INTRODUCTION: Liver ischemia–reperfusion (I/R) injury, commonly occurring in trauma, organ trans-plantation, major hepatic surgery, and shock, not only impairs hepatic function but also induces dysfunction in distant organs such as the kidneys, lungs, and heart, leading to increased morbidity and mortality. This study investigated whether non-invasive transauricular vagus nerve stimulation (tVNS) could mitigate cardiac and pulmonary injury in a rat hepatic I/R model.
METHODS: Twenty-one male Sprague–Dawley rats were randomly assigned to three groups (n=7 each): Control (laparotomy only), I/R (1 h hepatic ischemia + 3 h reperfusion), and I/R+tVNS (1 h ischemia + 3 h reperfusion with concurrent tVNS). At the end of reperfusion, cardiac and pulmonary tissues were harvested for biochemical analysis.
RESULTS: tVNS reduced oxidative stress and inflammatory responses in both organs. In cardiac tissue, the I/R+tVNS group demonstrated significantly higher total antioxidant status (TAS) and lower total oxidant status (TOS), oxidative stress index (OSI), interleukin-1β (IL-1β), and hypoxia-inducible factor-1α (HIF-1α) compared with the I/R group. In pulmonary tissue, OSI and IL-1β levels were significantly decreased by tVNS, while HIF-1α showed a downward trend without statistical significance.
DISCUSSION AND CONCLUSION: Non-invasive tVNS effectively alleviated oxidative stress and enhanced antioxidant capacity in the heart and lungs following hepatic I/R. These results suggest that tVNS confers cardiopulmonary protection against hepatic I/R injury, likely through modulation of inflammatory cytokine responses and reinforcement of antioxidant defences.

INTRODUCTION: To evaluate the learning curve of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy during early adoption and to assess changes in operative performance and perioperative safety over consecutive cases. Study Design is retrospective observational learning curve analysis. Setting is tertiary referral center for minimally invasive gynecologic surgery. Forty consecutive patients who underwent vNOTES hysterectomy for benign gynecologic indications. vNOTES hysterectomy performed by a single surgeon during the initial implementation period.
METHODS: Operative performance was assessed using total operative time, and learning dynamics were evaluated with cumulative summation (CUSUM) analysis.
RESULTS: Mean operative time decreased progressively across sequential quartiles, from 89.3±7.5 minutes in the first 10 cases to 46.2±3.1 minutes in the final 10 cases. CUSUM analysis demonstrated a clear inflection point at approximately the 18th case, indicating transition from early technical adaptation to stabilized operative performance. Minor perioperative complications and conversions occurred only during the early learning phase, with no major complications observed throughout the series.
DISCUSSION AND CONCLUSION: vNOTES hysterectomy suggests a consistent learning curve pattern during early adoption. Operative efficiency improves progressively, with technical proficiency achieved after a limited number of cases and without compromise in perioperative safety. These findings support structured implementation and objective learning curve assessment during the introduction of vNOTES into minimally invasive gynecologic practice.

INTRODUCTION: This study aimed to evaluate serum 25-hydroxyvitamin D [25(OH)D] levels in chil-dren aged 0–5 years presenting with lower respiratory tract infection (LRTI) and to investigate the association between vitamin D deficiency and infection severity.
METHODS: In this prospective controlled study, a total of 100 children aged 0–5 years were enrolled. The study group consisted of patients diagnosed with LRTI, while the control group included healthy children. Serum 25(OH)D, calcium, phosphorus, alkaline phosphatase (ALP), C-reactive protein (CRP), and complete blood count parameters were measured in all partici-pants. Vitamin D status was classified as severe deficiency, deficiency, insufficiency, or normal. Statistical significance was set at p<0.05.
RESULTS: Children diagnosed with LRTI had significantly lower serum 25(OH)D levels com-pared to the control group (p<0.001). CRP and leukocyte levels were significantly higher in the study group (p<0.001). A significant association was observed between vitamin D deficiency and frequent infections as well as hospitalization rates. Inflammatory markers were higher in the severe vitamin D deficiency group. Additionally, serum 25(OH)D levels decreased with increasing age (p<0.001).
DISCUSSION AND CONCLUSION: Low serum 25(OH)D levels appear to be associated with increased frequency and severity of lower respiratory tract infections in early childhood. Early detection of vitamin D deficiency and maintenance of appropriate supplementation strategies may represent an important preventive approach to reducing infection burden.

