC enrolled irrespective of HRRm status. (Funded by AstraZeneca and Merck Sharp & Dohme, LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA; ClinicalTrials.gov number, NCT03732820.)

BACKGROUND: TREM2 is a transmembrane receptor that is predominantly expressed by microglia in the central nervous system. Rare variants in the TREM2 gene increase the risk for late-onset Alzheimer's disease (AD). Soluble TREM2 (sTREM2) resulting from shedding of the TREM2 ectodomain can be detected in the cerebrospinal fluid (CSF) and is a surrogate measure of TREM2-mediated microglia function. CSF sTREM2 has been previously reported to increase at different clinical stages of AD, however, alterations in relation to Amyloid β-peptide (Aβ) deposition or additional pathological processes in the amyloid cascade (such as tau pathology or neurodegeneration) remain unclear. In the current cross-sectional study, we employed the biomarker-based classification framework recently proposed by the NIA-AA consensus guidelines, in combination with clinical staging, in order to examine the CSF sTREM2 alterations at early asymptomatic and symptomatic stages of AD. METHODS: (A), phosphorylated tau (T) and total tau as a marker of neurodegeneration (N), at different clinical stages defined by the clinical dementia rating (CDR) score. RESULTS: CSF sTREM2 differed between TREM2 variants, whereas the p.R47H variant had higher CSF sTREM2, p.L211P had lower CSF sTREM2 than non-carriers. We found that CSF sTREM2 increased in early symptomatic stages of late-onset AD but, unexpectedly, we observed decreased CSF sTREM2 levels at the earliest asymptomatic phase when only abnormal Aβ pathology (A+) but no tau pathology or neurodegeneration (TN-), is present. CONCLUSIONS: Aβ pathology (A) and tau pathology/neurodegeneration (TN) have differing associations with CSF sTREM2. While tau-related neurodegeneration is associated with an increase in CSF sTREM2, Aβ pathology in the absence of downstream tau-related neurodegeneration is associated with a decrease in CSF sTREM2.

Autosomal recessive distal renal tubular acidosis (rdRTA) is characterised by severe hyperchloraemic metabolic acidosis in childhood, hypokalaemia, decreased urinary calcium solubility, and impaired bone physiology and growth. Two types of rdRTA have been differentiated by the presence or absence of sensorineural hearing loss, but appear otherwise clinically similar. Recently, we identified mutations in genes encoding two different subunits of the renal alpha-intercalated cell's apical H(+)-ATPase that cause rdRTA. Defects in the B1 subunit gene ATP6V1B1, and the a4 subunit gene ATP6V0A4, cause rdRTA with deafness and with preserved hearing, respectively. We have investigated 26 new rdRTA kindreds, of which 23 are consanguineous. Linkage analysis of seven novel SNPs and five polymorphic markers in, and tightly linked to, ATP6V1B1 and ATP6V0A4 suggested that four families do not link to either locus, providing strong evidence for additional genetic heterogeneity. In ATP6V1B1, one novel and five previously reported mutations were found in 10 kindreds. In 12 ATP6V0A4 kindreds, seven of 10 mutations were novel. A further nine novel ATP6V0A4 mutations were found in "sporadic" cases. The previously reported association between ATP6V1B1 defects and severe hearing loss in childhood was maintained. However, several patients with ATP6V0A4 mutations have developed hearing loss, usually in young adulthood. We show here that ATP6V0A4 is expressed within the human inner ear. These findings provide further evidence for genetic heterogeneity in rdRTA, extend the spectrum of disease causing mutations in ATP6V1B1 and ATP6V0A4, and show ATP6V0A4 expression within the cochlea for the first time.

Pancreatic cancer is a fatal malignancies which is predominantly seen in men and at advanced age (40-85 years) and has an aggressive course. Its frequency is gradually increasing over the past years. It accounts for 2% of all cancers and 5% of cancer-related deaths. Pancreatic cancer takes the first place among asymptomatic cancers. Ninety percent of cases are adenocarcinomas. Ten percent of the patients have a familial disposition. The disease is very difficult to detect as it has no early signs and spreads rapidly to surrounding organs is one of the most deadly types of cancer. Pancreatic cancer may result from hereditary germline or somatic acquired mutations in cancer-related genes and mutations also cause cancer progression and metastasis.

