Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

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

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Autologous ovarian tissue transplantation: Preoperative assessment and preparation of the patient
(Wolters Kluwer Health, 2024) Turan, Volkan; Öktem, Özgür
Importance: Ovarian tissue cryopreservation (OTC) is an innovative and established fertility preservation method. More than 150 live births have been reported worldwide to date with the use of this strategy. OTC is one of the options to preserve fertility in prepubertal girls and for women who have time constraints and/or contraindications for ovarian stimulation for oocyte/embryo freezing before cancer treatment. The success rate of the ovarian tissue transplantation (OTT) depends on many interrelated factors. Therefore, preoperative evaluation and preparation of the candidate patients for the procedure are of paramount importance. Objective: In this review, our aim was to provide a guide for the clinicians, which demonstrates step-by-step assessment and preparation of the patients and ovarian tissue samples for transplantation. Evidence Acquisition: We searched for published articles in the PubMed database containing key words, such as OTT, OTC, preoperative assessment, primordial follicle density, and cancer, in the English-language literature until May 2024. We did not include abstracts or conference proceedings. Results: OTT is still a developing method as an effective fertility preservation approach. It is essential to perform a thorough preoperative evaluation of the patient to improve the success rates of transplantation. Conclusions and Relevance: Preoperative evaluation and preparation of women for ovarian transplantation surgery should include safety management to prevent reimplantation of malignant cells, transplanting ovarian tissue with minimum follicle loss and the decision of the best transfer site.
Comparison of the effects of four laser wavelengths on Medication-Related Osteonecrosis of the Jaw (MRONJ) in a murine model: An in vivo photobiomodulation study
(Ivyspring International Publisher, 2024) Ayhan, Mustafa; Gedik, Betül; Kalelioğlu, Ekrem Emir; Kundakçıoğlu, Abdulsamet; Küçükgergin, Canan; Turgut, Cevat Tuğrul; Kocaelli, Hümeyra; Alatlı, Fatma Canan; İşsever, Halim; Ademoğlu, Evin; Yaltırık, Mehmet
Background: This study aims to investigate the effectiveness of lasers at various wavelengths in treating medication-related osteonecrosis of the jaw (MRONJ) using biochemical, clinical scoring, micro CT analysis, and histopathological methods. The study follows the ARRIVE guidelines to ensure robust and transparent research. Methods: In our study, there were 6 groups, including one SHAM group, one CONTROL group, and four experimental groups, with 8 rats in each individual group. Each rat received antiresorptive drug intraperitoneally for 4 weeks and then had the left second molar in the mandible extracted. All animals were sacrificed at the end of the 12th week. In the experimental groups, lasers at wavelengths of 405nm, 445nm, 660nm, and 808nm were applied to the animals. Parameters such as serum vitamin D levels, bone density and bone volume at the extraction site, new bone formation, dead bone count, inflammatory cell count, and epithelial regeneration were examined. Additionally, clinical scoring was conducted after sacrifice. The laser parameters included power density, area, time, fluence, and mode (continuous wave), and the light was administered using a fiber with a Gaussian profile. Statistical analyses were performed with the NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) package program. The results were evaluated at the p<0.05 significance level. Results: According to the results obtained from our study, new bone formation in all experimental groups was significantly higher than in the SHAM and CONTROL groups. Furthermore, the 660nm and 808nm wavelengths increased serum vitamin D levels significantly. The most successful outcomes were observed in clinical scoring, dead bone count, epithelial cell regeneration, and bone density in the 660nm and 808nm wavelength groups. Conclusions: The combined use of lasers at 660nm and 808nm wavelengths may yield successful results in treating MRONJ.
