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Item Diet and pravastatin administration prior to in vitro fertilization treatment may improve pregnancy outcome in women with dyslipidemia(2022) Zeyneloglu, Hulusi Bulent; Tohma, Yusuf Aytac; Gunakan, Emre; Abasiyanik, Mehmet Ali; Sozen, Ceren; Onalan, Gogsen; 0000-0002-0289-2642; 0000-0001-9418-4733; 0000-0001-8854-8190; 0000-0002-5741-8489; 35257641; B-6487-2009; ABI-1707-2020In this study, we aimed to identify whether using statins may increase the chance of pregnancy in In Vitro Fertilisation / Intra-Cytoplasmic Sperm Injection (IVF/ICSI) patients with hyperlipidaemia. Therefore, in this retrospective cohort study, 70 patients constituted the study population and all patients were managed by lipid lowering diet. Ten mg pravastatin (pravachol DEVA, Istanbul, Turkey) was added to therapy in case of resistant hypercholesterolaemia after 15 days of the diet. Fifty-one patients were treated with diet only and the remaining nineteen patients were offered both diet and pravastatin. Clinical pregnancy rate was significantly better with the patients who used pravastatin (68.4% vs. 39.2%, p = .029). Ongoing pregnancy rates were 63.2% and 33.3% with pravastatin and diet only, respectively, which were statistically significant (p:.024). According to multivariate analysis, pravastatin use was found independently and statistically significant for clinical pregnancy and ongoing pregnancy rate after IVF/ICSI in patients with dyslipidemia (HR 3.79; 95% CI 1.31-10.97; p:.014 and HR 3.18; 95% CI 1.22-8.27; p:.018). When we analysed stratified data according to the AMH levels, we noticed that as AMH levels increased, the pregnancy rates increased; the most benefit from pravastatin was in the group with AMH levels >2 ng/mL.IMPACT STATEMENT What is already known on this subject? Dyslipidemia in In IVF/ICSI patients with polycystic ovary syndrome had negative impact on pregnancy rates What the results of this study add? The findings of the study support that pravastatin may help to improve pregnancy outcome, especially in normal and high responders, regardless of whether decreased serum LDL or total cholesterol level. What the implications are of these findings for clinical practice and/or further research? As a result of our data, we speculated that it should be routine to investigate the lipid profile in every IVF/ICSI patient and should be treated accordingly, if necessary.Item A Novel Technique for Prediction of Preterm Birth: Fetal Nasal Flow Doppler(2021) Esin, Sertac; Okuyan, Erhan; Gunakan, Emre; Zengin, Hatice Yagmur; Hayran, Mutlu; Tohma, Yusuf Aytac; 0000-0001-8854-8190; 0000-0002-9855-2449; 0000-0001-9418-4733; 33180051; ABI-1707-2020; ABA-3224-2021; AAE-6482-2021Objectives: Absence of fetal breathing movements (FBM) has been found to be a good predictor of preterm delivery in symptomatic patients. However, analysis of FBM patterns and Doppler measurement of them for preterm birth prediction have not been performed before. In this study, we aimed to investigate and analyze FBM patterns in symptomatic preterm labor patients by fetal ultrasonography and nasal Doppler. Methods: This was a multicenter, prospective cohort study. Singleton pregnant patients between 24 and 37 gestational weeks diagnosed with preterm labor were included in the study. Patients were evaluated in three groups: no FBM (Group 1), regular FBM (Group 2), irregular FBM (Group3). Results: Seventy-three patients were available for the final analysis after exclusion. Preterm delivery rate in 24 h in groups were 91.7, 32.7 and 100%, respectively. The absence of FBM (Group 1) was statistically significant for preterm delivery in for both 24 (91.7 vs. 42.6%, p=0.002) and 48 h (91.7 vs. 49.2%, p=0.006) when compared with fetal breathing positive Group 2 and 3. In fetal nasal Doppler analyses in Group 2, the inspiration/expiration number rate was significantly lower in the patients who delivered in 24 h (0 .98 +/- 0.2 vs. 1.25 +/- 0.57, p=0.015). By using fetal nasal Doppler, combination of absence of FBM or irregular FBM or regular FBM with inspiration number/expiration number (I/E) <1.25 detects 94.6% of patients who will eventually deliver in the first 24 h after admission. Conclusions: Examining FBM patterns and using nasal Doppler may help the clinician to differentiate those who will deliver preterm and may be an invaluable tool for managing preterm labor patients.Item Dydrogesterone primed luteal phase stimulation may be better than follicular phase stimulation in patients with diminished ovarian reserve(2021) Zeyneloglu, Hulusi Bulent; Tohma, Yusuf Aytac; Gunakan, Emre; 