This study comprised the development of a new index called the ‘universal water quality index (UWQI)’. This index has advantages over pre-existing indices by reflecting the appropriateness of water for specific use, e.g. drinking water supply rather than general supply, and has been developed by studying the supranational standard, i.e. the European Community Standard. Three classification schemes for water quality are proposed for surface water quality assessment. Water quality determinants of the new index are cadmium, cyanide, mercury, selenium, arsenic, fluoride, nitrate-nitrogen, dissolved oxygen, biochemical oxygen demand, total phosphorus, pH and total coliform. The mathematical equations to transform the actual concentration values into quality indices have been formulated. The weighted sum method was proposed to obtain overall index scores based on individual index (sub-index) values. The application of the new index was demonstrated at a sampling station on Tahtali Reservoir in Turkey based on observed water quality data. Results revealed that the overall quality of the surface water falls under the ‘excellent’ class. On the other hand water quality was strongly affected by agricultural and domestic uses. This technique is believed to assist decision makers in reporting the state of the water quality, as well as investigating spatial and temporal changes. It is also useful to determine the level of acceptability for the individual parameter by referring to the concentration ranges defined in the proposed classification scheme.

AIM: To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS: A retrospective review of patients aged > 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS: There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION: Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.

Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated9 (Cas9) endonuclease system is a powerful RNA-guided genome editing tool. CRISPR/Cas9 has been well studied in model plant species for targeted genome editing. However, few studies have been reported on plant species without whole genome sequence information. Currently, no study has been performed to manipulate metabolic pathways using CRISPR/Cas9. In this study, the type II CRISPR/SpCas9 system was used to knock out, via nonhomologous end-joining genome repair, the 4'OMT2 in opium poppy (Papaver somniferum L.), a gene which regulates the biosythesis of benzylisoquinoline alkaloids (BIAs). For sgRNA transcription, viral-based TRV and synthetic binary plasmids were designed and delivered into plant cells with a Cas9 encoding-synthetic vector by Agrobacterium-mediated transformation. InDels formed by CRISPR/Cas9 were detected by sequence analysis. Our results showed that the biosynthesis of BIAs (e.g. morphine, thebaine) was significantly reduced in the transgenic plants suggesting that 4'OMT2 was efficiently knocked-out by our CRISPR-Cas9 genome editing approach. In addition, a novel uncharacterized alkaloid was observed only in CRISPR/Cas9 edited plants. Thus, the applicabilitiy of the CRISPR/Cas9 system was demonstrated for the first time for medicinal aromatic plants by sgRNAs transcribed from both synthetic and viral vectors to regulate BIA metabolism and biosynthesis.

BACKGROUND: Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3-5), HD and RT patients with a control group of patients is still lacking. METHODS: We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3-5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared. RESULTS: A total of 1210 patients were included [median age, 61 (quartile 1-quartile 3 48-71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9-45.2; and 82/289 (28.4%); 95% CI 23.9-34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3-29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0-20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2-30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7-19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8-10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5-6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52-5.44); P = 0.001; 2.44 (1.35-4.40); P = 0.003; HD: 2.32 (1.21-4.46); P = 0.011; 2.25 (1.23-4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76-4.72); P = 0.169; 1.87 (0.81-4.28); P = 0.138, respectively]. CONCLUSIONS: Hospitalized COVID-19 patients with CKDs, including Stages 3-5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3-5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on Antibiotics in Endodontics. The statement is based on current scientific evidence as well as the expertise of the committee. The goal is to provide dentists and other healthcare workers with evidence-based criteria for when to use antibiotics in the treatment of endodontic infections, traumatic injuries of the teeth, revascularization procedures in immature teeth with pulp necrosis, and in prophylaxis for medically compromised patients. It also highlights the role that dentists and others can play in preventing the overuse of antibiotics. A recent review article provides the basis for this position statement and more detailed background information (International Endodontic Journal, 2017, https://doi.org/10.1111/iej.12741). Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

In late December 2019, reports from China of the incidence of pneumonia with unknown etiology were sent to the World Health Organization (WHO). Shortly afterwards, the cause of this disease was identified as the novel beta-coronavirus, SARS-CoV-2, and its genetic sequence was published on January 12, 2020. Human-to-human transmission via respiratory droplets and contact with aerosol infected surfaces are the major ways of transmitting this virus. Here we attempted to collect information on virus stability in the air and on surfaces and ways of preventing of SARS-CoV-2 spreading.