Komplike olmayan üriner sistem enfeksiyonlarında lokal antibiyotik direncinin çok merkezli taranması: 37 merkezden 1850 hasta
(Ankara Microbiology Society, 2024) Cinislioğlu, Ahmet Emre; Cinislioğlu, Nazan; Öztürk, Metin İshak; Akkaş, Fatih; Aksakallı, Tugay; Atilla, Mustafa Kemal; Atiş, Gökhan; Aydın, Hasan Rıza; Balcı, Uğur; Bayrak, Ömer; Bedir, Selahattin; Biçer, Hüseyin; Çevik, Gökhan; Çift, Ali; Çiftçi, Halil; Coşkun, Burhan; Demirdöğen, Şaban Oğuz; Demirkol, Mehmet Kutlu; Dinçer, Murat; Doğan, Ahmet Emin; Dursun, Murat; Erdemir, Fikret; Erkan, Anıl; Eryıldırım, Bilal; Görür, Sadık; Hızlı, Fatih; Kadıhasanoğlu, Mustafa; Kalkan, Senad; Karabulut, İbrahim; Keskin, Mehmet Zeynel; Kızılay, Fuat; Köse, Osman; Küçük, Eyüp Veli; Odabaş, Öner; Oksay, Taylan; Özbey, Isa; Şefik, Ertuğrul; Sönmez, Mehmet Giray; Tek, Mesut; Tuğlu, Devrim; Tuncay, Ömer Levent; Usta, Mustafa Faruk; Yılmaz, Sercan; Kadıoğlu, Ateş
Bu çalışma, Türkiye’nin yedi farklı coğrafi bölgesinde komplike olmayan üriner sistem enfeksiyonu tanısı olan hastalardan elde edilen ayaktan üriner izolatlara göre en sık izlenen patojenleri tespit etmek ve bu patojenlere karşı kullanılan antibiyotiklerin direnç oranlarının coğrafi bölgelere göre anlamlı farklılık gösterip göstermediğini belirlemek amacıyla yapılmıştır. Mart 2021 ile Ağustos 2022 arasında, Türkiye genelindeki 37 farklı merkezde yapılan tetkikler sonucunda komplike olmayan üriner sistem enfeksiyonu tanısı koyulan ve pozitif idrar kültürleri olan 18 ile 65 yaş arası hastalar çalışmaya dahil edilmiştir. Araştırmaya katılan merkezler, idrar kültürlerinin verilerinin standardizasyonunu sağlamak için mikrobiyoloji laboratuvarlarında Avrupa Antimikrobiyal Duyarlılık Test Komitesi tarafından disk difüzyon yöntemini kullanan merkezlerden seçilmiştir. Bu çalışmaya, dahil edilme kriterlerine uyan toplam 1850 hasta dahil edilmiştir. Escherichia coli izolatlarının antibiyotik direnç oranlarının dağılımının analizi, ampisilin, fosfomisin ve nitrofurantoin dirençlerinde coğrafi bölgelere göre istatistiksel açıdan anlamlı farklılıkların olduğunu saptamıştır (sırasıyla p< 0.05, p< 0.05, p< 0.05). Güneydoğu Anadolu Bölgesi fosfomisin ve trimetoprimsülfametoksazol direncinin en yüksek olduğu bölge olarak tespit edilmiştir (sırasıyla; %27.4 ve %35.3). Bunun yanı sıra nitrofurantoin direncinin en yüksek olduğu bölge %35.7 oranıyla Doğu Anadolu Bölgesi ve siprofloksasin direncinin en yüksek olduğu bölge %51 oranıyla İç Anadolu Bölgesi olarak belirlenmiştir. Çalışma, komplike olmayan üriner sistem enfeksiyonlarının tedavisinde kullanılan antibiyotiklere direncin coğrafi bölgelere göre farklılık gösterdiğini ortaya koymuştur. Bu kapsamlı, ulusal prospektif araştırmanın, komplike olmayan üriner sistem enfeksiyonu için ampirik tedavi planlayan klinisyenlere değerli öngörüler sağlayacağı düşünülmektedir.
