Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

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Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser
(Springer Nature Link, 2026) Arslan, Naciye Çiğdem; Bilgin, İsmail Ahmet; Gülcü, Barış; Bayraktar, Barış; Eray, İsmail Cem; Bisgin, Tayfun; Yıldırım, Yasemin; Aghayeva, Afaq; Aydın, İshak; Bilgiç, Çağrı; Bölük, Salih; Kurtul, Cahide İnci; Ramoğlu, Nur; Yıldırım, Ali; Erenler Bayraktar, İlknur; Bayraktar, Onur
Objectives: The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. Methods: This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. Results: Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001). Complete healing was achieved in 97.4% of patients, with a median time of 14 days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. Conclusions: While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness.
Increased residual anterior knee laxity at one year is associated with a dose‐dependent increase in graft re‐rupture risk following hamstring autograft ACL reconstruction in athletes
(Wiley, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, Mahmut Enes; Toker, Berkin; Taşer, Ömer
Purpose: Residual anterior knee laxity following anterior cruciate ligament reconstruction (ACLR) has been associated with inferior subjective out comes and an increased risk of revision surgery; however, its prognostic value for predicting subsequent graft re‐rupture remains unclear. This study aimed to assess the association between KT‐1000–measured 1‐year post operative anterior knee laxity and graft re‐rupture after ACLR. We hy pothesised that increased residual anterior knee laxity at 1 year post operatively would be associated with a higher risk of graft re‐rupture in a dose‐dependent manner. Methods: This retrospective cohort study included 1011 amateur and pro fessional athletes who underwent primary ACLR with hamstring tendon autograft (HTA) between 2005 and 2024 by a single surgeon using a standardised surgical technique. Patients undergoing revision ACLR, mul tiligament reconstruction, or any lateral extra‐articular augmentation pro cedure were excluded. Anterior knee laxity was quantified using the KT 1000 arthrometer at a mean of 12.1±1.3 months post‐operatively. A landmark time‐to‐event design was applied, with follow‐up starting from the KT‐1000 assessment to minimise immortal time bias and to focus on anterior knee laxity after biological graft maturation. The primary exposure was KT‐1000 side‐to‐side difference (SSD), analysed as both a continuous variable and using clinically relevant thresholds (<3mm, 3–5mm, and >5mm). Associations between post‐operative laxity and graft re‐rupture, adjusting for demographic, surgical, and activity‐related factors were assessed using a multivariable Cox proportional hazards model. Secondary analyses evaluated the relationship between KT‐1000 laxity, return‐to‐play status, and post‐operative activity level. Results: Patients who experienced graft re‐rupture had significantly greater post‐operative KT‐1000 SSD compared with those without re‐rupture (3.5 ± 1.3mm vs. 2.1±0.9mm; p<0.001). Increased KT‐1000 SSD was independently associated with higher graft re‐rupture risk (adjusted hazard ratio, 2.97 per 1‐mm increase; 95% confidence interval [CI], 2.5–3.5). Higher laxity categories were associated with progressively increased re‐rupture risk with adjusted hazard ratios of 1.76 (95% CI, 1.3–2.3; p<0.001) for 3–5mm and 8.85 (95% CI, 4.7–16.4; p<0.001) for >5mm compared with <3mm. Post‐operative 1‐year KT‐1000 anterior knee laxity was not significantly associated with return‐to‐play status (odds ratio, 0.84 per 1‐mm increase; 95% CI, 0.6–1.1; p=0.28), but was modestly associ ated with lower post‐operative Tegner activity level (p<0.001). Conclusion: KT‐1000–measured post‐operative anterior knee laxity at 1 year post‐operatively was independently associated with the risk of sub sequent graft re‐rupture after HTA ACLR in athletic patients. These findings suggest that residual laxity may serve as a useful risk stratification tool, rather than a deterministic predictor of failure, and should be interpreted in the context of overall clinical and biomechanical assessment. Level of Evidence: Level III.
