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Uzer G, Demirel M, Kara D, Toker B, Yildiz F, Ucan V. Talonavicular-cuneiform arthrodesis in the management of Mueller-Weiss Syndrome: a retrospective case series. Acta Orthop Belg 2024; 90:154-159. [PMID: 38669667 DOI: 10.52628/90.1.10628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Mueller-Weiss Syndrome (MWS), characterized by spontaneous adult-onset tarsal navicular osteonecrosis, is an uncommon cause of chronic midfoot pain that can lead to functional impairment and progressive deformities. This study aimed to present clinical and radiological outcomes of talonavicular-cuneiform (TNC) arthrodesis in the treatment of patients with MWS. A retrospective study was performed on 8 consecutive patients (6 female, 2 male; mean age = 50 years; range = 33-64) who underwent TNC arthrodesis using plate fixation with autologous bone grafting for the treatment of MWS. To evaluate clinical status, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Midfoot Score was performed immediately preoperatively and at the final follow-up. In radiographic evaluation, talus-first metatarsal angle (Meary's angle) was measured preoperatively and at the final follow-up. Solid fusion was also examined on postoperative radiographs and computerised tomography. The mean follow-up was 35 months (range = 24-52). The mean AOFAS improved from 37 (range = 24-53) preoperatively to 85 (range = 80-93) at the final follow-up (p < 0.001). No major intra- operative complications were observed in any of the patients. According to the Maceira and Rochera radiological staging system, 5 feet was stage 3, and 3 feet was stage 4. The mean union time was 10 months (range = 5-15). Radiographic solid fusion was achieved in all but one foot that developed talonavicular non-union. TNC arthrodesis using plate fixation with autologous bone grafting seems to be an effective surgical method for reconstruction of MWS.
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Yilmaz MT, Kamer S, Agaoglu F, Hayran KM, Yildiz F. Involved-site Radiotherapy Delineation Dilemmas in the Treatment of Adult Hodgkin Lymphoma: Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology and TBI Study Group Case-based Questionnaire Review (TROD 03-005). Clin Oncol (R Coll Radiol) 2024; 36:80-86. [PMID: 38042670 DOI: 10.1016/j.clon.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
AIMS The International Lymphoma Radiation Oncology Group (ILROG) defined involved-site radiotherapy (ISRT) guidelines. These rules offer a certain variability that allows for autonomous decision-making in diverse clinical settings. However, this flexibility also gives rise to conflicts about the selection of treatment fields in the daily decision-making process. The aim of this study was to show the extent of interobserver variability when ILROG-ISRT recommendations were used in different clinical scenarios. MATERIALS AND METHODS The 10-question survey used in our study consisted of two parts (part A and part B) and was prepared by four senior radiation oncologists experienced in the haemato-oncology field. The results were presented by stratifying according to clinical experience (<10 years, ≥10 years). Binomial tests (one-sided) were conducted to assess whether answers for each group and the whole group reached a consensus. RESULTS Twenty-six radiation oncologists, 13 of whom had less than 10 years of experience and 13 seniors, participated in the survey. Eighty per cent of respondents thought ILROG did not bring sufficient solutions for all clinical scenarios but offered solutions in some cases. In different case-based scenarios, the consensus among the respondents decreased down to 38%. Senior radiation oncologists were found to have more doubts about the adequacy of current guidelines. CONCLUSIONS ILROG guidelines allow for a high degree of variability in real-life clinical scenarios and different interpretation of the recommendations may lead to increased toxicity and recurrences. Therefore, there is a need for refinement in ISRT delineation strategies. On behalf of the Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology and TBI Study Group, we are planning to carry out further educational contouring sessions to detect the interobserver variability in real-life contouring cases.
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Affiliation(s)
- M T Yilmaz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Kamer
- Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - F Agaoglu
- Department of Radiation Oncology, Acibadem Mehmet Aydinlar University Faculty of Medicine, Istanbul, Turkey
| | - K M Hayran
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Celik GE, Aydin O, Gokmen D, Koycu Buhari G, Celebi Sozener Z, Gemicioglu B, Bulut I, Beyaz S, Orcen C, Ozdemir SK, Keren M, Damadoglu E, Yakut T, Kalpaklioglu AF, Baccioglu A, Yalim SA, Yilmaz I, Koca Kalkan I, Uysal MA, Ozgun Niksarlioglu EY, Kalyoncu AF, Karakaya G, Erbay M, Nayci S, Tepetam FM, Gelincik AA, Dirol H, Goksel O, Karaoglanoglu S, Oner Erkekol F, Isik SR, Yildiz F, Yavuz Y, Karadogan D, Bozkurt N, Seker U, Oguzulgen IK, Basyigit I, Baris SA, Yilmazel Ucar E, Erdogan T, Polatli M, Ediger D, Gunaydin FE, Turk M, Pur L, Katran ZY, Sekibag Y, Aykac EF, Mungan D, Gul O, Cengiz A, Akkurt B, Ozden S, Demir S, Unal D, Aslan AF, Can A, Gumusburun R, Bogatekin G, Akten HS, Inan S, Erdinc M, Ogus AC, Kavas M, Polat Yulug D, Cakmak ME, Kaya SB, Alpagat G, Ozgur ES, Uzun O, Tas Gulen S, Pekbak G, Kizilirmak D, Havlucu Y, Donmez H, Arslan B, Cetin GP, Soyyigit S, Kara BY, Pasaoglu Karakis G, Dursun AB, Kendirlinan R, Ozturk AB, Sevinc C, Omeroglu Simsek G, Abadoglu O, Cerci P, Yucel T, Yorulmaz I, Tezcaner ZC, Tatar EC, Suslu AE, Ozer S, Dursun E, Yorgancioglu A. Picturing asthma in Turkey: results from the Turkish adult asthma registry. J Asthma 2023; 60:1973-1986. [PMID: 37096963 DOI: 10.1080/02770903.2023.2206902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.