Overcoming barriers to cervical cancer prevention inAfghanistan: The imperative for an HPV vaccination andscreening program
(Wiley, 2024) Sadat, Rowaida; Saçıntı, Koray Görkem; Topçu, Elif Göknur; Saeed, Saeeda
The critical situation of cervical cancer screening and human papillo-mavirus (HPV) vaccination in Afghanistan demands urgent attention,especially in view of the ongoing political unrest and humanitarianchallenges faced by the country. Recent data underscore the urgentneed for immediate action to address this pressing issue.
Trends and regional differences for fertil ity preservation procedures in women with breast cancer
(Elsevier, 2024) Turan, Volkan; Bedoschi, Giuliano; Lee, Dong-Yun; Barbosa, Caio Parente; Oliveira, Renato de; Saçıntı, Koray Görkem; Sönmezer, Murat; Lambertini, Matteo; Massarotti, Claudia; Schaub, Amelia; Wang, Erica; Gayete-Lafuente, Sonia; Dunlop, Cheryl; Anderson, Richard A.; Bang, Heejung; Oktay, Kutluk H.
Introduction : Breast cancer is the most common malignancy in women of reproductive age and chemotherapy protocols impair fertility, frequently necessitating fertility preservation (FP) referral. Embryo, oocyte, or ovarian tissue cryopreservation are established FP modalities in women with breast cancer but there are few data on their uptake over time. In this study our aim was to determine the regional time trends and utility differences for fertility preservation methods of reproductive tissue cryopreservation. Methods : This multicenter study included 1,623 women diagnosed with breast cancer from seven tertiary centers in six countries (Brazil, Italy, Scotland, South Korea, Turkey, USA). Participant centers provided the details of FP cryopreservation approaches broken down annually from 2012 to 2021. Women with newly diagnosed breast cancer, aged 18-45 years who were referred for FP at participating centers and had normal ovarian function at the time were included. Results : We found a mean increase of 7% per year (p=0.002, adjusting for centers) in the number of women referred for FP. Of those who were referred (n=1623), a mean 38.7% underwent FP (n=629), with a range of 12% in South Korea) to 95% in Brazil. The number of women undergoing ovarian stimulation for FP continually increased until 2021, with oocyte cryopreservation being the most common procedure throughout the study period (p=0.014 for time trend). The proportion of random start ovarian stimulation cycles increased each year from 58.3% in 2012 to 86.8% in 2021, (p=0.005 for time trend, and p=0.04 for 2012 vs. 2021). Conclusions : The utility of FP has steadily increased for young women with breast cancer over the last decade, although regional differences significantly influence FP practices. The findings of our study could have value for policy making in FP care for young women with breast cancer at the local, regional, or global level. Micro abstract Breast cancer is the most common malignancy in women of reproductive age and chemotherapy protocols impair fertility, frequently necessitating fertility preservation referral. The utility of fertility preservation has steadily increased for young women with breast cancer over the last decade, although regional differences significantly influence fertility preservation practices.
Safety and effectiveness of controlled ovarian stimulation and oocyte retrieval during prepubertal and peripubertal period
(Springer, 2024) Sönmezer, Meltem; Gemici, Ali; Şükür, Yavuz Emre; Turan, Hande; Alimoğulları, Ebru; Avşar, Betül; Atabekoğlu, Cem Somer; Özmen, Batuhan; Turan, Volkan; Sönmezer, Murat
Purpose Is it safe and efective to perform controlled ovarian stimulation (COS) and oocyte retrieval (OR) in prepubertal and peripubertal patients? Methods In this retrospective cohort study, data of 20 pre-/peripubertal patients who underwent COS and OR for the purpose of oocyte cryopreservation (OC) between 2008 and 2023 were reviewed. Following COS, all OR procedures were performed transabdominally using a vaginal ultrasound probe. Ovarian reserve was assessed by serum FSH, LH, estradiol, AMH, and antral follicle counts (AFC) in all subjects. All mature oocytes were vitrifed. Results Mean age of the patients was 15.05±1.87, mean AMH was 0.84±0.8 ng/ml, mean FSH was 6.39±3.95 IU/L, mean estradiol