Prognostic significance of lymphovascular space invasion in endometrial cancer and its relationship with other prognostic factors
(Galenos Publishing House, 2026) Nalbant Gürer, Vildan; Küçükbaş, Mehmet; Karateke, Ateş
Objective: To investigate the prognostic significance of lymphovascular space invasion (LVSI) and its relationship with other prognostic factors in patients with endometrial cancer. Material and Methods: Patients with stage IA-IVB endometrial cancer who underwent hysterectomy and/or staging surgery between January 2016 and December 2020 at a tertiary referral center were retrospectively analyzed. Pathological data including histological type, stage, grade, LVSI (lymphatic invasion, vascular invasion), tumor size, depth of myometrial invasion, cervical involvement, lymph node evaluation (pelvic, paraaortic), and peritoneal wash cytology were analyzed using univariate and multivariate methods. Results: The study included 304 patients. Non-endometrioid tumors were associated with a 6.35-fold higher risk of LVSI. Each 1 mm increase in tumor size raised the risk by 1.03-fold. LVSI was present in 53.3% of cases with lymph node metastasis and was 7.2-fold more frequent in deceased patients (odds ratio: 7.209; 95% confidence interval: 3.137-16.570; p<0.001). Multivariate analysis identified tumor grade and survival as independent predictors of LVSI: grade 3 tumors had a 4.88-fold higher risk (p=0.014), and mortality was associated with a 4.16-fold higher risk (p=0.007). Survival was significantly linked to LVSI, tumor size ≥35 mm, and recurrence, but not to age, histological type, lymph node status, or peritoneal cytology. Conclusion: Our results demonstrated that LVSI was significantly associated with histological grade and survival. Furthermore, LVSI, tumor diameter ≥35 mm, and recurrence were found to significantly affect survival, highlighting their prognostic relevance for risk assessment and postoperative management. [J Turk Ger Gynecol Assoc.]
Combination of bilateral rectus sheath and modified BRILMA blocks for postoperative analgesia in pediatric liver transplantation: A tailored approach
(Edizioni Minerva Medica, 2026) Alver, Selçuk; Çiftçi, Bahadır; Büget, Mehmet İlke; Emek, Ertan; Erbiş, Halil; Öztürk, Nadi Nazım; Umutoğlu, Tarık
Combination of bilateral rectus sheath and modified BRILMA blocks for postoperative analgesia in pediatric liver transplantation: A tailored approach
The effects of anthocyanin consumption on functional connectivity in dementia and type 2 diabetes mellitus
(Elsevier, 2026) Müdüroğlu Kırmızıbekmez, Aynur; Önder, Alparslan; Özdemir, Mustafa Yasir; Yüksel Eryiğit, Önder; Kara, İhsan
This study investigates the effects of 12 weeks of anthocyanin consumption on brain function in individuals with Dementia with Type 2 Diabetes Mellitus (T2DM) and Dementia alone. Two groups of individuals: 12 participants with T2DM comorbid with dementia and 31 participants with dementia alone. EEG recordings were collected at baseline, before the start of the study, and after 12 weeks of anthocyanin consumption. During the study period, participants consumed 300 mg of anthocyanins daily. EEG recordings were conducted using a 21-channel gel EEG cap following the 10–20 system at a sampling rate of 500 Hz. EEG signals were divided into seven frequency bands, and the Imaginary Part of Coherence (iCOH) metric, which reduces volume conduction effects, was used to evaluate functional connectivity. Within-group analyses were performed using the Wilcoxon signed-rank test, and between-group comparisons were conducted using the Mann-Whitney U test, both implemented in Python. This study demonstrates that 12 weeks of anthocyanin supplementation positively impacts neural network ef ficiency and functional connectivity in both the Cognitive Impairment (CI) group and the Type 2 Diabetes Mellitus with Cognitive Impairments (T2DMwCI) group. Significant improvements were observed in iCOH, GE, and LE metrics across delta, theta, beta, and gamma frequency bands, indicating enhanced information pro cessing and potential compensatory mechanisms. These findings highlight the neuroprotective properties of anthocyanins, suggesting their potential to mitigate cognitive decline associated with T2DM and dementia. As a result, it supports the idea that anthocyanins are a potential dietary intervention for mitigating cognitive decline, though further research is needed to validate and expand these results.
