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Can blastocyst formation rate play a role as a predictor of PGT-A cycle outcomes?
(Elsevier, 2025) Aydın, Gerçek
OBJECTIVE To investigate clinical and embryological parameters that may serve as predictors of pregnancy outcomes in preimplantation genetic testing for aneuploidy (PGT-A) cycles. MATERIALS AND METHODS A total of 98 PGT-A cycles at a private in-vitro fertilization (IVF) center between April 2022 and July 2025 were enrolled. Trophectoderm biopsy cases without any known uterine anomalies and endometrial factor are included. Ovulation induction with letrozole (n=29) or hormone replacement therapy (HRT) (n=69) were used for endometrium preparation. Clinical and embryological cycle characteristics are analysed. Blastocyst formation rate (BFR) was calculated as the number of blastocysts per MII, and the euploidy rate refers to euploid embryos per biopsied embryos. Statistical analysis included t-tests or Mann-Whitney U for continuous variables, and Chi-square test for categorical variables. To identify potential confounding factors subgroup analyses and multivariate logistic regression were performed. RESULTS Among the 98 patients, 62 (63.3%) achieved pregnancy and 36 (36.7%) did not. There were no significant differences between the groups regarding age, BMI, total gonadotropin dose, or stimulation duration. Recombinant FSH agents were the most frequently administered (n=38), followed by hMG (n=23), combination of both (n=15) and recombinant FSH+recombinant LH (n=22). Analyzing the pregnancy results, no statistically significance was observed regarding the agents used, (p>0,05). The BFR was significantly higher in the pregnant group (0.36 ± 0.28) compared to the non-pregnant group (0.27 ± 0.24, p = 0.045). The estradiol/oocyte ratio was slightly higher in the pregnant group (319 ± 180 pg/mL) than in the non-pregnant group (287 ± 148 pg/mL), although not statistically significant (p = 0.48). The euploidy rate per was 59.3% (89/150) in the pregnant group and 68.8% (66/96) in the non-pregnant group, being not statistically significant (p = 0.13). Regarding confounding factors (female or male aneuploidy, the type of gonadotropin, the type of endometrial preparation protocol), none of these demonstrated a statistically significant association with pregnancy outcome in either univariate or multivariate models. CONCLUSIONS Given our results, BFRs may predict pregnancy outcomes whereas euploidy rates do not, despite being higher in non-pregnant cases contrary to expectations. IMPACT STATEMENT BFR in PGT-A cycles may help clinicians both to counsel current patients and to shape more individualized management strategies for future cases.
Logistical requirements for high-resolution anoscopy: Pre-procedure preparation and materials – A video vignette
(Wiley, 2025) Arslan, Çiğdem
High-resolution anoscopy (HRA) is a diagnostic procedure that in-volves examining the anus, anal canal and perianal region with amicroscope, utilizing 5% acetic acid and Lugol's solution to detectabnormal epithelial changes and early precursors of anal cancer.Vital stains cause epithelial and vascular changes that distinguishnormal tissue from lesions, aiding in clinical decision-making forbiopsy.
Can neoadjuvant chemoradiotherapy be omitted in cT2N+ and cT3 mid-rectal cancer: Protocol for a prospective, observational, cohort study (CANO)
(Public Library of Science, 2025) Karakayalı, Feza; Arslan, Çiğdem; Bisgin, Tayfun; Erenler Bayraktar, İlknur; Bayraktar, Onur; Canda, Aras Emre
Background Neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer. However, nCRT is associ ated with significant morbidity, impacting patients’ quality of life. Recent advancements in MRI-based risk stratification have raised the possibility of omitting nCRT in selected patients without compromising oncologic outcomes. This study aims to evaluate whether upfront TME alone achieves similar 3-year disease-free survival compared to the standard approach of nCRT followed by TME in patients with cT2N+ and cT3Nx mid-rectal cancer without MRI-based high-risk features regarding local recurrence. Methods The CANO trial is a prospective, multicenter, observational cohort study involving 436 patients across Türkiye. Eligible patients will be classified into two groups: those undergoing direct TME and those receiving nCRT followed by TME. The primary endpoint is 3-year disease-free survival (DFS), with secondary outcomes including 5-year DFS, overall survival, local recurrence rates, and quality of life assessments using validated questionnaires. Data will be prospectively collected and monitored by the steering committee with predefined interim analyses. Discussion The CANO trial addresses the ongoing debate regarding selective omission of nCRT in low-risk mid-rectal cancer. By leveraging MRI-based risk stratification and PLOS One | https://doi.org/10.1371/journal.pone.0321819 November 5, 2025 2 / 11 a collaborative national network, the study aims to provide high-quality evidence supporting a more personalized treatment approach. The findings have the potential to reduce treatment-related morbidity without compromising oncologic safety, contrib uting to the refinement of current guidelines.
Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study
(Wiley, 2025) Bilgin, İsmail Ahmet; Ramoğlu, Nur; Saylık, Onur; Benlice, Çigdem; Erkaya, Metincan; Kurtul, İnci; Aghayeva, Afag; Turan, Ersin; Maden, Abdullah Sami; Acar, Fahrettin; Karahasanoğlu, Tayfun; Hamzaoğlu, İsmail; Baca, Bilgi; Doğru, Osman
Aim: Pilonidal sinus disease (PSD) primarily affects young adults; rapid recovery is essential and yet lacks a standardized treatment approach. While excisional techniques delay recovery, minimally invasive options like laser ablation and phenol application are gaining interest, yet comparative long-term evidence is scarce. This study compared short- and long-term outcomes of laser versus phenol treatment in PSD. Method: In this multicentre retrospective cohort study (Nov. 2017–Sep. 2024), patients treated with laser or phenol were included. 1:3 propensity score matching using the nearest neighbour algorithm was performed based on age, gender, prior surgical history and year of operation. Categorical variables were analysed using chi-squared or Fisher's exact tests, whereas continuous variables were compared using Student's t-test or Mann– Whitney U test depending on distribution normality. Results: Out of 897 eligible patients, 644 were included (median age: 26 years, body mass index [BMI]: 26.2 kg/m2 , male-to-female ratio: 4:1). The number of sinuses/pits was 2–3 in both groups. Operating time was significantly longer in the laser group. Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1–3] vs. 1 [0–2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%–86%). Conclusion: Both treatments demonstrated low complication and recurrence rates with high recovery rates. Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.
Labia majora lifting technique with polydioxanone threads
(Oxford University Press, 2025) Ağlamış, Savaş Özgür; Akkaya, Selver Kübra; Şahin, Elif; Şahin, Hanifi
Background: Polydioxanone (PDO) thread is a synthetic absorbable surgical suture used for rejuvenation and lifting. Aim: The aim of this study is to use PDO threads for rejuvenation and enlargement effect in patients with labium majus hypotrophy. Methods: Twenty-one patients with labia majora hypotrophy were included in the study. Conventionally, surgery, fat filling or hyaluronic acid filling is used for labia majora rejuvenation. In this study, a different technique, the PDO thread suspension technique, was applied. For PDO thread, Hyundae Meditech Co.Ltd’s Secret Line Up product containing 50 mm screw thread with 30 G-38 mm needle tip was used. It was planned to use 10 PDO threads for right and left labia majora. After a total of 20 needles were inserted, the needles were removed one by one and the PDO threads remained in the subcutaneous superficial layer and the procedure was terminated 5 min later. Preoperative and postoperative the Female Genital Self-Image Scale (FGSIS) scores of the patients were compared. Outcomes: The overall FGSIS total score demonstrated a significant increase following the intervention. Results: The FGSIS total mean score in the preoperative period was increased in the postoperative period. This difference was statistically significant. Moreover, the mean score calculated for each parameter of FGSIS in the preoperative period increased significantly in the postoperative period. Clinical Implications: These findings indicate a favorable safety profile for the use of PDO threads in this clinical context. Strengths and Limitations: The strength of the study is to introduce a minimally invasive and effective method for labia majora lifting, on the other hand, the small number of patients in the study, limitation of the study. Conclusion: We would like to point out that in this study, we evaluated labium majus rejuvenation from the same perspective, based on the shaping and enlargement of genital appearance and its positive effect on self-confidence and increase in sexual functions. Unlike many labium majus rejuvenation procedures, this less invasive procedure has achieved similar results. In this context, it is a preferable alternative to surgery.