was 61.6±51.9 pg/ml, mean LH was 4.69±3.46 IU/L, and mean AFC was 5.5±5.82. Among the patients, 12 had regular menstrual cycle, 5 had irregular menstrual cycle, whereas 3 patients still did not have their menarche yet. The indi cations for OC were as follows: primary ovarian insufciency (n=7), ovarian surgery for ovarian tumors (n=5) or ovarian torsion (n=1), mosaic Turner syndrome (n=2), acute lymphoblastic leukemia (n=1) anaplastic B-cell lymphoma (n=1), Ewing’s sarcoma (n=1), Noonan syndrome (n=1), and Thalassemia (n=1). The mean number of oocytes retrieved, MII oocytes frozen, and maturation rate were 5.11±5.0, 3.92±4.48, and 75.1±25.6%, respectively. Stepwise linear regression analysis demonstrated a positive correlation between AFC and number of total oocytes retrieved and number of MII oocytes. In the case diagnosed with Noonan syndrome, all 7 retrieved oocytes were MI and all frozen at MI phase. No patient had any complication related to COS or OR. Conclusion Even though number of the enrolled subjects is limited and mean AMH is lower in our cohort, we demonstrated that performing COS and OR is safe in pre-/peripubertal patients. If required, transabdominal route can be performed in this age group for OR. AFC appears as a prognostic factor for stimulation outcome in this age group. Pediatric patients or young adolescents at risk for primary ovarian insufciency should not be discouraged from utilizing OC.
Deep brain stimulation with double targeting of the VIM and PSA for the treatment of rare tremor syndromes
(Karger, 2024) Yılmaz, Atilla; Eray, Halit Anıl; Çakır, Murtaza; Ceylan, Mustafa; Blomstedt, Patric
Introduction: In tremor syndromes, pharmacological therapy is the primary treatment, but deep brain stimulation (DBS) is used when it is insufficient. We explore the use of DBS, focusing on the globus pallidus internus for dystonia and the ventral intermediate nucleus (VIM) for tremor conditions. We introduce the posterior subthalamic area (PSA) as a potential target, suggesting its efficacy in tremor reduction, particularly in rare tremor syndromes. We aim to evaluate the efficacy and safety of double targeting the VIM and PSA in rare tremor conditions, highlighting the limited existing data on this. Methods: Between 2019 and 2023, 22 patients with rare tremor syndromes were treated with bilateral DBS of the VIM and PSA. This case series consisted of 7 isolated head tremor, 1 hepatic encephalopathic tremor due to Abernethy syndrome, 2 voice tremor, 4 dystonic tremor, and 8 Holmes tremor (2 multiple sclerosis, 2 cerebellar insult, and 4 posttraumatic) patients. Patients' preoperative and 12-month postoperative tremor scores were compared, and the optimum VIM and PSA stimulation areas were investigated. Results: There was a significant reduction in the mean TRS score from 3.70 (±0.57) to 0.45 (±0.68) after 12 months of surgery. Specific outcomes for different indications were observed: for head tremor, 6 of 7 patients showed a reduction in TRS scores to 0 points; the vocal tremor patients demonstrated improvement; this change was not statistically significant, which is likely to be due to the low number of patients in this subgroup; the dystonic tremor patients showed either complete tremor abolition or a reduction in TRS scores; the Holmes tremor patients showed an 80% reduction in TRS scores; and the hepatic encephalopathy tremor and Abernethy syndrome patients showed a 75% improvement in TRS scores. The stimulation parameters converged on the VIM and dorsal PSA. Complications included the need for electrode repositioning, infections requiring electrode removal and re-implantation, dysarthria, and stimulation-induced ataxia, which was resolved by adjusting the stimulation parameters. Discussion: The literature on DBS for rare tremors is limited. Double targeting of the VIM and PSA appears to produce promising improvements on the outcomes reported in the existing literature on VIM-only DBS. The proximity of the VIM and PSA allows for flexible electrode placement, contributing to the potential success of the dual-target approach. We also discuss the theoretical advantages of targeting the PSA based on the distribution of tremor circuits, emphasizing the need for further research and electrophysiological studies.