Genel Patoloji
(Güneş Tıp Kitabevleri, 2026) Alatlı, Fatma Canan; Balcıoğlu, Hüseyin Avni
Sağlık kısaca vücudun hastalık belirtisi olmadan, işlevlerini sürdürebildiği durumdur. Dünya Sağlık Örgütü (DSÖ) sağlığı, hem fiziksel, hem ruhsal, hem de sosyal olarak tam bir iyilik hali şeklinde tanımlamaktadır.
Efficacy-oriented approach for medium-sized follicles: A perspective on stimulation, expectation, and triggering strategy in IVF cycles
(Wiley, 2026) Aydın, Gerçek; Ergin, Elif; Araç, Merve; Bülbül, Mehmet; Çalışkan, Eray; Hatırnaz, Şafak; Dahan, Michael; Malvasi, Antonio; Tinelli, Andrea
Objective: To assess the therapeutic significance of routinely aspirating mid-sized fol licles (14.0–16.9 mm) during oocyte pick-up (OPU) by looking at procedural efficiency and embryo usage in cycles with varied follicular cohorts. Methods: In vitro fertilization (IVF) cycles with follicles classified as large (≥17 mm) or mid-sized (14.0–16.9 mm) at the time of OPU were included in this prospective cohort. Each group's oocytes were extracted and treated independently while main taining rigorous traceability. Analysis was performed on embryologic results, opera tive time factors, and embryo transfer utilization across successive transfer attempts. Pregnancy outcomes and the length of the operation were investigated. Laboratory results pertaining to trigger strategies were assessed descriptively. Results: When measured per mature oocyte, oocytes from mid-sized follicles showed comparable fertilization and blastocyst development rates. However, only a small percentage of embryo transfers included embryos from mid-sized follicles, especially in the initial two transfer attempts. Large follicles had a longer total OPU duration, and cycles that resulted in miscarriage had significantly longer operative times among large-follicle-derived embryo transfers. For mid-sized follicles, there were no differ ences in the length of the procedure based on the pregnancy outcome. Conclusion: The contribution of mid-sized follicle-derived oocytes to embryo trans fer selection seems to be restricted in everyday practice, despite their reassuring laboratory competence. Procedural efficiency is a potentially significant factor in customized IVF care, as evidenced by the correlation between longer operating times and worse clinical outcomes. In certain clinical situations, a focused stimula tion and aspiration approach might be suitable without obviously jeopardizing cu mulative results.
Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: Systematic review and meta-analysis
(BMJ Publishing Group, 2026) Vilela Filho, Osvaldo; Bannach, Matheus A.; Martins Lino Filho, Adriano; Hamani, Clement; Nuttin, Bart; Hariz, Marwan; Schulder, Michael; David Greenberg, Benjamin; Yılmaz, Atilla; Gonçalves Ferreira, António
Background Psychiatric disorders are increasingly contributing to global disability. Despite advances in conservative management, the prevalence of treatment-resistant cases remains high. Meanwhile, neurosurgery for psychiatric disorders (NPD) remains underused, largely due to strict regulations and historical concerns, particularly those related to neuropsychological side effects (NPSE). Objective To address this issue, we conducted a systematic review with meta-analysis to compare NPSE associated with radiofrequency ablative NPD to those observed in neuro-oncological, neurovascular and epilepsy surgeries. Methods PubMed, Embase and LILACS databases were searched in April 2024 for articles published in English/Spanish from 1990 to 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results A total of 48 articles with 2678 participants were included. The frequency of transient and permanent NPSE in the NPD group ranged from 0.94% to 11.50% and 0.94% to 2.03%, respectively, comparable to the other surgical groups (epilepsy: 0.31–11.70%; vascular: 0.52–22.90%; oncology: 0.94–17.60% for transient NPSE; epilepsy: 0.31–12%; vascular: 0.40–1.96% and oncology: 0.84–1.48% for permanent NPSE). Regarding permanent NPSE, arguably the most critical consideration, the NPD group showed better outcomes in memory, language and social cognition than the epilepsy group, but worse outcomes in executive and perceptual-motor functions. Compared with the vascular group, the NPD group had better executive function but worse complex attention. Finally, the NPD group had fewer permanent deficits than the oncology group in executive function, complex attention and perceptual-motor domains, although language performance was lower. Conclusions Contemporary NPD apparently carries a similar risk of NPSE as other conventional neurosurgical procedures, challenging misconceptions and this unjustified barrier to its broader use.