INTRODUCTION: Mammographic subcutaneous fat thickness (SFT) has been proposed as a spatially specific surrogate of locoregional adiposity in breast cancer research. This study aimed to evaluate the relationship between mammographically measured SFT and molecular subtypes, Ki-67 proliferation index, hormone receptor expression, and key clinicopathological parameters in patients with invasive ductal carcinoma (IDC).
METHODS: This retrospective, cross-sectional, single-center study included 180 female patients who underwent surgical treatment for IDC between October 2023 and January 2026. SFT was measured from standard mammographic images. Molecular subtype classification followed the St. Gallen 2013 Consensus criteria. Statistical analyses included Spearman correlation, Kruskal–Wallis and Mann–Whitney U tests, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis.
RESULTS: SFT showed no statistically significant correlation with Ki-67 (ρ=0.127, p=0.089), tumor size, age, estrogen receptor (ER) percentage, or progesterone receptor (PR) percentage. SFT did not differ significantly across molecular subtypes, BI-RADS density categories, histological grade, or lymph node status. In multivariable linear regression, body mass index (BMI) was the sole independent predictor of SFT (β=0.331, p<0.001; R²=0.110). BMI differed significantly across molecular subtypes (p=0.024), with the triple-negative (TN) subtype associated with significantly higher BMI than both Luminal A (p=0.021) and Luminal B (p=0.004). A statistically significant linear trend was identified between increasing BI-RADS density category and tumor biological aggressiveness (linear-by-linear association, p=0.046). The area under the ROC curve (AUC) for SFT in predicting Ki-67≥20% was 0.590 (95% CI: 0.458–0.721, p=0.192), and for BMI was 0.417 (95% CI: 0.287–0.547, p=0.227); neither reached statistical significance.
DISCUSSION AND CONCLUSION: In IDC, mammographic SFT reflects systemic adiposity rather than tumor biology and lacks clinically meaningful discriminatory power as an independent imaging biomarker. The association between the triple-negative subtype and higher BMI supports the role of systemic adiposity in subtype-specific tumor biology.

INTRODUCTION: Evidence of subclinical myocardial and pericardial involvement has been described in patients with Familial Mediterranean Fever (FMF), even during clinically inactive periods. However, the potential impact of colchicine resistance on cardiac function has not been fully elucidated. The present study investigated myocardial performance in FMF patients with differing responses to colchicine therapy using speckle-tracking echocardiography.
METHODS: This study evaluated 74 patients diagnosed with FMF, including 57 colchicine-responsive and 17 colchicine-resistant individuals, together with 74 age- and sex-matched healthy controls. Participants with established cardiovascular risk factors were excluded. Colchicine resistance was defined by recurrent attacks occurring at least once every three months despite treatment with 2 mg/day or the maximum tolerated dose of colchicine, the requirement for biologic therapy, and/or the presence of amyloidosis, defined as proteinuria ≥500 mg/day on at least two occasions or biopsy-confirmed disease. Demographic, clinical, and laboratory variables were collected using a standardized assessment form. All subjects underwent speckle-tracking echocardiographic evaluation performed by experienced cardiologists who were blinded to clinical information.
RESULTS: No significant differences were observed between colchicine-resistant and colchicine-responsive FMF patients with respect to age, sex distribution, or disease duration (p>0.05). Global longitudinal strain (GLS) values were significantly reduced in colchicine-responsive FMF patients compared with healthy controls (p<0.05). In contrast, GLS measurements did not differ significantly between colchicine-resistant and colchicine-responsive patient groups (p>0.05).
DISCUSSION AND CONCLUSION: Patients with FMF demonstrate subclinical myocardial dysfunction when compared with healthy individuals. However, resistance to colchicine therapy does not appear to be associated with additional impairment in myocardial strain parameters, suggesting that mechanisms independent of treatment response may contribute to cardiac involvement in FMF.