In the paper titled “Does Urinary Bladder Shape Affect Urinary Flow Rate in Men with Lower Urinary Tract Symptoms?” we should add an author who has contributed to our study for the images: Murat Cinar, Department of Biomedical Engineering, Faculty of Engineering and Architecture, Izmir Katip Celebi University, 35620 Izmir, Turkey. In addition we should here correct the affiliation of one of the authors named Omer Karal and the postal code in the affiliation of the author Mahmut Pekedis.

BACKGROUND: It is well known that diabetes mellitus is associated with impairment of testicular function. In the present study, we aimed to demonstrate the effect of melatonin on testicular damage in male rats with streptozotocin (STZ)-induced diabetes. METHODS: Male Wistar rats were divided into 4 groups: (1) control group, (2) melatonin-treated nondiabetic group, (3) diabetic group and (4) melatonin-treated diabetic group. Diabetes was induced by STZ injection. Melatonin was administered intraperitoneally at the dose of 10 mg/kg for 5 days. Testicular damage was examined by using hematoxylin and eosin staining and periodic acid-Schiff staining, and apoptosis was determined by terminal-deoxynucleotidyl-transferase-mediated dUTP nick end labeling (TUNEL). Potential disorders associated with seminiferous tubular sperm formation were evaluated using the Johnsen score. RESULTS: Diabetic rats showed a reduction in seminiferous tubule diameter, increased thickening of the basement membrane in seminiferous tubules and degenerated germ cells. TUNEL-positive cells were significantly more numerous in diabetic rats than in control rats. Melatonin significantly attenuated the diabetes-induced morphological changes and germ cell apoptosis in the diabetic rat testis. The number of polymorphonuclear leukocytes was significantly decreased in group 4 when compared to group 3. CONCLUSIONS: These results suggest that intraperitoneal administration of melatonin for 5 days is a potentially beneficial agent to reduce testicular damage in adult diabetic rats, probably by decreasing oxidative stress.

Heart disease remains the leading cause of death, such that nearly one-third of all deaths worldwide are estimated to be caused by heart-related conditions. Advancing applications of classification-based machine learning to medicine facilitates earlier detection. In this study, the Classification and Regression Tree (CART) algorithm, a supervised machine learning method, has been employed to predict heart disease and extract decision rules in clarifying relationships between input and output variables. In addition, the study’s findings rank the features influencing heart disease based on importance. When considering all performance parameters, the 87% accuracy of the prediction validates the model’s reliability. On the other hand, extracted decision rules reported in the study can simplify the use of clinical purposes without needing additional knowledge. Overall, the proposed algorithm can support not only healthcare professionals but patients who are subjected to cost and time constraints in the diagnosis and treatment processes of heart disease.

BACKGROUND: Coronary artery anomalies are found in 0.2% to 1.3% of patients undergoing coronary angiography and 0.3% of an autopsy series. We aimed to estimate the frequency of coronary artery anomalies in our patient population. METHODS: The data were collected retrospectively by analyzing the angiographic data of 12 457 consecutive adult patients undergoing coronary angiography between September 2002 and October 2007. RESULTS: Coronary artery anomalies were found in 112 patients (0.9% incidence), 100 patients (89.3%) had origin and distribution anomalies, and 12 patients (10.7%) had coronary artery fistulae. Their mean age was 52 ± 8 years (range, 22-79 y). Separate origins of left anterior descending and left circumflex coronary artery from the left sinus of Valsalva was the most common anomaly (63.4%). The right coronary artery rising from the left coronary sinus of Valsalva was found in 10 (8.9%) patients. Anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva was seen in 10 (8.9%) patients. The left main coronary artery from the right coronary sinus of Valsalva was found in 1 (0.89%) patient while an isolated single coronary artery was seen in 2 (1.78%) patients. CONCLUSION: The incidence and the pattern of coronary artery anomalies in our patient population were almost identical with previous studies. Cardiologists should be aware of the coronary anomalies which may be associated with potentially serious cardiac events, because recognition of these coronary anomalies is mandatory in order to prescribe appropriate therapy.