Predictors of re-biopsy in percutaneous musculoskeletal tumor biopsies: A single-center retrospective cohort study
(SAGE Publications, 2026) Yücesan, Ali; Arıkan, Yavuz; Doğukan, Fatih Mert; Mutlu, İlhan Nahit; Toy, Serdar; Atan, Tamer; Özer, Devrim
Purpose: This study aimed to evaluate the diagnostic success of percutaneous biopsies performed for suspected mus culoskeletal tumors and to identify clinical, anatomical, and procedural factors associated with the need for repeat biopsy (re-biopsy). The secondary objective was to assess the impact of multidisciplinary team (MDT) evaluation on reducing unnecessary re-biopsy procedures. Methods: A total of 565 patients (331 bone, 234 soft tissue lesions) who underwent percutaneous biopsy for suspected musculoskeletal tumors between 2020 and 2024 were retrospectively analyzed. Diagnostic success was defined as a biopsy yielding a definitive histopathological diagnosis sufficient to guide treatment planning without additional tissue sampling. Predictive factors including lesion size, depth, location, and performing specialty were evaluated using univariate and multivariate logistic regression analyses. Results: The initial diagnostic yield was 65.5%. Multivariate analysis revealed that lesion width <2 cm (OR = 2.01; 95% CI, 1.19–3.39; p = 0.009) and biopsy performed by an interventional radiologist (compared to an orthopedic surgeon) (OR = 5.25; 95% CI, 2.83–9.74; p < 0.001) were independent predictors of re-biopsy recommendation. Among 72 patients recommended for re-biopsy, MDT evaluation averted the need for a second procedure in 38 cases (52.8%). Conclusion: Smaller lesion size (<2 cm) and the medical specialty performing the biopsy were independent predictors of re-biopsy recommendation, with the latter likely reflecting systematic differences in case complexity and procedural environment rather than operator skill. Structured MDT evaluation significantly reduced unnecessary repeat procedures.
Functional and surgical outcomes of ventral mesh rectopexy in male patients with rectal prolapse: A nationwide multicenter retrospective cohort study by the pelvic floor working group of the Turkish society of colon and rectal surgery (TSCRS)
(Springer Nature Link, 2026) Gültekin, Fatma Ayça; Balcı, Bengi; Kuzeyli Yıldırım, Yasemin; Arslan, Çiǧdem; Yaşar, Necdet Fatih; Bisgin, Tayfun; Bayraktar, Adem; Zenger, Serkan; Şengül, Neriman; Bulut, Türker Mehmet
Background The indications and outcomes of ventral mesh rectopexy (VMR) in the treatment of rectal prolapse in males have been minimally addressed in the literature. This study aimed to evaluate the demographics, clinical characteristics, and surgical outcomes associated with VMR in male patients. Methods This nationwide retrospective cohort study included male patients who underwent VMR at centers performing pelvic floor surgery across Turkey. Clinical and surgical characteristics were obtained, and functional outcomes were evalu ated using Cleveland Clinic Incontinence score (CCIS) and Altomare Obstructed Defecation Syndrome (ODS) scores at the pre- and postoperative periods. Results Forty-one male patients (mean age, 45.4 years; mean BMI, 25.6 kg/m2 ) underwent VMR (2 open, 5 robotic, and 34 laparoscopic). The cohort comprised 11 patients with internal rectal prolapse (IRP) and 30 with external rectal prolapse (ERP). The overall complication rate was 17.1% (2.4% related to mesh), with a 12% recurrence rate. The median follow-up was 33 (6–127) months. The recurrence rate was 36.4% for IRP patients and 3.3% for ERP patients (p=0.014). Significant improvements were observed in the CCIS (preoperative: 6.1±4.8; postoperative: 2.8±3.3, p=0.005) and Altomare ODS (preoperative: 11.9±4.6; postoperative: 7.26±5.8, p<0.001). Conclusions In this nationwide retrospective cohort study, VMR was associated with favorable functional outcomes in males. Recurrence rates were significantly higher in those with internal rectal prolapse. As sexual function was not systematically assessed, prospective studies with standardized patient-reported outcomes are warranted.
