OBJECTIVE: Ventriculoatrial shunts (VAS) are increasingly used as a salvage option in pediatric hydrocephalus when ven-triculoperitoneal shunts (VPS) fail. Although ultrasound-guided percutaneous techniques facilitate catheter placement and reduce surgical trauma, the incidence and management of thrombotic complications remain insufficiently defined.
METHODS: We retrospectively analyzed eight pediatric patients who underwent ultrasound-guided percutaneous VAS place-ment between January 2019 and December 2024. Demographic characteristics, etiology of hydrocephalus, operative details, and post-operative complications were evaluated, with a particular focus on thrombotic events.
RESULTS: Patients underwent a mean of 3.8±1.3 VPS revisions before VAS placement. Myelomeningocele was the most com-mon etiology (50%). The mean operative time was 75.6±13.9 min, and the mean intraoperative blood loss was 86.25±43.07 mL. Post-operative complications occurred in 3 patients (37.5%), including thrombotic events in 2 patients (25%) and infection in 1 patient (12.5%). One patient required early shunt removal due to thrombus formation with vegetation, whereas another devel-oped late asymptomatic thrombosis requiring intervention. The internal jugular vein was the most commonly used access site.
CONCLUSION: Ultrasound-guided percutaneous VAS placement is a feasible and minimally invasive alternative in selected pediatric patients. However, thrombotic complications may be more frequent than previously reported and can occur both early and late in the post-operative period. These findings highlight the need for standardized surveillance protocols and further investigation into prophylactic strategies, including antiplatelet therapy.

OBJECTIVE: This study aimed to systematically map the intellectual evolution, thematic development, and collaborative patterns of oral anticoagulation research in atrial fibrillation (AF) from 2006 to 2025.
METHODS: This bibliometric study analyzed 11,039 documents indexed in the Web of Science Core Collection (2006–2025) using the Bibliometrix R package (version 4.x) within the R statistical environment (version 4.3.1) for comprehensive science mapping. The analytical workflow comprised descriptive performance analysis, collaboration network analysis, keyword co-occurrence analysis, strategic thematic mapping, and latent Dirichlet allocation (LDA) topic modeling.
RESULTS: Publication output increased exponentially from 2 articles per year (2006) to a peak of 960 per year (2021), with subsequent stabilization that may reflect consolidation of the field. The United States produced the highest number of publi-cations (3636; 32.9%). The RE-LY trial received the most citations (n=8788). Thematic mapping revealed two main research clusters: Motor themes (141 keywords), representing direct oral anticoagulant agents, stroke prevention, and clinical outcomes; and emerging/declining themes (43 keywords), including venous thromboembolism and pharmacokinetics. LDA topic modeling identified nine distinct research domains encompassing real-world data, safety reporting, and implementation guidelines.
CONCLUSION: The bibliometric patterns observed are consistent with a maturing research field, characterized by a gradual shift from efficacy-focused randomized trials toward real-world effectiveness studies, implementation science, and personal-ized anticoagulation strategies. Future research may benefit from increased emphasis on long-term adherence, health-eco-nomic outcomes, and personalized approaches integrating genetic, clinical, and patient-centered factors.

OBJECTIVE: Conventional treatments for advanced knee osteoarthritis (OA) are often insufficient, and surgery is not always feasible. This retrospective cohort study aimed to evaluate changes in pain, function, and safety over 12 months following ultrasound-guided genicular nerve radiofrequency ablation (GNRFA).
METHODS: We included 44 patients with chronic knee pain unresponsive to conservative treatments for at least 3 months. All patients underwent US-guided radiofrequency ablation of the superomedial, superolateral, and inferomedial genicular nerves. Pain numeric rating scale (NRS) and functional status Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed at baseline, and routinely at 1, 6, and 12 months post-procedure.
RESULTS: Compared to baseline, mean NRS and WOMAC scores decreased significantly at all follow-up points (p<0.001). Based on a ≥50% pain reduction threshold (clinical success), 81.8% of patients achieved success at 1 month, and 75.0% maintained it at 6 months. By 12 months, this rate declined to 11.4%. No statistically significant differences in outcomes were observed between radiological grades. A strong positive correlation between NRS and WOMAC scores was observed across all follow-up times. No serious adverse events were reported.
CONCLUSION: US-guided GNRFA was associated with improvements in pain and function, which were most pronounced within the first 6 months in patients with advanced knee OA. However, the marked decline in responder rates at 12 months suggests reduced durability beyond 6 months. These findings suggest that GNRFA may serve as a medium-term management option rather than a permanent solution, and that re-evaluation may be appropriate in patients with recurrent symptoms.

