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Öğe Thin endometrium restricts peri-ovulatory physiological transition between anti-adhesive and adhesive receptivity modulators(Reproductive Healthcare Ltd., 2025) Çelik, Önder; Erşahin, Aynur; Güngör, Nur D.; Uluğ, Ulun; Çelik, Nilüfer; Yardım, Meltem; Tektemur, Ehmet; Dalkılıç, Semih; Kuloğlu, Tuncay; Erşahin, Suat Süphan; Çelik, Sudenaz; Akkoç, Ramazan F.Research question: Does endometrial thinning affect the physiological transition of the endometrium from a non-receptive to a receptive state? Design: Fifty-eight women who underwent total embryo freezing were divided into three groups according to their endometrial thickness (EMT): group 1, EMT ≤ 7 mm; group 2, 7 mm < EMT ≤ 10 mm; and group 3, EMT > 10 mm. Group 1 was considered as having a thin EMT and groups 2 and 3 as a normal EMT. Endometrial sampling was performed at the time of oocyte retrieval. Anti-adhesive podocalyxin (PDX), adhesive homeobox A10 and A11 (HOXA10, HOXA11) and leukaemia inhibitory factor (LIF) mRNA, proinflammatory cytokines, oxidative stress markers and collagen deposition were determined. Results: Compared with groups 2 and 3, the relative expression of HOXA10, HOXA11 and LIF mRNA was down-regulated in group 1 (all P < 0.001), while PDX levels significantly increased (P < 0.001). The nuclear factor-κB, long pentraxin 3 (PTX3), tumour necrosis factor-α and total oxidant status of the thin endometrium group were significantly higher than those of participants with normal endometrium (all P < 0.001), while total antioxidant status was significantly lower (P < 0.001). The histoscore values for PTX3, PDX and Masson's trichrome were significantly higher in the thin endometrium group (P < 0.001 for each). Each millimetre increase in EMT decreased the risk of down-regulation of adhesive receptivity genes. The adjusted odds ratio for PDX was 1.69, representing a 69% increase in PDX expression. Conclusion: Endometrial thinning causes defective expression of anti-adhesive and adhesive receptivity modulators, restricting the transition of the endometrium from a non-receptive to a receptive state.Öğe Is age a determinant in cervical cancer screening in women aged 18 to 29?: An observational study(Lippincott Williams & Wilkins, 2025) Küçükyurt, Ayça K.; Atakul, Nil; Kolcu, Selma Atiye; Özcan, Ayşet Janet; Abdullazade, NarminThis study aims to analyze the impact of aging on cervical cancer screening among women aged 20 to 29. Specifically, it examines the occurrence of abnormal histological results and Cervical Intraepithelial Neoplasia (CIN) (+) lesions within these age groups. We retrospectively analyzed women aged 18 to 29 (<30) who underwent cervical cancer screening through cytology between 2014 and 2024. A total of 842 women who visited the gynecology outpatient clinic were included, and their Pap smear, colposcopy, and loop electrosurgical excision procedure/conization results were reviewed. Patients were divided into 2 age groups (18-25 and 26-29) for comparative analysis. Among the 842 women who underwent cytological evaluation: 744 (88.4%) had normal results, 51 (6.1%) were diagnosed with atypical squamous cells of undetermined significance (ASC-US), 31 (3.7%) with low-grade squamous intraepithelial lesion (LSIL), 8 (1.0%) with atypical squamous cells - cannot exclude high-grade lesion (ASC-H), 4 (0.5%) with High-Grade Squamous Intraepithelial Lesion (HSIL), and 4 (0.5%) with Atypical Glandular Cells (AGC). HPV (Human Papillomavirus) testing was performed on 75 women, and 40 (53.3%) tested positive for HPV. Colposcopy was conducted on 53 women, revealing CIN + lesions in 38 cases, while conization confirmed CIN + lesions in 23 cases. Colposcopy results revealed the presence of CIN 1, CIN 2, and CIN 3 lesions in both age groups. However, CIN 3 lesions were observed less frequently in the > 26 age group. Similarly, conization results showed a lower incidence of CIN 3 lesions in women older than 26. Women aged 18 to 25 had a higher likelihood of CIN 3 diagnosis. These findings emphasize the importance of considering age in the diagnosis of CIN (+) lesions during cervical cancer screening.Öğe Day 4 Versus Day 5 Fresh Embryo Transfer in In Vitro Fertilization: Is It All About Timing?