INTRODUCTION: To evaluate patient-reported satisfaction and symptom improvement after holmium laser enucleation of the prostate (HoLEP) in a real-world cohort using a structured postoperative telephone survey.
METHODS: This single-center observational follow-up study combined retrospective chart review with a structured telephone questionnaire. All HoLEP procedures performed between January 2023 and January 2026 were screened (n=519). Among 462 contact-eligible patients, 209 provided verbal consent and completed the survey in March 2026. The questionnaire assessed global satisfaction, perceived change in voiding symptoms, willingness to undergo HoLEP again, willingness to recommend the procedure, temporal changes in satisfaction, residual symptoms, symptom-related bother, and need for additional treatment.
RESULTS: Favorable overall satisfaction was reported by 146 patients (69.9%), and 184 (88.0%) reported improvement in voiding complaints. In addition, 149 patients (71.3%) stated that they would choose the same operation again, and 143 (68.4%) would recommend HoLEP to others. Favorable satisfaction increased from 22.0% in the first postoperative week to 68.9% at interview. Urinary incontinence was the most frequent residual complaint (78.0%). Less favorable satisfaction was associated with residual symptoms and additional medication requirement (both p<0.0001). Longer follow-up showed a weak association with better satisfaction (rho=0.269, p<0.0001).
DISCUSSION AND CONCLUSION: HoLEP was associated with substantial patient-reported symptom improvement and generally favorable postoperative appraisal. However, satisfaction was dynamic and was closely related to residual symptoms, additional treatment, and postoperative recovery over time.

INTRODUCTION: Candida auris (C. auris) is an emerging multidrug-resistant yeast associated with healthcare-associated outbreaks, particularly in intensive care units (ICUs), and is linked to high mortality. This study aimed to evaluate the incidence of C. auris colonization and infection, clinical outcomes, and risk factors in ICU patients at a tertiary hospital in Türkiye.
METHODS: This retrospective single-center study was conducted at Kartal Dr. Lütfi Kırdar City Hospital (Istanbul, Türkiye) between March 1 and August 31, 2025. Weekly surveillance screening was performed using combined axilla and groin swabs. Clinical specimens were collected in suspected infections. Identification was performed by MALDI-TOF MS. Demographic and clinical variables were analyzed, and logistic regression was used to identify predictors of 30-day mortality.
RESULTS: A total of 38 ICU patients with C. auris detection were included. The mean age was 68.8±15.4 years, and 55.3% were male. Colonization was detected in 60.5% of patients, while 39.5% had infection. The overall incidence of C. auris was 1.6%. Bloodstream infection was the most common infection type (31.6%). The overall 30-day mortality rate was 55.3%. Azole resistance was observed in 80.0% of isolates, amphotericin B resistance in 73.3%, and echinocandin resistance in 13.3%. In multivariable analysis, mechanical ventilation was independently associated with 30-day mortality (OR=19.27,95% CI: 1.02–363.48; p=0.04).
DISCUSSION AND CONCLUSION: C. auris infections have become a serious threat in ICUs in recent years. The mortality rate is quite high in this study. Advanced age, high comorbidity scores, mechanical ventilation, central venous catheterization, and broad-spectrum antibiotic use were highlighted as risk factors for C. auris. From a cost-effectiveness perspective, early diagnosis of high-risk patients and targeted preventive strategies may be more appropriate than routine weekly C. auris screening. Early detection of C. auris, implementation of contact isolation, strengthening of environmental disinfection, and review of antifungal treatment strategies are critical in controlling this infection.

