Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

Bu koleksiyon için kalıcı URI

https://hdl.handle.net/20.500.13055/57

Listeleniyor 1 - 20 / 72

Sahin transvaginal extracorporeal myomectomy as a novel minimally‑invasive technique for the management of uterine myomas: A retrospective cohort analysis
(Medycyna Praktyczna, 2025) Şahin, Turan; Şahin, Eda A.; Şahin, Hanifi
Introduction: Vaginal myomectomy (VM) is a minimally-invasive surgery to remove uterine fibroids; however, limited exposure, difficulties in suturing, and challenges in achieving hemostasis restrict its wider adoption. To address these limitations, the Sahin transvaginal extracorporeal (STVEC) technique was developed, allowing for complete uterine exteriorization for extracorporeal reconstruction. Aim: We aimed to evaluate the safety, feasibility, and perioperative outcomes of the STVEC technique in women undergoing surgery for symptomatic uterine myomas. Materials and methods: This retrospective cohort included 200 consecutive patients who underwent VM using the STVEC technique between February 2021 and October 2024. Demographic characteristics, myoma features according to the International Federation of Gynecology and Obstetrics (FIGO) classification, operative variables, postoperative outcomes, and complications were analyzed. The complications were graded using the Clavien–Dindo system. Conversion to laparotomy was performed when safe continuation of the STVEC approach was not feasible. Results: Mean (SD) age of the study cohort was 39.1 (6.5) years and mean (SD) body mass index was 27.5 (5.8) kg/m². Mean (SD) myoma count was 1.8 (1.4; range: 1–5) and mean (SD) diameter was 6.7 (2.4; range, 5–10) cm. Intramural myomas (FIGO type 2–5) were the most common (55%). Conversion to laparotomy occurred in 8 patients (4%) due to adenomyotic uteri, adhesions, prior vaginal surgery, or altered cervical anatomy. Median (interquartile range [IQR]) hemoglobin decrease was 1.7 g/dl, median (IQR) estimated blood loss was 180 ml, and mean (SD) operative time was 71.9 (19.5) minutes. Blood transfusion was required in 18 patients (9%). Early complications occurred in 7 participants (3.5%), and all were minor. Conclusions: The STVEC technique appears safe and feasible, offering good bleeding control, low complication rates, and rapid recovery. Further multicenter studies are needed to confirm our findings.
Radiographic medial posterior tibial slope ≥16° predicts multiple revisions after anterior cruciate ligament reconstruction
(Wiley, 2026) Kayaalp, Mahmut Enes; Inoue, Jumpei; Konstantinou, Efstathios; Kahraman, Hamit Çağlayan; Erden, Tunay; Musahl, Volker
Purpose: An increased posterior tibial slope (PTS) has been implicated as a risk factor for anterior cruciate ligament (ACL) graft failure. This matched case–control study aimed to compare radiographic and magnetic reso nance imaging (MRI)‐based PTS measurements between patients under going multiple revision anterior cruciate ligament reconstruction (ACLR) and those with successful primary ACLR and to identify thresholds predictive of high revision risk. Methods: In this matched case–control study, 156 patients were analysed: 78 patients undergoing multiple revision ACLR and 78 patients with suc cessful primary ACLR. Medial PTS was measured on radiographs, while medial, lateral and PTS difference (PTS asymmetry) were measured on MRI. Group differences were assessed using independent t tests and χ2 tests. Receiver operating characteristic (ROC) analysis identified optimal thresholds, and logistic regression quantified odds ratios (ORs) for multiple revisions per 1° increase in radiographic medial PTS, adjusting for body mass index (BMI), sex, side, height and weight. Results: Radiographic medial PTS was significantly higher in the multiple‐ revision group (12.5 ± 3.5° vs. 11.2 ± 3.0°, p = 0.016). ROC analysis identi fied an optimal medial PTS cutoff of 13° (area under the curve = 0.58, sensitivity = 0.49, specificity = 0.65), but only a PTS ≥ 16° was significantly associated with increased multiple revision risk (OR = 3.10, 95% confidence interval [CI]: 1.14–8.40; p = 0.037; specificity = 0.91; positive predictive value [PPV] = 0.70). MRI‐based medial and lateral PTSs, as well as PTS asymmetry, did not differ significantly between groups. Univariate logistic regression demonstrated a 10% increase in odds per 1° increase in radio graphic PTS (OR = 1.10, 95% CI: 1.00–1.22, p = 0.049), remaining signifi cant after adjustment for BMI, sex, side, height and weight (adjusted OR = 1.11, 95% CI: 1.01–1.23, p = 0.034). Radiographic medial PTS cor related moderately with MRI‐based medial PTS (r = 0.49, p < 0.001), but not with lateral PTS (p: n.s.). Conclusion: Radiographic medial PTS showed the strongest differentiation between successful primary ACLR and multiple‐revision ACLR. A PTS ≥ 16° identifies patients at significantly higher risk of multiple revisions, whereas MRI‐based medial PTS, lateral PTS and PTS asymmetry provide no addi tional discriminatory value. Radiographic medial PTS appears practical for preoperative risk stratification, whereas MRI‐based measures do not show similar utility. Level of Evidence: Level III.
PCOS phenotypes and hematological immune-inflammatory indices: A comparative evaluation
(Elsevier, 2025) Kından, Aykut; Kından, Goncagül; Soysal, Çağanay; Turan, Volkan