OBJECTIVE: Laparoscopic cholecystectomy (LC) is the gold standard surgical treatment for gallbladder diseases. This study aimed to evaluate the effectiveness of an intraoperative gallbladder scoring system in predicting surgical difficulty and periop-erative outcomes in patients undergoing LC.
METHODS: A total of 798 patients who underwent elective LC for cholecystopathy (symptomatic cholelithiasis, gallbladder polyps, and adenomyomatosis) performed by a single surgeon at our institution between March 2019 and February 2024 were retrospectively analyzed. Demographic characteristics, American Society of Anesthesiologists scores, and predisposing factors were recorded. The degree of intraoperative gallbladder adhesions was graded on a scale from 0 to 4 operative time, drain usage, conversion to open surgery, and post-operative complications were evaluated. The relationship between the intraoperative gallbladder score and surgical outcomes was statistically analyzed.
RESULTS: The mean age of the patients was 51 years, and 61% were female. The intraoperative gallbladder score was 1 in 45.9% of patients, 2 in 26.3%, 3 in 15.1%, and 4 in 10.5%. Drain placement was required in 33.1% of cases. The conversion rate to open surgery was 2.1%. The post-operative complication rate was 1.1%. A statistically significant association was found between increasing intraoperative gallbladder scores and drain usage, post-operative complications, and conversion to open surgery (p<0.05). No significant association was observed between the intraoperative score and the need for endo-scopic retrograde cholangiopancreatography.
CONCLUSION: The intraoperative gallbladder scoring system is a reliable and practical method for predicting surgical dif-ficulty and adverse perioperative outcomes in LC. Its routine use may support surgical decision-making and improve patient safety and surgical outcomes.

OBJECTIVE: Candidozyma auris has emerged as a global “urgent threat” characterized by multidrug resistance and high mortality. While six distinct lineages have been identified, Clade I (South Asian) is the primary driver of global nosocomial outbreaks and exhibits the most profound resistance profiles. This study aims to provide a high-resolution genomic charac-terization of Clade I, focusing on the consolidation of resistance mechanisms and virulence factors that support its global dominance.
METHODS: We performed a comprehensive genomic analysis focusing on a cohort of 647 Clade I isolates, selected from a total of 662 global C. auris genomes available in public repositories. Using a standardized bioinformatic pipeline, we conduct-ed core-genome single-nucleotide polymorphisms-based phylogenetic reconstruction, non-synonymous mutation profiling of key resistance genes (TAC1B, FKS1, ERG11/6/3), and functional mapping of virulence-related pathways (ALS4, secretable aspartyl proteases [SAP5], LIP1). The remaining isolates from Clades II to VI were utilized as comparative reference groups to identify clade-specific signatures.
RESULTS: Analysis of the Clade I cohort (n=647; 97.73% of the total dataset) revealed a significant consolidation of resis-tance markers. The Y132F and K143R substitutions in ERG11 were near-ubiquitous, often co-occurring with specific TAC1B variants (A640V, V742A). Notably, 24.32% of the Clade I isolates demonstrated a highly synchronized “genomic armor,” characterized by the simultaneous presence of TAC1B (A: YTDQ/A: GSVG), FKS1 (S: SL), and deletions in ERG6/ERG3. Viru-lence profiling showed high-frequency conservation of biofilm-associated (ALS4) and proteolytic (SAP5) genes, suggesting a synergistic evolution of resilience and pathogenicity.
CONCLUSION: This study delineates the genomic landscape of C. auris Clade I, highlighting how the consolidation of mul-tiple resistance and virulence markers contributes to its clinical success. The high frequency of multidrug-resistant genotypes within this lineage mandates a transition toward genome-led surveillance and personalized antifungal stewardship.