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Affiliation(s)
- Gulfem Elif Celik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Omur Aydin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Zeynep Celebi Sozener
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
| | - Bilun Gemicioglu
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ismet Bulut
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sengul Beyaz
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Cihan Orcen
- Clinic of Allergy and Immunology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Secil Kepil Ozdemir
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Metin Keren
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ebru Damadoglu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Tugce Yakut
- Clinic of Immunology and Allergic Diseases, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ayse Fusun Kalpaklioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Ayse Baccioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Sumeyra Alan Yalim
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Insu Yilmaz
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Ilkay Koca Kalkan
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Atilla Uysal
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Elif Yelda Ozgun Niksarlioglu
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Muge Erbay
- Clinic of Immunology and Allergy Diseases, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Sibel Nayci
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Fatma Merve Tepetam
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Asli Akkor Gelincik
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Hulya Dirol
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ozlem Goksel
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Selen Karaoglanoglu
- Department of Pulmonology, Ordu University, Training and Research Hospital, Ordu, Turkey
| | - Ferda Oner Erkekol
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
- Division of Allergy and Immunology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Sacide Rana Isik
- Adult Allergy and Immunology Department, American Hospital, Istanbul, Turkey
| | - Fusun Yildiz
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
- School of Medicine, Department of Pulmonary Diseases, Cyprus Internatıonal Unıversıty, Cyprus
| | - Yasemin Yavuz
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Dilek Karadogan
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgul Bozkurt
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ummuhan Seker
- Clinic of Immunology and Allergic Diseases, Bursa City Hospital, Bursa, Turkey
| | | | - Ilknur Basyigit
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Serap Argun Baris
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Elif Yilmazel Ucar
- Faculty of Medicine, Department of Pulmonary Disease, Ataturk University, Erzurum, Turkey
| | - Tuba Erdogan
- Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergy, Baskent University, Ankara, Turkey
| | - Mehmet Polatli
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Dane Ediger
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Fatma Esra Gunaydin
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Murat Turk
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
- Clinic of Immunologic and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Leyla Pur
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Zeynep Yegin Katran
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yonca Sekibag
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Enes Furkan Aykac
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Dilsad Mungan
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ozcan Gul
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Cengiz
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Bulent Akkurt
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Seyma Ozden
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semra Demir
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ayse Feyza Aslan
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Reyhan Gumusburun
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Gulhan Bogatekin
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Hatice Serpil Akten
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Sinem Inan
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Munevver Erdinc
- Faculty of Medicine, Department of Pulmonology, Ege University, Izmir, Turkey
| | - Aliye Candan Ogus
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Murat Kavas
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Demet Polat Yulug
- Clinic of Chest Diseases, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mehmet Erdem Cakmak
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gulistan Alpagat
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Eylem Sercan Ozgur
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Oguz Uzun
- Department of Pulmonary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sule Tas Gulen
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gulseren Pekbak
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Deniz Kizilirmak
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yavuz Havlucu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Halil Donmez
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bahar Arslan
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Gulden Pacaci Cetin
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Sadan Soyyigit
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilge Yilmaz Kara
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Gulden Pasaoglu Karakis
- School of Medicine, Department of Chest Diseases, Adult Allergy-Immunology Unit, Biruni University, Istanbul, Turkey
| | - Adile Berna Dursun
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
- Medical School, Department of Respiratory Medicine, Lokman Hekim University, Ankara, Turkey
| | - Resat Kendirlinan