INTRODUCTION: To identify independent maternal risk factors associated with term antepartum still-birth and to evaluate incidence patterns in a tertiary referral setting.
METHODS: This retrospective case–control study was conducted at a tertiary referral center in Türkiye. Singleton term pregnancies between 37+0 and 41+6 weeks of gestation were included. Cases comprised 70 women with term antepartum stillbirth confirmed prior to labor onset, and 282 term live births served as controls. Maternal sociodemographic, obstetric, and clinical variables were analyzed using univariable logistic regression, followed by a prespecified multivariable model including maternal age, obesity, HDP, smoking during pregnancy, and diabetes in pregnancy.
RESULTS: The incidence of term antepartum stillbirth ranged from 2.1 to 2.7 per 1,000 term births and remained stable over time. In univariable analyses, advanced maternal age, low educational attainment, unemployment, smoking, obesity,HDP, and a history of stillbirth were associated with increased odds of term antepartum stillbirth. In the adjusted model, maternal age ≥35 years (aOR 3.01; 95% CI 1.64–5.52), obesity (aOR 1.74; 95% CI 1.02–2.96), HDP (aOR 2.48; 95% CI 1.34–4.61), and smoking during pregnancy (aOR 1.86; 95% CI 1.01–3.44) remained independently associated, whereas diabetes in pregnancy was not. Small for gestational age (SGA) and placental abruption showed strong univariable associations but were excluded from multivariable models due to potential intermediary effects.
DISCUSSION AND CONCLUSION: Term antepartum stillbirth is uncommon but strongly associated with identifiable maternal risk factors, underscoring the need for individualized risk stratification in late gestation.

INTRODUCTION: Smoking is a deleterious habit with profound health consequences, often resulting in systemic inflammation that contributes to chronic diseases. We aimed to investigate how different types of exposure (active or passive smoking) affect systemic inflammatory responses, compared to non-smokers.
METHODS: This retrospective, single-center study included 306 healthy individuals categorized according to smoking status, with a predominantly female population (253 females and 53 males). Hematologic inflammatory markers, including the systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were assessed alongside C-reactive protein (CRP) levels. A CRP level ≥3 mg/L was considered to define systemic inflammation.
RESULTS: Among active smokers, SIRI was the only marker that showed a statistically significant diagnostic value for identifying elevated CRP levels (AUC=0.662, 95% CI: 0.522–0.802, p=0.021), whereas the remaining indices were not significant in any group.
The optimal cut-off value for SIRI was 1.50, with a sensitivity of 38.1% and a specificity of 95.8%. In passive smokers and non-smokers there was no significant association was observed between hematologic indices and CRP levels.
DISCUSSION AND CONCLUSION: SIRI may be a helpful and easily accessible parameter for assessing the inflammatory response in active smokers. Although its discriminatory performance was modest, its derivation from routine complete blood count parameters may support its use as an adjunctive marker in clinical evaluation.

INTRODUCTION: The objective of this research is to assess the correlation between the length of breastfeeding and the Body Mass Index (BMI) of children in the 3-6 age group, as well as to ascertain the impact of early childhood nutrition on the incidence of obesity.
METHODS: A questionnaire was administered to the parents of children aged 3-6 who presented to the outpatient clinic, inquiring about demographic characteristics and the children’s feeding practices between the ages of 0-2. Anthropometric measurements of the children were also taken.
RESULTS: A total of 399 children took part in the investigation, with 236 being boys. Judging by the Body Mass Index (BMI) metrics, 27% were categorized as underweight, 54% fell within the normal range, 5% were identified as overweight, and 14% were classified as obese. Notably, 8% of the participants had never experienced breastfeeding, 42% had undergone breastfeeding for six months or less, 25% had a breastfeeding duration of 7-23 months, and another 25% had been breastfed for 24 months or more. Despite the variations in breastfeeding duration, no statistically significant disparities were detected in the BMI values (p>0.05). Among those who had never been breastfed, 22% were identified as obese. In contrast, only 9% of individuals breastfed for less than six months fell into the obese category, while 16% of those breastfed for 7-23 months and another 16% breastfed for 24 months or more were deemed obese. Interestingly, a statistically significant association emerged between the duration of breastfeeding and the incidence of chronic illnesses (p<0.05). A noteworthy 71.4% of children with chronic ailments had been breastfed for six months or less, indicating a potential link between shorter breastfeeding periods and the presence of chronic illnesses in children.
DISCUSSION AND CONCLUSION: In our study, no relationship was found between the duration of breastfeeding and BMI values. However, children with chronic illnesses were observed to have a shorter duration of breastfeeding.

