Objectives: In this study, the systemic proinflammatory status was assessed using the systemic immune-inflammation index (SII) and SIRI systemic immune-inflammatory response index (SIRI) in children and adolescents with type 1 diabetes mellitus (T1DM). Methods: The study involved 159 patients aged between 6 and 16 years. The SII and SIRI values were calculated based on the complete blood count. Basic blood biochemistry evaluated, and carotid intima-media thickness (cIMT) was measured and recorded. The cumulative glycemic exposure was calculated by multiplying the value above the normal reference range of the HbA_1c value. The sum of all these values obtained from the time of diagnosis to obtain the cumulative glycemic exposure. All findings were compared statistically. All statistically significant parameters were evaluated in the multivariate logistic regression analysis. Results: The analysis revealed that only cIMT (Exp(B)/OR: 0.769, 95 % CI: 0.694–0.853, p<0.001), high-density lipoprotein (Exp(B)/OR: 3.924, 95 % CI: 2.335–6.596, p<0.001), monocyte count (Exp(B)/OR: 1.650, 95 % CI: 1.257–2.178, p<0.001), hematocrit (Exp(B)/OR: 0.675, 95 % CI: 0.523–0.870, p<0.001), and SIRI (Exp(B)/OR: 1.005, 95 % CI: 1.002–1.008, p<0.001) were significantly associated with T1DM. A statistically significant positive association was found between cumulative glycemic exposure and SIRI only (r=0.213, p=0.032). To our knowledge, this is the first study to evaluate SII and SIRI in children with type 1 diabetes. Conclusions: These findings indicate that SIRI could serve as a potential biomarker for detecting early-onset proatherosclerotic processes in diabetic children. However, further clinical studies are required to confirm this.

Active surveillance (AS) is an established strategy for managing low-risk prostate cancer (LRPCa), aiming to reduce overtreatment while maintaining oncological safety. This retrospective cohort study included 102 patients diagnosed with LRPCa between 2015 and 2025, managed with serial prostate-specific antigen (PSA) testing, digital rectal examination, multiparametric MRI (mpMRI), and confirmatory biopsies. Transition criteria included Gleason score upgrading, PSA progression, lesion progression on mpMRI, or patient preference. The median follow-up was 16 months (range: 6–123), while the estimated median surveillance duration was 36 months (95% confidence interval: 30–42). Retention rates at 2 and 5 years were 72% and 50%, respectively. A total of 35.3% (36/102) of patients discontinued AS, most frequently due to patient preference (61.1%), followed by PSA progression (25.0%) and histopathological upgrading (13.9%). Only 25.5% (26/102) of patients underwent confirmatory biopsy during follow-up, reflecting suboptimal adherence that may have contributed to an underestimation of true pathological progression. Multivariate analysis revealed that higher final PSA levels (odds ratio [OR]: 1.559, P = .001), abnormal digital rectal examination findings (OR: 11.079, P < .001), and Prostate Imaging-Reporting and Data System 4 to 5 lesions on mpMRI (OR: 5.482, P < .001) were independently associated with transition to definitive treatment. These findings suggest that AS remains a feasible and effective management strategy for LRPCa, though confirmatory biopsies and structured psychological support are essential to optimize adherence and prevent overtreatment. Future studies should investigate the integration of biomarkers and AI-assisted imaging in refining AS protocols.

Urinary stone disease is a common urological disorder, particularly among middle-aged individuals. Extracorporeal Shock Wave Lithotripsy (ESWL) is often the first-line treatment for kidney and ureteral stones. Traditionally, fluoroscopy is used for stone targeting in ESWL, but it exposes patients and clinicians to radiation and cannot visualize non-opaque stones. Ultrasonographic targeting eliminates these issues. This study compares the advantages and disadvantages of fluoroscopy and ultrasound-targeted ESWL. At Düzce University Hospital, 100 patients with radio-opaque stones indicated for ESWL between February 2023 and February 2024 were divided into two groups. Group A underwent ESWL with fluoroscopic targeting, while Group B used ultrasonographic targeting. Patient demographics, stone size (measured by CT), and stone locations were recorded. The number of shocks per session, energy intensity (kV), and fluoroscopy time were noted for Group A. One week after each ESWL session, patients were evaluated by ultrasound or direct radiography. Success was defined as being stone-free or having ≤ 4 mm asymptomatic residual stones after up to four sessions. Failure was defined as no results after two sessions or the need for additional treatment. The procedure success rate was 66% for men and 78% for women, with no statistically significant gender difference (p > 0.05). Stone locations were similar in both groups. Success rates were 66% in Group A and 74% in Group B, with no significant difference (p > 0.05). Successful procedures were associated with an average patient weight of 76.6 kg, stone size of 8.9 mm, and total energy of 12.2 kV, with significant differences compared to unsuccessful procedures (p < 0.04, p < 0.04, p < 0.001, respectively). No significant differences were found between Group A and Group B in terms of age, height, BMI, stone density (HU), and number of sessions (p > 0.05). Ultrasonography is as effective as fluoroscopy for imaging and focusing during ESWL treatment. It enhances the success of ESWL for non-opaque stones and reduces radiation exposure disadvantages.