(MDPI, 2025) Şişmanoğlu, Alper; Oğlak, Süleyman Cemil; Özcan, Cenk; Uluğ, UlunObjective: Most studies concentrate on comparisons between the cleavage stage and blastocyst stage of embryos during in vitro stimulation treatment. We aimed, in this study, to compare the pregnancy rates of day 4 or day 5 blastocyst transfers, all derived from fresh, antagonist-regulated in vitro fertilization (IVF) cycles, and to evaluate the factors affecting pregnancy success. Methods: This retrospective cohort study evaluated 3681 fresh embryo transfer cycles conducted at a private IVF center between 2019 and 2021. Patients were divided into two groups based on the day of embryo transfer: day 4 (Group 1) and day 5 (Group 2). Subgroup analyses were performed according to age (≤40 vs. >40 years) and the number of oocytes retrieved (≤4 vs. >4). All patients underwent ovarian stimulation with FSH alone or in combination with hMG, and GnRH antagonist protocols were used for pituitary suppression. Final oocyte maturation was triggered with recombinant hCG, and fertilization was achieved via intracytoplasmic sperm injection (ICSI) for all cases. Embryos were cultured in sequential media and assessed daily until transfer on day 4 or day 5, based on embryo morphology and clinic logistics. Results: Pregnancy was more likely among women under 40 than among women over 40. There were a total of 1217 women who underwent day 4 transfer and 2464 women who underwent day 5 transfer. A total of 660 (54.2%) of the women transferred on day 4 developed pregnancy. Among those transferred on day 5, 1610 (65.3%) developed pregnancy. When compared to the 4th day, a single embryo transfer on the 5th day enhances pregnancy success by 1.8 times, while two embryo transfers raise it by 1.6 times. Furthermore, when the number of oocytes is greater than four and the number of embryos transferred is two, the pregnancy success rate is 2.5 times higher when embryo transfer is performed on the fifth day versus the fourth day. Regardless of age, oocyte count, or number of embryos transferred, 5th-day fresh embryo transfers enhanced pregnancy success by 1.9 times compared to 4th-day transfer. Conclusions: Transfers of fresh embryos on day 5 are superior to those on day 4 and should be favored, especially for people over the age of 40, regardless of the number of embryos transferred, even if that individual has fewer than four oocytes.Öğe Causes of diagnostic and treatment delays in locally advanced breast cancer: a nationwide multicenter survey and electronic health records analysis in Turkiye(Almqvist & Wiksell International, 2025) Karadeniz Çakmak, Güldeniz; Tali, Ufuk; Balbaloğlu, Hakan; Taşdöven, İlhan; Özkurt, Enver; Karanlık, Hasan; Zihni, İsmail; Doğan, Lütfi; Akçay, Müfide; Günay, Semra; Basım, Pelin; Küçük, G. Ozan; Pergel, Ahmet; Maralcan, Göktürk; Uğurlu, M. Ümit; Gürleyik, Günay; Akan, Arzu; Uzunköy, Ali; Yıldırım, Emine; Köksal, Hande; Haberal, Elifcan; Gülçelik, M. Ali; Morkavuk, Barış; Kıvılcım, Taner; Uçar, B. İmge; Koçer, H. Belma; Gümüşay, Özge; Uras, Cihan; Varlı, Metin; Ersoy, Yeliz; Özçınar, Beyza; Kafadar, Tolga; Badak, Bartu; Dağ, Ahmet; Sezer, Atakan; Özkan Gürdal, Sibel; Ağcaoğlu, Orhan; Cantürk, N. Zafer; Yıldız, O. Eren; Dalcı, Kubilay; Altınok, Ayşe; Aktaş, Ayşegül; Kebudi, Abut; Dilege, Ece; BAtu, H. Figen; Vural, Veli; Sakman, Gürhan; Bölükbaşı, Yasemin; Emiroğlu, Selman; Cabioğlu, Neslihan; Deniz, Oğuzhan; Filiz, A. İlker; Yıldırım, A. Cihat; Bayır, Duygu; Ölmez, Özgür; Bakkal, Bekir H.; Bahadır, Burak; Alıcıoğlu, Banu; Büyükuysal, M. Çağatay; Özaydın, Yiğit; Kaya, Hamide; Bakır, Nurullah; Cömert, Mustafa; Özmen, VahitDelays in breast cancer (BC) diagnosis and treatment negatively impact survival outcomes. Understanding patient- and provider-related factors behind these delays is crucial. This study aimed to identify nationwide reasons for delayed diagnosis and treatment of locally advanced BC in Turkiye. A prospective, multicenter hospital-based survey was conducted across 35 institutions between 2023 and 2024. Patient- and provider-related delays were assessed via a structured 61-item face-to-face survey, supplemented by clinical data from electronic health records. Delays exceeding 3 months were clinically categorized as significant. A total of 1322 women participated from seven regions across Turkiye. Factors contributing to diagnostic delays on a national level included economic reasons (5.5%), lack of family support (3.3%), lack of knowledge (12.4%), lack of time due to household work (3.8%), difficulty in finding an appointment (6.7%), pregnancy-related reasons (1.1%), fear of losing the breast (8.9%), fear of death (9.8%), and transportation difficulties (5.1%). Provider-related delays were infrequent. About 89.3% of the patients had the initial doctor appointment and 89.6% had the first specialist consultation within one month. Treatment planning was predominantly based on a multidisciplinary team decision in 88.3% of patients. Regarding treatment initiation, 93.2% started required treatment within 1 month of decision. Patient-related factors are the major causes of diagnostic delay in Turkiye. On the other hand, from the provider's perspective, the presence of multidisciplinary teams, including dedicated breast surgeons, represents a key factor in ensuring the timely implementation of diagnostic procedures and treatment strategies.