INTRODUCTION: Pulmonary pleomorphic carcinoma (PPC) is one of the rarest subtypes of non-small cell lung cancer (NSCLC) and is associated with a poor prognosis. Since this tumor is known to be chemoresistant, anatomical resection is considered the primary treatment option, especially in the early stages. Due to its rarity, the number of studies on this subject in the literature is quite limited. In this study, we aimed to investigate the long-term postoperative outcomes of patients operated on for PPC and the factors affecting survival.
METHODS: Patients who underwent surgery for lung cancer were retrospectively reviewed. Those with a postoperative histopathological diagnosis of PPE were included. Demographic and clinicopathological characteristics were analyzed, and factors affecting overall survival (OS) and disease-free survival (DFS) were investigated.
RESULTS: A total of 25 patients who underwent surgery for PPC between 2016 and 2025 were included in the study. After excluding surgical mortality, the mean OS was calculated as 54.3±9.9 months, with a 5-year OS rate of 49.6%. Recurrence developed in 13 (52%) patients. The mean DFS was 43.1±9.9 months, and the 5-year DFS rate was 40.9%. Surgical incision analysis reveals the mean OS was 48.2±11.6 months and the 5-year OS rate was 43.8% in patients who underwent thoracotomy. These values were 77.6±12.9 months and 80% in patients who underwent VATS, respectively (p=0.048). A statistically significant relationship was found between stage and survival (p=0.042). Although not reaching statistical significance, the presence of spread-through air spaces (STAS), perineural invasion, and vascular invasion was associated with poorer prognosis.
DISCUSSION AND CONCLUSION: In our study, the prognostic factors that had a statistically significant effect on survival in PPC were the use of minimally invasive surgery and the stage of the disease. Invasion-related parameters such as STAS, perineural invasion, and vascular invasion were also found to negatively affect survival, although they did not reach statistical significance.

INTRODUCTION: Concurrent chemoradiotherapy (CRT) is the standard treatment for patients with unresectable stage III non-small cell lung cancer (NSCLC). However, data on its efficacy and safety in elderly populations are limited. This study aimed to evaluate survival outcomes, treatment response, and toxicity profiles of CRT with three different chemotherapy regimens in elderly patients with stage III NSCLC.
METHODS: We retrospectively analyzed 75 patients aged ≥65 years with unresectable stage IIIA–IIIB NSCLC who received CRT between October 2006 and October 2014. Patients were treated with one of the following regimens: Carboplatin plus paclitaxel (PC; n=41), cisplatin plus docetaxel (PD; n=21), or cisplatin plus etoposide (PE; n=13). Radiotherapy was administered concurrently in all cases (60 Gy in 30 fractions). Clinical endpoints included overall survival (OS), progression-free survival (PFS), treatment response (per RECIST v1.1), and toxicity (per NCI-CTCAE v4.03).
RESULTS: Median OS was 31.6 months in the PE group, 20.0 months in the PC group, and 13.7 months in the PD group (p=0.322). Median PFS was 19.8, 10.6, and 10.9 months for PE, PC, and PD groups, respectively (p=0.643). Disease control rates—defined as complete response (CR), partial response (PR), and stable disease (SD)—were 92.3% (PE), 75.6% (PC), and 71.4% (PD) (p=0.279). Neuropathy was most common in the PC group (20%), while hematologic toxicities occurred more frequently in the PD group. Chemotherapy discontinuation was significantly higher in patients with Eastern Cooperative Oncology Group (ECOG) performance status of 2 (p=0.012).
DISCUSSION AND CONCLUSION: In elderly patients with inoperable stage III NSCLC, all three CRT regimens demonstrated acceptable efficacy and safety profiles. Although not statistically significant, the PE regimen was associated with numerically better survival outcomes and higher disease control rates, suggesting it may be a favorable option for selected elderly patients.

