Tıp Fakültesi Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11499/46004
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Letter Response to Comment ‘Comment on “The Effects of Early Rehabilitation on Physical and Psychosocial Functions after Breast Cancer Surgery”’(Springer, 2026-03-13) Özdemir, Atiye Kaş; Atalay, Orçin Telli; Yılmaz, Sevda; Şenol, HandeArticle Microsurgical Management of Vein of Galen Aneurysmal Malformations(Springer, 2026-03-27) Geyik, Murat; Nehir, Ali; Egemen, Emrah; Doğruel, Yücel; Aksoğan, Yiğit; Üçler, Necati; Çeltikçi, EmrahObjective Vein of Galen aneurysmal malformations (VGAMs) are rare congenital vascular anomalies typically treated with endovascular embolization. Microsurgery, once the standard, has largely been abandoned due to historically high mortality rates. This study evaluates contemporary outcomes of microsurgical VGAM management using the posterior interhemispheric approach and proposes its reconsideration as a primary treatment option in selected cases. Methods We retrospectively reviewed seven consecutive pediatric patients with VGAM treated microsurgically between 2014 and 2024 at a single institution. Clinical, cardiac, and radiological outcomes were assessed preoperatively, early postoperatively (< 24 h), and at long-term follow-up (10 months-6 years). Patients were classified according to Yaşargil's system. Results The cohort included 4 males and 3 females (mean age 11.1 months). Presentations included hydrocephalus (n = 3), heart failure (n = 3), and both (n = 1). VGAM types were III (n = 4), I (n = 2), and IVB (n = 1). No intraoperative mortality, major bleeding, or postoperative neurological deficits occurred. VP shunts were required in three patients; the remainder had resolution of hydrocephalus after feeder occlusion. Cardiac symptoms resolved in all affected patients. Follow-up imaging demonstrated shrinkage of the dilated vein in all cases. All patients were alive with normal age-appropriate development at follow-up. Conclusions In this series, modern microsurgical VGAM management achieved safe and durable outcomes, challenging the perception of surgery as solely a salvage option. These findings suggest that microsurgery may still have a role in the treatment of VGAM in carefully selected patients, particularly in centers with appropriate microsurgical expertise or in situations where endovascular therapy is unavailable or anatomically unfeasible. Multicenter prospective studies are needed to confirm these findings and refine patient selection.Article Clinical and Microbiological Characteristics of Nocardia Infections: A 10-Year Multicentre Study from Türkiye(Springer, 2026-03-25) Ozturk, Eren; Bali, Elif Aguloglu; Kiymaz, Yasemin Cakir; Tepe, Dilsat; Can, Ilkay Nur; Kaya, Arda; Bolataslan, Benan Atak; Bosnak, Cemre; Karasin, Fatih; Pekguzel, Mehmet; Buyukkoruk, Merve; Kuzi, Semanur; Usta, Berkan Alp; Agaoglu, Yusra; Ergonul, OnderPurpose Multicentre studies from countries such as Spain, Australia, Japan, China, and Taiwan have revealed significant geographic variation in Nocardia species patterns, resistance profiles, and patient outcomes. In Turkiye, however, most available data originate from single-centre reports with limited species-level identification and antimicrobial resistance profiling, highlighting a significant gap in the current understanding of nocardiosis at the national level. Our aim was to evaluate the clinical and microbiological characteristics of Nocardia infections in Turkiye. Methods In this multicentre, retrospective observational cohort study, adult patients (>= 18 years) diagnosed with microbiologically confirmed nocardiosis between January 1, 2014, and December 31, 2024 from 18 tertiary care hospitals in Turkiye were examined. Results 109 microbiologically confirmed nocardiosis cases were identified, with a mean age of 55.9 years (median 59, range 18-80) and a predominance of male patients (66.1%). The most common presenting symptom was productive cough (40.3%), and sputum was the most frequent specimen type yielding Nocardia isolates (41.2%). Species-level identification was achieved in 51 cases, with Nocardia farcinica (41.2%), N. cyriacigeorgica (29.4%) being the most prevalent species. In multivariate logistic regression, increasing age was independently associated with mortality (OR = 