Öğe Evaluatıng the Role of Overactıve Bladder Dıagnosıs ın Predıctıng the Rısk of Postspınal Hypotensıon Durıng Electıve Cesarean Sectıon Operatıons: Randomızed Trıple-Blınded Study(Medical and Dental Consultants' Association of Nigeria, 2025) Dostbil, A.; Kaşali, K.; Şenocak, Gnc.; İnce, İ.; Özkaya, F.; Özkal, M. S.; Atalay, C.; Aksoy, M.; Uç, İrfan; Akbulut, F. A.Background: It is important to predict hypotension following spinal anesthesia (SA) during cesarean section (C/S), in terms of preventing the adverse affects. Aim: The aim of this study is to evaluate diagnosing overactive bladder via the overactive bladder (OAB)-V8 questionnaire that could be a prediction method for postspinal hypotension during elective cesarean section under combined spinal-epidural anesthesia. Materials and Methods: This study was carried out on 143 primipara women in the third trimester planned for elective cesarean section under combined spinal-epidural anesthesia. Each primipara parturient in her third trimester was seen by a urology specialist for diagnosis before surgery, where she was directed to the OAB-V8 questionnaire in Turkish. Patients diagnosed with overactive bladder were recorded under Group I, and the others under Group II. Results: 39,9% of patients had hypotension. Hypotension occurrence was statistically higher in Group I than in Group II (47% vs 30%). According to the diagnostic test results for using overactive bladder diagnosis in the prediction of hypotension, the sensitivity was 68%, the specificity was 49%, positive predictive values were 47%, and negative predictive values were 70%. Conclusion: The risk of postspinal hypotension in parturients with overactive bladder is higher. Higher caution must be taken for hypotension after SA intervention in patients with over active bladder.Öğe The impact of body mass index on the diagnostic and surgical outcomes in primary hyperparathyroidism(Associação Médica Brasileira, 2025) Parlak, Nazım Serhat; Ertekin, Süleyman Çağlar; Kırdak, TurkayOBJECTIVE: The aim of this study was to investigate the influence of body mass index on the diagnostic and surgical outcomes in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS: A total of 446 patients with primary hyperparathyroidism were divided into four groups according to their body mass index: normal weight (body mass index<25 kg/m2) (n=130), overweight (25≤body mass index<30 kg/m2) (n=166), obese (30≤body mass index<35 kg/m2) (n=112), and morbidly obese (body mass index≥35 kg/m2) (n=38). Perioperative findings were compared between the groups. RESULTS: The preoperative median parathormone level in the morbidly obese group (204 pg/mL, min:max 72:1,178) was significantly lower than that in the normal-weight (246 pg/mL, min:max 60:4,262) (p=0.026) and obese (251 pg/mL, min:max 74:2,094) (p=0.012) groups. The osteoporosis rate in the normal-weight group (51%) was higher than that in the overweight (35.4%) (p=0.041) and morbidly obese (25%) (p=0.023) groups. The symptomatic hypocalcemia rate in the normal-weight group (10.2%) was significantly higher than that in the obese group (1.8%) (p=0.017). CONCLUSION: Normal-weight patients with primary hyperparathyroidism have higher blood parathormone values, higher rates of osteoporosis, and postoperative symptomatic hypocalcemia compared to patients with higher body mass index. For this reason, the surgeon should consider the possibility of symptomatic hypocalcemia after undergoing parathyroidectomy for primary hyperparathyroidism in normal-weight cases.Öğe Efficiency of Axillary Bolster Use for Ultrasound-Guided Glenohumeral Joint Injection in MR Arthrography(2025) Sakcı, Zakir; Oğul, Hayri; Tuncer, Kutsi; Kaya, Serhat; Kızıloğlu, Alper; Polat, Gökhan; Kantarcı, MecitPurpose: The purpose of this study was to prospectively evaluate the accuracy of the ultrasonography (US)-guided posterior injection technique using an axillary bolster for magnetic resonance (MR) arthrography of the shoulder joint. Materials and methods: This study included 60 patients (30 US-guided injections with an axillary bolster, 30 US-guided injections without an axillary bolster). There were 37 men and 23 women whose ages ranged from 17 to 64 years (mean, 36.87 years). All procedures were performed by two radiologists with less than 1 year of experience in arthrographic procedures. The accuracy of the two injection techniques was compared. Extraarticular contrast material leak was graded according to the MR arthrography findings. The number of injection attempts and the effect of contrast material extravasation rate on diagnostic quality were recorded. Results: There were no significant differences between US-guided punctures with and without an axillary bolster in regard to pain (p = 0.39). Injections with an axillary bolster had a higher likelihood of success on the first attempt (p = 0.0031). Complete extravasation in the US-guided posterior approach technique without an axillary bolster was significantly higher than the US-guided posterior injection technique with an axillary bolster (p < 0.0001). Conclusion: Although there is no significant difference in pain scores for both techniques, complete contrast material extravasation is seen at a higher rate in the US-guided posterior approach injection technique without the use of an axillary bolster compared to the technique used.