INTRODUCTION: Pelvic incidence–lumbar lordosis (PI–LL) mismatch is considered a marker of sagittal imbalance, but its clinical significance in chronic low back pain remains uncertain. This study aimed to investigate the relationship between spinopelvic alignment and clinical outcomes in patients with chronic low back pain (CLBP).
METHODS: In this cross-sectional observational study, 101 patients aged 18 years and older with CLBP (>12 weeks) were included. Spinopelvic parameters, including pelvic incidence (PI) and lumbar lordosis (LL), were measured using standardized standing radiographs. Patients were divided into two groups based on the PI-LL mismatch: PI-LL<10° (normal alignment) and PI-LL ≥10° (mismatch). Visual Analog Scale (VAS), Short Form-36 (SF-36), and Oswestry Disability Index (ODI) scores were compared between the groups.
RESULTS: There were statistically significant differences in PI, LL, and PI-LL between the groups (p=0.026, p<0.001, and p<0.001, respectively). No significant differences were found in ODI, VAS (rest and activity), or SF-36 subdomains, except for general health (p=0.045). Multivariate logistic regression identified general health as a significant predictor of PI-LL mismatch (OR=0.973, p=0.045). BMI showed a statistically significant association (p=0.036).
DISCUSSION AND CONCLUSION: Spinopelvic mismatch may be associated with higher BMI and lower general health perception, but not with pain or disability scores.

INTRODUCTION: To develop a novel, standardized, and objective method for estimating prostate volume using digital rectal examination (DRE) and to establish a treatment-oriented grading
system.
METHODS: A total of 330 men aged ≥45 years scheduled for prostate needle biopsy were prospectively analyzed (Group 1). During DRE, the width, length, and height of the posterior prostate surface were measured using the examiner’s pre-measured index finger. Reproducibility was assessed in 63 patients examined independently by two urologists (Group 2). Posterior surface area and volume were calculated using ellipse and ellipsoid formulas. Prostate volume measured by transrectal ultrasonography (TRUS) served as the reference standard. Linear regression analyses were performed to generate prediction equations.
RESULTS: Posterior surface area predicted TRUS-measured prostate volume more strongly than palpable posterior prostate volume, explaining 91% of the variance (R²=0.909, p<0.0001). No significant interobserver difference was observed (p=0.061), while strong correlation (r=0.733, p<0.0001) and high reliability were demonstrated (ICC=0.821). The proposed grading system showed strong agreement with TRUS-based grading (κ=0.884; 95% CI, 0.846–0.922).
DISCUSSION AND CONCLUSION: Posterior prostate surface area measured by DRE is a reliable and reproducible approach for estimating prostate volume categories. Further validation of this method using advanced imaging techniques such as magnetic resonance imaging is recommended.

