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1دورية أكاديمية
المؤلفون: Deniz Ugur Cengiz, Busra Kurtcu, Hanifi Korkmaz, Sanem Can Colak, Mehmet Aslan, Mehmet Turan Cicek, Sezai Yilmaz
المصدر: Medicine Science, Vol 12, Iss 3, Pp 896-901 (2023)
مصطلحات موضوعية: liver transplantation, tinnitus, anxiety, noise sensitivity, early-late stage, Medicine
الوصف: This study aims to evaluate the perception of anxiety, tinnitus, and noise sensitivity in liver transplant patients according to early and late periods following transplantation. The study included 76 patients with liver transplantation. They were divided into two groups according to the duration of time after transplantation: early (1-3 years) and late (5 years or more). A demographic data form, the Tinnitus Handicap Inventory (THI), Weinstein's Noise Sensitivity Scale (WNSS), and the Beck Anxiety Inventory (BAI) were administered and used for data collection. There was a statistically significant difference between the early and late-period groups in terms of WNSS and THI scores (p0.05). Noise sensitivity and tinnitus perception of the late-period group were statistically higher than those of the early-period group (p [Med-Science 2023; 12(3.000): 896-901]
وصف الملف: electronic resource
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2دورية أكاديمية
المؤلفون: Sertac Usta, Sami Akbulut, Kemal Baris Sarici, Ibrahim Umar Garzali, Fatih Ozdemir, Fatih Gonultas, Adil Baskiran, Burak Isik, Sezai Yilmaz
المصدر: Journal of Clinical Medicine, Vol 13, Iss 10, p 2924 (2024)
مصطلحات موضوعية: living donor liver transplantation, living donor hepatectomy, portal vein narrowing, elbow patch, homologous vascular grafts, Medicine
الوصف: Background: Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the “elbow patch reconstruction technique” to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Methods: Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the “elbow patch reconstruction technique” were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Results: Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178–4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Conclusions: Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named “elbow patch reconstruction technique”. This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.
وصف الملف: electronic resource
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3دورية أكاديمية
المؤلفون: Yasin Dalda, Sami Akbulut, Tevfik Tolga Sahin, Adem Tuncer, Zeki Ogut, Basri Satilmis, Ozlem Dalda, Mehmet Gul, Sezai Yilmaz
المصدر: Medicina, Vol 60, Iss 4, p 649 (2024)
مصطلحات موضوعية: liver transplantation, Pringle maneuver, ischemia–reperfusion injury, living liver donors, recipients, immune response, Medicine (General), R5-920
الوصف: Background and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses.
وصف الملف: electronic resource
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4دورية أكاديمية
المؤلفون: Yakup GEZER, Elif Seren TANRIVERDİ, Barış OTLU, Sezai YILMAZ, Yaşar BAYINDIR
المصدر: Mediterranean Journal of Infection, Microbes and Antimicrobials, Vol 11, Iss 1 (2022)
مصطلحات موضوعية: bacteremia, enterobacteriaceae, fosa, fosa3, fosc2, hepatic transplantation, phosphomycin resistance, Medicine, Infectious and parasitic diseases, RC109-216
الوصف: Introduction: Interest in fosfomycin, an old antibiotic, has been reignited because of the use of its intravenous formulation (fosfomycin sodium) in resistant infections. The aim of this study was to screen for carbapenem resistance in Enterobacterales isolates from the bloodstream, and determine the frequency of carbapenamases types and fosfomycin resistance genes in carbapenem-resistant Enterobacterales (CRE) strains. Materials and Methods: Enterobacterales isolates from the bloodstream of liver transplant patients aged 18 years and older were screened for carbapenem resistance between 2017 and 2019. In isolates that were resistant to at least one carbapenem antibiotic were further screened for fosfomycin susceptibility. Carbapenem susceptibility was tested for by the E-test, fosfomycin susceptibility was tested for by the agar dilution methods, and evaluated in accordance with European Committee on Antimicrobial Susceptibility Testing criteria. The frequency of OXA-48, NDM, KPC, VIM, and IMP type carbapenemases and fosA, fosA3, and fosC2 fosfomycin resistance genes were screened for using the polymerase chain reaction method. Results: A total of 115 Enterobacterales isolates from bloodstream infections were obtained. Carbapenem resistance was detected in 34 (29.3%) isolates, 41.2% of them were Escherichia coli and 58.8% of them were Klebsiella pneumoniae. Out of the 34 isolates, 61.8% produced carbapenemases, and OXA-48 was the most common type of carbapenemase. The fosfomycin resistance rate was 73.5%. Among the 34 carbapenem-resistant isolates, the frequency of the fosA gene was 5.9%. The genes fosA3 and fosC2 were not detected in any isolates. FosA + OXA-48 and fosA + NDM genes were detected in CRE isolates. Conclusion: This is the first study reporting on the screening for fosfomycin resistance genes in blood isolates of liver transplant patients in Turkey. Despite high fosfomycin resistance, detection of only two resistance genes reveals that there may be fosfomycin resistance due to other resistance mechanisms.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Gulec Mert Dogan, M.D., Ahmet Sığırcı, M.D., Gokalp Okut, M.D., Sait Murat Dogan, M.D., Ph.D., Sezai Yilmaz, M.D.