Öğe Vacuum-assisted closure in secondary wound healing after pilonidal sinus surgery(2025) Akyol, Hüseyin; Berrin, ErokObjective: This study evaluated the utility of vacuum-assisted closure (VAC) in comparison to standard open wound care in patients operated for pilonidal sinus disease (PSD). Method: Patients with PSD who underwent standard pilonidal sinus excision-lay open technique/surgery in the Altinbas University School of Medicine Bahcelievler Medical Park Hospital, Istanbul, Turkey, between May 2015 and May 2018, were included in this study. A retrospective analysis of prospectively collected data was performed. The patients were divided into two groups according to the type of wound care, including the vacuum-assisted closure group (n=30, postoperative vacuum-assisted closure application) and the control group (n=30, standard open wound care). Wound size, postoperative infection rates and wound healing times were compared between study groups. Results: The experimental cohort included 60 patients. There was no statistically significant difference between vacuum-assisted closure and the control groups in terms of preoperative and postoperative infection rates (p>0.05). The total recovery time (time to complete wound healing) was significantly shorter in the vacuum-assisted closure group compared with the control group (21.47±4.38 days versus 67.60±7.83 days, p=0.001). Conclusion: The findings of this study emphasise that the use of vacuum-assisted closure in PSD patients treated with the lay-open technique seems notable in terms of its potential to shorten the otherwise longer secondary recovery time and thus enables the consideration of the lay-open technique once again among the most preferable methods. However, there is a need for larger scale prospective studies addressing the utility of vacuum-assisted closure in patients with PSD to validate these findings.Öğe Tailored Callosotomy in Third Ventricle Colloid Cyst Resection via Anterior Interhemispheric Transcallosal Approach(2025) Özöner, Barış; Gürses, Muhammet Enes; Öztürk, Mehmet; Arslan, Safa; Ergen, Anıl; Tubbs, Richard S.; Gonzalez-Lopez, M. Pablo; Luzzi, Sabino; Güngör, AbuzerBackground: The colloid cyst represents a relatively uncommon intracranial lesion. It garners significant attention from neurosurgeons due to its benign nature, deep-seated location, and promising prognosis when identified early and surgically removed. A variety of surgical methods are used to treat these cysts, each with their strengths and weaknesses. Objectives: The aim of this study to introduce and assess a precise microsurgical technique for managing colloid cysts using the anterior interhemispheric transcallosal approach. Methods: The research involved a retrospective analysis of 14 cases between 2021 and 2023 treated with the anterior interhemispheric transcallosal approach by two experienced skull base surgeons. The evaluation encompassed demographic, clinical, radiological, histological, and surgical data. Additionally, the Colloid Cyst Risk Score (CCRS) was used to assess the risk of obstructive hydrocephalus. The procedure incorporated neuronavigation and ultrasound to determine the precise entry point and to plan the trajectory. Results: The minimally invasive microsurgical technique was effectively employed in all 14 cases, with no reported postoperative complications. Post-surgery MRI scans confirmed complete cyst removal, with an average callosotomy measurement of 5.4 ± 2.5 mm. Importantly, none of the patients experienced disconnection syndrome associated with callosotomy. Conclusions: The adapted microsurgical approach via the anterior interhemispheric transcallosal method emerges as a secure and efficient way to address colloid cysts. It ensures comprehensive cyst removal while minimizing complications, boasting advantages such as reduced invasiveness, enhanced visibility, and minimal tissue disturbance, thereby confirming its role in colloid cyst surgical interventions.Öğe Efficacy of ursodeoxycholic acid in reducing the necessity of cholecystectomy due to pre-existing and subsequently formed gallstones in patients who underwent laparoscopic sleeve gastrectomy(2024) Demirpolat, Muhammed Taha; Çelikkaya, Muhammet Oğuz; Ertekin, Süleyman Çağlar; Başak, Fatih; Şişik, AbdullahBackground: In this study, we aimed to investigate whether ursodeoxycholic acid (UDCA) would reduce the necessity of cholecystectomy in patients diagnosed with asymptomatic gallstones after laparoscopic sleeve gastrectomy (LSG) and in patients diagnosed with asymptomatic gallstones before LSG. Methods: Between July 2020 and November 2022, at least 2-year follow-ups of patients who underwent LSG for obesity were retrospectively analyzed. Patients with pre-existing asymptomatic gallstones during preoperative evaluation, those with UDCA treatment (group 1), and observation group (group 2). Patients with newly