Yeditepe University Hospital

BACKGROUND: This study was designed to investigate the fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging characteristics of triple-negative (estrogen receptor-negative [ER-]/progesterone receptor-negative [PR-]/HER2-negative [HER2-]) breast carcinoma and compare the results with characteristics of ER+/PR+/HER2- breast carcinomas, which usually carry a favorable prognosis. METHODS: Patients with newly diagnosed breast carcinoma who had undergone dual-time-point FDG-PET before any therapeutic intervention and were identified as either ER-/PR-/HER2- or ER+/PR+/HER2- (the control group) on histopathology of the surgical specimen, were considered candidates for inclusion in this analysis. These patients underwent FDG-PET as a component of a prospective study that evaluated the role of multimodality imaging for characterizing primary breast lesions and locoregional staging. Breast cancer lesions were imaged twice at approximately 63 minutes and 101 minutes after the administration of FDG. Maximum standardized uptake values (SUVmax) were measured at both time points (SUVmax1 and SUVmax2) to analyze the data generated. After FDG-PET imaging, the patients underwent either breast-conserving surgery or mastectomy, and histopathology reports were used to provide the definitive diagnosis against which the PET study results were compared. RESULTS: In total, 88 patients with breast cancer (29 patients with 'triple-negative' breast cancer and 59 patients with ER+/PR+/HER2- breast malignancies) were selected among 206 individuals who were enrolled in the study protocol. The 'triple-negative' group comprised 14.08% of the total study population. The age of the patients with this subtype of tumor ranged from 33 years to 75 years (mean age+/-standard deviation, 51.6 +/- 10.1 years), and tumors in this subgroup ranged in size from 0.9 cm to 6 cm (mean size, 1.99 cm). Among the histopathologic subtypes, 25 tumors were infiltrating ductal carcinoma (86%), and 1 tumor each (3.5% each subtype) was lobular, mixed ductal-lobular, medullary, and tubular. For the calculation of FDG-PET parameters in this group, only patients who had undergone FDG-PET studies before any intervention were considered, and 18 patients in the triple-negative group met this criterion. According to same criterion, a control group of 59 patients with ER+/PR+/HER2- cancer who had focal FDG uptake were selected for comparison with the triple-negative population. The breast cancer lesions were observed as areas with focally enhanced uptake of FDG in all patients (sensitivity, 100%) in the triple-negative group. The mean (+/-standard deviation) SUVmax1 of the primary lesion for the triple-negative group was 7.27 +/- 5.6, the mean SUVmax2 was 8.29 +/- 6.4, and the percentage change in SUVmax (%DeltaSUVmax) was 14.3 +/- 15.8%. In the control group of 59 patients with ER+/PR+/HER2- breast carcinoma, the mean values for SUVmax1, SUVmax2, and %DeltaSUVmax were 2.68 +/- 1.9, 2.84 +/- 2.2, and 3.7 +/- 13.0%, respectively. The mean values for SUVmax1, SUVmax2, and %Dgr;SUVmax in the triple-negative group were significantly higher compared with the values in the nontriple-negative control group (P = .0032, P = .002, and P = .017, respectively). When the 2 subgroups were compared according to tumor size, grade, and stage, the SUVmax1 was significantly higher in the triple-negative group for both size categories (5.4 vs 1.9, P = .006; and 9.2 vs 3.5, P = .04) and for grade 3 tumors (9.1 vs 3.9, P = .022). The %DeltaSUVmax values for patients in the triple-negative group who had tumors that measured < or =2 cm and > 2 cm were 14.8 and 13.8, respectively; and the corresponding values for patients in the control group were 0.6 and 6.7, respectively. Although the mean %DeltaSUVmax clearly was higher in the triple-negative group for both tumor size categories, comparison between the 2 groups demonstrated a statistically significant difference in tumors that measured < or =2 cm (P = .016). The authors also observed that, in the triple-negative group, tumor grades were correlated significantly with the magnitude of SUVmax1 and SUVmax2 (P = .012 and P = .01, respectively). Stage for stage, tumors from the triple-negative group appeared to have a higher mean SUVmax1 compared with tumors from nontriple-negative control group. However, the trend reached statistical significance in patients with stage II disease. CONCLUSIONS: Triple-negative breast tumors were associated with enhanced FDG uptake commensurate with their aggressive biology and were detected with very high sensitivity by using FDG-PET imaging.

