Fakülteler / Faculties
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Item Comparison of Visual Performance and Quality of Life with A New Nondiffractive EDOF Intraocular Lens and A Trifocal Intraocular Lens(2023) Asena, Leyla; Dogan, Irem Kirci; Oto, Sibel; Altinors, Dilek Dursun; 0000-0003-0171-4200; 0000-0002-6848-203X; 0000-0002-5574-7318; 36700928; AAJ-4668-2021; E-5914-2016Purpose: To compare visual performance and quality of life (QoL) following bilateral implantation of a new nondiffractive extended depth-of-focus (EDOF) intraocular lens (IOL) and a trifocal IOL. Setting: Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey. Design: Prospective comparative interventional case series. Methods: 104 eyes of 52 patients with cataract, bilaterally implanted with a nondiffractive EDOF IOL or a trifocal IOL, were included. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity and distance corrected near visual acuity, defocus curves, QoL (Visual Function Index 14), quality of vision (Quality of Vision [QoV] index), contrast sensitivity (Pelli-Robson chart), and binocular reading speed. Results: Twenty-six patients were included in each group. The UDVA and CDVA were better in the EDOF group (0.05 +/- 0.04 and 0.01 +/- 0.04) than the trifocal group (0.13 +/- 0.06 and 0.11 +/- 0.07) (P=.02 and .01). Defocus curves showed that visual acuity was better with the EDOF IOL for vergences at 0.00, -0.50, and -1.00 and better with the trifocal IOL for vergences at -2.50, -3.00, -3.50, and -4.00. Contrast sensitivity scores were similar with both IOLs (P=.12). The overall mean QoL scores were lower in the EDOF group, indicating a better QoL (P=.04). The QoV was better in the EDOF group with significantly less glare, halos, and blurry vision (P<.01). Conclusions: The EDOF IOL performed better at distance, and the trifocal IOL performed better at near. Overall QoL and quality of vision were better with the EDOF IOL. Copyright (c) 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRSItem First-Line Cemiplimab Monotherapy and Continued Cemiplimab Beyond Progression Plus Chemotherapy for Advanced Non-Small-Cell Lung Cancer With PD-L1 50% Or More (EMPOWER-Lung 1): 35-Month Follow-Up From A Multicentre, Open-Label, Randomised, Phase 3 Trial(2023) Ozguroglu, Mustafa; Kilickap, Saadettin; Sezer, Ahmet; Gumus, Mahmut; Bondarenko, Igor; Gogishvili, Miranda; Nechaeva, Marina; Schenker, Michael; Cicin, Irfan; Ho, Gwo Fuang; Kulyaba, Yaroslav; Zyuhal, Kasimova; Scheusan, Roxana-Ioana; Garassino, Marina Chiara; He, Xuanyao; Kaul, Manika; Okoye, Emmanuel; Li, Yuntong; Li, Siyu; Pouliot, Jean-Francois; Seebach, Frank; Lowy, Israel; Gullo, Giuseppe; Rietschel, Petra; 37591293Background: Cemiplimab provided significant survival benefit to patients with advanced non-small-cell lung cancer with PD-L1 tumour expression of at least 50% and no actionable biomarkers at 1-year follow-up. In this exploratory analysis, we provide outcomes after 35 months' follow-up and the effect of adding chemotherapy to cemiplimab at the time of disease progression.Methods: EMPOWER-Lung 1 was a multicentre, open-label, randomised, phase 3 trial. We enrolled patients (aged >= 18 years) with histologically confirmed squamous or non-squamous advanced non-small-cell lung cancer with PD-L1 tumour expression of 50% or more. We randomly assigned (1:1) patients to intravenous cemiplimab 350 mg every 3 weeks for up to 108 weeks, or until disease progression, or investigator's choice of chemotherapy. Central randomisation scheme generated by an interactive web response system governed the randomisation process that was stratified by histology and geographical region. Primary endpoints were overall survival and progression free survival, as assessed by a blinded independent central review (BICR) per Response Evaluation Criteria in Solid Tumours version 1.1. Patients with disease progression on cemiplimab could continue cemiplimab with the addition of up to four cycles of chemotherapy. We assessed response in these patients by BICR against a new baseline, defined as the last scan before chemotherapy initiation. The primary endpoints were assessed in all randomly assigned participants (ie, intention-to-treat population) and in those with a PD-L1 expression of at least 50%. We assessed adverse events in all patients who received at least one dose of their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT03088540.Findings: Between May 29, 2017, and March 4, 2020, we recruited 712 patients (607 [85%] were male and 105 [15%] were female). We randomly assigned 357 (50%) to cemiplimab and 355 (50%) to chemotherapy. 