Clinical outcomes following medial patellofemoral ligament reconstruction using ultra high-strength 2-mm-wide tape in non-elite athletes
(Elsevier, 2025) Erden, Tunay; Ağır, Muzaffer; Ali, Jotyar; Çelik, Malik; Batar, Suat; Toprak, Ali; Toker, Berkin; Taşer, Ömer
Background: The medial patellofemoral ligament (MPFL) reconstruction is commonly conducted using gracilis, semitendinosus, quadriceps or tensor fascia lata tendon autografts or allografts. This approach, however, can sometimes lead to complications or morbidity at the site from which the graft is harvested. This study reports the clinical outcomes of non-elite competitive athletes who undergone MPFL reconstruction using an ultrahigh strength 2-mm-wide tape. Patients and methods: This retrospective cohort study included 67 non-elite athletes with acute or recurrent lateral patellar instability who underwent surgical treatment between December 2015 and December 2020. Athletes who underwent tibial tubercle osteotomy due to severe patellofemoral arthritis or severe osteochondral damage (kissing lesions or >2.5cm2 ) (1), trochlear dysplasia (Dejour type D dysplasia) (5), open physis (19) and revison MPFL reconstruction (8), were excluded. The remaining 34 athletes were followed postoperatively for a mini mum of 48 months. Results: During the follow-up period, there was only one case and which was revised by adding Fulkerson Osteotomy. Two patients had limited range of motion and joint mobilization was performed under general anesthesia at the end of the second month. The International Knee documentation Committee (IKDC), Kujala, and visual analog scale (VAS) scores showed improvement postoperatively (p < 0.001). Moreover, the mean im provements in IKDC (≈+41), Kujala (≈+33), and VAS (≈− 3.8) scores exceeded the established minimal clini cally important difference (MCID) thresholds, indicating that the outcomes were not only statistically significant but also clinically meaningful for patients. When comparing the pre- and postoperative radiological measure ments, the mean tilt angle and mean congruence angle showed a significant decrease (p < 0.001) Conclusion: Suture tape may be a good alternative to autograft, as it does not cause donor site morbidity. However, its most important disadvantage is its higher cost. Level of evidence: IV; Retrospective case series.
Long-term outcomes of extended versus segmental resection for transverse colon cancer: A population-based analysis based on the SEER database
(Galenos Publishing House, 2025) Benlice, Çiğdem; Erkaya, Metincan; Aghayeva, Afag; Özben, Volkan; Görgün, Emre; Atasoy, Deniz; Baca, Bilgi
Objective: To investigate long-term cancer-specific outcomes associated with extended versus segmental colectomy (SC) in patients with stage I-III transverse colon adenocarcinoma using a large, population-based cohort. Material and Methods: Patients who diagnosed with transverse colon cancer undergoing curative-intent colectomy were identified from the surveillance, epidemiology, and end results database (2013-2019). Surgical procedures were categorized as extended colectomy (EC) or SC based on standardized procedural coding. 1:1 propensity score matching was performed to reduce selection bias and balance baseline characteristics. Cancer-specific survival (CSS) was analyzed using multivariable Cox proportional hazards regression. Results: Among 18,799 eligible patients, 58% underwent EC. EC was more frequently performed in individuals with higher tumor stage (p<0.01) and those receiving adjuvant chemotherapy (26% vs. 23%, p<0.01). After matching (n=7.904 in each group), EC was associated with a higher rate of adequate lymphadenectomy (>12 lymph nodes retrieved: 94% vs. 89%, p<0.01). Five-year overall survival did not differ significantly between groups (65.6% for EC vs. 66.9% for SC, p=0.074). However, SC was associated with a modest but statistically significant improvement in CSS (84.3% vs. 81.7%, p<0.01). In adjusted analysis, surgical extent (HR=0.8376, p<0.001), along with age, sex, tumor grade, stage, and lymph node yield, were independently associated with CSS. Conclusion: While EC is more commonly utilized in advanced-stage disease and facilitates higher lymph node retrieval, SC offers comparable—and potentially superior—CSS in selected patients. These findings support the consideration of a tailored surgical strategy based on tumor biology and individual patient characteristics.