BACKGROUND: The aim of our study was to evaluate the pulmonary and hemodynamic effects of two different recruitment maneuvers after open heart surgery. METHODS: Sixty patients undergoing coronary artery bypass surgery were randomized into three groups after operation: recruitment maneuver with continuous positive airway pressure (CPAP) (CPAP-40 group, n = 20), recruitment by positive end-expiratory pressure (PEEP) (PEEP-20 group, n = 20), and 5 cm H2O PEEP (PEEP-5 group, n = 20). In the CPAP-40 group, 40 cm H2O peak inspiratory pressure was applied for 30 s, then PEEP was reduced to 20 cm H2O and ventilation was continued with baseline variables with PEEP decreased until the best Pao2 was achieved. In the PEEP-20 group, 20 cm H2O PEEP was set for 2 min, tidal volume was adjusted to achieve a peak inspiratory airway pressure of 40 cm H2O during the maneuver, then PEEP was decreased until the best Pao2 had been achieved. In the PEEP-5 group, 5 cm H2O PEEP was applied postoperatively. RESULTS: The mean arterial blood pressure of the CPAP-40 group was lower than that of the PEEP-20 (P < 0.01) and PEEP-5 groups (P < 0.01) during the interventions. Oxygenation was higher in both recruitment groups than in the PEEP-5 group during the mechanical ventilation period. There was no significant difference among the groups beyond that period. The atelectasis score of the PEEP-5 group (1.3 +/- 0.9) on postoperative day 1 was higher than that of the CPAP-40 (0.65 +/- 0.6; P = 0.01) and PEEP-20 (0.65 +/- 0.5; P = 0.01) groups. CONCLUSIONS: The recruitment techniques with postmaneuver PEEP increased oxygenation and decreased atelectasis equally, whereas PEEP-20 provided more stable hemodynamic conditions than the CPAP maneuver.

OBJECTIVE: Bleeding and allogeneic transfusion remain constant problems in cardiac surgical procedures. In this study, we aimed to test the role of a routine thromboelastography (TEG)-based algorithm on bleeding and transfusions in patients undergoing elective coronary artery bypass grafting (CABG). METHODS: Patients (n = 224) undergoing elective CABG with cardiopulmonary bypass were prospectively randomized into two groups according to transfusion strategy: in group 1 (clinician-directed transfusion, n = 110) need for blood transfusion was based on clinician's discretion and standard coagulation tests and in group 2 (TEG algorithm group, n = 114) kaolin-activated (k) TEG-based algorithm-guided perioperative transfusion management. Transfusion, blood loss, and outcome data were recorded. RESULTS: There were no differences in consumption of packed cell units, blood loss, re-exploration for bleeding, and early clinical outcome between the groups. Patients in the TEG group had significantly lower median units of fresh frozen plasma and platelets compared with the other group (p = 0.001). The median number of total allogeneic units transfused (packed cells and blood products) was significantly reduced in the TEG group compared with the other group (median 2, range 1-3 units vs. median 3, range 2-4 units, respectively, p = 0.001). The need for tranexamic acid was significantly diminished in the TEG group compared with the other group (10.3% vs. 19%, respectively, p = 0.007). CONCLUSION: Our results show that routine use of a kTEG-guided algorithm reduces the consumption of blood products in patients undergoing elective CABG. Adopting such an algorithm into routine management of these patients may help to improve clinical outcome and reduce the potential risks of transfusion-related complications and total costs after CABG.

CONTEXT: Products of at least five specific steroidogenic genes, including steroidogenic acute regulatory protein (StAR), which facilitates the entry of cytosolic cholesterol into the mitochondrion, side chain cleavage P450 enzyme, 3beta-hydroxysteroid-dehydrogenase-2, 17-hydroxylase/17-20-lyase, and aromatase, which catalyzes the final step, are necessary for the conversion of cholesterol to estrogen. Expression and biological activity of StAR and aromatase were previously demonstrated in endometriosis but not in normal endometrium. Prostaglandin E2 (PGE2) induces aromatase expression via the transcriptional factor steroidogenic factor-1 (SF1) in endometriosis, which is opposed by chicken-ovalbumin upstream-transcription factor (COUP-TF) and Wilms' tumor-1 (WT1) in endometrium. OBJECTIVE: The aim of the study was to demonstrate a complete steroidogenic pathway leading to estrogen biosynthesis in endometriotic cells and the transcriptional mechanisms that regulate basal and PGE2-stimulated estrogen production in endometriotic cells and endometrium. RESULTS: Compared with normal endometrial tissues, mRNA levels of StAR, side chain cleavage P450, 3beta-hydroxysteroid-dehydrogenase-2, 17-hydroxylase/17-20-lyase, aromatase, and SF1 were significantly higher in endometriotic tissues. PGE2 induced the expression of all steroidogenic genes; production of progesterone, estrone, and estradiol; and StAR promoter activity in endometriotic cells. Overexpression of SF1 induced, whereas COUP-TFII or WT1 suppressed, StAR promoter activity. PGE2 induced coordinate binding of SF1 to StAR and aromatase promoters but decreased COUP-TFII binding in endometriotic cells. COUP-TFII or WT1 binding to both promoters was significantly higher in endometrial compared with endometriotic cells. CONCLUSION: Endometriotic cells contain the full complement of steroidogenic genes for de novo synthesis of estradiol from cholesterol, which is stimulated by PGE2 via enhanced binding of SF1 to promoters of StAR and aromatase genes in a synchronous fashion.