Background/Objectives: It has been suggested that chronic inflammatory diseases may be associated with an increased risk of cardiovascular disease. In this study, we investigated plasma soluble CD40 ligand (sCD40L) levels and their association with carotid intima–media thickness (cIMT) in children with Familial Mediterranean fever (FMF). Methods: The study was designed as a prospective cross-sectional study. The study included 68 asymptomatic children aged 5–18 years with FMF, diagnosed according to Tel Hashomer criteria, who were followed up regularly for at least one year, receiving regular colchicine treatment and not in an acute exacerbation period, along with 65 healthy children with similar demographic characteristics. cIMT was assessed by ultrasound and plasma sCD40L levels were measured by sandwich ELISA in all children. Results: Erythrocyte sedimentation rate, high-sensitivity C-reactive protein and serum amyloid A levels were not significantly different between patients and controls. However, sCD40L (p = 0.004) and fibrinogen (p = 0.011) levels were significantly higher in the FMF group compared to the control group. No significant difference was found between the patient and control groups in terms of carotid intima–media thickness (p = 0.517). Multivariate logistic regression was performed to assess the independent associations of fibrinogen and sCD40L with FMF. The results of this analysis indicated that sCD40L, but not fibrinogen, demonstrated a significant association with FMF (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.001–1.006, p = 0.011). To determine the diagnostic performance of sCD40L, a receiver operating characteristic (ROC) curve was generated. This analysis demonstrated that sCD40L levels exceeding 100 pg/mL were predictive of FMF, yielding a sensitivity of 70.6% and a specificity of 62.3%. The positive predictive value and negative predictive value were 55.4% and 64.3%, respectively. The area under the curve for sCD40L was 0.644 (95% CI: 0.549–0.738, p = 0.004), signifying a statistically significant predictive capacity. Plasma sCD40L levels were significantly higher in FMF children with the M694V mutation (p = 0.013). Conclusions: The results of this study suggest that the high plasma sCD40L levels found in children with FMF may be related to the inflammatory activation of the disease rather than to atherosclerosis.

Background: Although transrectal ultrasound (TRUS)-guided prostate biopsy is widely used for prostate cancer diagnosis, the role of pre-biopsy ejaculation in influencing procedural outcomes and complication risk remains largely unexplored. This study aimed to evaluate whether recent ejaculation affects seminal vesicle volume, biopsy-related complications, and patient-reported outcomes. Methods: In this prospective comparative study, 32 patients undergoing TRUS-guided 12-core prostate biopsy were divided into two groups based on their sexual activity: the ejaculation group (n = 14), who ejaculated within 24 h prior to the procedure, and the abstinence group (n = 18), who reported abstinence for at least 3 days. Data collected included seminal vesicle volume, pain scores, urinary symptoms, erectile function, quality of life, and post-procedural complications. Histopathological results were also recorded and summarized. ROC analyses were used to determine cutoff values for key complications. Although transperineal biopsy is now recommended by current EAU guidelines, our study was conducted using the transrectal approach, which remains widely practiced and relevant in clinical settings. Results: While seminal vesicle volume tended to be higher in the abstinence group, the difference was not statistically significant (p = 0.184). No meaningful differences were found in pain perception, urinary symptoms, erectile function, or quality of life. However, hematospermia (p = 0.017) and hematochezia (p = 0.011) were significantly more frequent in the ejaculation group. ROC analysis showed that abstinence ≤ 7.5 days predicted hematospermia (AUC = 0.731), and abstinence ≤ 2 days predicted hematochezia (AUC = 0.760). A pain score ≥ 1.5 was predictive of hematuria (AUC = 0.810). Histological analysis revealed benign findings in the majority of patients, with no significant difference in cancer grade between groups. Conclusion: Ejaculation prior to TRUS-guided prostate biopsy may increase the risk of certain complications without negatively affecting patient comfort. Abstinence duration could serve as a simple and modifiable factor in optimizing biopsy preparation. Despite the limited sample size, this prospective study provides preliminary evidence supporting patient counseling on sexual activity prior to biopsy.

Background and Objectives: Gestational hydronephrosis (GH) is a physiological condition commonly observed during pregnancy, resulting from hormonal effects and mechanical compression of the ureters by the enlarging uterus. Although often asymptomatic, GH can cause urinary stasis, recurrent infections, and renal function impairment in symptomatic cases. The optimal management of such cases remains controversial, especially regarding the role of ureteral stent placement. This study aimed to compare clinical outcomes—including renal function, inflammatory markers, and obstetric parameters—in pregnant women with symptomatic GH who underwent ureteral stent placement versus those managed conservatively. Materials and Methods: We conducted a retrospective cohort study at Düzce University Hospital between 2020 and 2024, including 40 pregnant women diagnosed with symptomatic GH. The patients were divided into the following two groups: those who received a ureteral stent (n = 20) and those who were managed with conservative treatment (n = 20). Conservative management included hydration therapy, acetaminophen-based analgesia, and close clinical monitoring. The parameters assessed included serum creatinine, estimated glomerular filtration rate (GFR), inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count), urinary findings, obstetric outcomes, and postpartum complications. Statistical significance was set at p < 0.05. Results: Gestational age at diagnosis was significantly higher in the stent group (29.1 ± 3.2 weeks) than in the non-stent group (27.1 ± 3.5 weeks; p = 0.045), possibly reflecting increased mechanical compression in later pregnancy. Renal function parameters (serum creatinine and GFR), inflammatory markers (CRP, ESR, and WBC count), and obstetric outcomes (birth weight, Apgar scores) showed no significant differences between groups (p > 0.05). Interestingly, gestational diabetes mellitus (GDM) was more prevalent in the non-stent group (20% vs. 5%; p = 0.042), although no significant differences were found in fasting glucose levels. Conclusions: Ureteral stent placement in symptomatic GH does not appear to significantly improve renal function or obstetric outcomes. However, it may provide symptom relief in select patients with persistent or severe discomfort. Given the limitations of retrospective data and a small sample size, further prospective studies with larger cohorts and quality-of-life assessments are warranted to optimize management strategies and enhance patient-centered care.