1.053, 95% CI 1.012-1.096, p = 0.011) and the CCI was independently associated with mortality (OR = 1.244, 95% CI 1.043-1.483, p = 0.015). Conclusion This study demonstrates that clinical outcomes in nocardiosis are primarily dictated by patient-intrinsic factors, namely advanced age and cumulative comorbidity burden. This finding requires confirmation in prospective studies.Article Alkaptonuria as a Cause of Pseudo-Proteinuria in Two Children Evaluated for Renal Disease(Springer, 2026-03-23) Becerir, Tulay; Kilic, Pinar; Girisgen, Ilknur; Altintas, Ummuhan Seda; Kabukcuoglu, Mirac Burak; Yuksel, SelcukProteinuria in childhood is a major warning sign of kidney disease and often prompts an extensive diagnostic work-up. However, not all protein detected by routine laboratory methods reflects true renal protein loss, and analytical interference may lead to misinterpretation and unnecessary invasive procedures. Alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism characterized by lifelong accumulation of homogentisic acid, which is known to interfere with some colorimetric urine protein assays and may cause pseudo-proteinuria. We report two children evaluated in a pediatric nephrology setting because of significant proteinuria. The first patient, who had familial Mediterranean fever, underwent kidney biopsy to exclude amyloidosis before the diagnosis of alkaptonuria was considered after a seemingly minor historical clue provided by the mother. The second patient was followed after a severe episode of hemolytic uremic syndrome, and persistent proteinuria was initially attributed to residual renal damage; however, further evaluation revealed underlying alkaptonuria and a marked discordance between total protein and albumin excretion. These cases illustrate an important diagnostic pitfall and emphasize that, particularly in the presence of discordance between total urine protein and albumin, pseudo-proteinuria should be considered. A simple question such as whether the urine darkens on standing may provide a crucial clue and prevent unnecessary investigations.Article Single-Layer Spherical (SLS) vs Single-Layer (SL) Woven EndoBridge (WEB) Device in the Treatment of Narrow-Neck Intracranial Aneurysms: A Propensity Score-Matched Analysis(Springer, 2026-03-03) Salim, Hamza Adel; Yedavalli, Vivek; Milhem, Fathi; Adeeb, Nimer; Musmar, Basel; Essibayi, Muhammed Amir; Daraghma, Motaz; Dibas, Mahmoud; Cancelliere, Nicole M.; Diestro, Jose Danilo Bengzon; Algin, Oktay; Ghozy, Sherief; Lay, Sovann V.; Guenego, Adrien; Renieri, Leonardo; Carnevale, Joseph; Saliou, Guillaume; Mastorakos, Panagiotis; Naamani, Kareem El; Arslan, Muhammet; Dmytriw, Adam A.Data on the use of Woven EndoBridge (WEB) devices in the treatment of narrow-neck intracranial aneurysms (NNA) are limited. We compared the efficacy and safety of single-layer (SL) and single-layer spherical (SLS) WEB devices in treating NNA. We conducted a multicenter retrospective analysis of adult patients with NNA (neck <= 4 mm and width-to-neck ratio >= 2) treated with SL or SLS WEB devices between January 2011 and December 2022. Patients with fusiform or blister aneurysms, adjunctive treatments, or devices other than SL or SLS were excluded. Propensity score matching was used to adjust for confounding variables. Outcomes included procedural complications, angiographic occlusion rates using the Raymond Roy classification, major device compaction, need for retreatment, and functional outcomes assessed by the modified Rankin Scale (mRS). After matching, resulting in 101 patients in each group, baseline characteristics were well-balanced. Thromboembolic complications occurred in 2.0% of the SLS group and 5.9% of the SL group (P = 0.28). Hemorrhagic complications occurred in 1.0% of the SLS group and 6.4% of the SL group (P = 0.062). Adequate occlusion rates (Raymond Roy grades I and II) were similar between groups (96% in SLS vs. 91% in SL; P = 0.20). Major device compaction was significantly less frequent in the SLS group compared to the SL group (0% vs. 7.6%; P = 0.024). The need for retreatment trended to be lower in the SLS group (1.1% vs. 6.6% in SL; P = 0.12). Functional outcomes (mRS 0-1) at last follow-up were comparable (82% in SLS vs. 86% in SL; P = 0.41). In the treatment of narrow-neck intracranial aneurysms, the SLS WEB device was