Artificial intelligence in medical education: Curriculum design, assessment models, and educational infrastructure across undergraduate and residency training – A narrative review
(Turkish Society of Cardiology, 2026) Göçer, Hakan; Durukan, Ahmet Barış; Özyüksel, Arda
Artificial intelligence (AI) is rapidly becoming an integral part of everyday clinical practice, including cardiology and cardiovascular surgery. As AI increasingly influences diagnostic and therapeutic decisions, physicians are expected to interact with these systems in a critical, safe, and ethically grounded manner. This narrative review aims to explore how AI can be systematically integrated into undergraduate and residency medical education, with a particular focus on curriculum design, teaching strategies, assessment models, and educational infrastructure, while considering the context of the Turkish medical education system. A narrative synthesis of international medical education literature, policy documents, and institutional reports was conducted without quantitative meta-analysis. The review was guided by the principles of human-in-the-loop clinical reasoning, ethical AI use, and patient safety. Effective integration of AI into medical education requires a longitudinal and staged curriculum spanning preclinical, clinical, and residency training. Assessment strategies must explicitly address AI-assisted decision-making and be supported by transparent institutional policies governing AI use in examinations, as well as by secure, regulation-compliant digital infrastructure. Educational approaches should encourage learners to critically appraise and contextualize AI outputs rather than accept them uncritically. The reviewed literature supports a competency-based educational framework that integrates AI literacy, ethical reasoning, and context-aware clinical judgment. AI education should be viewed as a core clinical competency that strengthens rather than replaces human judgment. Particularly in high-risk cardiovascular disciplines, a standardized, ethics-centered, and competency-based educational framework is essential to prepare future physicians for AI-augmented healthcare environments.
Safety, feasibility and indications of transabdominal oocyte pick-up: Initial experience
(World Scientific, 2026) Turan, Volkan; Öktem, Özgür
Although the transvaginal route is the preferred method for the oocyte retrieval procedure, the transabdominal (TA) route may be preferred in certain conditions. In this opinion we presented our experience with TA oocyte pick-up in 101 patients across several different indications and assessed the safety of the procedure.
WCN26-6583 Oral lactoferrin in anemia of chronic kidney disease: A systematic review and meta-analysis
(Elsevier, 2026) Magal, Abhijith; Arslan, Felemez; Silva, Rafaela Pereira; Bayer, Ekin Şiar; Paiva de Almeida, Vitor
Introduction: Anemia is a prevalent and multifactorial complication of chronic kidney disease (CKD), often driven by inflammation, impaired iron metabolism, and reduced erythropoietin production. Lactoferrin, an iron-binding glycoprotein with immunomodulatory and antimi crobial properties, has demonstrated efficacy in improving iron indices in general iron deficiency anemia. However, its role in CKD-associated anemia remains inadequately characterized. Methods: A systematic review and meta-analysis were conducted to evaluate the effectiveness of oral lactoferrin compared to standard-of care therapies—including iron supplementation and/or erythropoiesis stimulating agents—for the treatment of anemia in adult and pediatric CKD patients. PubMed, Embase, and Cochrane CENTRAL were searched through May 7, 2025. Data were pooled using a random-ef fects model, and heterogeneity was assessed using the I2 statistic. Sensitivity analyses and trial sequential analysis (TSA) were performed to assess robustness and adequacy of cumulative evidence. Results: Four studies comprising 413 participants were included in the final analysis. Lactoferrin supplementation was associated with a statistically significant increase in transferrin saturation (MD: 8.12%; 95% CI: [0.61, 15.63]; p = 0.03), while improvements in hemoglobin (MD: 0.66 g/dL; 95% CI: [-0.06, 1.38]; p = 0.07) and serum iron (MD: 19.20 mcg/dL; 95% CI: [-4.56, 42.96]; p = 0.11) did not reach statistical significance. Conclusion: Oral lactoferrin supplementation was associated with a significant improvement in transferrin saturation and a non-significant trend toward higher hemoglobin and serum iron levels in CKD-related anemia. While these findings suggest a potential role in improving functional iron availability, further well-designed trials are needed to confirm its clinical utility.