formed gallstones in postoperative outpatient clinic follow-up, those with UDCA treatment (group A), and those without UDCA treatment (group B). Results: A total of 425 patients included. At the end of the first year, patients who had newly formed gallstones after LSG had a higher total weight loss percentages (TWL%) (39.8 ± 6.1) compared to those who did not develop gallstones (37.9 ± 7.4), which were statistically significant (p = 0.004). Among patients who developed gallstones postoperatively, UDCA treatment was associated with a significantly lower cholecystectomy rate in patients with newly formed gallstones postoperatively (p = 0.025), while no significant difference was shown in patients with preoperative gallstones (p = 0.631). Conclusion: UDCA is a promising option for reducing the need for cholecystectomy in patients with post-LSG gallstones, but it appears ineffective for pre-existing gallstones.Öğe A comparative analysis of the liver retraction with long surgical gauze in three-port sleeve gastrectomy and the four-port nathanson retractor technique(2025) Ertekin, Süleyman Çağlar; Önsal, Ufuk; Turgut, Emre; Akyol, Hüseyin; Ünver, Mutlu; Demirpolat, Muhammed Taha; Akbulut, GökhanBackground: This study evaluated the long surgical gauze (SurG) technique as a liver retraction method in laparoscopic sleeve gastrectomy (LSG). Traditional methods involve the Nathanson retractor, associated with ischemia and necrosis complications. In addition, these techniques require an additional trocar with an incision that increases postoperative pain. Our aim, therefore, was to reduce such complications through the use of SurG and evaluate recovery and outcome implications. Methods: In this retrospective study, patients who underwent laparoscopic sleeve gastrectomy (LSG) between January and December 2023 were divided into two groups based on the liver retraction method used: NR or SurG. Demographic data, surgery times, postoperative liver enzyme levels (AST, ALT), C-reactive protein (CRP), pain scores, and analgesic use (VAS) were collected from medical records and statistically analyzed. Results: The SurG group demonstrated significantly lower postoperative pain scores and reduced analgesic use compared to the NR group (p < 0.001). Additionally, liver enzyme levels (AST, ALT, CRP) were lower in the SurG group, indicating less liver stress. Early mobilization was achieved more quickly in the SurG group, aligning with Enhanced Recovery After Surgery (ERAS) protocols. However, the SurG method showed some limitations during the dissection of the greater curvature due to the narrower field of view. Conclusions: The long surgical gauze method provides a viable alternative to the Nathanson retractor, offering advantages such as less postoperative pain, reduced liver stress, and quicker mobilization. Despite some technical limitations, this method can improve patient outcomes in sleeve gastrectomy.Öğe De-escalation of nodal surgery in clinically node-positive breast cancer(2025) Cabioğlu, Neslihan; Koçer, Havva Belma; Karanlık, Hasan; Gülçelik, Mehmet Ali; İğci, Abdullah; Müslümanoğlu, Mahmut; Uras, Cihan; Mantoğlu, Barış; Trabulus, Didem Can; Akgül, Giray; Tükenmez, Mustafa; Şenol, Kazım; Özkurt, Enver; Şen, Ebru; Karadeniz Çakmak, Güldeniz; Bademler, Süleyman; Emiroğlu, Selman; Yıldırım, Nilüfer; Kara, Halil; Dağ, Ahmet; Dilege, Ece; Altınok, Ayşe; Başaran, Gül; Varol, Ecenur; Uğurlu, Ümit; Bölükbaşı, Yasemin; Ersoy, Yeliz Emine; Zengel, Baha; Karaman, Niyazi; Özbaş, Serdar; Zer, Leyla; Kılıç, Halime Gül; Ağcaoğlu, Orhan; Sakman, Gürhan; Utkan, Zafer; Soyder, Aykut; Akcan, Alper; Ergün, Sefa; Yılmaz, Ravza; Aydıner, Adnan; Soran, Atilla; İbiş, Kamuran; Özmen, VahitImportance: Increasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC). Objective: To evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)-positive breast cancer and patients whose disease became cN negative after NAC (ycN negative). Design, setting, and participants: In the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated. Exposure: Treatment with SLNB or TAD after NAC. Main outcomes and measures: The primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated. Results: A total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P = .09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P = .03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥ .99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P = .50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P = .07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P = .03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P = .007). Conclusions and relevance: The short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed by regional nodal irradiation regardless of the SLNB technique or nodal pathology. Whether TAD might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up.