associated with significantly lower rates of major device compaction compared to the SL device. Reduced compaction may lead to a lower need for retreatment. Overall imaging outcomes and safety profiles were similar between the two devices.Article Investigation of Transcription Factor NFκB-Mediated Autophagy Regulation Mechanisms in Non-Small Cell Lung Cancer(Springer, 2026-02-13) Alvur, Ozge; Akca, HakanBackgroundAutophagy is a conserved intracellular degradation and recycling process in eukaryotic cells. Autophagy dysfunction is linked to several diseases, including cancer. Depending on cancer type and context, autophagy may act as a tumor suppressor or promote tumor progression. Various cellular pathways regulate autophagy, among which the NF kappa B signaling pathway plays a dual role, either promoting or inhibiting autophagy. Since many cancer therapies affect both autophagy and NF kappa B, understanding their interaction can help develop more effective combination treatments. However, the specific mechanisms by which NF kappa B regulates autophagy in Non-Small Cell Lung Cancer (NSCLC) remain unclear. In this study, we aimed to elucidate this regulatory relationship and identify key genes involved.Methods and resultsWe established NSCLC cell groups with NF kappa B overexpression or suppression, and with or without autophagy induction. Autophagy levels were assessed via western blot. RNA-seq analysis was performed to identify differentially expressed genes among these groups, and candidate regulators were selected based on expression patterns and in silico analysis. Selected genes were validated with qRT-PCR. Our results show that NF kappa B positively regulates autophagy-related processes in NSCLC cells, as reflected by altered LC3B-II levels. Genes with expression which decreased upon NF kappa B suppression but increased with NF kappa B overexpression under autophagy-induced conditions were identified as candidate regulators. Among these, the putative NF kappa B-NLRP3 regulatory relationship appears to play a particularly important role in the upregulation of autophagy.ConclusionsThis study provides an NSCLC-specific transcriptional framework linking NF kappa B activity to autophagy- and inflammation-associated gene networks. By integrating expression profiling and in silico analyses, we identify candidate NF kappa B-responsive genes, including NLRP3, that may contribute to autophagy-related cellular responses in NSCLC.Article Clinical Course of Proteinuria Due to Cubilin Variants: A Large Multicenter Pediatric Cohort(Springer, 2026-03-04) Cicek, Neslihan; Alavanda, Ceren; Pinarbasi, Ayse Seda; Inal, Aylin; Atmis, Bahriye; Kezer, Secil; Kara, Mehtap Akbalik; Akaci, Okan; Pul, Serim; Hatipoglu, Sevcan; Yildirim, Zeynep Nagehan Yuruk; Agbas, Ayse; Girisgen, Ilknur; Leventoglu, Emre; Gokce, IbrahimIntroduction We aimed to evaluate the clinical and genetic characteristics and clinical course of children with persistent proteinuria associated with CUBN variants. Methods Forty-eight children with CUBN variants from 15 pediatric nephrology centers were included. Patients' characteristics, serum creatinine, albumin, hemoglobin, vitamin B12 levels, urinalysis, spot urine protein/creatinine (uPCR), microalbumin/creatinine (uACR), beta-2 microglobulin/creatinine (uBMCR) ratios, estimated glomerular filtration rates (eGFRs), treatments, kidney biopsies, and genetic findings were evaluated. Results All patients had normal serum albumin and creatinine and preserved eGFR. There was no significant change in eGFR between the first and last visits (p = 0.15), whereas uPCR was lower at the last visit (p = 0.001). Kidney biopsy was performed in 13 (27%); light microscopy was normal in all except one patient with focal segmental glomerulosclerosis (FSGS). Thirty-five patients (72.9%) had ACEi/ARB therapy, which was discontinued in 21 patients without subsequent worsening of proteinuria. Overall, 26 distinct CUBN variants were identified, predominantly in the C-terminal region. The most frequent variant was c.10102A > G (p.Met3368Val). Variant types included 15 (57.7%) missense, 7 (27%) nonsense, 3 (11.5%) splicing, and 1 (3.8%) frameshift variants. Conclusions In this multicenter, large pediatric cohort, proteinuria associated with CUBN variants generally followed a benign course over short to