المصدر: Radiology Case Reports, Vol 17, Iss 1, Pp 147-151 (2022)
مصطلحات موضوعية: Sarcoma, Liver, Metastasis, Pediatric, Epidural, Magnetic resonance image, Medical physics. Medical radiology. Nuclear medicine, R895-920
الوصف: Undifferentiated embryonal sarcoma of the liver (UESL) is very rare and has a very poor prognosis. UESL metastases have been reported in 5%-13% of the children with UESL and most metastases reported in the literature are present at diagnosis. Metastases reported in the literature belong to the lungs, pleura, and peritoneum. Radiological diagnosis of the UESL remains a poorly understood problem due to its rarity. Most of the reports published in the literature are also based on a relatively small number of patients. Approximately 200 cases have been reported regarding imaging features of this tumor. We reported a girl with UESL, who applied to the emergency department with abdominal pain. The lesion was solid and had cystic areas on ultrasound and there were peripherally enhanced serpenginous vessels in the lesion on Computed Tomography and MRI. Immunohistochemical diagnosis of the lesion was UESL. 26 months after surgery and adjuvant chemotherapy extradural and subcutaneus metastases were detected. These metastasis sites were first described for UESL.
وصف الملف: electronic resource
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6دورية أكاديمية
المؤلفون: Sami Akbulut, Fatma Hilal Yagin, Tevfik Tolga Sahin, Ibrahim Umar Garzali, Adem Tuncer, Musap Akyuz, Nazlican Bagci, Bora Barut, Selver Unsal, Kemal Baris Sarici, Serdar Saritas, Ali Ozer, Recep Bentli, Cemil Colak, Yasar Bayindir, Sezai Yilmaz
المصدر: Journal of Clinical Medicine, Vol 12, Iss 13, p 4466 (2023)
مصطلحات موضوعية: COVID-19 pandemic, liver transplantation, immunosuppressive agents, COVID-19 vaccine, Medicine
الوصف: Background: In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. Methods: This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. Results: The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. Conclusion: The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.
وصف الملف: electronic resource
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7دورية أكاديمية
المؤلفون: Suleyman Koc, Abuzer Dirican, Vural Soyer, Cengiz Ara, Saim Yologlu, Sezai Yilmaz
المصدر: Eurasian Journal of Medicine, Vol 53, Iss 3, Pp 192-196 (2021)
مصطلحات موضوعية: Medicine (General), R5-920
وصف الملف: electronic resource
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8دورية أكاديمية
المؤلفون: Sami Akbulut, Zeynep Kucukakcali, Hasan Saritas, Cigdem Bozkir, Murat Tamer, Musap Akyuz, Nazlican Bagci, Selver Unsal, Mehmet Serdar Akbulut, Tevfik Tolga Sahin, Cemil Colak, Sezai Yilmaz
المصدر: Diagnostics, Vol 13, Iss 8, p 1410 (2023)
مصطلحات موضوعية: liver transplantation, hepatocellular carcinoma, COVID-19 pandemic, Depression Anxiety Stress Scale, Coronavirus Anxiety Scale, COVID-19 vaccine, Medicine (General), R5-920
الوصف: Background: The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress. Method: A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case–control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine. Results: Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach’s alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively. Conclusion: This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.