PURPOSE: To evaluate the effect of uncomplicated phacoemulsification surgery on macula by optical coherence tomography (OCT). METHODS: A total of 110 eyes of 102 patients who underwent uncomplicated phacoemulsification and foldable intraocular lens implantation at Beyoglu Eye Research and Training Hospital between February and March 2005 and who were without any systemic disease, fundus or other ocular pathology were included. Postoperatively, topical prednisolone acetate (6 x 1) and ofloxacine (5 x 1) was started, and by decreasing the dosage progressively, treatment was continued for 6 weeks. Full ophthalmologic and OCT examinations were done preoperatively and at the postoperative 1st day, 1st week, 1st, 3rd, and 6th months. Mean retinal thicknesses, volumetric analyses at central fovea, superior, inferior, temporal, and nasal macular quadrants, and thinnest foveal retinal thicknesses were recorded. Preoperative and postoperative measurements were analyzed statistically by using ANOVA test, paired samples t-test with Bonferroni correction, and Pearson's correlation test. RESULTS: The mean central foveal retinal thickness was preoperatively 202.4 +/- 25.9 micro m, postoperatively 200.4 +/- 26.1 micro m at 1st day (p = 0.29), 208.4 +/- 27.6 micro m at 1st week (p = 0.29), 226.2 +/- 54.9 micro m at 1st month, 215.2 +/- 24.0 micro m at 3rd month, 213.5 +/- 29.4 micro m at 6th month (p < 0.001). Perifoveal macular thicknesses at superior, inferior, temporal, and nasal quadrants were 264.9 +/- 28.8 micro m, 266.1 +/- 29.5 micro m, 255.0 +/- 31.3 micro m, 260.3 +/- 34.0 micro m, respectively, preoperatively; 287.9 +/- 28.4 micro m, 288.0 +/- 26.3 micro m, 286.8 +/- 33.1 micro m, 272.0 +/- 32.4 micro m, respectively, at postoperative 1st month (p < 0.001). The change in mean central foveal thickness, foveal thinnest retinal thickness, mean perifoveal retinal thickness and volumetric analyses was insignificant at postoperative 1st day (p > 0.05), and significant at 1st week, 1st, 3rd, and 6th months (p < 0.05 for all measurements). CONCLUSIONS: Statistically significant increase in macular thickness was detected at postoperative early periods, after the 1st week after uncomplicated cataract operation. The increase in macular thickness starts from parafoveal regions. Longer follow-up of patients is required for the macular consequences, and different treatment protocols should be studied in a randomized controlled fashion.

OBJECTIVE: To evaluate changes in perceptual and several acoustic parameters of voice in patients with Parkinson's disease (PD) and to find out any relation with these parameters and motor components of Unified Parkinson's Disease Rating Scale (UPDRS) in this patient group. MATERIALS AND METHODS: Twenty patients with PD (12 male and 8 female) were given objective and subjective voice tests and results were compared with those of 20 age- and sex-matched controls. Patient's perceptual voice analysis was assessed using GRBAS scale including Grade of Dysphonia, Roughness, Breathiness, Asthenia and Strain items. Measurements for objective voice analysis, acoustic assessment tests including frequency perturbation [jitter (jitt)%], intensity perturbation [shimmer (shim)%], noise to harmonic ratio (NHR), fundamental frequency (F0), variability of fundamental frequency (vF0), diadochokinetic rate (DDK) and maximum phonation time (MPT) were used. An assessment of disability caused by voice disorders was scored according to the Voice Handicap Index (VHI) by the patient. All subjects also underwent videolaryngostroboscopic (VLS) examination. Motor components of UPDRS and acoustic parameters of voice were investigated for any correlations. RESULTS: Compared with controls, roughness (P = 0.15), breathiness (P = 0.004) and asthenia (P = 0.031) values of males and breathiness (P = 0.043) and asthenia (P = 0.023) values of females were higher in patients with PD. Mean VHI scores of patients with PD were higher for both male and female patients (P = 0.0001 for male, P = 0.002 for female). The mean values for MPT (P = 0.02) and DDK (P = 0.025) were shorter in patients with PD. Jitt%, shim% and mean F0 values were similar among the two groups. But mean vF0 values were significantly higher in male patients with PD (P = 0.05). On VLS examination, non-closure glottic pattern was found to be more frequent in the PD group. CONCLUSION: Although it is well known that pathophysiological changes in PD affect the voice, the present study found only few significant correlations between motor component of UPDRS and voice parameters.