This review article comprehensively examines the role of nanotechnology in advancing medical science, with a focus on its applications in drug delivery, diagnostics, and tissue engineering. We explore the classification of nanomaterials based on dimensionality, composition, and dispersion, and discuss their critical role in revolutionizing medicine. Nanomaterials such as liposomes, protein-based nanoparticles, and dendrimers are highlighted for their ability to enhance drug delivery systems, improving targeting, bioavailability, and reducing side effects. We investigate theranostics, where nanoparticles integrate diagnostic imaging and treatment capabilities in a single platform, enabling more effective cancer therapies through targeted drug delivery. The article also covers advancements in tissue engineering, where nanomaterial-based scaffolds are used to regenerate damaged tissues and organs. We present novel developments in creating bioinspired scaffolds using chitosan, cellulose, and graphene oxide, which improve cell adhesion and enhance mechanical properties for tissue regeneration. The review also discusses the nanoparticles’ potential in bioimaging tools such as MRI, PET, and fluorescent imaging. We highlight cutting-edge developments in nanoparticle-based contrast agents that improve imaging accuracy and enable real-time monitoring of therapeutic interventions. Our review stands out by integrating recent advancements in the multifunctional use of nanomaterials for personalized medicine. We address the challenges of toxicity, regulatory concerns, and the future potential of nanotechnology in clinical translation, positioning this work as a significant contribution to the field of nanomedicine. Nanomedicine is an emerging field that harnesses the unique properties of nanomaterials to revolutionize healthcare, offering significant advances in diagnostics, targeted drug delivery, therapeutic interventions, and tissue engineering. This review comprehensively examines the various categories of nanomaterials, including metal-based (e.g., gold and silver), carbon-based (e.g., graphene and carbon nanotubes), organic (e.g., dendrimers and liposomes), and hybrid materials, highlighting their potential applications in drug delivery, bioimaging, and theranostics. Nanomaterials are utilized for their ability to improve drug bioavailability, target specific tissues, and enable precise control over drug release, making them highly effective in treating diseases like cancer and neurological disorders. The review explores the mechanisms and clinical applications of key imaging technologies such as Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), fluorescence, and surface-enhanced Raman scattering (SERS), where nanomaterials significantly enhance sensitivity, resolution, and tissue penetration. Additionally, the role of aggregation-induced emission (AIE) in fluorescence imaging and the promise of nanoparticle-based theranostic platforms—integrating both diagnostic and therapeutic functions—are discussed in depth. These multifunctional nanoparticles have the potential to revolutionize personalized medicine by offering precise disease monitoring and treatment simultaneously. Further, the review delves into the clinical progress and regulatory aspects of nanomedicine, noting recent advancements in clinical trials and approved therapies, including mRNA-based vaccines and targeted nanomedicine therapies for cancer. The development of nanoparticle-based scaffolds for tissue regeneration and their integration into clinical practice are also highlighted, alongside challenges in biocompatibility, toxicity, and scalability. The discussion includes insights into patents, ongoing clinical studies, and the road ahead for overcoming current limitations in nanomedicine. This review provides a holistic view of the state of nanomedicine, offering a comprehensive understanding of its current and future impact on healthcare, therapeutic efficacy, and clinical translation.