0000-0002-0289-2642; 0000-0001-9418-4733; 0000-0001-8854-8190; 33944650; B-6487-2009; AAE-6482-2021; ABI-1707-2020Objective In this study, we aimed to compare the efficacy of luteal phase stimulation (LPS) and follicular phase stimulation (FPS) in two separate menstrual cycles (2-5 months intervals) of the same patient, utilizing LPS with dydrogesteron only. Methods This retrospective case control study was conducted with patients with diminished ovarian reserve (DOR) (Group 1) and infertile patients with Anti-Mullerian hormone >1.2 ng/mL (Group 2) undergoing two ovarian stimulations (FPS and LPS with dydrogesteron only) and two oocyte retrievals in two separate menstrual cycles (2-5 months intervals) in the Division of Reproductive Endocrinology and Infertility of Baskent University, Ankara, between April 2019 and December 2019. Results In group 1, the number of frozen embryos was significantly higher in LPS when compared to FPS; 1.71 vs. 0.54, (p < .001), respectively. In group 2, the number of frozen embryos was higher in LPS when compared to FPS (0.8 vs. 0.4) however the difference did not reach a statistical significance (p: 0.157). Conclusion LPS may be beneficial especially in the patients with diminished ovarian reserve with follicular asynchronization in the menstrual onset. In addition, it should be kept in mind that dydrogesterone only may be used instead of gonadotropin-releasing hormone antagonist to prevent possible luteinizing hormone rise in LPS.Item Complications of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: An evaluation of 100 cases(2021) Akilli, Huseyin; Gunakan, Emre; Haberal, Ali; Altundag, Ozden; Kuscu, Ulku Esra; Taskiran, Cagatay; Ayhan, Ali; 0000-0002-5240-8441; 0000-0001-8854-8190; 0000-0003-0197-6622; 34038007; AAX-3230-2020; ABI-1707-2020; W-9219-2019Objective To evaluate the perioperative outcomes and complications of patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods This retrospective study included 100 patients operated on between 2016 and 2020. Patients' characteristics, including age, comorbidities, chemotherapy history, treatment failures, cancer type, histology, platinum sensitivity, and perioperative complications, were documented. Perioperative complications were classified according to the Clavien-Dindo classification. Results Median age was 58 years and median follow-up time was 16 months. Eighty-six (86%) patients had ovarian cancer; 11 (11%) experienced grade III-IV complications, and the only relevant factor was the presence of multiple metastasis (P = 0.031). Seven patients (7%) had surgical-site infection; in multivariant analyses, only ostomy formation was found as an independent risk factor for surgical-site infection (odds ratio [OR] 14.01; 95% confidence interval [CI] 1.36-143.52; P = 0.024). Fifteen (15%) patients experienced elevated serum creatinine after surgery and the median time to creatinine elevation was 5 days postoperatively (range 3-15 days). In multivariant analyses, only age of of 58 years or more was found as a significant factor for the elevation of serum creatinine (OR 6.96; 95% CI 1.42-32.81; P = 0.014). Conclusion Our results showed that the presence of multiple metastases increased the risk of grade III-IV complications and age of 58 years or more was the leading risk factor for renal complications. However, we could not find a relation between postoperative complications and oncologic outcomes. HIPEC seems to be a safe approach in experienced hands.Item Management of a Patient in the State of Total Occlusion of Aorta Due to Takayasu Arteritis in Preconceptional and Pregnancy Period(2021) Gunakan, Emre; Akay, Tankut; Esin, Sertac; 0000-0001-8854-8190; ABI-1707-2020Objectives: Total aortic occlusion is a severe complication of Takayasu arteritis (TAK). Pregnancy follow-up in the state of total aortic occlusion due to TAK has not been reported before. Case presentation: A 35 year-old nulliparous woman with total aortic occlusion in the distal aorta due to TAK, admitted with pregnancy desire. She had developed a collateral vessel system which has maintained the lower body circulation. She was informed about the potential risks after an evaluation and she admitted to our clinic at the seventh week of pregnancy, and acetylsalicylic acid was prescribed. At 20th gestational week anomaly screening was in normal limits although the uterine artery Doppler had lower S/D, PI and RI values. She was followed-up regularly in every two weeks. Vascular examination was performed by using an ankle brachial index (ABI) by duplex ultrasound. At 20th gestational week ankle brachial index score was 0.8-0.9 which indicates mild