Comparison of caudal and retrolaminar blocks for postoperative analgesia in pediatric orchidopexy: A randomized controlled trial
(Edizioni Minerva Medica S.p.A., 2026) Özen, Volkan; Umutoğlu, Tarık; Turan, Engin İhsan; Ayas, Tahir Arda; Yiğit, Doğakan; Çiftçi, Bahadır; Alver, Selçuk
Background: Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. METHODS: In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. RESULTS: Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. CONCLUSIONS: In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways.
Shrinking follow-up duration in pilonidal sinus surgery, 1970–2020: A patient-weighted longitudinal analysis of 2,285 studies
(Springer Nature Link, 2026) Arslan, Çiğdem; Seifert, Jannik; Doll, Dietrich
Background: Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP). Despite evidence suggesting ≥5 years is necessary, contemporary reports appear to adopt progressively shorter surveillance windows. Methods: We assembled a structured database of 2,285 pilonidal surgery series (1850–present) and extracted publication mid-decade, FUP since surgery, and cohort size (n). For 1970–2020, we calculated decade-wise patient-weighted mean FUP. Secular change was estimated using weighted least squares (WLS; weights=n), with unweighted sensitivity analyses. Associations between decade and FUP were assessed via weighted Pearson correlation with Kish effective sample size. We summarized proportions meeting ≥2, ≥5, ≥10 years and patient shares by FUP bands. Results: Median FUP was 1.67 years; mean 2.50 years. Only 14.2% of studies reported ≥5 years and 2.9% ≥10 years. Patient-weighted mean FUP peaked in the 1980s at 6.69 years, declining to 5.26 (1990s), 4.26 (2000s), 3.14 (2010s), and 2.55 years (2020s). Relative to the 1970s (3.78 years), the 2020s were −1.23 years (−32.5%), and −4.14 years (−61.9%) below the 1980s. The WLS slope was −0.0766 years·year⁻¹ (95% CI −0.0856 to −0.0675; p=4.57×10⁻⁵⁸); unweighted slope −0.0407 (95% CI −0.0479 to −0.0334; p=1.47×10⁻²⁷). Weighted correlation: Rw=−0.342 (Kish n≈216; p=2.5×10⁻⁷). In the 2020s, patients were distributed as 55.3% <2 years, 26.6% 2–<5, 15.8% 5–<10, 2.3% ≥10. Conclusions: Follow-up windows have contracted substantially, risking under ascertainment of late recurrences. A minimum of ≥5-year FUP with staged reporting at 5 and 10 years and registry-based surveillance is recommended. The absence of a pilonidal core outcome set (COS) in guidelines impedes consistent, long-horizon reporting; COS development and guideline adoption should be prioritized.