BACKGROUND: The purpose of this study was to determine the incidence and seasonal distribution of viral etiological agents and to compare their clinical manifestations and disease severity, including single and co infections. METHODS: Multiplex reverse-transcription PCR was performed for the detection of viruses in nasopharyngeal aspirat. Disease severity was grouped using a categorization index as very mild/mild, and moderate/severe. Clinical and laboratory characteristics of hospitalized children with viral respiratory tract infection were analyzed. RESULTS: Viral pathogens were detected in 103/155 (66.5%) of patients. In order of frequency, identified pathogens were respiratory syncytial virus (32.0%), adenovirus (26.2%), parainfluenza viruses type 1-4 (19.4%), rhinovirus (18.4%), influenza A and B (12.6%), human metapneumovirus (12.6%), coronavirus (2.9%), and bocavirus (0.9%). Coinfections were present in 21 samples. Most of the children had very mild (38.8%) and mild disease (37.9%). Severity of illness was not worse with coinfections. The most common discharge diagnoses were "URTI" with or without LRTI/asthma (n=58). Most viruses exhibited strong seasonal patterns. Leukocytosis (22.2%) and neutrophilia (36.6%) were most commonly detected in patients with adenovirus and rhinovirus (p<0.05). Monocytosis was the most remarkable finding in the patients (n=48, 53.3%), especially in patients with adenovirus (p<0.05). CONCLUSIONS: RSV and RhV were associated with higher severity of illness in hospitalized children. RSV found to account for half of LRTI hospitalizations. In AdV and FluA and B infections, fever lasted longer than in other viruses. Coinfections were detected in 21 of the patients. The presence of coinfections was not associated with increased disease severity.

Ama: Dnya Salk rgt'nn (DS) aratrmasna gre anemi tm dnyada 1,5 milyardan fazla kiiyi etkileyen en yaygn hastalktr. Tm dnyadaki anemi orannn yarsn demir eksiklii anemisi (DEA) oluturmaktadr. Gebelikte ve postpartum dnemde DEA sk grlr ve ciddi maternal ve fetal komplikasyonlara yol aabilir. Bu almann amac, bir multidisipliner uzman grubunun deneyimlerini paylamak ve gebelikteki ve postpartum dnemdeki demir eksiklii anemisine dair optimal tan ve tedavi yaklamlar iin bir referans oluturmaktr. DEA tan ve tedavisi ile ilgili ulusal ve uluslararas dergilerde yaynlanm almalar ve klavuzlar gzden geirildi. Uzman paneli tarafndan konsensus yntemi kullanlarak sonu mahiyetinde neriler oluturuldu. E zamanl inflamatuvar bir durum olmadka, DEA tans iin en yksek duyarlla ve zglle sahip test serum ferritin lmdr. Gebelikte en dk hemoglobin (Hb) eik deeri 1. ve 3. trimester boyunca <11 gr/dL, 2. trimester boyunca <10,5 gr/dL'dir. Postpartum dnemde Hb deerinin 10 gr/dL'nin altna inmesi ciddi anemiye iaret eder. Oral demir tedavisi DEA'da birinci basamak tedavi olarak verilir. Her ne kadar veriler imdilik snrl olsa da; oral tedavi yantszl, yan etkilerin varl, tedaviye uyum sorunu, ok dk hemoglobin deerleri ve hzl demir

OBJECTIVES: The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor. STUDY DESIGN: 4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHA <Class I. RESULTS: The absolute and estimated prevalences were 2.9% and 6.9% for HF, and 4.8% and 7.9% for ASVD, respectively. Advanced age, male gender, history of heart disease, HT and CRF were independent predictors of HF. In patients with ejection fraction (EF) <50%, HF prevalence was higher in men, while HF prevalences were higher in women when EF ≥ 50%. In global sum, HF and ALVD prevalence were similar in male and females. CONCLUSION: The prevalences of HF and ASVD are higher in Turkey when compared with western countries, despite a younger Turkish population. The established predictors of HF are valid for Turkey as well. There is a significant ASVD population in Turkey with similar characteristics and risk factors to HF. Focusing on the early detection and treatment of ASVD may prevent the progression to HF, and therefore would decrease the prevalence of HF in Turkey.