INTRODUCTION: It is aimed to evaluate the concordance between quantitative fluorescent polymerase chain reaction (QF-PCR) and conventional cytogenetic analysis in pregnancies undergoing cordocentesis, and to assess indications, diagnostic yield, turnaround time, and the association between maternal age and chromosomal abnormalities.
METHODS: This retrospective cohort study included 160 pregnancies that underwent cordocentesis between August 2019 and July 2022 in the Department of Perinatology of a tertiary referral center. Maternal age, indication for procedure, gestational age, QF-PCR results, conventional karyotype findings, and laboratory reporting times were analyzed. Procedure indications were categorized according to ultrasonographic findings, screening test results, and previous prenatal invasive genetic test results.
RESULTS: The most common indication was major ultrasonographic abnormalities (53.1%). QF-PCR demonstrated 100% concordance with cytogenetic analysis for trisomy 21 and trisomy 18. However, among cases reported as normal by QF-PCR, structural chromosomal abnormalities (4.5%) and rare numerical anomalies, including mosaic trisomy 8 and trisomy 9, were detected on conventional karyotyping. The highest rate of abnormal karyotype was observed in the major ultrasonographic findings group (12.9%). Mean turnaround time for conventional cytogenetic results was 11.7±3.5 days. Advanced maternal age was strongly associated with trisomy 21 and trisomy 18.
DISCUSSION AND CONCLUSION: QF-PCR provides a rapid and reliable preliminary assessment for common aneuploidies in cordocentesis cases; however, conventional cytogenetic analysis remains essential for definitive diagnosis due to its ability to detect structural and rare chromosomal abnormalities. In late-gestation referrals, the relatively short reporting time of fetal blood culture supports cordocentesis as a valuable diagnostic option when timely clinical decision-making is required.

INTRODUCTION: Vitamin D prophylaxis (400 IU/day) is recommended for all children, at least during the first year of life. This prophylaxis is usually ceased in children with nephrolithiasis despite limited evidence. This study aimed to determine whether the cessation of vitamin D prophylaxis affects the number and size of stones in young children with nephrolithiasis.
METHODS: This prospective study evaluated children aged<3 years who were referred to a pediatric nephrology center for nephrolithiasis. Renal ultrasonography was performed by a single experienced pediatric radiologist. Twenty-eight children (17 males, 60.7%) with persistent nephrolithiasis were enrolled. Vitamin D prophylaxis was ceased during the first 3 months (P1) and subsequently administered for 3 months (P2). The number and size of stones were assessed using ultrasonography at the end of both periods.
RESULTS: The mean age at the initial ultrasonography was 13.7±10.7 (range, 2.7−39.4) months. Serum creatinine, calcium levels were normal in all patients, and none had vitamin D hypervitaminosis. Metabolic abnormalities were detected in 12 patients (42.9%), most commonly hypercalciuria (n=8), hypocitraturia (n=7). Stone number and size decreased significantly during both P1 and P2. None of the 12 children who were stone-free at the end of P1 developed new stones after vitamin D prophylaxis was reintroduced during P2. Reduction in stone number was more frequent in younger children (p=0.01), whereas no other clinical or laboratory parameters were associated with stone improvement.
DISCUSSION AND CONCLUSION: Routine cessation of vitamin D prophylaxis may not be necessary in children with nephrolithiasis when close ultrasonographic monitoring is performed.

Scalp tissue defects may arise secondary to trauma or tumor resection. Dermal and epidermal matrices provide an important reconstructive alternative for complex scalp defects with exposed bone by promoting vascularization and granulation tissue formation. Depending on the size of the defect, biodegradable temporizing matrices may be applied either as a two-stage procedure in combination with skin grafting or as a single-stage treatment. A 9-year-old male patient presented with a scalp tissue defect measuring 6 × 8 cm with exposed bone following a motor vehicle accident. After debridement of devitalized tissue at the wound margins, a biodegradable temporizing matrix was applied simultaneously. Weekly follow-up evaluations demonstrated progressive color changes within the matrix. At the end of five weeks, sufficient granulation tissue formation was observed beneath the matrix. The outer layer of the matrix was removed, and a split-thickness skin graft was applied to the wound bed. Biodegradable temporizing matrix application facilitates staged reconstruction of scalp defects, particularly in pediatric patients, without the need for complex surgical procedures. It supports reconstructive planning by enabling sequential use of reconstruction steps and represents a safe and effective adjunct in scalp reconstruction.