Association of body mass index with orbital fat volume in lower eyelid blepharoplasty
(Springer Nature, 2025) Solmaz, İskender Alkın; Ertan, Elif
Purpose To investigate the relationship between body mass index (BMI) and the volume of orbital fat excised during lower eyelid blepharoplasty. Methods This retrospective cross-sectional study included 58 patients who underwent bilateral transconjunctival lower eyelid blepharoplasty between January and December 2024. Total orbital fat volume was measured intraoperatively using a graduated cylinder. BMI was calculated from preoperative height and weight and classified according to World Health Organization criteria. Statistical analyses included Pearson correlation, one-way ANOVA with Tukey’s post-hoc test, and univariate and multivariable linear regression. Results The mean age of the patients was 49.2±11.6 years, and the mean BMI was 24.5±3.8 kg/m². The mean total orbital fat volume excised was 2.08 ± 0.94 cc. Fat volume differed significantly across BMI categories (p<0.001), with obese and overweight patients having greater excised fat than normal-weight individuals. Pearson correlation demonstrated a strong positive association between BMI and fat volume (r=0.592, p<0.001). In regression analysis, BMI was the only significant predictor of orbital fat volume, explaining 35.1% of the variance (R²=0.351). Conclusion BMI is strongly associated with orbital fat volume excised during lower eyelid blepharoplasty. These findings suggest that systemic adiposity extends to the periorbital region and highlight the relevance of considering BMI in preoperative planning to optimize surgical outcomes.
Limitations of MRI in differentiating solid and cystic components of craniopharyngiomas
(Springer Nature Link, 2025) Karaalioğlu, Banu; Çakıcı Öksüz, Nazlı; İpek, Veyselkarani; Çakır, Aslı; Kahraman, Osman; Özbek, Muhammet Arif
Purpose Craniopharyngiomas (CP) present with both solid and cystic structures in magnetic resonance imaging (MRI) stud ies. Contrary to MRI appearance, components described as cysts are not infrequently found as non-fluent structures during surgery. This study aims to address the discrepancy between radiology and surgery regarding the nature of these lesions and to evaluate them for their preoperative predictability. Materials and methods Preoperative MRI images of 24 CP patients were analyzed. The cystic components of the tumors were assessed in terms of quantitative and qualitative signal properties and contrast enhancement on conventional pulse sequences, and analyzed based on their macroscopic appearances. Results Thirteen of 31 lesions (42%) that suggested cyst on MRI were solid during surgery, with none showing contrast uptake. MRI demonstrated 100% sensitivity and negative predictive value (NPV), 71.7% specificity, and 58% positive pre dictive value (PPV) in identifying true cysts. Most lesions resembling cysts were hyperintense on FLAIR and T1WI and isointense on ADC maps, suggesting high protein content. However, surgically confirmed fluid-filled cysts exhibited similar signal characteristics in a comparable proportion. The only significant imaging indicator was a hypointense appearance on T2WI, with a mean intensity ratio close to that of the basal ganglia. Conclusion Accurate identification of solid and cystic components in craniopharyngiomas is critical for effective treatment planning. Although MRI is traditionally considered reliable for this purpose, 42% of lesions that appeared cystic without contrast enhancement were ultimately confirmed as non-fluid or solid during surgery. This study was unable to establish definitive MRI characteristics to reliably differentiate between cystic and solid components. Further research with larger cohorts is warranted to validate potential imaging markers and improve diagnostic accuracy.
Harnessing GPT technology for clinical decision support in retinal detachment
(Galenos Publishing House, 2025) Ağın, Abdullah; Öztürk, Yücel; Kıvrak, Ulviye
Aim: Considering the increasing incorporation of artificial intelligence (AI) in healthcare, it is crucial to comprehend the advantages and constraints of these technologies within ophthalmologic settings for their secure and efficient clinical utilization. This study aims to comprehensively assess the efficacy of three leading Generative Pre-trained Transformer (GPT) -based platforms in providing clinical decision-support for retinal detachment (RD). Methods: This cross-sectional comparative study was conducted between April 2024 and May 2024. Fifty questions were created based on the American Academy of Ophthalmology “Retina Book”, specifically targeting RD. The answers were produced by three different platforms and assessed by three independent reviewers who used Likert scales to evaluate their comprehensiveness and accuracy. Six readability metrics, including the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES), average words per sentence, average syllables per word, total sentence count, and total word count, were assessed. Results: Gemini earned the most outstanding results for comprehensiveness (4.11±0.72) and accuracy (1.49±0.61), followed by ChatGPT and Copilot. ChatGPT had superior readability metrics, achieving an FKGL of 15.62±2.85 and a FRES of 62.54±12.34, establishing it as the most accessible platform. ChatGPT demonstrated significantly higher performance compared to other platforms in the metrics of average syllables per word (p=0.0421) and total word count (p=0.0115). At the same time, no significant differences were found among the platforms in the metrics of average words per sentence (p=0.0842) and total sentence count (p=0.1603). Intraclass correlation coefficient (ICC) values indicated strong inter-rater agreement for comprehensiveness (ICC >0.74) and moderate to-high agreement for accuracy (ICC >0.56). Conclusion: Gemini’s detailed and accurate responses position it as a robust tool for professional use, while ChatGPT’s superior readability makes it suitable for patient education. These findings emphasize the synergistic advantages of AI platforms in research and development management and show the necessity for hybrid systems that integrate accessibility with accuracy.