BACKGROUND: Although ST-segment elevation (STE) has been used synonymously with acute coronary occlusion (ACO), current STE criteria miss nearly one-third of ACO and result in a substantial amount of false catheterization laboratory activations. As many other electrocardiographic (ECG) findings can reliably indicate ACO, we sought whether a new ACO/non-ACO myocardial infarction (MI) paradigm would result in better identification of the patients who need acute reperfusion therapy. METHODS: A total of 3000 patients were enrolled in STEMI, non-STEMI and control groups. All ECGs were reviewed by two cardiologists, blinded to any outcomes, for the current STEMI criteria and other subtle signs. A combined ACO endpoint was composed of peak troponin level, troponin rise within the first 24 h and angiographic appearance. The dead or alive status was checked from hospital records and from the electronic national database. RESULTS: In non-STEMI group, 28.2% of the patients were re-classified by the ECG reviewers as having ACO. This subgroup had a higher frequency of ACO, myocardial damage, and both in-hospital and long-term mortality compared to non-STEMI group. A prospective ACOMI/non-ACOMI approach to the ECG had superior diagnostic accuracy compared to the STE/non-STEMI approach in the prediction of ACO and long-term mortality. In Cox-regression analysis early intervention in patients with non-ACO-predicting ECGs was associated with a higher long-term mortality. CONCLUSIONS: We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI. (DIFOCCULT study; ClinicalTrials.gov number, NCT04022668.).

Neonatal diabetes is caused by single gene mutations reducing pancreatic β cell number or impairing β cell function. Understanding the genetic basis of rare diabetes subtypes highlights fundamental biological processes in β cells. We identified 6 patients from 5 families with homozygous mutations in the YIPF5 gene, which is involved in trafficking between the endoplasmic reticulum (ER) and the Golgi. All patients had neonatal/early-onset diabetes, severe microcephaly, and epilepsy. YIPF5 is expressed during human brain development, in adult brain and pancreatic islets. We used 3 human β cell models (YIPF5 silencing in EndoC-βH1 cells, YIPF5 knockout and mutation knockin in embryonic stem cells, and patient-derived induced pluripotent stem cells) to investigate the mechanism through which YIPF5 loss of function affects β cells. Loss of YIPF5 function in stem cell-derived islet cells resulted in proinsulin retention in the ER, marked ER stress, and β cell failure. Partial YIPF5 silencing in EndoC-βH1 cells and a patient mutation in stem cells increased the β cell sensitivity to ER stress-induced apoptosis. We report recessive YIPF5 mutations as the genetic cause of a congenital syndrome of microcephaly, epilepsy, and neonatal/early-onset diabetes, highlighting a critical role of YIPF5 in β cells and neurons. We believe this is the first report of mutations disrupting the ER-to-Golgi trafficking, resulting in diabetes.

BACKGROUND: Gabapentin is an anticonvulsant drug that has analgesic properties for acute postoperative pain. However, the analgesic effect of gabapentin as an antiepileptic prophylactic drug on patients undergoing craniotomy is unclear. In this study, we evaluated the postoperative effectiveness of gabapentin on acute postoperative pain when it is used for antiepileptic prophylaxis in patients undergoing craniotomy for supratentorial tumor resection. METHODS: Eighty patients undergoing craniotomy for supratentorial tumor resection were randomly assigned into two groups. Patients in Group G (n = 40) received oral gabapentin (3 x 400 mg), and patients in Group P (n = 40) received oral phenytoin (3 x 100 mg) for 7 days before the operation and postoperatively. An identical anesthesia protocol was performed for both the groups. Anesthesia was maintained with propofol and remifentanil infusion. Patient-controlled analgesia with morphine was used, and pain levels were measured. The antiepileptic-related side effects, anesthetic consumption, duration of anesthesia and surgery, tracheal extubation time, postoperative pain scores, morphine consumption, and sedation scores were recorded. RESULTS: Thirty-seven patients in Group G and 38 patients in Group P completed the study. During the preoperative period in Group G, one patient had severe fatigue, one had severe dizziness, and one patient's surgical procedure was changed. The median plasma levels of gabapentin were 34 micromol/mL (range, 23-51 micromol/mL) in 34 patients. In Group P, one patient withdrew from the study preoperatively and one developed transient neurological symptoms postoperatively. The demographic data and mean duration of anesthesia and surgery were similar in both the groups. The total propofol and remifentanil consumption in Group G (1847 +/- 548 mg/3034 +/- 1334 microg) was significantly less than that of Group P (2293 +/- 580 mg/4287 +/- 1282 microg) (P = 0.01). However, tracheal extubation could be done earlier in Group P (4.5 +/- 2 min) than in Group G (16.6 +/- 22 min) (P < 0.001). Pain scores were significantly higher in Group P at 15 min, 30 min, and 1 h (P < 0.001). The total morphine consumption was also significantly higher in Group P (33 +/- 17 mg vs 24 +/- 19 mg) (P = 0.01). The postoperative sedation scores were significantly higher in Group G at 15 min, 30 min, 1 h, and 2 h (P < 0.001). CONCLUSIONS: The administration of gabapentin to patients undergoing craniotomy for supratentorial tumor resection was effective for acute postoperative pain. It also decreased analgesic consumption after surgery. However, it may lead to side effects such as delayed tracheal extubation and increased sedation postoperatively.