disease. Around 28th gestational week her claudication got worse again and ABI was in moderate level (0.5-0.8) and low molecular weight heparin was started. Until 37th gestational week her disease was stable, ABI was above 0.5, her blood pressure was in normal limits, no vascular complication occurred and the baby's growth percentile was at 25th centile. At 37th gestational week a 2,640 g baby was delivered. Patient was discharged without any complications at third post-operative day. Conclusions: Complicated TAK patients may have good obstetric outcomes with a multidisciplinary approach in experienced tertiary centers.Item Does Polyp-Originated Growing have Prognostic Significance for Stage 1 Endometrioid-Type Endometrial Cancer?(2020) Kucukyildiz, Irem Alyazici; Gunakan, Emre; Akilli, Huseyin; Haberal, Asuman Nihan; Kuscu, Esra; Haberal, Ali; Ayhan, Ali; 0000-0002-5240-8441; 0000-0002-0992-6980; 0000-0001-9852-9911; 0000-0002-1486-7209; AAX-3230-2020; AAI-8792-2021; AAK-4587-2021; AAI-9331-2021Purpose Endometrioid-type endometrial cancer is usually diagnosed in the early stages and has a good prognosis. Patients with stage 1 disease have survival rates over 95%. Tumor factors affect survival in these patients, but polyp-originated growing has not been sufficiently discussed in the literature. This study aimed to determine the effect of polyp-originated growing in stage 1 endometrioid-type endometrial cancer and to provide a review of the literature. Methods This study includes 318 stage 1 endometrioid-type endometrial cancer patients. The patients were divided into two groups based on the tumor origin. Group I included patients with polyp-originated growing tumors, and Group II included patients with endometrial surface-originated growing tumors. Results Groups I and II included 39 and 279 patients, respectively. The general properties of the patients were similar; there were no significant differences. The univariate survival analyses showed that overall survival for Groups I and II was 65.5 and 83.6 months, respectively; this difference was statistically significant (p = 0.002). The multivariate analysis of age, maximum tumor diameter, tumor origin, lymphovascular space involvement, myometrial invasion depth and tumor grade showed that polyp-originated growing was independently and significantly associated with overall survival (HR 4.05; 95% CI 1.2-13.5; p = 0.023). Conclusion Polyp-originated growing may be a prognostic factor for early stage endometrioid-type endometrial cancer. The prognostic effect of polyp-originated growing is not well known, and further investigation is necessary.Item The Role of Analysis of NK Cell Subsets in Peripheral Blood and Uterine Lavage Samples in Evaluation of Patients with Recurrent Implantation Failure(2020) Tohma, Yusuf Aytac; Musabak, Ugur; Gunakan, Emre; Akilli, Huseyin; Onalan, Gogsen; Zeyneloglu, Hulusi Bulent; 0000-0003-1511-7634; 0000-0002-0289-2642; 0000-0001-8854-8190; 32413518; AAU-1810-2020; B-6487-2009; ABI-1707-2020; AAX-3230-2020Objective: In this study, we aimed to determine the role of analyses of NK cell subsets in peripheral blood and uterine lavage samples in evaluation of patients with unexplained RIF. Methods: This retrospective single-institution case-control study included two different cohorts between 2017-2019. First cohort included patients examined with peripheral blood samples for evaluation of possible immunologic problems in patients with unexplained recurrent implantation failure; in the study period, a total of 75 consecutive patients with RIF (study group; n: 42) or infertile patients without RIF (control group; n: 33) were included. Second cohort included those patients whose uterine samples were assessed for immunologic problems; RIF (study group ; n: 16) or infertile patients without RIF (control group; n: 25). Results: In the first cohort, the percentage of NK cells (CD3-CD16(+)56(+)) is statistically significantly lower (9.8 vs. 12.6, respectively, p: 0.038) in the study group than those of the controls whereas there was no statistical significance in the absolute number of NK cells (CD3-CD16(+)56(+)). In the second cohort, the only remarkable finding in uterine lavage samples was significantly increased uNKs cells (CD3-CD16(di)(m)56(bright)) percentages in controls (9.95 vs 12.7, respectively, p: 0.026) compared to those of study group. Conclusion: Our data shows that the analysis of NK cell subtypes in peripheral blood does not seem appropriate to investigate the patients with RIF and we suggest that uterine lavage samples instead of peripheral blood samples be implemented and evaluated. (C) 2020 Elsevier Masson