Endometrial sampling in the absence of hysteroscopy: Insights from more than 1000 dilatation and curettage cases
(Wiley, 2025) Şentürk, Şenol; Aydın, Gerçek; Can Bayrak, Çiğdem; Hatırnaz, Şafak; Stojković, Marta; Sparic, Radmila; Pecorella, Giovanni; Tinelli, Andrea
Objectives: The aim of this epidemiological study is to present the distribution of histopathological results of endometrial biopsies performed for indications in women and their relationship with symptoms. Methods: A retrospective analysis was conducted on patients with abnormal uterine bleeding (AUB) assessed by endometrial biopsy between January 2020 and July 2022. Analyzing the distribution and association of patients' demographic traits, biopsy motivations, and histopathologic findings was the main goal of the study. Results: A total of 1216 patients were included in the study, and their average age was 48.48 ± 8.79 years. AUB was found to be the most common reason for biopsy (n= 616; 50.7%). The most common diagnosis among the histologic findings (320; 26.3%) was endometrial polyp. The most common symptoms among individuals with premalignant and malignant diseases were AUB, endometrial thickening, and postmenopausal hemorrhage. Additionally, it was determined that 21 (6.3%) postmenopausal patients had inadequate material. Conclusions: The most common histologic diagnosis from the procedure was endometrial polyp. It is important to make sure that the sample taken includes the entire uterine cavity because postmenopausal women may have insufficient biopsy samples. This is especially true if a hysteroscopy with biopsy cannot be performed (for a variety of reasons). In fact, suspect endometrial cancers should be thoroughly evaluated by hysteroscopy in patients with postmenopausal bleeding, endometrial thickness, and atypical uterine bleeding.
Is neurodegeneration accelerated? Investigating covıd-19’s impact on dementia via functional connectivity
(Turkish Neuropsychiatric Society, 2025) Müdüroğlu Kırmızıbekmez, Aynur; Önder, Alparslan; Özdemir, Mustafa Yasir; Eryiğit, Önder Yüksel; Yurdakoş, Ertan
Introduction: COVID-19 has been associated with various neurological complications, including cognitive impairments such as memory deficits, attention difficulties, and executive dysfunction. These symptoms raise concerns about potential long-term effects, particularly in individuals with preexisting neurodegenerative conditions. Emerging evidence suggests that systemic inflammation, blood-brain barrier (BBB) dysfunction, and neuroinflammation may contribute to cognitive decline in COVID-19 patients. However, the impact of COVID-19 on functional brain connectivity, particularly in dementia patients, remains unclear. This study aims to investigate the differences in functional connectivity across different frequency bands (delta, theta, alpha, beta, and gamma) in dementia patients with and without a history of COVID-19 (D-COVID and D-nCOVID) compared to a healthy control (HC) group. The study explores whether COVID-19 accelerates neurodegenerative processes by disrupting functional brain networks. Methods: Functional connectivity was assessed using electroencephalography (EEG)-based network analysis in three groups: D-COVID, D-nCOVID, and HC. Connectivity metrics were compared across frequency bands, with a focus on local efficiency (LE) and global network alterations. The Kruskal-Wallis test assessed statistical significance, while the Dunn test was used for post-hoc analysis. Results: Findings indicate a significant reduction in functional connectivity across multiple brain regions in dementia patients, with the D-COVID group exhibiting more pronounced declines. The observed decrease in connectivity suggests that COVID-19 may accelerate neurodegenerative processes. Additionally, the HC group demonstrated stronger connectivity and higher LE metrics, highlighting the widespread impact of dementia on brain networks. Conclusion: These findings support the hypothesis that COVID-19 contributes to cognitive decline by exacerbating neurodegenerative mechanisms. The disruption of functional brain connectivity observed in D-COVID patients aligns with previous studies suggesting that SARS-CoV-2 may indirectly promote neuronal degeneration. Further longitudinal studies are needed to determine the long-term cognitive consequences of COVID-19 and potential therapeutic interventions to mitigate these effects.