OBJECTIVE: Contemporary guidelines recommend conservative, non-pharmacological management as first-line treatment for low back pain (LBP), yet real-world implementation remains variable. Understanding temporal trends in prescribing pat-terns is essential for evaluating alignment with evidence-based recommendations. The purpose of this study was to evaluate changes in pharmacological and non-pharmacological treatment strategies for LBP in a tertiary physical medicine and reha-bilitation (PMR) outpatient clinic by comparing 2 time periods 4 years apart.
METHODS: This retrospective observational study reviewed medical records of consecutive adult patients (≥18 years) pre-senting with LBP during October–November 2021 (n=252) and October–November 2025 (n=267) at a tertiary PMR center. Treatment strategies were categorized as non-steroidal anti-inflammatory drugs (NSAIDs) alone, muscle relaxants alone, combination therapy (NSAID+muscle relaxant), or non-pharmacological management only. Statistical comparisons were performed using Chi-square tests and odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS: Overall pharmacological prescribing decreased significantly from 51.6% (130/252) in 2021 to 36.3% (97/267) in 2025 (OR: 0.54, 95% CI: 0.38–0.77, p=0.001). NSAID prescribing declined from 25.4% to 13.5% (p=0.001), whereas non-pharmacological management increased from 48.4% to 63.7% (p=0.001). The shift toward conservative management was most pronounced in patients aged ≥65 years, with pharmacological prescribing decreasing from 58.3% to 36.5% (OR: 0.41, 95% CI: 0.22–0.77, p=0.005).
CONCLUSION: Treatment strategies for LBP in a tertiary PMR setting appeared to reflect greater alignment with contem-porary guideline recommendations over the 4-year study period. These findings may reflect increasing alignment with con-temporary evidence-based recommendations emphasizing non-pharmacological approaches and reduced pharmacological exposure, particularly in older adults at higher risk of medication-related adverse events.

OBJECTIVE: Traditional rigid posterior lumbar fusion frequently induces adjacent segment disease due to non-physiological stress concentrations. While dynamic and semi-rigid posterior stabilization systems were introduced to preserve segmental motion and share biomechanical loads, the expanding global literature remains fragmented. This study aims to perform a comprehensive bibliometric and computational science mapping analysis to decode the global intellectual architecture, collab-orative networks, and shifting research frontiers of dynamic posterior spinal stabilization from 1999 to June 2026.
METHODS: Global literature metadata regarding dynamic posterior stabilization was systematically retrieved from the PubMed/MEDLINE database covering a 27-year timespan (1999–June 2026). Following Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines, an initial search yielded 375 records. A rigorous multi-step filtration and screening protocol was executed to remove ineligible and off-topic documents, resulting in a final, highly targeted dataset of 332 peer-reviewed articles. Quantitative bibliometric processing, social network mapping, and strategic thematic clustering were executed utilizing the open-source Bibliometrix package in R Studio (v4.3.2).
RESULTS: The field exhibits a sustained annual compounding growth rate of 5.27%, with publication volumes peaking sharply in 2010 and 2016. Scholarly output is heavily clustered within elite spinal literature, led by SPINE (n=29) and the Eu-ropean Spine Journal (n=27). Geographically and institutionally, a pioneer Turkish research cluster led by Ozer AF, Oktenoglu T, and Sasani M maintains a high publication volume and prominent research influence. Social network tracking identified a robust transatlantic collaboration axis connecting Turkish pioneers directly to elite North American institutions, alongside a substantial contemporary East Asian research surge. Chronological timeline (Trend Topics) and strategic thematic mapping revealed a profound paradigm shift: The research frontier has matured from basic hardware safety and clinical cohort valida-tion toward advanced engineering-driven computational optimization, heavily dominated by finite element analysis evaluating load-sharing configurations and prosthesis failure modalities. Conversely, complex posterior element configurations like total facet arthroplasty have drifted into declining quadrants.
CONCLUSION: Dynamic posterior stabilization remains a highly active research domain within mainstream spine surgery. The global scientific landscape has successfully evolved into a sophisticated bioengineering-driven discipline centered on computational simulation and sagittal alignment customization. Integrating advanced finite element modeling with long-term prospective multicenter registries will dictate the development of next-generation motion-preserving spinal implants.