284 (50%) patients assigned to cemiplimab and 281 (50%) assigned to chemotherapy had verified PD-L1 expression of at least 50%. At 35 months' follow-up, among those with a verified PD-L1 expression of at least 50% median overall survival in the cemiplimab group was 261 months (95% CI 221-318; 149 [52%] of 284 died) versus 133 months (105-162; 188 [67%] of 281 died) in the chemotherapy group (hazard ratio [HR] 057, 95% CI 046-071; p<00001), median progression-free survival was 81 months (95% CI 62-88; 214 events occurred) in the cemiplimab group versus 53 months (43-61; 236 events occurred) in the chemotherapy group (HR 051, 95% CI 042-062; p<00001). Continued cemiplimab plus chemotherapy as second-line therapy (n=64) resulted in a median progression-free survival of 66 months (61-93) and overall survival of 151 months (113-187). The most common grade 3-4 treatment-emergent adverse events were anaemia (15 [4%] of 356 patients in the cemiplimab group vs 60 [17%] of 343 in the control group), neutropenia (three [1%] vs 35 [10%]), and pneumonia (18 [5%] vs 13 [4%]). Treatment-related deaths occurred in ten (3%) of 356 patients treated with cemiplimab (due to autoimmune myocarditis, cardiac failure, cardio-respiratory arrest, cardiopulmonary failure, septic shock, tumour hyperprogression, nephritis, respiratory failure, [n=1 each] and general disorders or unknown [n=2]) and in seven (2%) of 343 patients treated with chemotherapy (due to pneumonia and pulmonary embolism [n=2 each], and cardiac arrest, lung abscess, and myocardial infarction [n=1 each]). The safety profile of cemiplimab at 35 months, and of continued cemiplimab plus chemotherapy, was generally consistent with that previously observed for these treatments, with no new safety signalsINTERPRETATION: At 35 months' follow-up, the survival benefit of cemiplimab for patients with advanced non-small-cell lung cancer was at least as pronounced as at 1 year, affirming its use as first-line monotherapy for this population. Adding chemotherapy to cemiplimab at progression might provide a new second-line treatment for patients with advanced non-small-cell lung cancer.Copyright (c) 2023 Elsevier Ltd. All rights reserved.Item Asymptomatic Lower Pole Small Renal Stones: Shock Wave Lithotripsy, Flexible Ureteroscopy, or Observation? A Prospective Randomized Trial(2015) Sener, Nevzat Can; Bas, Okan; Sener, Emine; Zengin, Kursad; Ozturk, Ufuk; Altunkol, Adem; Evliyaoglu, Yalcin; 25440816; HKN-9151-2023OBJECTIVE To present the outcomes of flexible ureteroscopy (F-URS), shock wave lithotripsy (SWL), and observation in the management of asymptomatic lower calyceal stones. METHODS A total of 150 patients with asymptomatic lower calyceal stones were randomized into F-URS (group 1), SWL (group 2), and observation (group 3) groups. The main criteria for patient enrollment were having asymptomatic single lower pole stones <1 cm. RESULTS In F-URS, the mean stone-free rate was 92% (46 of 50). The mean number of sessions for the SWL group was 1.48 +/- 0.65. Stone-free rate was 90% (45 of 50). In the observation group, patients were followed up for a mean of 21.02 +/- 3.65 months. Three stones passed spontaneously without any symptoms. Pain developed in 3 patients during follow-up, and 2 of them passed a stone and responded to analgesics without further treatment. Complication rates for groups 1 and 2 were similar, but group 2 had higher Clavien grades. CONCLUSION For asymptomatic small-sized lower calyceal stones, SWL and F-URS are established treatment modalities. However, with low auxiliary treatment rates, observation may be an option for the management of nonsymptomatic small-sized lower pole kidney stones. (C) 2015 Elsevier Inc.Item Prophylactic Red Blood Cell Exchange May Be Beneficial in the Management of Sickle Cell Disease in Pregnancy(2015) Asma, Suheyl; Kozanoglu, Ilknur; Tarim, Ebru; Sariturk, Cagla; Gereklioglu, Cigdem; Akdeniz, Aydan; Kasar, Mutlu; Turgut, Nurhilal H.; Yeral, Mahmut; Kandemir, Fatih; Boga, Can; Ozdogu, Hakan; 