Öğe Photoprotective effects of quercetin on photoaging-induced rats(2024) Kızılkan, Betül; Şereflican, Betül; Çetinkaya, Ayhan; Erdoğan Düzcü, Selma; Altuğ, Cevher; Kızılkan, JehatPurpose: Photoaging is characterised by cutaneous changes caused by exposure to ultraviolet light over time. Quercetin is a bioflavanoid with antioxidant, antineoplastic, and anti-inflammatory effects. This study investigated the therapeutic effects of topical quercetin on photoaging, a phenomenon not previously studied in ultraviolet A (UVA)-induced photoaging. Methods: A total of 40 rats were randomly categorised into 5 groups, each comprising 8 rats. A photoaging model was induced by applying UVA to the dorsal region of all rats, except for the negative control group. Topical 0.1% retinoic acid was applied to one UVA group, topical 0.3% quercetin to another UVA group, and both agents were applied in combination to yet another UVA group 5 days a week for 8 weeks. Subsequently, wrinkle values were measured, reactive oxygen species (ROS) and matrix metalloproteinase-1 (MMP-1) levels were analysed, and histopathological parameters were examined. Results: The wrinkle value of the UVA group was found to be significantly higher than that of the UVA + Quercetin group. Collagen damage was lower in the UVA + Quercetin group than in the UVA group, although this difference was not statistically significant. Compared with the UVA + Retinoic Acid group, the UVA + Quercetin group exhibited a more significant decrease in inflammation. MMP-1 values were considerably higher in the UVA + Retinoic Acid and UVA + Quercetin + Retinoic Acid groups as well as in the UVA + Quercetin group compared with the control and UVA groups. Conclusion: The present study showed that quercetin can be utilised in the treatment of photoaging, especially when combined with retinoic acid.Öğe Differential diagnosis of submucosal gastric tumors: gastric schwannomas misdiagnosed as GISTs(2024) Ünver, Mutlu; Ertekin, Süleyman Çağlar; Kebapçı, Eyüp; Ölmez, Mustafa; Ergin, Erhan; Öztürk, Şafak; Şahin, Erkan; Ortaç, RagıpSchwannomas commonly occur in the head and neck region but are rarely seen in the gastrointestinal tract; the stomach and small intestine are the most commonly involved sites. These tumors are usually misdiagnosed as gastrointestinal stromal tumors (GISTs) before histopathological confirmation due to radiological similarity. GI schwannomas show positivity for S100 protein and vimentin but are negative for CD 117 and CD 34, which helps in differentiating the tumor from GISTs. Case 1: a 70-year-old woman was referred to our hospital by complaints of abdominal pain and discomfort. Upper GI endoscopy demonstrated a protruding lesion at the lesser curvature of the gastric body, and fine-needle aspiration biopsy showed chronic inflammation without malignancy. Since the lesion was suspected to be GIST, this patient had surgery, and a gastric schwannoma was resected successfully. Case 2: a 66-year-old female with anemia and abdominal discomfort was found to have a submucosal elevated mass at the greater curvature of the antrum. Fine needle aspiration biopsy was suggestive of a spindle cell tumor resembling GIST. The patient underwent subtotal gastrectomy with Roux-en-Y reconstruction. Histopathology confirmed schwannoma. It is necessary to differentiate gastric schwannomas from other submucosal tumors of the stomach, especially GISTs. Surgical complete resection of schwannomas usually has a good prognosis with a low probability of recurrence. Though rare, gastric schwannomas should be included in the differential diagnosis of submucosal gastric tumors because the correct identification of this tumor type helps in proper management and evasion of unnecessary extensive surgery.Öğe Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome(2024) Akyol, HüseyinBackground: This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD). Methods: A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate were recorded in each patient and compared between KF and SiLaT groups. Results: The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively. Conclusions: SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.Öğe Splenic flexure mobilization: does body topography matter?(2024) Akyol, Hüseyin; Arslan, N. C.; Kocak, M.; Shahhosseini, R.; Pekuz, C. K.; Haksal, M.; Gogenur, I.; Onel, MustafaBackground: Splenic flexure mobilization can be technically challenging, and its oncological benefits remain uncertain. This study aims to explore the relationship between patient and clinical characteristics and splenic flexure mobilization time as well as the implications of prolonged splenic flexure mobilization duration. Methods: This retrospective cohort study includes 105 patients who underwent laparoscopic distal colorectal cancer surgery between 2013 and 2018. The study analyzed patient characteristics, duration of surgical steps, and postoperative outcomes. Splenic flexure mobilization time was assessed using operation videos, and the impact of patient-related factors on splenic flexure mobilization