Patients with gynecological malignancies are similar to other IVF patients without cancer for clinical and molecular reproductive parameters and DNA damage response pattern
(Nature Portfolio, 2024) Esmaeilian, Yashar; Yusufoğlu, Sevgi; İltumur, Ece; Uğurlu Çimen, Deniz; Vatansever, Doğan; Taşkıran, Çağatay; Turan, Volkan; Yakın, Kayhan; İncir, Said; Urman, Bülent; Öktem, Özgür
This study intended to investigate if gynecological cancers compromise ovarian function and reduce the success of assisted reproduction techniques (ART). No clinical and molecular data together is available on this issue for gynecological or other organ cancers. Steroidogenic pathways and DNA damage response characteristics of the granulosa cells retrieved from the 39 gynecological cancer patients were analyzed together with their clinical ART characteristics in comparison to 31 control ART patients. Patients with gynecological malignancies were similar to the control IVF patients for the number of mature oocytes retrieved, fertilization rates and embryo development competency. Molecular analyses of the granulosa cells retrieved from these cancer patients did not detect any perturbations in gonadotropin receptor expression and response, sex steroid production, cholesterol utilization/storage and, DNA damage response pattern in comparison to control IVF patients without cancer. This study provides the first reassuring clinical and molecular combined data set that the presence of gynecological malignancy does not appear to have any detrimental effect on clinical IVF cycle characteristics and ovarian functioning at molecular level.
Covid-19 ve ürolojik hastalıklar
(Ankara Nobel Tıp Kitabevileri, 2023) Aybal, Halil Çağrı; Kaya, Engin
Koronavlrüs hastalığı 2019 (COVID-19) pandemisini yönetmede dünyanın dört bir yanındaki sağlık sistemleri vakaların ilk görüldüğü günden bu yana mücadele etmektedir. Bu mücadelede sosyal izolasyon ve toplumsal aşılamanın etkileri ve katkısı büyüktür. Sosyal izolasyonla birlikte hastaların hastaneye COVID semptomları {ateş, ishal, tat - koku alamama, öksürük, nefes darlığı, baş ve kas ağrısı) şikayetleri dışında başvuruları sırasında hastalara müdahale önceliği ile ilgili yönergeler oluşturulmaya çalışılmıştır. Karar vermeyi kolaylaştırabilecek araçlarla hem hastaların sağlık bakımı desteklenmeye çalışılmış hem de ürologlar ile ürolojlk bakım sağlayan sağlık çalışanları için bu zor dönemde desteklenmeye çalışılmıştır.
Restless legs syndrome: From diagnosis to treatment
(Duzce University, 2023) İsmayilov, Rashad; Değirmenci, Yıldız
Restless legs syndrome (RLS) can be described by an urge to move limbs that typically coincides with an uncomfortable sensation. When at rest or inactivity, signs may start or develop worse; they usually go away when one moves or gets up for a walk. RLS can be both idiopathic or secondary to many kinds of health conditions, such as deficiency of iron, diabetes, obesity, hypothyroidism, and chronic renal failure. At the admission, secondary causes and iron tests, such as transferrin saturation and ferritin, must be evaluated. Assessments should be repeated when symptoms worsen, or when augmentation develops. Augmentation is a significant adverse effect of therapy by levodopa and dopamine agonists. More severe signs, early appearance of symptoms, and spreading of symptoms from the legs to other body parts are indicative of augmentation. Non-pharmacological treatments help some RLS patients control their symptoms. Iron-replacement therapy is a first-line treatment option for patients with indications of low body iron stores. The use of α2δ ligands as initial treatments instead of dopamine agonists has been recommended recently.
Current DBS programming
(Deep Brain Stimulation Society, 2024) Değirmenci, Yıldız
Deep brain stimulation is an established treatment option for various neurological and psychiatric disorders. Throughout its journey as a confirmed long-term efficacious therapeutic option for movement disorders such as Parkinson’ s disease, essential tremor and dystonia over the last three decades, programming strategies continuously improved to due to the development of DBS technologies. The aim of this review is to take a glance into current programming strategies in the era of movement disorders particularly with an updated review of the literature for current and emerging DBS technologies.