Harnessing generative pre-trained transformer technology for clinical decision support in retinal detachment
(Galenos Publishing House, 2025) Ağın, Abdullah; Öztürk, Yücel; Kıvrak, Ulviye
Aim: Considering the increasing incorporation of artificial intelligence (AI) in healthcare, it is crucial to comprehend the advantages and constraints of these technologies within ophthalmologic settings for their secure and efficient clinical utilization. This study aims to comprehensively assess the efficacy of three leading Generative Pre-trained Transformer (GPT) -based platforms in providing clinical decision-support for retinal detachment (RD). Methods: This cross-sectional comparative study was conducted between April 2024 and May 2024. Fifty questions were created based on the American Academy of Ophthalmology “Retina Book”, specifically targeting RD. The answers were produced by three different platforms and assessed by three independent reviewers who used Likert scales to evaluate their comprehensiveness and accuracy. Six readability metrics, including the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES), average words per sentence, average syllables per word, total sentence count, and total word count, were assessed. Results: Gemini earned the most outstanding results for comprehensiveness (4.11±0.72) and accuracy (1.49±0.61), followed by ChatGPT and Copilot. ChatGPT had superior readability metrics, achieving an FKGL of 15.62±2.85 and a FRES of 62.54±12.34, establishing it as the most accessible platform. ChatGPT demonstrated significantly higher performance compared to other platforms in the metrics of average syllables per word (p=0.0421) and total word count (p=0.0115). At the same time, no significant differences were found among the platforms in the metrics of average words per sentence (p=0.0842) and total sentence count (p=0.1603). Intraclass correlation coefficient (ICC) values indicated strong inter-rater agreement for comprehensiveness (ICC >0.74) and moderate to-high agreement for accuracy (ICC >0.56). Conclusion: Gemini’s detailed and accurate responses position it as a robust tool for professional use, while ChatGPT’s superior readability makes it suitable for patient education. These findings emphasize the synergistic advantages of AI platforms in research and development management and show the necessity for hybrid systems that integrate accessibility with accuracy.
Considering its mechanism of action it may be logical to choose letrozole as an initial option for endometrium preparation before vitrified-warmed embryo transfer
(Wiley, 2025) Aydın, Gerçek; Aslan, Kiper; Araç, Merve; Ergin, Elif; Kasapoğlu, Işıl; Uncu, Gürkan
Aim: To assess the efficacy of letrozole and programmed hormone replacement therapy (HRT) cycles in terms of obstetric outcomes for women undergoing a single vitrified-warmed blastocyst embryo transfer (SVBT). Methods: This study is a retrospective study conducted in a private IVF (in vitro fertilization) clinic. A total of 324 FET cycles (letrozole group = 183, HRT = 141), consisting of primary infertile patients aged <40 years, were enrolled. The cycle characteristics, pregnancy results, and perinatal parameters were recorded. The primary outcomes of this study are pregnancy and miscarriage rates, live birth rates, whereas hypertensive disease of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth are the secondary outcomes. Results: Positive β-HCG rates were 53% (97/183) versus 61% (86/141), whereas clinical pregnancy rates were 47% (86/183) versus 51.1% (72/141) for the letrozole and HRT groups, respectively. For clinical miscarriage, the results were 6.5% (12/183) for letrozole versus 15.6% (22/141) for HRT groups, which were statistically significant. For live birth rate (LBR), letrozole was found to be slightly better compared to HRT 40.4% (74/183) versus 35.5% (50/141). Considering the perinatal outcomes, the parameters were comparable between the groups. Conclusions: In terms of perinatal outcomes and IVF success, letrozole was not found to be inferior to HRT. Letrozole can be utilized as a safe and effective agent, even as a first-line treatment, given the potential benefits offered by its mechanism of action and being a reasonable option for both ovulatory and unovulatory patients.