Survival at stake: Surgical decision-making in metastatic femoral
(Acta Medica Belgica, 2025) Yücesan, Ali; Arıkan, Yavuz; Toy, Serdar; Karaduman, Volkan; Özer, Devrim
Pathological femoral fractures resulting from primary or metastatic tumors represent a complex clinical challenge for orthopedic surgeons, often requiring individualized treatment strategies. This retrospective study aimed to evaluate and compare the outcomes of different surgical approaches used in the management of pathological femoral fractures secondary to metastatic disease. A total of 46 patients (52 femoral fractures) who underwent surgical treatment between 2020 and 2023 were included in the study. Data collected encompassed demographic characteristics, tumor histology, surgical techniques employed, and clinical outcomes. Statistical analysis was conducted using appropriate parametric and non-parametric tests, depending on data distribution. Of the patients included, 51% underwent tumor resection followed by endoprosthetic reconstruction, 40% were treated with intramedullary nailing, and 9.4% underwent plate osteosynthesis. The highest postoperative mortality rate was observed among patients with lung cancer metastases. Blood transfusions were necessary in 66% of cases. The overall mean survival time following surgery was 4.5 months, with significant variation according to tumor type and metastatic burden. The findings of this study underscore the importance of a multidisciplinary approach in the surgical management of pathological femoral fractures caused by metastatic tumors. Surgical interventions such as intramedullary nailing, plate fixation, and endoprosthetic reconstruction can effectively restore mechanical stability and contribute to improved patient quality of life. Selection of the optimal surgical technique should be guided by tumor histopathology, anatomical location and extent of bone involvement, number of metastatic lesions, and overall patient prognosis. Timely and appropriate surgical intervention remains critical to minimizing complications and enhancing survival outcomes in this patient population.
The effect of phosphoric acid on the development of neural tube defects in chick embryos
(International Scientific Information, Inc., 2026) Yücel, Murat; Çetin, Eyüp; Canbaz, Halime Tuba; Karip, Betül Zehra; Demir, Emine; Kocaoğlu, Sarper; Demir, Hüseyin
Introduction: Neural tube defects (NTDs) are among the most common congenital malformations and arise from disruption of early neurulation. Phosphoric acid is a widely used food additive; however, its potential effects on early neu ral tube development have not previously been evaluated in experimental neurulation models. This proof-of concept study aimed to investigate the embryotoxic and teratogenic effects of phosphoric acid on neural tube development in a chick-embryo model of neurulation, at a single tested concentration. Material/Methods: Fertilized pathogen-free chicken eggs (n=30) were randomly allocated into 2 groups. Control embryos (n=15) received no injection, whereas embryos in the experimental group (n=15) were injected beneath the embryon ic disc with 0.25 mM phosphoric acid, at Hamburger-Hamilton stage 9. Embryos were incubated for 72 hours, after which survival was recorded and neural tube development was evaluated macroscopically and histopath ologically. Statistical comparisons were performed using Fisher’s exact test. Results: All control embryos survived (15/15, 100%) and exhibited normal neural tube closure. In the phosphoric acid–treat ed group, survival was significantly reduced (10/15, 66.7%; P=0.0421). Among surviving treated embryos, 80% (8/10) demonstrated NTDs, including cranial and caudal closure abnormalities (P<0.001). Histopathological ex amination confirmed incomplete neural fold closure, irregular notochord morphology, and disrupted somite or ganization in affected embryos. Conclusions: Phosphoric acid exposure at the tested concentration and developmental stage markedly reduced embryo sur vival and induced a high incidence of neural tube closure defects in a chick-embryo model. These findings pro vide the first experimental proof-of-concept evidence that phosphoric acid can directly disrupt early neurula tion in a vertebrate neurulation model. However, vehicle-controlled replication, dose–response analyses, and exposure-bridging studies are required to distinguish teratogenic specificity from general embryotoxicity and to assess potential relevance to human embryogenesis.