BACKGROUND: To compare the efficacy, safety, and long-term results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation (DCPC) and Ahmed glaucoma valve (AGV) implant in cases of neovascular glaucoma. METHODS: A total of 66 eyes of 66 patients with neovascular glaucoma were prospectively assigned to either DCPC or AGV implantation. All patients underwent a baseline complete ophthalmologic examination and IOP measurement by Goldmann applanation tonometry before and after 1,3, 6, 12, and 24 months follow-up. Complications and the number of medications were recorded. RESULTS: Mean age of the patients was 60.0+/-11.7 years (range: 20 to 85) in the DCPC group and 57.2+/-10.3 years (range: 20 to 85) in the AGV group. The preoperative IOP was 43.4+/-11.9 mm Hg and 43.3+/-7.4 mm Hg for the DCPC and AGV group, respectively (P>0.05). The postoperative IOP was 16.5+/-11.3 mm Hg and 22.09+/-7.6 mm Hg for the DCPC and AGV groups, respectively (P>0.05) at the last visit. Kaplan-Meier survival analysis showed a probability of success at 24 months of 61.18% and 59.26% for the DCPC and AGV groups (P>0.05). All the patients had a visual acuity of hand movement or worse preoperatively. Visual acuity decreased in 6 eyes (24%) in the DCPC group and 9 eyes (27%) in AGV group. Complications included anterior segment inflammation in 5 eyes (20%), neurotrophic keratitis in 2 eyes (8%), and hypotony in 3 eyes (15%) in the DCPC group and hyphema in 5 eyes (15%) and tube occlusion in 3 eyes (9%) in AGV group. CONCLUSIONS: There was no significant difference in the success rate between the DCPC and AGV implantation in neovascular glaucoma treatment. However, DCPC is less time consuming and easier method for lowering IOP in patients with neovascular glaucoma.

OBJECTIVE: The aim of this study is to evaluate the effect of the Viking 3-dimensional (3D) system on performance time of laparoscopic cholecystectomy. METHODS: Twenty-two patients were included in the study. The groups were standardized using a multiparameters filter (MPF) depending on preoperative ultrasonography and perioperative exploration findings. The 11 patients operated with the Viking 3D system (group A) were compared with 11 patients operated with the Olympus 2D/HD system (group B). RESULTS: The mean performance time was 20.63 ± 5.66 and 30.0 ± 6.03 minutes in the group A (3D) and group B (2D), respectively (P<0.01). CONCLUSIONS: The 3D imaging systems may cause a significant reduction in the performance time of laparoscopic cholecystectomy.

AIM: One of the major treatment goals in congestive heart failure (CHF) is to preserve the functional level of the patient and to improve psychosocial factors. For these purposes, exercise training is recommended for the management of CHF. With this background, the aim of this study is to investigate the effects of aerobic exercise on quality of life, depression and anxiety levels in a Turkish patient population with CHF. METHODS: Sixty patients with CHF in stage II-III according to NYHA were included. Patients were randomly assigned either to a cardiac rehabilitation group or to a control group. Twenty-seven patients were allocated to a weekly aerobic walking program on treadmill, thrice a week for 8 weeks, and 26 patients did not receive any exercise training. Both groups were assessed by an ergospirometric exercise test, Hacettepe Quality of Life Questionnaire (HQoL), Beck Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI) at baseline and at the end. RESULTS: Forty-four patients (treatment group: 23) completed the study. In the treatment group, significant increases in peak oxygen consumption, exercise time and metabolic equivalents (MET) levels were attained (P=0.001, P=0.001, P=0.003, respectively). Significant decreases in BDI (P=0.004) and STAI subgroups (P=0.049, P=0.023, respectively) were observed, whereas there was no change in HQoL scores. In the control group, there was no difference between baseline and 8th week evaluation in all parameters. CONCLUSIONS: Patients with CHF tolerated aerobic exercise programs well. This resulted with improvement in both physical and psychologic wellbeing, but not in quality of life in the short term.