وصف الملف: electronic resource
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9دورية أكاديمية
المؤلفون: Sami Akbulut, Fatma Hilal Yagin, Ipek Balikci Cicek, Cemalettin Koc, Cemil Colak, Sezai Yilmaz
المصدر: Diagnostics, Vol 13, Iss 6, p 1173 (2023)
مصطلحات موضوعية: nonperforated acute appendicitis, perforated acute appendicitis, predictive markers, machine learning, explainable artificial intelligence, Medicine (General), R5-920
الوصف: Background: The primary aim of this study was to create a machine learning (ML) model that can predict perforated and nonperforated acute appendicitis (AAp) with high accuracy and to demonstrate the clinical interpretability of the model with explainable artificial intelligence (XAI). Method: A total of 1797 patients who underwent appendectomy with a preliminary diagnosis of AAp between May 2009 and March 2022 were included in the study. Considering the histopathological examination, the patients were divided into two groups as AAp (n = 1465) and non-AAp (NA; n = 332); the non-AAp group is also referred to as negative appendectomy. Subsequently, patients confirmed to have AAp were divided into two subgroups: nonperforated (n = 1161) and perforated AAp (n = 304). The missing values in the data set were assigned using the Random Forest method. The Boruta variable selection method was used to identify the most important variables associated with AAp and perforated AAp. The class imbalance problem in the data set was resolved by the SMOTE method. The CatBoost model was used to classify AAp and non-AAp patients and perforated and nonperforated AAp patients. The performance of the model in the holdout test set was evaluated with accuracy, F1- score, sensitivity, specificity, and area under the receiver operator curve (AUC). The SHAP method, which is one of the XAI methods, was used to interpret the model results. Results: The CatBoost model could distinguish AAp patients from non-AAp individuals with an accuracy of 88.2% (85.6–90.8%), while distinguishing perforated AAp patients from nonperforated AAp individuals with an accuracy of 92% (89.6–94.5%). According to the results of the SHAP method applied to the CatBoost model, it was observed that high total bilirubin, WBC, Netrophil, WLR, NLR, CRP, and WNR values, and low PNR, PDW, and MCV values increased the prediction of AAp biochemically. On the other hand, high CRP, Age, Total Bilirubin, PLT, RDW, WBC, MCV, WLR, NLR, and Neutrophil values, and low Lymphocyte, PDW, MPV, and PNR values were observed to increase the prediction of perforated AAp. Conclusion: For the first time in the literature, a new approach combining ML and XAI methods was tried to predict AAp and perforated AAp, and both clinical conditions were predicted with high accuracy. This new approach proved successful in showing how well which demographic and biochemical parameters could explain the current clinical situation in predicting AAp and perforated AAp.
وصف الملف: electronic resource
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10دورية أكاديمية
المؤلفون: Arthur A. Cross-Najafi, Kevin Lopez, Abdulkadir Isidan, Yujin Park, Wenjun Zhang, Ping Li, Sezai Yilmaz, Sami Akbulut, Burcin Ekser
المصدر: Frontiers in Immunology, Vol 13 (2022)
مصطلحات موضوعية: liver xenotransplantation, thrombocytopenia, xenograft, immune rejection, porcine, Immunologic diseases. Allergy, RC581-607
الوصف: Preclinical trials of pig-to-nonhuman primate liver xenotransplantation have recently achieved longer survival times. However, life-threatening thrombocytopenia and coagulation dysregulation continue to limit preclinical liver xenograft survival times to less than one month despite various genetic modifications in pigs and intensive pharmacological support. Transfusion of human coagulation factors and complex immunosuppressive regimens have resulted in substantial improvements in recipient survival. The fundamental biological mechanisms of thrombocytopenia and coagulation dysregulation remain incompletely understood. Current studies demonstrate that porcine von Willebrand Factor binds more tightly to human platelet GPIb receptors due to increased O-linked glycosylation, resulting in increased human platelet activation. Porcine liver sinusoidal endothelial cells and Kupffer cells phagocytose human platelets in an asialoglycoprotein receptor 1-dependent and CD40/CD154-dependent manner, respectively. Porcine Kupffer cells phagocytose human platelets via a species-incompatible SIRPα/CD47 axis. Key drivers of coagulation dysregulation include constitutive activation of the extrinsic clotting cascade due to failure of porcine tissue factor pathway inhibitor to repress recipient tissue factor. Additionally, porcine thrombomodulin fails to activate human protein C when bound by human thrombin, leading to a hypercoagulable state. Combined genetic modification of these key genes may mitigate liver xenotransplantation-induced thrombocytopenia and coagulation dysregulation, leading to greater recipient survival in pig-to-nonhuman primate liver xenotransplantation and, potentially, the first pig-to-human clinical trial.
وصف الملف: electronic resource
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