A pilot investigation on possible interactions between clinical parameters and the psychology of couples undergoing IVF
(Wiley, 2025) Aydın, Gerçek; Bülbül, Mehmet; Ergin, Elif; Aydin, Ayşe Gül; Akkaya, Cengiz; Hatırnaz, Şafak; Tinelli, Andrea
Objective: To investigate the potential reciprocal influences between in vitro fertiliza tion (IVF) and the psychological states of patients. Materials and Methods: A prospective cohort study involved 180 couples who sought consultation for IVF. To monitor the fluctuations in the emotional states of the cou ples throughout the IVF process, questionnaires were administered on two separate occasions: the first was conducted immediately before the initiation of medication, and the second was administered promptly following the completion of embryo trans fer. The BECK inventories for anxiety and depression were employed for evaluation. Pregnancy outcomes were exclusively analyzed for women who received high-quality blastocysts, with cleavage-stage embryo transfers being excluded from consideration. Results: Pregnancy rates did not significantly differ based on the presence of height ened anxiety and/or depression among couples. Notably, a correlation was identified between severe anxiety in women before IVF and diminished rates of fertilization, as well as lower blastocyst/oocyte and blastocyst/metaphase II (M2) ratios (8.7 ± 5.0 vs. 7.5 ± 6.1, P= 0.029; 0.284 ± 0.199 vs. 0.218 ± 0.209, P= 0.001; and 0.333 ± 0.209 vs. 0.272 ± 0.232, P= 0.016, respectively). In the male cohort, elevated anxiety scores, ei ther pre- or post-IVF treatment, were found to be linked with a reduced mean oocyte count, as well as lower rates of M2, fertilization, blastocyst, and total embryo counts (P< 0.05). Conclusions: Pregnancy rates were not affected by the presence of anxiety and de pression, as they do not exert a significant impact on the implantation success of blas tocysts. However, given that fertilization rates are statistically diminished in instances of severe anxiety, which consequently results in a reduced number of blastocysts and total embryos, a decline in cumulative pregnancy rates may be anticipated.
Pediatrik chiari malformasyonları
(Akademisyen Yayınevi Kitabevi, 2025) Çakıcı Öksüz, Nazlı; Akdemir, Hidayet
Chiari malformasyonları ilk kez 19.yy sonunda (1891) Avusturyalı patolog Hans Chiari tarafından postmortem incelenen 40 vakanın sonuçları ile tariflenmiş tir. Sonrasında Alman patolog Julius Arnold’un da miyelodisplazi ve arka beyin herniasyonu olan bir vaka tanımlaması CM II Arnold-Chiari sendromu adı ve rilmiştir (1–3). Hans Chiari ilk olarak 3 tip tanımlamış ve 4 yıl sonra yayınladığı yayında 2 vaka ile birlikte Chiari tip IV’ü tanımlamıştır (4,5). Ancak zaman için de bu tanımlamaların tam olarak kliniği ve radyolojik bulguları yansıtamaması nedeni ile yeni tiplerin tanımlanması ihtiyacı doğmuştur (6,7). En son yapılan tanımlamalar ile birlikte, CM Tip 0, I, 1.5, II, III, 3.5, IV ve 5 olarak yeni alt tip leri kullanılmaktadır (6–13). 2000 yıllarındaki yeni klinik ve deneysel araştırmaları ve teknolojik buluşları sonrası özellikle hakemli dergilerde tanımlanan CM’lerin tarihsel ve yeni güncel sınıflandırmaları Tip 0, Tip 0.5, Tip I, Tip 1.5, Tip II, Tip 3.5, Tip 5 ve kompleks tip gibi yeni alt tipleri kullanılmaktadır (6–14).
Role of ovarian stem cells in postnatal oogenesis and implications in fertility preservation
(Springer Nature Link, 2025) Benlioğlu, Can; Turan, Volkan; Öktem, Özgür
It is a long-held dogma in reproductive biology that females are born with a set nonrenewable number of oocytes in the ovary. While some animal studies challenged this dogma by demonstrating allegedly postnatal oogenesis and the presence of certain stem cell factor expression germ cell markers, their biological roles are yet to be defined. In this chapter, we revisited this issue revisit this dogma in light of most recent data. The chapter outlines the characteristics of these putative OSCs, including their morphological features, expression of germline markers (e.g., DDX4, DAZL), telomerase activity, and methods for their isolation and culture, acknowledging the ongoing debate and methodological controversies surrounding their identification, particularly the reliability of DDX4-based sorting. We critically evaluate the evidence for their capacity to differentiate into oocyte-like cells in vitro and in vivo, including experiments involving transplantation into animal models. Finally, the chapter explores the profound implications these OSCs hold for fertility preservation, especially for women facing premature ovarian insufficiency, age-related infertility, or gonadotoxic treatments. We discuss potential future applications, such as autologous OSC transplantation to restore ovarian function or in vitro generation of mature oocytes for fertilization. We highlight the significant technical and safety hurdles that must be overcome, including optimizing culture systems, ensuring genomic stability, and validating human functional competency. While the physiological role and definitive existence of functional OSCs in adult human ovaries remain contentious subjects requiring further rigorous investigation using advanced techniques like single-cell analysis and lineage tracing, the potential therapeutic promise continues to drive research in this exciting, albeit controversial, area of reproductive medicine.