Flavonoids have been recently identified as a potential anticancer agent against various human epithelial cancers. In this study, the elucidation of mechanisms underlying the anticancer effects of the apigenin, luteolin and myricetin will be new knowledge about preventive strategies against epithelial ovarian cancer in which the effect of flavonoids is still unclear. The cytotoxic effect of flavonoids was assessed by MTT analysis of the ovarian cancer cells (A2780, OVCAR-3 and SKOV-3) in comparison to the ovarian epithelial cells (OSE). The intracellular reactive oxygen species (ROS) generation, malondialdehyde (MDA) and protein carbonyl levels, caspase-3 and -9 activities were evaluated using fluorescence spectrometry. Apoptosis and cell cycle arrest, and cell invasion were measured by flow cytometry and Boyden chamber assay, respectively. MTT analysis showed that flavonoids selectively decreased the cell viability of cancer cells. Furthermore, the intracellular ROS generation was induced or scavenged by flavonoids depending on the structural differences. The flavonoids increased MDA levels due to the disruption of the membrane. Caspase activities indicated that flavonoids activated the extrinsic apoptotic pathway when ROS was scavenged. In contrast, the induced intracellular ROS generation resulted in the activation of the intrinsic apoptotic pathway. In addition, the cell cycle was arrested in different cell cycle phases and cell invasion on the collagen was disrupted by flavonoids. The anticancer activities of apigenin, luteolin and myricetin were attributed to the alterations of ROS signaling, and as well as the induction of apoptosis, cell cycle arrest and abrogation of the invasion. The present study may uncover new strategies for ovarian cancer therapy.

Federated learning (FL) is a distributed machine learning process, which allows multiple nodes to work together to train a shared model without exchanging raw data. It offers several key advantages, such as data privacy, security, efficiency, and scalability, by keeping data local and only exchanging model updates through the communication network. This review paper provides a comprehensive overview of federated learning, including its principles, strategies, applications, and tools along with opportunities, challenges, and future research directions. The findings of this paper emphasize that federated learning strategies can significantly help overcome privacy and confidentiality concerns, particularly for high-risk applications.

Cognitive and behavioral impairments are found more often among epileptic children than among their peers. In this study, we evaluated the anxiety and depression in epileptic children to compare their results with that of a healthy control group and to determine the relationship of anxiety and depression scores to epilepsy-related factors. The State Trait Anxiety Inventory (STAI) and Children's Depression Inventory (CDI) were applied to 35 patients with epilepsy aged 9 to 18 years (mean age 12.9 +/- 2.52 years) and to 35 healthy children who served as the control group. Both study and control groups were divided into two age groups (9 to 11 and 12 to 18 years) to exclude the effect of puberty on anxiety and depression scores. Significant depression and suicidal ideation were determined in the study group. The mean trait anxiety score was significantly higher in the 9- to 11-year age group of epileptic patients than the corresponding control group (35.90 +/- 6.90 and 29.33 +/- 2.84, P < .05). The mean state anxiety score (33.90 +/- 3.90 and 30.40 +/- 6.02, P < .05), trait anxiety score (38.20 +/- 6.84 and 32.20 +/- 3.90, P < .05), and depression score (16.65 +/- 8.32 and 8.15 +/- 3.15, P < .05) were significantly higher in the 12- to 18-year age group of epileptic children than in the control group. Among the epilepsy-related factors, whereas epilepsy duration, seizure frequency, and polytherapy were determined to increase anxiety and depression, age of seizure onset, seizure type, and electroencephalographic findings were not related to anxiety and depression. Symptoms of anxiety and depression are common among epileptic children, especially during puberty. The State Trait Anxiety Inventory and Children's Depression Inventory may be used as a tool to provide information to clinicians.

The aim of this study was to evaluate the preoperative and operative presentations of one paediatric and 30 adult patients with bronchogenic cyst of the mediastinum (n = 11) and lung (n = 20). At initial presentation, six patients were asymptomatic and 25 were symptomatic. The mean age of asymptomatic and symptomatic patients was 25 and 33 yrs, respectively. Six patients presented with complications, including superior vena cava syndrome, tracheal compression, pneumothorax, pleurisy and pneumonia. Two patients who were asymptomatic when initially observed eventually needed surgery because of the development of symptoms or enlargement of the cyst size. In one patient, the cyst was not seen on the chest radiograph but appeared as a lobulated nodule of 2 cm diameter in a chest computerized tomography (CT) scan. Operative difficulties were encountered in 13 patients, all of whom were symptomatic preoperatively. In conclusion, life-threatening complications occurred in these patients. Despite various diagnostic studies, definitive tissue diagnosis was established only by means of surgical excision. The frequency of operative difficulties in symptomatic cysts was higher than those of asymptomatic cysts. Surgery may be considered as the treatment of choice even when the cyst is asymptomatic, since complications are not uncommon.