Accelerometry has the potential to measure balance, defined as high-frequency body sway, ambulatorily in a simple and inexpensive way. The aim of this study was to determine and compare the sensitivity of accelerometric balance parameters during the sit-to-stand (STS) movement. Eleven healthy subjects (four males, 28.2 +/-7.9 years) and 31 patients with stroke (21 males; 63.3+/-12.8 years) were included. The healthy subjects performed STS movements in four conditions with different levels of difficulty. Data of the patients were compared 1) with healthy subjects, 2) between patient subgroups, and 3) between different phases of recovery to assess the sensitivity of accelerometry for differences in balance control. Accelerometers were attached to the trunk, and force plate measurements were simultaneously done in the healthy subjects. Main outcome measures were root mean square (rms) and area under the curve (AUC) derived from the high-frequency component of the transversal acceleration signal of the trunk. In all comparisons there was a significant difference in AUC data ( p < 0.05), and AUC appeared to be more sensitive than rms. Variability in AUC was not completely or mainly the result of changes and differences in the duration of the STS movement. As a conclusion, accelerometry is a potentially valuable technique to measure balance during the STS movement.

PURPOSE: To evaluate corneal viscoelastic and intraocular pressure (IOP) changes measured by an ocular response analyzer (ORA) after phacoemulsification and intraocular lens (IOL) implantation. SETTING: Yeditepe University Department of Ophthalmology, Istanbul, Turkey. METHODS: Fifty-one eyes scheduled for cataract surgery were included in the study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured by ORA preoperatively and 1 week and 1 and 3 months postoperatively. Central corneal thickness (CCT) was measured using the ORA's integrated handheld ultrasonic pachymeter. RESULTS: The mean preoperative CCT (537 microm+/-46 [SD]) did not change significantly by the end of 1 month postoperatively. The mean preoperative IOPcc (17.2+/-3.0 mm Hg) decreased significantly by 3 months postoperatively (15.2+/-3.7 mm Hg) (P= .018). The mean CH decreased from 10.36+/-1.48 mm Hg preoperatively to 9.64+/-1.26 mm Hg at 1 week (P= .028); it increased to preoperative values at the end of 1 month (10.20+/-1.70) and 3 months (10.74+/-1.54) (P>.05). The mean CRF decreased from 10.94+/-2.54 mm Hg preoperatively to 9.99+/-1.77 at 1 week (P= .026); it increased to preoperative values at 1 month (10.26+/-1.59) and 3 months (10.35+/-1.46) (P>.05). CONCLUSIONS: Although CH and the CRF decreased in the early postoperative period, the parameters increased and reached preoperative values by 3 months postoperatively, showing that corneal biomechanical properties are influenced by phacoemulsification and IOL implantation.