complexity was examined. Results: The study identified significant correlations of higher body mass index (BMI) (p = 0.0086), weight (p = 0.002), and height (p = 0.043) with longer splenic flexure mobilization time. Gender did not significantly influence splenic flexure mobilization duration. Splenic flexure mobilization time was correlated with the durations of other individual surgical steps (Step 1: medial-to-lateral dissection [p = 0.0013], Step 2: pelvic dissection [p = 0.067], Step 3: dissection of white line and mobilization of descending colon [p = 0.0088], Step 5: stapling, resection, extraction of the specimen, and anastomosis [p = 0.04]) and the overall operation time (p < 0.0001). A 10-min cutoff point predicts the total operation time more efficiently than other potential thresholds. Conclusion: This research suggests that patient characteristics including BMI, weight, and height may serve as indicators for prolonged splenic flexure mobilization time in laparoscopic distal colorectal cancer surgery. Longer splenic flexure mobilization durations were correlated with extended durations of other surgical steps. A BMI-based approach to anticipate SFM duration may enhance preoperative planning, potentially aiding in surgical decision-making.Öğe Evaluation of veress needle as a liver retraction technique in laparoscopic sleeve gastrectomy(2024) Ertekin, Süleyman Çağlar; Akbulut, Gökhan; Turgut, Emre; Akyol, Hüseyin; Ergenç, Muhammer; Yeğen, CumhurBackground: Liver retraction management in laparoscopic sleeve gastrectomy (LSG) is challenging for surgeons, especially in patients with enlarged livers. Traditional methods, such as the Nathanson retractor (NR), often necessitate additional incisions, potentially increasing liver enzymes and increasing the risk of complications. The aim of this study was to evaluate the efficacy of the use of a Veress needle (VN), an alternative liver retraction technique, in LSG surgery compared with NR. Materials and methods: This study was conducted at a university-affiliated hospital between May 2022 and December 2022. Patients who underwent LSG were divided into two groups: one utilizing the NR and the other employing the VN for liver retraction. Parameters such as operation duration, retraction time, liver laceration, trocar-induced hemorrhage, subxiphoid trocar site infections, pain scores measured via the visual analog scale (VAS) at various time points, pre- and postoperative liver enzyme levels (AST, ALT, GGT, ALP) and CRP levels were analyzed. Results: Data from 151 patients were analyzed. The AST/ALT elevations (P < 0.001) were significantly lower in the VN group (73 patients) than in the NR group (78 patients), while there was no significant difference in GGT/ALP levels. Retraction-related bleeding was significantly greater in the NR group than in the VN group (6.4% vs 0%, P = 0.035). Postoperative infection rate was lower in the VN group but not statistically significant (0% vs 3.8%, P = 0.135). CRP differences were significant on the first postoperative day (P < 0.001). Postoperative VAS scores were significantly lower in the VN group at all measured time points except at the 48th hour and 10th day. Conclusions: The VN technique in LSG significantly reduces liver enzyme elevation and the need for an extra trocar and incision, potentially lowering complication risk and enhancing patient outcomes.Öğe Comparison of the postoperative analgesic efficacy of serratus anterior plane block with different types of blocks for video-assisted thoracoscopic surgery: A systematic review and meta-analysis of randomized controlled trials(Baycinar Medical Publishing, 2024) Dostbil, Aysenur; Kasali, Kamber; Aydin, Yener; Ince, Ilker; Ulas, Ali Bilal; Yilmaz, Mehmet Akif; Ceren, Muhammed; Eroğlu, Atilla; Ozgodek, Habip Burak; Ozkal, Mirac Selcen; Elsharkawy, HeshamBackground: The study aimed to compare the analgesic efficacy of single-shot serratus anterior plane block (SAPB) for video-assisted thoracoscopic surgery (VATS) with other regional block techniques. Methods: In this meta-analysis, randomized controlled trials published in the PubMed, Scopus, Web of Science, ClinicalKey, and PROSPERO electronic databases between March 24, 2014 and March 24, 2024 comparing the analgesic efficacy of SABP with other regional blocks in adult patients undergoing VATS were reviewed. Results: Nine randomized controlled trials consisting of a total of 537 participants (287 males, 250 females; mean age: 55.2±13.1 years) were included in this meta-analysis. Serratus anterior plane block was compared with erector spinae plane block (ESPB), local infiltration anesthesia (LIA), and thoracic paravertebral block (TPVB). The postoperative 24-h cumulative opioid consumption was statistically significantly higher in SAPB than in ESPB (standardized mean difference [SMD]=1.98; 95% confidence interval [CI], 0.23 to 3.73; Z=2.22; p=0.03; I2=97%; random effects model) and TPVB (SMD=0.63; 95% CI, 0.31 to 