To evaluate hematological immune-inflammatory indices across different polycystic ovary syndrome (PCOS) phenotypes and assess their potential as diagnostic biomarkers. This retrospective cross-sectional study included 89 women aged 18–40 years diagnosed with PCOS according to the Rotterdam criteria, stratified into four phenotypes (A–D). Demographic, anthropometric, reproductive, biochemical, and hormonal data were extracted from clinical records. Hematological indices were calculated from complete blood counts. Group comparisons were performed using appropriate statistical tests, correlations with metabolic and hormonal parameters were assessed, and logistic regression analyses were conducted to identify independent predictors. Phenotype A demonstrated significantly higher body mass indeks (BMI), waist circumference, fasting glucose, insulin, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values compared with other phenotypes (all p < 0.01). Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), and Systemic Immune-Inflammation Index (SII) differed significantly across phenotypes, whereas Platelet-to-Lymphocyte Ratio (PLR) did not. ROC analysis revealed that SII had the highest discriminative ability (AUC=0.822, p < 0.001). NLR (AUC=0.663, p = 0.020) and MLR (AUC=0.642, p = 0.043) also showed moderate predictive value. Correlation analyses indicated positive associations of NLR and SII with total testosterone and Free Androgen Index (FAI), and negative correlations with Sex Hormone-Binding Globulin (SHBG) and High-Density Lipoprotein (HDL) cholesterol. Logistic regression identified BMI, SII, and LH/FSH ratio as independent pre dictors of specific phenotypes, further supporting their role as clinically relevant biomarkers. Hematological immune-inflammatory indices, particularly SII, may serve as cost-effective and accessible biomarkers for dis tinguishing PCOS phenotypes.
Decoding surgical proficiency and complexity: A machine learning framework for robotic herniorrhaphy
(Springer Nature Link, 2025) Shin, Thomas H.; Fanta, Abeselom; Gökçal, Fahri; Shields, Mallory; Benlice, Çiğdem; Kudsi, Omar Yusef
Objective To evaluate the predictive value of objective performance indicators (OPIs) for case complexity assessment and explore their role in quantifying skill acquisition during robotic ventral herniorrhaphy. Summary background data Despite advances in herniorrhaphy techniques, unclear metrics of case complexity have signifi cant implications for operative planning, resource allocation, and patient outcomes. While existing complexity definitions rely primarily on clinical factors external to operator behavior, the expanding adoption of robotic platforms in ventral her nia repair provides unprecedented access to quantifiable surgical performance metrics. However, the relationship between these objective performance indicators and both case complexity and skill development remains incompletely understood, representing a gap that machine learning approaches may help address. Methods OPI and clinical data from 561 consecutive robotic ventral hernia repairs over eight years were analyzed using iterative ensemble machine learning models to predict case complexity. Dimensional reduction analyses using t-distributed stochastic neighbor embedding tracked skill evolution, with Euclidean distances calculated between successive cases to quantify skill acquisition over time. Results Gradient boosting models integrating clinical and OPI variables achieved F1 score of 0.87, while OPIs alone scored 0.58. Longitudinal analysis revealed high OPI variability during early cases, stabilizing within 10 months despite increas ing case complexity, indicating skill acquisition may compensate for procedural difficulty. Dimensional reduction analyses captured this evolution through weighted Euclidean distances. Conclusions Objective performance indicators poorly predict case complexity independently, yet their temporal evolution reveals surgical skill acquisition. The concurrent stabilization of OPI stochasticity and progression to more complex cases demonstrates that surgical proficiency and complexity assessment are interdependent phenomena, establishing digital metrics as tools for understanding the dynamic relationship between surgeon learning and case difficulty.
Feeding the mind: Preliminary insights into the effects of anthocyanin-rich extract from black carrots on brain activity and gut microbiota in patients with cognitive impairments
(Nature Research, 2025) Müdüroğlu Kırmızıbekmez, Aynur; Önder, Alparslan; Özdemir, Mustafa Yasir; Gürerk, Gamze; Aydın, Sevcan; Eryiğit, Önder Yüksel; Güloğlu, Mehmet Oktar; Kara, İhsan
Anthocyanins, known for their antioxidant and anti-inflammatory properties, have been associated with cognitive benefits, potentially mediated by gut-brain axis interactions. This study investigates the effects of a 12-week Anthocyanin-Rich Extract (ARE) intervention on brain activity and gut microbiota composition in older adults with neurocognitive impairments. In this study, 50 participants underwent electroencephalography (EEG) recordings and gut microbiota analyses before and after the intervention. EEG data were analyzed using connectivity and entropy metrics across multiple frequency bands. Gut microbiota composition was assessed via 16S rRNA sequencing to evaluate taxonomic shifts. Results revealed increased EEG connectivity, particularly in alpha, beta, and gamma frequency bands, suggesting improved neural communication and complexity following ARE consumption. Significant changes in nonlinear EEG metrics were observed, consistent with previous findings in the literature. Microbiota analysis indicated non-significant alterations in overall diversity but revealed increases in Alistipes, Streptococcus thermophilus, and Flavonifractor, alongside a decrease in Hungatella, potentially implicating SCFA metabolism and inflammatory regulation. These findings suggest ARE may enhance cognitive health by modulating neural activity and gut microbiota composition. While these results provide preliminary evidence of neuroprotective effects, further research with larger, disorder-specific cohorts and placebo-controlled designs is necessary to validate outcomes and explore gut-brain axis mechanisms in cognitive decline.
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.

Güncel Gönderiler