Sentinel lymph node biopsy (SLNB) is the current standard of care for breast cancers with no clinically palpable axillary lymph nodes. Almost 50 % of sentinel lymph node positive patients have negative non-sentinel nodes and undergo non-therapeutic axillary dissection. Five different scoring systems, reported in the literature, were compared for their predictive ability of non-SLN involvement in patients with SLN positive breast cancer. 242 patients who underwent breast surgery and SLNB were included in the study. Of these, 70 who were confirmed to have SLN metastasis and received complementary ALND and constituted the final study population. The nomograms (MSKCC, M.D. Anderson Cancer Center, Tenon model, Stanford and Turkish) were statistically compared for their prediction of non-SLN metastasis (95 % confidence interval). We have determined only two clinicopathologic (multifocality and size of the primary tumor) situations which have a statistically significant association between SLN metastasis with using a multivariate logistic regression analysis. Multifocality (P = 0.001) and size of the primary tumor (P = 0.001) were associated with a higher probability of-SLN metastasis. No predictive model was constructed that showed good area under the curve (AUC) discrimination in the validation series. Currently published predictive models lack accuracy when applied to a different population. Multi-institutional heterogenic population studies are important to determine the exact combination of scoring systems and/or nomograms.

Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis. Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail. A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative albumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively). The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.

Objective: The objective of this study was to identify potential robust acoustic biomarkers for functional post-thyroidectomy voice disorder (PTVD) that may support early diagnosis and personalized treatment strategies, using acoustic analysis and explainable machine learning methods. Methods: Spectral and cepstral features were extracted from /a/ and /i/ voice recordings collected preoperatively and 4–6 weeks postoperatively from a total of 126 patients. Various Support Vector Machine (SVM) and Boosting models were trained. SHapley Additive exPlanations (SHAP) analysis was applied to enhance interpretability. SHAP values from training and test sets were compared via scatter plots to identify stable candidate biomarkers with high consistency. Results: GentleBoost (AUC = 0.85) and LogitBoost (AUC = 0.81) demonstrated the highest classification performance. Performance metrics across all models were evaluated for statistical significance. DeLong’s test was conducted to assess differences between ROC curves. The features iCPP, aCPP, and aHNR were identified as stable candidate biomarkers, exhibiting consistent SHAP distributions in both training and test sets in terms of direction and magnitude. These features showed statistically significant correlations with PTVD (p < 0.05) and demonstrated strong effect sizes (Cohen’s d = −2.95, −1.13, −0.60). Their diagnostic relevance was further supported by post hoc power analyses (iCPP: 1.00; aCPP: 0.998). Conclusions: SHAP-supported machine learning models offer an objective and clinically meaningful approach for evaluating PTVD. The identified features may serve as potential biomarkers to guide individualized voice therapy decisions during the early postoperative period.

Objective: Improving the care of injuries resulting from terrorist attacks requires understanding injury mechanisms in armed conflicts. The aim of this study was to identify injury characteristics in military personnel with thoracoabdominal combat injuries resulting from terrorist attacks in urban settings. Material and Methods: A retrospective study of military personnel with thoracoabdominal injuries who were referred to a tertiary center after treating and stabilizing at a primary healthcare organization due to terror-related injuries in various urban regions of Turkey between June 2015 and December 2016 was performed. Results: A total of 70 patients were included in this study, of whom 87.1% were injured by explosives and 12.9% (n= 9) had gunshot wounds (GSWs). Mean injury severity score (ISS) was 21, blood transfusion amount was 3.7 units, and mortality rate was 8.5%. Patients injured by explosives had most commonly abdominal and extremity injuries (31.1%), whereas isolated abdominal injuries (55.6%) were observed among patients with GSWs. There were no significant differences between the mechanisms of injuries and the ISS, blood transfusion, and mortality (p= 0.635, p= 0.634, and p= 0.770, respectively). A significant correlation was observed between the ISS and transfusion amounts (r= 0.548, p< 0.001). Mortality was significantly higher in those with a high ISS and those undergoing massive blood transfusions (p= 0.004 and p< 0.001, respectively). Conclusion: Explosive injuries, concomitant vascular injuries, high ISS, and the need for massive transfusions increased the mortality rate in urban combat injuries. To quickly identify high-risk patients and improve the care of injuries, it is essential to use predictive models or scoring systems.