0.96; Z=3.84; p<0.001; I2=0%; fixed effects model) and lower than in LIA (SMD=–1.77; 95% CI, –2.24 to –1.30; Z=7.41; p<0.001; I2=0%; fixed effects model). Active pain scores 2 h postoperatively were statistically significantly lower in SAPB than in LIA (SMD=–2.90; 95% CI, –5.29 to –0.50; Z=2.37; p=0.02; I2=93%; random-effects model). At 12 h postoperatively, both passive pain scores (SMD=0.37; 95% CI, 0.07 to 0.66; Z=2.41; p=0.02; I2=0%; fixed effects model) and active pain scores (SMD=0.55; 95% CI, 0.25 to 0.85; Z=3.60; p<0.001; I2=0%; fixed effects model) were statistically significantly lower in ESBP than in SAPB. There was no difference between SAPB and the other groups in terms of the incidence of postoperative nausea and vomiting. Conclusion:After a comprehensive evaluation of postoperative analgesic effects, it appears that ESBP and TPVB may be better than SABP, and SABP may be better than LIA for analgesia of patients undergoing VATS. Further studies are required to determine the optimal regional analgesia technique in VATS.Öğe Is immunohistochemical galectin-3 expression associated with the epithelial-mesenchymal transition in high- and low-grade invasive urothelial carcinomas of the bladder?(2024) Cin, Merve; Akyıldız İğdem, Ayşenur; Bektaş, Sibel; Gündoğar, Özgecan; Cin, Selçuk; Komut, Neslihan; Çetin, BuğraBackground/Objectives: Bladder cancer, predominantly urothelial carcinoma, is an important malignancy of the urinary system. Despite the same histologic grade and stage, some patients seem to have a worse prognosis. In this context, the epithelial-mesenchymal transition (EMT), characterized by the loss of E-cadherin and gain of vimentin expression, is an important process in tumor progression. Galectin-3, a lactose-binding protein involved in various cellular processes, has been associated with increased tumor cell migration, invasion, and treatment resistance. Methods: In this study, 223 bladder cancer cases were examined, and E-cadherin, vimentin, and galectin-3 expression was evaluated by immunohistochemical staining in tumor budding areas and invasive components. These markers were also correlated with clinicopathological parameters, including tumor grade and stage. Results: The results indicated a significant decrease in E-cadherin expression and an increase in vimentin staining in higher-grade and higher-stage tumors, supporting EMT involvement. Galectin-3 expression was notably higher in T1 high-grade tumors but decreased in T2 stage tumors. Despite this, no significant correlation was found between galectin-3 and E-cadherin or vimentin, suggesting a complex role of galectin-3 in EMT. Conclusions: High galectin-3 expression in T1 high-grade tumors highlights its potential role in early tumor progression and as a therapeutic target. However, the decrease in its expression in advanced stages underscores the need for further research to understand its multifaceted involvement in bladder cancer. These findings suggest that while galectin-3 may contribute to the EMT and early tumor progression, its exact role and potential as a therapeutic target require more detailed investigation.Öğe Comparison of early postoperative outcomes of omentopexy and clips along the staple line during laparoscopic sleeve gastrectomy: a randomized study(2024) Demirpolat, Muhammed Taha; İslam, Mehmet Muzaffer; Bacaksız, Mehmet Erman; Ertekin, Süleyman Çağlar; Şişik, AbdullahBackground: We aimed to compare the omentopexy and clipping reinforcement methods performed along the staple line during laparoscopic sleeve gastrectomy (LSG) in terms of the effectiveness on postoperative bleeding. Methods: In this prospective randomized controlled study, patients were divided into two groups: clips group (CG) and omentopexy group (OG). The groups were compared in terms of postoperative bleeding, duration of surgery, length of hospital stay, hospital readmissions in the postoperative first 30-days. Results: A total of 148 patients were included in the study. Postoperative bleeding was observed in 11 patients (14.9%) of CG and 2 patients (2.7%) of the OG, and the difference between the groups was found to be significant (p = 0.009). Similarly, the number of patients with bleeding that did not require intervention was 9 (12.2%) in CG and 2 (2.7%) in OG, and the difference between the groups was also significant (p = 0.028). The duration of surgery in the CG was 30 (27 to 36) minutes, whereas in the OG, it was 43 (39 to 45) minutes, with a significant difference noted (p < 0.001). Additionally, the rate of patients readmitted to the hospital within the first 30 days was 16 (21.6%) in the CG and 7 (9.5%) in the OG, with a significant difference observed (p = 0.041). Conclusion: In terms of bleeding requiring intervention, there was no difference between omentopexy and clipping techniques. In addition, omentopexy showed more satisfactory results than clipping in terms of non-interventional bleeding, but its clinical significance is unclear.