The impact of conventional chemotherapy regimens and targeted drugs on ovarian function in breast cancer patients
(Springer Nature Link, 2026) Hasköylü, Şeyma; Şahin, Şevval Berfin; Altıntaş, Alara; Yıldız, Şule; Bildik, Gamze; Benlioğlu, Can; Turan, Volkan; Kim, Samuel; Öktem, Özgür
Breast cancer is the most common malignancy among women, affecting nearly 1.5 million individuals worldwide every year. While survival rates improve, many reproductive-age survivors confront significant long-term consequences, particu larly diminished ovarian reserve, infertility, and premature ovarian insufficiency due to the gonadotoxic effects of chemo therapy. Postponement of pregnancy for five years or more after treatment exacerbates the decline in fertility due to ongo ing ovarian aging and depletion of residual ovarian reserve. Women carrying BRCA1/2 mutations may already exhibit reduced ovarian reserve and are more vulnerable to gonadal damage, possibly due to impaired DNA repair mechanisms associated with these mutations. The contribution of other breast cancer susceptibility genes (e.g., ATM, CHEK2, PALB2, BARD1, RAD51C, RAD51D, and TP53) to chemotherapy-induced gonadotoxicity remains unclear. Although animal data shows depletion of primordial follicle pool and granulosa cells dysfunction, the ovarian effects of the poly(ADP-ribose) polymerase (PARP) inhibitors in women with and without BRCA mutation are not clear. Immune-check point inhibi tors (ICIs) causes immune-mediated destruction of the primordial follicle pool and reduction in ovarian reserve. Cyclin dependent kinase inhibitors appear to be less toxic than ICIs. In this narrative review of the current literature we aimed to provide a comprehensive overview of the molecular mechanisms underlying ovarian toxicity associated with conventional chemotherapy and targeted therapies in breast cancer treatment.
An update on fertility preservation from the asian society for fertility preservation
(Wiley, 2026) Turan, Volkan; Faizal Bin Ahmad, Mohd; Di, Wen; Gook, Debra; Kaul, Nalini; Kim, Seok Hyun; Ko, Jennifer; Chau Le, Thi Minh; Lee, Jung Ryeol; Öktem, Özgür
Fertility preservation (FP) is a rapidly expanding field in reproductive medicine with still limited data on outcomes. FP aims to protect the fertility of children, women, and men who face the potential risk of fertility loss for various medical conditions, including but not limited to cancer and its gonadotoxic treatment forms. Therefore, it is crucial to provide evidence-based recommendations to assist health professionals in discussing FP options. Our aim was to provide a guideline for multidiscipli nary medical staff in considering the availability of FP options and to help them decide whether to provide FP. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure the maintenance or preserving reproductive health. Therefore, people who are at risk of losing fertility should be evaluated for and counseled about future reproductive risks. Embryo, oocyte, and ovarian tissue cryopreservation are the established FP options in adult females, with ovarian tissue cryopreservation the only option for prepubertal girls. A wide range of variables affect the choice of the FP strategy. These include age and ovarian reserve of women, the time available before the initiation of cancer treatment, puber tal status, and cancer type and stage. In males, sperm cryopreservation is a highly effective method in adolescent and adult males, while testicular tissue cryopreservation, which is experimental, is the only available option for prepubertal males. This review addressed the important clinical questions and provided answers for FP in females, males, and children according to the indications and availability of FP.
Complete healing after umbilical mesenchymal stem cell-derived exosome therapy for a refractory complex anal fistula
(Springer Nature Link, 2026) Arslan, Çiğdem; Erenler, İlknur; Karaöz, Erdal
Complex anal fistulas pose a persistent challenge due to high recurrence and the risk of continence impairment. While sphincter-sparing techniques exist, outcomes are variable in refractory disease. Mesenchymal stromal cell (MSC) therapies show promise but face logistical barriers, prompting interest in acellular exosome-based approaches. We report a 45-year-old woman with a complex anterior anal fistula refractory to multiple surgeries, including two endoanal advancement flaps, complicated by new-onset flatus incontinence. Following the second endoanal advancement flap, the patient's Cleveland Clinic Continence Score (CCIS) was 10, and the Quality of Life in Patients with Anal Fistula Questionnaire (QoLAF-Q) score was 51. A two-stage salvage strategy was undertaken: meticulous curettage and closure of the internal opening, followed by local administration of MSC-derived exosomes at baseline and three weeks. Significant wound reduction was observed, progressing to complete epithelialization within two weeks after the second exosome application. At six months after combined surgical intervention and exosome therapy, CCIS and QoLAF-Q scores improved to 0 and 28, respectively, indicating full restoration of continence and a marked improvement in quality of life. This case suggests that local exosome therapy, used as an adjunct to careful surgical preparation, may support healing and functional recovery in refractory complex anal fistulas. Controlled studies with standardized protocols are warranted to define efficacy, dosing, and durability.

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