0000-0002-5268-1210; 0000-0002-8902-1283; 0000-0003-3856-7005; 0000-0001-5335-7976; 0000-0002-9580-628X; 0000-0002-4130-1059; 0000-0002-9680-1958; 25070465; AAE-1241-2021; AAD-5542-2021; AAL-3906-2021; AAI-7831-2021; ABC-4148-2020; AAD-6222-2021; AAS-7129-2021BackgroundSickle cell disease (SCD) is associated with chronic hemolysis and painful episodes. Pregnancy accelerates sickle cell complications, including prepartum and postpartum vasoocclusive crisis, pulmonary complications, and preeclampsia or eclampsia. Fetal complications include preterm birth and its associated risks, intrauterine growth restriction, and a high rate of perinatal mortality. The purpose of this study was to evaluate pregnancy outcomes in patients with SCD who underwent planned preventive red blood cell exchange (RBCX). Study Design and MethodsWe retrospectively evaluated the complications of SCD in 37 pregnant patients. Patients with SCD who had undergone prophylactic RBCX were compared with a control group who had not undergone RBCX during pregnancy. ResultsForty-three exchange procedures were performed in 24 patients. The control group comprised 13 patients with a mean age of 27.43.3 years who had not undergone RBCX during pregnancy. Four of the five patients who developed a vasoocclusive crisis died. There was a significant difference in maternal mortality between the study and control groups (p=0.011). There was also a significant difference in the incidence of vasoocclusive crisis between the study and control groups. One fetal death occurred in the 20th gestational week in a patient in the control group, although there were no postpartum complications in either the babies or the mothers in the control group. ConclusionThis study has demonstrated that prophylactic RBCX during pregnancy is a feasible and safe procedure for prevention of complications. Given the decrease in the risks of transfusion, RBCX warrants further study.Item Safety and Palliative Efficacy of Single-Dose 8-Gy Reirradiation for Painful Local Failure in Patients with Stage IV Non-Small Cell Lung Cancer Previously Treated with Radical Chemoradiation Therapy(2015) Topkan, Erkan; Yildirim, Berna Akkus; Guler, Ozan Cem; Parlak, Cem; Pehlivan, Berrin; Selek, Ugur; 0000-0001-8120-7123; 0000-0001-6170-0383; 0000-0001-6661-4185; 0000-0001-6908-3412; 0000-0001-8087-3140; 25752391; AAG-2213-2021; B-3671-2014; V-5717-2017; AAC-5654-2020; O-5474-2014Purpose: To investigate the safety and efficacy of single-dose 8-Gy palliative chest reirradiation (CRI) in metastatic non-small cell lung cancer (M-NSCLC) patients with painful thoracic failures (TF) within the previous radiation portal. Patients and Methods: We retrospectively analyzed the clinical data of 78 M-NSCLC patients who received single-dose 8-Gy CRI for painful TF after concurrent chemoradiation therapy to a total radiation dose of 52 to 66 Gy between 2007 and 2012. Primary endpoints included significant pain relief (SPR) defined as a >= 2 point decrement in the Visual Analogue Scale for Pain inventory (VAS-P), time to pain relief, and duration of pain control. Secondary objectives were survival and prognostic factors. Results: Treatment was well tolerated, with only 5.1% grade 3 pneumonitis and 1.3% grade 2 esophagitis. Pre-CRI median and post-CRI minimum VAS-P were 7 and 3 (P < .001), respectively. SPR was noted in 67 (85.9%) patients, and only 3 (3.9%) scored progressive pain. Median time to lowest VAS-P and duration of pain control were 27 days and 6.1 months, respectively. Median overall survival (OS) was 7.7 months, and the 1-year OS rate was 26.5%. On multivariate analyses, lower Eastern Cooperative Oncology group score (1-2; P < .001), absence of anemia (P = .001), and fewer metastatic sites (1-2; P < .001) were found to be associated with longer OS. Conclusions: Single-dose 8-Gy CRI provides safe, effective, and durable pain palliation for TF in radically irradiated M-NSCLC patients. Because of its convenience, lower cost, and higher comfort, the present protocol can be considered an appropriate option for patients with limited life spans. (C) 2015 Elsevier Inc.Item Comparison of Anteromedial and Transtibial ACL Reconstruction Using Expandable Fixation(2017) Ozel, Omer; Yucel, Bulent; Orman, Osman; Demircay, Emre; Mutlu, Serhat; 0000-0002-2753-426X; 