Gastrik band revizyonları
(İstanbul Üniversitesi–Cerrahpaşa Yayınevi, 2023) Kavlakoğlu, Burak; Khwaja, Haris
İlk başlarda takılması basit ve sıfıra yakın komplikasyon oranları ile kolay öğrenilebilir bir teknik olması nedeniyle çok iyimser bir yaklaşımla tüm dünyada hızla yaygınlaşmıştır. LAGB kullanıma girdikten sonra birçok merkezde cerrahi teknik olarak yerleştirme kolaylığı, geri dönüşümlü olması, nispeten düşük morbidite profili ve kalıcı kilo kaybı sağlayabilme umudu ile bir anda en çok uygulanan obezite cerrahisi yöntemi olmuştur. Ancak zaman içerisinde beklenmedik bir şekilde kayma, prolapsus, erozyon, mide içine göç gibi komplikasyon oranlarının yüksek olması ve istenilen kilo kaybı hedefine ulaşamama veya tekrar kaybedilen kilonun geri alınması ile sonuçta %20-30 hastada revizyonel cerrahi ve/veya başka tekniğe konversiyon cerrahisi gerekmesi, yöntemin popülerliğini yitirmesine neden olmuştur. Revizyon cerrahisinde seçilecek teknik konusunda fikir birliği olmayıp bandın çıkarılması ve takip, yeniden band yerleştirme, Revizyonel-SleeveGastrektomi, Revizyonel-LaparoskopikRoux n Y Bypass, Revizyonel One Anastomosis Gastric Bypass (Mini Gastric Bypass) gibi geniş bir yelpazede ele alınmalı, hastaya özel olarak hastayla birlikte komplikasyonun tipine ve midede meydana gelen hasar şiddetine göre karar verilmelidir.
FIGO best practice guidance in surgical consent
(Wiley, 2023) Topçu, Elif Göknur; McClenahan, Phil; Pule, Koketso; Khattak, Hajra; Karslı, Sezin Eda; Cukelj, Marijo; Ubom, Akaninyene E.; Algurjia, Esraa; Özpınar, Kübra; Perez, Yotin Ramon; Bunu, Rashid; Sanabria, Leopoldo Santiago; Portilla, Francisco J. R.; Pumpure, Elizabete; Roy, Priyankur; Fogarty, Paul
Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure-specific checklists for the most common obstetric and gynecological procedures.
Disaster preparedness: The effects of natural disasters on women's health in Turkey
(Wiley, 2023) Topçu, Elif Göknur
It is undeniable that natural disasters can have a catastrophic impact on the health of women and children. The effects do not end with the damage that is caused by the first impact, but the ensuing lack of resources is also devastating.
Contemporary issues in women's health
(Wiley, 2023) Stringer, Elizabeth; Topçu, Elif Göknur
Leiomyomas, also known as uterine fibroids or myomas, are the most common type of benign, monoclonal tumor in women of reproductive age. According to the population studied and diagnostic techniques used, incidence from 5% to 40% has been reported in the literature.