SAS. All rights reserved.Item A novel prediction method for lymph node involvement in endometrial cancer: machine learning(2019) Gunakan, Emre; Atan, Suat; Haberal, Asuman Nihan; Kucukyildiz, Irem Alyazici; Gokce, Ehad; Ayhan, Ali; 30718313Objective The necessity of lymphadenectomy and the prediction of lymph node involvement (LNI) in endometrial cancer (EC) have been hotly-debated questions in recent years. Machine learning is a broad field that can produce results and estimations. In this study we constructed prediction models for EC patients using the Naive Bayes machine learning algorithm for LNI prediction. Methods The study assessed 762 patients with EC. Algorithm models were based on the following histopathological factors: V1: final histology; V2: presence of lymphovascular space invasion (LVSI); V3: grade; V4: tumor diameter; V5: depth of myometrial invasion (MI); V6: cervical glandular stromal invasion (CGSI); V7: tubal or ovarian involvement; and V8: pelvic LNI. Logistic regression analysis was also used to evaluate the independent factors affecting LNI. Results The mean age of patients was 59.1 years. LNI was detected in 102 (13.4%) patients. Para-aortic LNI (PaLNI) was detected in 54 (7.1%) patients, of which four patients had isolated PaLNI. The accuracy rate of the algorithm models was found to be between 84.2% and 88.9% and 85.0% and 97.6% for LNI and PaLNI, respectively. In multivariate analysis, the histologic type, LVSI, depth of MI, and CGSI were independently and significantly associated with LNI (p<0.001 for all). Conclusions Machine learning may have a place in the decision tree for the management of EC. This is a preliminary report about the use of a new statistical technique. Larger studies with the addition of sentinel lymph node status, laboratory findings, or imaging results with machine learning algorithms may herald a new era in the management of EC.Item Oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C serous ovarian, tubal or peritoneal carcinomas(2019) Gurkan, Damla; Akin, Aylin Ceren; Sahin, Hanifi; Tohma, Yusuf Aytac; Sahin, Eda Adeviye; Gunakan, Emre; Iflazoglu, Nidal; Haberal, Asuman Nihan; Ayhan, Ali; 0000-0001-9418-4733; 31482736The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) of patients with Stage 3C serous ovarian, tubal and peritoneal carcinomas. A retrospective analysis of 111 patients who underwent maximal or optimal cytoreductive surgery was performed. Patients were divided into three groups as ovarian cancer (n = 47), tubal cancer (n = 24) and peritoneal cancer (n = 40). Median follow-up was 30 months. There was no significant difference in DFS and OS among the groups. Complete cytoreduction was an independent prognostic factor for DFS in all groups (HR 2.3, 95% CI 1.14-4.93; p=.020). Positive peritoneal cytology (HR 2.2, 95% CI 1.02-4.78; p=.044), and retroperitoneal lymph node involvement (HR 2.3, 95% CI1.11-4.89; p=.025) were independent risk factors for decreased OS, and extended cytoreduction (HR 2.7, 95% CI 1.05-6.99; p=.039) were independent risk factors for increased OS. In conclusion, these malignancies should be considered a single entity during treatment.IMPACT STATEMENT What is already known on this subject? Epithelial ovarian cancer is the second most common gynaecological cancer in women worldwide. There are different histological types including ovarian, tubal and peritoneal carcinomas in which malignant cells form in the tissue covering the ovary or lining the fallopian tube of peritoneum. Recent data have supported the view that these malignancies should be considered a single entity and should be treated the same way. What the results of this study add? In the present study, we evaluated overall survival and disease-free survival of patients with Stage 3C ovarian, tubal and peritoneal cancer undergoing maximal or optimal cytoreductive surgery. We found similar oncologic outcomes in all patient groups. To the best of our knowledge, this is the first study to compare oncologic outcomes of these similar and often confused malignancies in the literature. We, therefore, believe that the present study provides additional information to the body of knowledge on this topic. s are of these findings for clinical practice and/or further research? This study is important, as it indicates similar oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C ovarian, tubal and peritoneal cancer. Based on these findings, clinicians should keep in mind that these malignancies should be considered a single clinical entity and be treated the same way. We believe that our study would pave the way for further studies regarding this subject.