Artificial intelligence in predicting macular hole surgery outcomes: A focus on optical coherence tomography parameters
(Springer Nature, 2025) Öztürk, Yücel; Ağın, Abdullah; Yelmi, Burcu; Zorlutuna Kaymak, Nilufer
Purpose To evaluate the predictive performance of optical coherence tomography (OCT)-based indices and artificial intelligence (AI) using a Generative Pre-Trained Transformer (GPT) model and compare them with traditional logistic regression in forecasting anatomical success following macular hole (MH) surgery. Methods This retrospective observational study included 51 eyes of 51 patients who underwent pars plana vitrectomy for idiopathic MH. Preoperative OCT measurements of macular hole index (MHI), traction hole index (THI), hole form factor (HFF), basal hole diameter (BHD), and minimum hole diameter (MHD) were recorded. GPT-based AI predictions were generated using masked input data. A logistic regression model was developed with the same variables. Predictive performance was assessed using accuracy, area under the curve (AUC), positive predictive value (POPV), negative predictive value (NPV), and Kappa statistics. Results Anatomical success was achieved in 72.5% of cases. MHI, THI, and HFF were significantly higher in the successful group (p<0.0001). GPT achieved an accuracy of 77.0% and AUC of 0.770, with perfect POPV (1.000) but low NPV (0.452). Logistic regression outperformed GPT, achieving an accuracy of 84.3%, an AUC of 0.759, a higher NPV (0.800), and better agreement (Kappa 0.568 vs. 0.392). BHD and MHD showed poor predictive power (AUC 0.291). Conclusion OCT-derived indices, especially MHI, THI, and HFF, effectively predict MH surgery outcomes. Logistic regression based on actual patient data demonstrated superior predictive performance compared to GPT. AI models hold potential but require further development, integration of multimodal data, and validation before clinical application.
Pilonidal disease: Gaps in the guidelines and future perspectives
(Galenos Publishing House, 2025) Arslan, Çiğdem
Pilonidal disease (PD) is an increasingly common condition that predominantly affects the young population. The variety of treatment modalities described in the literature makes it nearly impossible to design a study capable of definitively identifying the optimal method. As a result, treatment strategies are broadly categorized into minimally invasive and excisional approaches, with the choice often tailored to the severity and complexity of the disease on an individual basis. Currently, four major guidelines and consensus reports have been published on PD: The American (1), German (2), and Italian (3) guidelines, as well as the most recent guideline from the European Society of Coloproctology (ESCP) (4) in 2024. While these guidelines share certain points of agreement, they also diverge on several issues, and most of their recommendations are based on expert opinion or very low levels of evidence. Furthermore, many questions frequently encountered by surgeons in daily practice are either not addressed or remain unanswered in these guidelines.
Utilization and fertility preservation outcomes in women undergoing embryo cryopreservation before breast cancer treatment: A meta-analysis
(Elsevier, 2025) Turan, Volkan; Öktem, Özgür; Bang, Heejung; Oktay, Kutluk Han
Our aim was to assess fertility preservation (the proportion of women who had at least 1 live birth) and utilization rates (the proportion of women who utilized their cryopreserved embryos) rates among women who cryopreserved their embryos before breast cancer treatments. PubMed and Cochrane library database were searched until December 2024. We included all studies that reported pregnancy outcomes, the number of women who returned for frozen embryo transfer, and the number of women who preserved their fertility. The primary outcome measures were the utilization and fertility preservation rates. Secondary outcome measures were implantation, clinical pregnancy, and live birth rates. Of the 12 studies, 9 met the criteria, encompassing >2126 women with breast cancer who cryopreserved their embryos for fertility preservation. In 9 studies that reported the total number of attempts, 424 women underwent 863 embryo transfers. Based on those studies, the clinical pregnancy and live birth rates were 50% (95% CI: 35-65, I 2: 80%) and 33% (95% CI: 22-46, I 2: 76%), respectively. The utilization and fertility preservation rates were 18% (95% CI: 9-32, I 2: 95%) and 39% (95% CI: 29-51, I 2: 48%), respectively, all from random-effects models. Fertility preservation success with embryos cryopreserved before breast cancer treatments seems to be promising. However, the utilization rate of cryopreserved embryos is low. Additional studies with larger sample size and longer follow up are required to evaluate the long-term utility rates.

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