mid-term follow-up even without sustained ACEi/ARB therapy. Embedding targeted CUBN testing into the evaluation of children with asymptomatic proteinuria and normal kidney function may reduce unnecessary kidney biopsies and prolonged medication, while improving family counseling. We outline a stepwise care pathway -> early genetic screening -> conservative monitoring with periodic eGFR and proteinuria assessment -> consideration of ACEi/ARB discontinuation and recommend prospective validation and cost-effectiveness studies.Article Assessment of Characteristics and Treatment Patterns of Adult Patients with Acquired Aplastic Anemia in Turkiye (PLANE-TR)(Springer, 2026-02-20) Gunduz, Eren; Ulas, Turgay; Ozkalemkas, Fahir; Toprak, Selami Kocak; Karakulak, Elifcan Aladag; Ar, Muhlis Cem; Gulbas, Zafer; Ozkocaman, Vildan; Aydogan, Merve; Buyukasik, Yahya; Cerme, Melis Dila Ozer; Mehtap, Ozgur; Kucur, Damlanur; Kaya, Emin; Yavasoglu, Irfan; Besisik, Sevgi Kalayoglu; Ersal, Tuba; Yuksel, Merve; Hacioglu, Sibel; Cagliyan, Gulsum Akgun; Dal, Mehmet SinanAcquired aplastic anemia (AA) is a rare blood disorder causing hypocellular bone marrow due to immune damage to hematopoietic stem cells, leading to low blood cell counts. This study investigates the demographics, treatment patterns, and clinical outcomes of AA in Turkiye. In this non-interventional, retrospective descriptive study, data of 274 patients (Female/Male: 4/5) diagnosed with AA between September 1, 2011, and September 1, 2021, were collected from 16 centers. Severe and very severe AA was diagnosed in 72% and 27.7% of patients, respectively. The mean time from diagnosis to first treatment was 119 +/- 287 days, while time to hematopoietic stem cell transplantation (HSCT) was 212 +/- 321 days, and to Anti-Thymocyte Globulin (ATG) was 87 +/- 242.5 days. The mean time to response after first-line and second-line treatment was 172.9 +/- 264.6 days and 191.9 +/- 211.9 days, respectively. The mean overall survival of patients with AA was 3.56 +/- 3.12 years, with a 5-year overall survival rate of 72.6%. HSCT and other initial treatments led to full or partial remission for most patients, improving survival rates for over half of them. The study observed comparable patterns to previous studies, providing vital insights into Turkiye's acquired AA treatment landscape.Conference Object Malignant Solid Pseudopapillary Neoplasms: Histological Features, Molecular Alterations and Survival Outcomes(Springer, 2025) Comut, E.; Celik, A.; Uguz, A.; Ergun, O.; Erbil, S.; Argon, A.; Nart, D; Demirkan, N. Calli; Yilmaz, F.Article Understanding Antipsychotic Polypharmacy in Bipolar Disorder: The Role of Long-Acting Injectable Antipsychotics in a Naturalistic Inpatient Setting(Springer, 2026-01-10) Oktar Erdogan, Nilgun; Yucens, Bengu; Ozcan, Osman Mert; Ayhan, Fatmanur; Tumkaya, SelimAntipsychotic (AP) polypharmacy is common in the treatment of bipolar disorder (BD), particularly during inpatient care. Long-acting injectable antipsychotics (LAIs) are frequently used to prevent relapse. However, their relationship with AP polypharmacy remains unclear. This study examined the prescription patterns in inpatients with BD, focusing on the relationship between clinical characteristics, LAI use, and AP polypharmacy. Sociodemographic and clinical data of 175 inpatients diagnosed with BD were retrospectively analyzed. Antipsychotic use at three time points (pre-hospitalization, at initial treatment, and at discharge) was recorded. Factors predicting discharge AP count, AP dosage, and the potential direct and indirect effects of pre-hospitalization LAI use were examined. Patients using LAIs before hospitalization had earlier onset of illness, more manic episodes, and higher AP burden compared to non-users. Discharge AP count and dosage were significantly associated with AP count at initial treatment, length of hospital stay, and manic episode frequency. LAI use demonstrated a trend-level indirect association with fewer APs at discharge, mediated by shorter hospital stays, and this pathway appeared stronger among patients with fewer prior manic episodes. AP polypharmacy is common in BD, especially among patients on LAI. However, the association is indirect and shaped by clinical factors. Regular review of treatment regimens may help minimize unnecessary polypharmacy.