A global study on the abortion views and knowledge of trainee obstetrician-gynecologists
(Wiley, 2023) Topçu, Elif Göknur; Ramirez, Atziri; Ubom, Akaninyene Eseme
Objective: To assess the knowledge and views of trainee obstetrician-gynecologists (ObGyn) on abortion. Methods: A cross-sectional study of trainee ObGyn was conducted by the World Association of Trainees in Obstetrics and Gynecology. A study-specific questionnaire designed using Google Forms® was utilized for the study. The questionnaire was distributed electronically to study participants, to gather information on their sociodemographic characteristics, opinions, knowledge, and training on abortion. Collected data were analyzed using the IBM SPSS, version 25. Results: Most (140, 74.8%) trainee ObGyn reported that abortion was legal in their countries and most (171, 91.4%) supported the legalization of abortion. Eleven (5.9%) trainees who did not support the legalization of abortion cited religious concerns as their most common reason (5/11, 45.5%). Nearly three-quarters (133, 71.1%) of the trainees would perform an abortion on request. Most of the trainees reported that abortion education was included in the medical school curricula (131, 70.1%) and the ObGyn residency training programs (155, 82.9%) in their countries. Notwithstanding, 36.4% (68) either did not know or did not correctly know the legal status of abortion in their countries. Conclusion: There is some disparity between ObGyn trainees' knowledge of safe abortion and their awareness of the legality of the same in their countries. There is a need for all countries to include abortion education in the curricula of medical schools and all ObGyn residency programs should offer abortion training to all residents. There is a need for increased advocacy for the legalization of abortion in countries where abortion remains criminalized.
A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants
(Wiley, 2023) Oktay, Kutluk H.; Turan, Volkan; Bedoschi, Giuliano; Abdo, Nadia; Bang, Heejung; Goldfarb, Shari
Background: Better tools for post-chemotherapy amenorrhea risk assessment are needed for fertility preservation decision-making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post-chemotherapy in women with breast cancer. Methods: 142 women with breast cancer were longitudinally followed for their menstrual changes at 6, 12, and 18 months after the completion of adjuvant chemotherapy with an Anthracycline-Cyclophosphamide-based (AC-based) or Cyclophosphamide-Methotrexate +5-Fluorouracil regimen. Pre- and/or post-chemo AMH levels, age, BMI, tamoxifen use, regimen type, and germline BRCA pathogenic variant (gBRCApv) status were evaluated for the prediction of amenorrhea at 6-18 months. Results: In multivariable-adjusted logistic regression, age (p = 0.03) and AMH (p = 0.03) at 12 months, and gBRCApv status (p = 0.03) at 18 months were significant predictors of amenorrhea (areas under the ROC curve of 0.77 and 0.76, for 12 and 18 months, respectively) among 102 evaluable subjects. An undetectable AMH immediately post-chemotherapy was predictive of amenorrhea with <18 month follow-up. In longitudinal analysis estimating time trends, baseline AMH and gBRCApv status was associated with the risk of amenorrhea over 6-18 months; the AMH >2.0 ng/mL group showed attenuated time-trend risk of amenorrhea versus AMH ≤2.0 group (ratio of ORs = 0.91, 95% CI = 0.86-0.97, p = 0.002), while the gBRCApv + showed a steeper time trend, versus the controls (ratio of ORs = 1.12, 95% CI = 1.04-1.20, p = 0.003). Conclusions: In addition to the pre- and post-treatment AMH levels, gBRCApv status is a novel potential predictor of amenorrhea at 12 and 18 months after chemotherapy. The higher likelihood of amenorrhea in women gBRCApv suggests that they are more prone to losing their fertility post-chemotherapy.
Oocyte cryopreservation with in vitro maturation for fertility preservation in girls at risk for ovarian insufficiency
(Springer/Plenum Publishers, 2023) Gayete-Lafuente, Sonia; Turan, Volkan; Oktay, Kutluk H.
