İstanbul Sağlık ve Teknoloji Üniversitesi Kurumsal Akademik Arşivi
DSpace@İSTÜN, Üniversite mensupları tarafından doğrudan ve dolaylı olarak yayınlanan; kitap, makale, tez, bildiri, rapor, araştırma verisi gibi tüm akademik kaynakları uluslararası standartlarda dijital ortamda depolar, Üniversitenin akademik performansını izlemeye aracılık eder, kaynakları uzun süreli saklar ve telif haklarına uygun olarak Açık Erişime sunar.
Güncel Gönderiler
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.
AnNLP-driven framework for automated radiology–pathology concordance assessment in breast biopsy
(MDPI Publishing, 2026) Esmerer, Emel; Nazlı, Mehmet Ali; Uzun-Per, Meryem; Gümüş Değidiben, Melike; Söyleyici, Merve; Tahir, Eren; Bal, Mert
Background/Objectives: To develop and assess the feasibility of a natural language processing (NLP) framework for automated assessment of radiology-pathology concordance in breast biopsy using machine learning-based analysis of unstructured reports. Methods: This retrospective study included 766 paired radiology and pathology reports from ultrasound- or mammography-guided breast biopsies (August 2020-May 2024). Reports underwent translation, normalization, tokenization, lemmatization, and synonym expansion, followed by structured encoding of BI-RADS and pathology categories. Three models were trained: a Decision Tree, a LightGBM classifier, and a fine-tuned BioBERT model. Concordance labels were defined by multidisciplinary consensus. Performance metrics included accuracy, sensitivity, specificity, F1-score, area under the curve (AUC), and Cohen's kappa. SHapley Additive exPlanations (SHAP) analysis was used to identify influential features. Results: Among 766 cases, 707 (92.3%) were concordant and 59 (7.7%) were initially discordant. After excluding B3 lesions (n = 46), 13 true discordant cases remained (1.7%). Including B3 lesions increased clinically non-concordant or indeterminate cases from 1.7% to 7.7%, indicating that the apparent performance of the models is likely sensitive to case definition and dataset composition. BI-RADS 4a was the most common category (31.3%), and benign pathology (B2) accounted for 64.4% of biopsies. Within this dataset, LightGBM yielded the highest apparent AUC (0.999) (however, given the extremely small number of true discordant cases, this estimate is likely unstable and should be interpreted with caution), while BioBERT showed the strongest agreement with expert consensus (κ = 0.89). SHAP analysis identified clinically meaningful terms such as calcification, hypoechoic, ductal, and carcinoma as key contributors to model predictions. Given the very limited number of true discordant cases, these performance estimates are likely unstable and should be regarded as preliminary, requiring validation in larger, multi-center cohorts. Conclusions: This study presents a proof-of-concept NLP-based framework for radiology-pathology concordance assessment. The models showed promising performance in identifying potentially discordant cases; however, given the limited number of true discordant samples, these findings should be considered preliminary and require further validation in larger, multi-center datasets before clinical implementation.
In vitro evaluation of the effect of children’s toothpastes with different ingredients on the surface microhardness and surface roughness of artificial caries of primary tooth enamel
(Türkiye Klinikleri Yayınevi, 2026) Kaçmaz, Nazlıcan; Yoğurucu Değerli, Gizem; Altun, Ceyhan
Objective: The aim of this study is to compare the remineralization efficacy of pediatric toothpastes with different compositions produced as alternatives to fluoridated pediatric toothpastes, under in vitro conditions. The contribution of this study to the literature is the comparative evaluation of the remineralization efficacy of pediatric toothpastes containing hydroxyapatite, propolis, and theobromine-whose remineralization effects have not previously been comparatively assessed-both among themselves and in comparison with a fluoridated pediatric toothpaste. Material and Methods: Eighty primary molar teeth without caries, cracks, or structural defects were stored in distilled water containing 0.1% thymol. Eighty enamel samples prepared from the primary molars were randomly divided into five groups: four study groups (Zubio® Kids, Glimo® Alfa, B-Good Care®, Oral-B® Junior) and one control group (distilled water) (n=8). Artificial carious lesions were created by immersing the enamel samples in a demineralization solution for 72 hours. Subsequently, during a 7-day pH cycling period, the samples were kept in a demineralization solution (pH 5.0) for 6 hours per day and in a remineralization solution (pH 7.0) for 18 hours per day, and were brushed twice daily with the toothpastes. The remineralization efficacy of the toothpastes was evaluated using surface microhardness analysis, surface roughness analysis, and scanning electron microscopy. Statistical analysis included analysis of variance (ANOVA), Tukey post hoc test, and paired sample t-test. A p-value of <0.05 was considered statistically significant. Results: After brushing, the microhardness value in the distilled water group was statistically significantly lower than in the toothpaste groups (p<0.001). The microhardness value in the fluoridated toothpaste group was found to be significantly higher than in all other toothpaste groups, while the surface roughness value was significantly lower (p<0.001). Conclusion: In this study, the fluoridated pediatric toothpaste exhibited the highest remineralization potential. Pediatric toothpastes containing theobromine and propolis demonstrated similar remineralization effects.
Trace determination of heptachlor in soil samples by Toner@CuFe2O4 nanocomposites based microextraction-gas chromatography-mass spectrometry
(Nature Research, 2026) Doru, Esra Sultan; Ali, Büşra; Serbest, Hakan; Bakırdere, Sezgin
In this paper, a green, sensitive, and accurate analytical method was described for the determination of heptachlor at low levels in the GC-MS system. In this context, the preconcentration of heptachlor was achieved by applying the dispersive solid-phase microextraction (DSPME) method prior to the separation and quantification in the GC-MS system. Toner@CuFe₂O₄ nanocomposites were synthesized by the hydrothermal synthesis method and used as the sorbent for the first time in literature. Under the optimal conditions determined by the univariate optimization approach, the limit of detection (LOD) and limit of quantification (LOQ) were found to be 0.61 µg kg⁻¹ and 2,0 µg kg⁻¹, respectively, and the sensitivity of the GC-MS system was enhanced by 68.5-fold. The applicability of the Toner@CuFe₂O₄-DSPME-GC-MS system was assessed by spiking tests applied to soil samples. The recovery results in the range of 93.2% and 105.7% obtained by applying the matrix matching calibration strategy proved the feasibility of the method. The Eco-scale and BAGI tools developed for green and analytical applicability assessment gave scores of 85 and 65, respectively, confirming that the method is environmentally friendly and analytically applicable.
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.]