COVID-19 vaccination campaign in Turkey started with two-dose regimen of CoronaVac (Sinovac Life Sciences), a chemically inactivated whole virus vaccine (IVV), in January 2021.1 It has been reported that humoral immune response to SARS-CoV-2 variants, such as 501Y.V2 (B.1.351), of the plasma and neutralizing antibodies elicited by CoronaVac suggest that a third-dose boost may be beneficial for combating SARS-CoV-2 variants when necessary.2 Recent rapid spread of the Delta variant worldwide, and the fact that this variant has partially nullified vaccination3 against SARS-CoV-2 forced many countries to consider application of additional vaccine doses. While administering third dose of messenger RNA (mRNA) vaccine was recommended for recipients in solid organ transplants in France4, 5 in April 2021, Turkish Ministry of Health recommended application of the third vaccine dose for healthcare workers (HCWs) and elderly people by the end of June 2021. By September 2021, more than 9 M Turkish citizens already had their third dose of CoronaVac or BNT162b2 vaccine.6 Some other countries (the United Arab Emirates, Thailand, Indonesia) also started giving a third shot to those inoculated with IVV. On the other hand, people in Israel were twice vaccinated with BNT162b2, and a third dose of the same type of mRNA vaccine was distributed to citizens over 60 years old.7 In this study, we compared the antibody recognizing the receptor binding domain of the spike (S), glycoprotein (IgG-S), and nucleocapsid protein (IgG-N) of SARS CoV-2 titers to investigate the interplay between humoral immune responses in 68 HCWs. CoronaVac was applied to 1030 HCWs of Yeditepe University Hospitals in two-dose regimens. Randomly selected 45 HCWs who had no previous infection were enrolled in this study (2IVV group). We compared the antibody recognizing the RBD of the spike (S) glycoprotein (IgG-S) and nucleocapsid protein (IgG-N) of SARS CoV-2 titers to investigate the interplay between humoral immune responses of HCWs. First antibody titers in 2IVV group were measured 1 month after administering second CoronaVac (booster1) dose. Grouping of HCWs was done after third (booster2) dose application (timing, in Figure 1). Second antibody titers were measured 1 month after third (=booster2) dose. 3IVV group contained 18 healthy HCWs of mean (SD) age of 41 (10.9) years, who had a third CoronaVac (booster2) dose approximately 6 months after the application of their prime dose. 2IVV + BNT group of 27 HCWs with mean age 40.7 (11.1) years had BNT162b2 vaccine as the third vaccine (booster2) dose approximately 6 months after the application of their first CoronaVac. Healthy control group (HCG) consisted of 23 “nonvaccinated and noninfected” HCWs with mean age 31 (6.4) years. Peripheral blood samples were collected for serology from all 68 participants who provided written informed consent for use of their blood samples. The presence of IgG-S and IgG-N antibody levels against SARS-CoV-2 were measured quantitatively by using Abbott Architect i2000 (Abbott Laboratories). Age structures of all groups were normally distributed and did not significantly differ from each other (independent t test, p > 0.05). However, IgG-S and IgG-N sample values for the 3IVV and 2IVV + BNT groups were not normally distributed. Measured IgG-S levels for 3IVV and 2IVV + BNT groups as well as IgG-N titers for both groups showed statistically significant differences (Mann–Whitney UIgG-S = 0, p < 0.001; Mann–Whitney UIgG-N = 84, p < 0.001). Measured IgG-S and IgG-N titers in the 3IVV group presented a high Spearman's correlation value (ρ = 0.715, p < 0.001), but correlation coefficient between IgG-S and IgG-N titers in 2IVV + BNT group was negligible (ρ = 0.063, p > 0.05). Table 1 lists descriptive statistics in the study groups. Median values of IgG-S titers were substantially higher in 2IVV + BNT group than those HCWs of the 3IVV and HCG. On the other hand, median values of IgG-N titers were higher in 3IVV group than those HCWs of the other two groups. While third CoronaVac inoculations yield 1.7 and 1.8 times increases in median values of IgG-S and IgG-N titers, respectively; BNT162b2 administration as the third vaccine dose boosted IgG-S median titers by a factor of 46.6, but IgG-N titers decreased by a factor of 6.5. Two-dimensional visualization of humoral responses using threshold values of each variable are displayed in Figure 1. More populated first quadrant with the same color of dot-scattering in this graph is the indicator of response effectivity in each study group against related SARS-CoV-2 immunity parameters. By clinically following the HCWs participated in our study, we will be able to tell which of these two vaccination programs provide higher protection against SARS-CoV-2. Limitations of this study are the absence of cellular immunity assays and relatively small sample size. We express our gratitude to all healthcare workers of Yeditepe University Hospitals who participated in this study. We are also thankful to anonymous reviewers for their constructive comments and suggestions. Aynur Eren Topkaya conceived the work and contributed to the design of the study. Ali Umit Keskin, Sibel Bolukcu, Aynur Eren Topkaya, Pinar Ciragil performed the literature search, Ali Umit Keskin, Aynur Eren Topkaya, and Pinar Ciragil contributed to the writing of the manuscript. Aynur Eren Topkaya supervised the project. Aynur Eren Topkaya, Sibel Bolukcu, and Pinar Ciragil were responsible for the recruitment, follow-up, and data collection, and laboratory analysis. Ali Umit Keskin performed data processing work. All authors contributed to the data interpretation, revision of the manuscript and approved the final manuscript version. All study data were available to all authors.

It is increasingly recognized that the autonomic nervous system (ANS) is a major contributor in many cardiac arrhythmias. Cardiac ANS can be divided into extrinsic and intrinsic parts according to the course of nerve fibers and localization of ganglia and neuron bodies. Although the role of the extrinsic part has historically gained more attention, the intrinsic cardiac ANS may affect cardiac function independently as well as influence the effects of the extrinsic nerves. Catheter-based modulation of the intrinsic cardiac ANS is emerging as a novel therapy for the management of patients with brady and tachyarrhythmias resulting from hyperactive vagal activation. However, the distribution of intrinsic cardiac nerve plexus in the human heart and the functional properties of intrinsic cardiac neural elements remain insufficiently understood. The present review aims to bring the clinical and anatomical elements of the immune effector cell-associated neurotoxicity together, by reviewing neuroanatomical terminologies and physiological functions, to guide the clinical electrophysiologist in the catheter lab and to serve as a reference for further research.

Cardioneuroablation has emerged as a potential alternative to cardiac pacing in selected cases with vasovagal reflex syncope, extrinsic vagally induced sinus bradycardia-arrest or atrioventricular block. The technique was first introduced decades ago, and its use has risen over the past decade. However, as with any intervention, proper patient selection and technique are a prerequisite for a safe and effective use of cardioneuroablation therapy. This document aims to review and interpret available scientific evidence and provide a summary position on the topic.