0000-0002-9177-2457; 0000-0003-1274-4288; 0000-0002-2062-991X; 28399324; AAG-3009-2020; HKW-6873-2023; AAL-2368-2021; J-9611-2014The influence of anatomical or nonanatomical femoral tunnel position on tunnel widening and clinical outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction is not fully understood. This retrospective study examined the influence of tunnel width and placement on anterior knee stability and clinical outcomes after ACL reconstruction using the AperFix System (Cayenne Medical Inc, Scottsdale, Arizona), a direct expandable fixation technique with autologous hamstring grafts. The records of 80 patients (79 men and 1 woman) who underwent ACL reconstruction were evaluated. In 38 patients, anatomical femoral tunnel placement was performed via an accessory medial portal (anteromedial group); in the remaining 42 patients, the femoral tunnel was positioned nonanatomically using a transtibial technique (transtibial group). Mean follow-up was 40.7 months (range, 27-60 months). Postoperative knee kinetics were measured, and clinical outcomes were assessed using International Knee Documentation Committee, Lysholm, and Tegner scores. Femoral tunnel widening was measured by comparing postoperative radiographs with final follow-up radiographs. Femoral tunnel width was significantly greater (P<.001) and anterior knee translation was significantly higher (P=.01) in the transtibial group. Lysholm and Tegner scores were not significantly different (P>.05) between the 2 groups. These findings suggest that femoral tunnel widening is associated with increased anterior joint laxity when a direct fixation technique is used for ACL reconstruction, particularly in nonanatomically positioned femoral tunnels. Anatomical femoral tunnel placement provides better anterior stability and less tunnel widening than transtibial tunnel placement; however, these benefits did not produce a detectable advantage in clinical outcomes measures.Item A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae(2016) Azap, Ozlem Kurt; 27712635Objective: To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods: A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results: The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion: A validated score predictive of early mortality in patients with BSIs due to CPE was developed. (C) 2016 Mayo Foundation for Medical Education and ResearchItem The Effect of Acceptance of Cosmetic Surgery, Body Appreciation, and Nasal Obstruction on Patient Satisfaction After Rhinoplasty(2023) Inan, Serhat; Yigman, Fatih; 0000-0001-8821-4481; 0000-0001-6052-7662; 36169630Background: It is difficult to predict functional and aesthetic results and provide patient satisfaction after rhinoplasty.Objective: To investigate the effect of nasal obstruction, body appreciation, and acceptance of cosmetic surgery (ACS) in predicting patient satisfaction postrhinoplasty.Methods: We prospectively included 97 consecutive participants who underwent rhinoplasty. We recorded age, gender, marital status, education, and body mass index (BMI), and nasal obstruction symptom evaluation (NOSE) scale, body appreciation scale-2 (BAS-2), acceptance of cosmetic surgery scale (ACSS), and rhinoplasty outcome evaluation (ROE) scale were determined preoperatively and at the 3-month postoperative follow-up.Results: The preoperative and postoperative NOSE, BAS-2, ACSS, and ROE scores differed significantly. The mean ROE score improved from 36.8 preoperatively to 82.1 postoperatively. The ROEpostop score was not correlated significantly with age, BMI, ACSSpreop, BAS-2postop, or ACCSpostop. The BAS-2preop scores were correlated significantly with ACCSpreop and ACSSpostop scores. The NOSEpreop and BAS-2preop scores were significant predictors of the ROEpostop scores in the regression analysis.Conclusion: Preoperative nasal obstruction and body appreciation, but not ACS, are factors that might affect patient satisfaction after rhinoplasty.Item Cardiac Failure Associated with Medical Therapy of Benign Prostatic Hyperplasia: A Population Based Study. Letter(2021) Coner, Ali; Ipekci, Tumay; 33835864Item The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey(2021) Gultekingil, Ayse; 0000-0001-7955-5735; 34669998; AAR-9945-2020Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.