Purpose To assess the feasibility and outcomes of oocyte cryopreservation with in vitro maturation (IVM) in post-pubertal girls undergoing fertility preservation (FP) for primary ovarian insufciency (POI) risk. Methods Ovarian stimulation was performed with an antagonist protocol or progesterone priming. Ultrasound monitoring was performed transabdominally. Oocytes were retrieved transvaginally under IV sedation. Immature oocytes were subjected to IVM for up to 36 h. All MII oocytes were vitrifed. The main outcome measure was the total number of mature oocytes cryopreserved. The secondary outcome was the increase in the mature oocyte yield after IVM. Results Indications for FP included mosaic Turner syndrome (mTS; n=10), malignancy (n=3), and POI risk (n=2). The mean±SD age, antral follicle count (AFC), and AMH levels were 14.2±1.4 years, 8±5.2 and 1.3±1.3 ng/mL. In girls with mTS, the ovarian reserve was low for age (AFC 7.4±4.7 and AMH 1.4±1.6 ng/mL). Oocyte cryopreservation was possible in all girls with a range of 1–27 mature oocytes obtained, even in those who were previously exposed to chemotherapy or with low ovarian reserve, and no surgical complications were encountered. After IVM, the median mature oocyte yield increased signifcantly from 7.5 to 10.5 (p=0.001). Conclusions Oocyte cryopreservation appears to be feasible and safe in girls as young as 12 years of age at risk for POI The utility of IVM increases the yield of cryopreserved mature oocytes. Prior exposure to chemotherapy or low ovarian reserve should not be an automatic reason to exclude these girls from FP consideration.
Cognitive impairment in Parkinson’s disease: An updated overview focusing on emerging pharmaceutical treatment approaches
(MDPI, 2023) Değirmenci, Yıldız; Angelopoulou, Efthalia; Georgakopoulou, Vasiliki Epameinondas; Bougea, Anastasia
Cognitive impairment in patients with Parkinson’s disease (PD), which may occur in various severities, represents one of the commonest and most disabling non-motor manifestations during the course of the disease, causing a negative impact on patients’ quality of life. Eventually, it becomes a burden for the family members and/or the caregivers of patients, as it progresses to PD dementia. Current pharmacological treatments for cognitive impairment in PD exhibit partial efficacy, while novel effective therapeutic strategies are required. Accumulating preclinical and clinical evidence shows that several agents may provide beneficial effects on patients with PD and cognitive impairment, including ceftriaxone, ambroxol, intranasal insulin, nilotinib, atomoxetine, mevidalen, blarcamesine, prasinezumab, SYN120, ENT-01, NYX-458, GRF6021, fosgonimeton, INT777, Neuropeptide S, silibinin, osmotin, cordycepin, huperzine A, fibroblast growth factor 21, Poloxamer 188, ginsenoside Rb1, thioredoxin-1, tangeretin, istradefylline, and Eugenia uniflora. Potential underlying mechanisms include the inhibition of a-synuclein aggregation, improvement of mitochondrial function, regulation of synaptic plasticity, impact on gut-brain axis, modulation of neuroinflammation, upregulation of neurotrophic factors, as well as cholinergic, dopaminergic, serotoninergic and norepinephrine neurotransmission. In this overview, we aim to cover the clinical aspects of PD associated cognitive impairment, highlighting recent evidence on emerging treatment approaches that are currently under investigation at a preclinical and clinical level.
Ovarian stimulation and oocyte cryopreservation in females with cancer
(Lippincott Williams & Wilkins, 2023) Oktay, Kutluk H.; Turan, Volkan
Purpose of review: We reviewed the most recent developments including the safety and effectiveness data and success rates in individualized ovarian stimulation protocols for adult and postpubertal females with cancer. Recent findings: In women with breast cancer, aromatase inhibitor- and tamoxifen-supplemented stimulation protocols increase the margin of safety by limiting estrogen exposure. The outcomes of ovarian stimulation appear similar between cancer and noncancer populations, even with the recently developed random-start protocols, which allow initiation of ovarian stimulation anytime during the menstrual cycle. Based on lower anti-Mullerian hormone levels and primordial follicle density, carriers of BRCA pathogenic variants (BRCApv) have decreased ovarian reserve in comparison to women without those variants and may lose larger portion of their ovarian reserve post chemotherapy. Oocyte cryopreservation is also emerging as a suitable fertility preservation approach for selected postpubertal girls as young as 12 years of age. Summary: Individualized ovarian stimulation approaches combined with improvements in cryopreservation techniques increased the success and safety margin to preserve fertility with oocyte freezing. Women with BRCApv, on the other hand, may be at disadvantage as they have lower ovarian reserve and may lose larger portion of their ovarian reserve post chemotherapy compared to women who do not carry these variants.

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