OBJECTIVE: Ingrown toenail (onychocryptosis) is a common foot disorder that negatively affects quality of life and may lead to chronic inflammation and recurrence. Public awareness regarding podological treatment methods remains limited. This study aimed to evaluate awareness of podological treatment approaches, treatment preferences, and factors associated with ingrown toenails among adults living in Turkiye.
METHODS: This descriptive cross-sectional study included 1,144 individuals aged 18–60 years between June and October 2023. Data were collected using a 15-item questionnaire administered online. Sociodemographic characteristics, occupational factors, footwear habits, diabetes status, genetic predisposition, podology awareness, treatment preferences, and recurrence rates were evaluated. Statistical analyses were performed using Pearson’s Chi-square test.
RESULTS: Chronic ingrown toenails were reported by 15.5% of participants, whereas 42.0% experienced occasional episodes. More than half of the participants (51.7%) had never heard of podology or orthonyxia applications, and only 16.2% had previously undergone treatment at a podology center. Chronic ingrown toenails were significantly associated with female sex, physically demanding occupations, inappropriate footwear use, diabetes, and family history (p<0.05). Self-management was the most common treatment preference (34.3%). Recurrence rates were significantly higher following surgical treatment compared with podological orthonyxia applications (67.6% vs. 28.7%, p<0.001).
CONCLUSION: Awareness of podological treatment methods in Turkiye remains insufficient. Conservative podological approaches were associated with lower recurrence rates than surgical treatment. Increasing public awareness and expanding access to podological care may contribute to improved management and prevention of ingrown toenails.

OBJECTIVE: This study aimed to evaluate whether different durations of transcutaneous electrical nerve stimulation (TENS), specifically 20 and 30 min, produce distinct effects on pain and functionality in individuals diagnosed with lumbar spondylosis.
METHODS: A retrospective analysis was conducted involving 42 patients with lumbar spondylosis. Participants were assigned to two treatment groups. In addition to therapeutic ultrasound, superficial heat therapy, and exercise, Group 1 received TENS for 20 min, whereas Group 2 underwent the same treatment protocol with a 30-min TENS application. Pain intensity and functional status were assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI) before treatment initiation and after completion of a 3-week intervention period. Outcomes were analyzed both within and between groups.
RESULTS: Following treatment, both groups exhibited significant reductions in VAS and ODI scores compared with baseline values (p<0.001). Comparison of treatment-related improvements revealed no significant differences between groups for either ΔODI or ΔVAS (p=0.052 and p=0.943, respectively). Although the between-group difference in ΔODI did not reach statistical significance, a moderate effect size favoring the 30-min TENS group was identified (Cohen’s d=0.618). In contrast, the effect size for ΔVAS was minimal (Cohen’s d=0.022).
CONCLUSION: The findings indicate that extending TENS application from 20 to 30 min does not provide additional benefits in terms of pain relief or functional recovery in patients with lumbar spondylosis. Given the comparable clinical outcomes, a 20-min TENS protocol may represent a more practical and cost-conscious approach for managing lumbar spondylosis-related low back pain.

OBJECTIVE: This study aimed to evaluate the early surgical outcomes according to the dominant clinical presentation in adult patients undergoing cardiac myxoma resection.
METHODS: A total of 315 patients who underwent cardiac mass resection procedures in a single center were retrospectively analyzed. After the exclusion criteria were applied, 133 consecutive adult patients who underwent surgical resection of histopathologically confirmed cardiac myxoma between January 2004 and December 2024 in a single center. Patients were categorized into four groups according to their dominant clinical presentation at diagnosis: asymptomatic, cardiac/obstructive, embolic, and constitutional. Baseline characteristics, tumor features, operative variables, and early post-operative outcomes were compared among the groups.
RESULTS: The median age was 63 years, and 63.9% of patients were female. Cardiac/obstructive symptoms represented the most frequent dominant presentation (47.4%). Major early post-operative outcomes were comparable among groups, whereas post-operative atrial fibrillation (AF) and intensive care unit/hospital stay were significantly higher in the cardiac/obstructive group.
CONCLUSION: Dominant clinical presentation was not associated with differences in major early post-operative outcomes following cardiac myxoma resection. Cardiac/obstructive presentation was associated with more post-operative AF and longer recovery.

OBJECTIVE: The long-term effects of bariatric surgery on glucose metabolism are well established; however, comparative data regarding glycemic outcomes after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RNYGB) in patients with pre-operative dysglycemia remain limited. This study aimed to compare 5-year glycemic outcomes following LSG and RNYGB in patients with prediabetes or Type 2 diabetes mellitus.
METHODS: This retrospective cohort study included patients with pre-operative dysglycemia (HbA1c ≥5.7%) who underwent primary LSG or RNYGB between January 2010 and December 2021 at a tertiary referral center and had at least 5 years of follow-up. Demographic characteristics, HbA1c levels, weight loss outcomes, and glycemic status were evaluated. Glycemic status was categorized as diabetes, prediabetes, or normal glycemia according to HbA1c levels.
RESULTS: A total of 142 patients were included, of whom 107 underwent LSG and 35 underwent RNYGB. Baseline HbA1c levels were similar between groups (7.70±1.83% vs. 6.87±1.53%, p=0.619). At 5 years, mean HbA1c was significantly lower in the RNYGB group compared with the LSG group (5.57±0.64% vs. 5.85±0.68%, p=0.033). Total weight loss percentage was greater after RNYGB (28.13±13.79% vs. 24.04±10.72%), although the difference was not statistically significant (p=0.084). Significant improvement in glycemic status was observed following bariatric surgery (p<0.001). At 5 years, normal glycemia was achieved in 44 (41.1%) patients after LSG and 22 (62.9%) patients after RNYGB, whereas persistent diabetes was observed in 10 (9.3%) and 2 (5.7%) patients, respectively.
CONCLUSION: Bariatric surgery resulted in significant long-term improvement in glycemic status among patients with pre-operative dysglycemia. Although both LSG and RNYGB effectively reduced the prevalence of diabetes and prediabetes, RNYGB was associated with lower HbA1c levels and a higher proportion of patients achieving normal glycemia at 5 years. These findings suggest that RNYGB may provide superior long-term glycemic outcomes in patients with obesity-associated dysglycemia.

OBJECTIVE: Arteriovenous fistula (AVF) is the gold standard for hemodialysis access, but traditional dual-needle cannulation is limited by a restricted cannulation area and progressive stenosis; single-puncture systems may reduce these risks if hemodynamics can be optimized to prevent recirculation. This study aimed to design a novel single-puncture dual-lumen coaxial catheter and to evaluate its hemodynamic performance, flow efficiency, and recirculation rate using high-resolution computational fluid dynamics (CFD).
METHODS: In this CFD and design-optimization study, a dual-lumen coaxial catheter with a unique fenestration geometry was designed and analyzed using SolidWorks Flow Simulation at a physiological temperature of 37°C. Boundary conditions included an AVF flow rate of 1000 mL/min and a dialysis pump speed of 300 mL/min. The primary endpoints were flow velocity, shear stress, and recirculation control.
RESULTS: CFD simulation (1,030,641 cells) showed a maximum flow velocity of 12.69 m/s and a peak calculated shear stress of 2,602.45 Pa at the narrowest lumen section; because blood damage depends on both stress magnitude and exposure time, these computational data alone do not establish blood compatibility. Thermodilution analysis yielded a theoretical recirculation rate of 0.007% under the modeled conditions, and flow trajectories showed spatial separation of the venous jet from the arterial intake.
CONCLUSION: Under the modeled steady-state conditions (AVF flow, 1000 mL/min; dialysis pump flow, 300 mL/min), CFD predicted stable separation of the return and aspiration streams and a theoretical recirculation rate of 0.007%. These proof-of-concept findings support further geometric optimization and physical testing; they do not establish clinical safety, efficacy, or superiority over standard dual-needle cannulation.

Health systems face a paradox. Aging populations, advanced therapeutics, and long-term needs expand demand for high-value care while large financial stocks coexist with incomplete service coverage and widespread financial hardship. The article examines whether this mismatch reflects a circulatory pathology of capital allocation in care-intensive sectors where biological vulnerability and human dignity are most exposed. This paper uses a structured conceptual synthesis for theory building rather than statistical estimation. It integrates research on precautionary saving, institutional trust, health financing, accreditation, real-world evidence, and programmable financial governance under protocols for source selection, bibliographic verification, and bias control. Interdisciplinary convergence is treated as theoretical triangulation, not empirical proof. The synthesis develops financial venous stasis and thrombosis as a bounded theory-building metaphor. Care cost insecurity is its proposed behavioral hinge. Capital may pool for future security and care assurance as well as yield. When prudent preservation against aging, illness, and care uncertainty scales through institutional routines and risk controls, it may harden into systemic low flow that monetary expansion alone may not resolve. The response is an institutional treatment architecture for financial thrombolysis. It places a clinical core without profit distributions within an auditable, phased centralized finance-to-decentralized finance governance structure supported by accreditation, real-world evidence, and transparent flow protocols. The framework does not claim empirical validation. It is a falsifiable health policy agenda dependent on pilot testing and assessable through clinical outcomes, patient experience, compliance integrity, cash flow durability, equity effects, and transparent social allocation. Its central contribution reframes capital not as a scarce resource to be rationed but as a circulatory medium whose movement may be impaired. It tests whether usable channels can restore circulation and convert defensive preservation into measurable care capacity that protects dignity without penalizing capital.