- Clinic of Immunology and Allergic Diseases, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ayse Bilge Ozturk
- Faculty of Medicine, Department of Allergy and Immunology, Medeniyet University, Istanbul, Turkey
| | - Can Sevinc
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | - Gokcen Omeroglu Simsek
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | | | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Van Regional Training and Research Hospital, Van, Turkey
| | - Taskin Yucel
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Irfan Yorulmaz
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Zahide Ciler Tezcaner
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Emel Cadalli Tatar
- Department of Otolaryngology, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Ahmet Emre Suslu
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
- Ahmet Emre Suslu Private Ear Nose and Throat Clinic, Ankara, Turkey
| | - Serdar Ozer
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Engin Dursun
- Faculty of Medicine, Department of Otorhinolaryngology, Lokman Hekim University, Ankara, Turkey
| | - Arzu Yorgancioglu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
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Beduk Esen CS, Gedik ME, Canpinar H, Yedekci FY, Yildiz F, Gunaydin G, Gultekin M. Radiosensitising Effects of Metformin Added to Concomitant Chemoradiotherapy with Cisplatin in Cervical Cancer. Clin Oncol (R Coll Radiol) 2023; 35:744-755. [PMID: 37679230 DOI: 10.1016/j.clon.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
AIMS The role of metformin on the radiosensitising effect of cisplatin is not clear. Here we investigated the radiosensitising effect of metformin alone and combined with cisplatin in HeLa cells, as well as the implications of the adenosine monophosphate-activated protein kinase (AMPK) pathway on the radiosensitising effect. MATERIALS AND METHODS HeLa cells were treated with ionising radiation, metformin, cisplatin, A769662 (AMPK activator) and dorsomorphin (AMPK inhibitor) or in combination. A cell proliferation assay, Western blot and flow cytometry were carried out. RESULTS Metformin potentiated cisplatin cytotoxicity when administered 4 h before ionising radiation. Although the radiosensitising effects of metformin and cisplatin alone were observed, which is more apparent at high ionising radiation doses, the metformin-cisplatin combination did not increase the radiosensitivity of cisplatin at any ionising radiation dose. Dorsomorphin alone significantly decreased cell proliferation and potentiated the radiosensitising effects of cisplatin with ionising radiation. Administration of A769662 24 h prior to cisplatin treatment resulted in an increased AMPK level that yielded resistance to cisplatin, but this effect was not observed in HeLa cells concomitantly treated with A769662 and cisplatin. CONCLUSIONS Modulation of AMPK may have a role in cervical cancer treatment. Increased AMPK levels result in higher sensitivity to ionising radiation but causes resistance to cisplatin. Dorsomorphin is proven to be a potent radiosensitising agent. The use of metformin alone may be an option as a radiosensitiser during high-dose ionising radiation (e.g. intracavitary brachytherapy).
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Affiliation(s)
- C S Beduk Esen
- Department of Radiation Oncology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.
| | - M E Gedik
- Department of Basic Oncology, Hacettepe University Cancer Institute, Sihhiye, Ankara, Turkey.
| | - H Canpinar
- Department of Basic Oncology, Hacettepe University Cancer Institute, Sihhiye, Ankara, Turkey.
| | - F Y Yedekci
- Department of Radiation Oncology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.
| | - F Yildiz
- Department of Radiation Oncology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.
| | - G Gunaydin
- Department of Radiation Oncology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey; Department of Basic Oncology, Hacettepe University Cancer Institute, Sihhiye, Ankara, Turkey.
| | - M Gultekin
- Department of Radiation Oncology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.
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Esen SB, Gedik M, Gunaydin G, Canpinar H, Yedekci F, Yildiz F, Gultekin M. Role of the Radiosensitizing Effect of Metformin Added to Concomitant Chemoradiotherapy with Cisplatin in Cervical Squamous Cell Cancer Cell Lines. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kahvecioglu A, Gurlek E, Sari SY, Yedekci F, Gultekin M, Yildiz F. Simultaneous or Sequential Boost to Clinically Involved Lymph Nodes in Cervical Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ay P, Yasin Y, Elbek O, Guner M, Gezer T, Pece Sonmez U, Ceyhan M, Yildiz F, Dagli E. Will plain packaging of cigarettes achieve the expected?
Perceptions among medical students. Tob Induc Dis 2022; 20:92. [DOI: 10.18332/tid/154056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/20/2021] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
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Yildirim E, Duru S, Sevim T, Topcu F, Gemicioglu B, Ozmen I, Ocakli B, Tuncay E, Altinoz H, Akpak YK, Celik P, Varol Y, Polat G, Ozkan S, Dursunoglu N, Kilic D, Gulhan PY, Ercen Diken O, Cetinkaya PD, Yorgancioglu A, Turkoglu Selcuk N, Yildiz F, Atacag T, Niksarlioglu EY, Uzaslan E, Kokturk N. Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey. Turk Thorac J 2022; 23:409-419. [DOI: 10.5152/turkthoracj.2022.22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Demir H, Caglayan D, Kaman O, İnanc M, Urvay S, Beypinar I, Demirci A, Davarci SE, Araz M, Baykara M, Artac M, Yildiz F. Evaluating the effect of tumor size and sidedness on prognosis in stage 2 colon cancer: a retrospective population study. Eur Rev Med Pharmacol Sci 2022; 26:1328-1340. [PMID: 35253189 DOI: 10.26355/eurrev_202202_28126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the effect of tumor size and tumor sidedness on prognosis in patients with stage 2 colon cancer. PATIENTS AND METHODS Data of 501 patients diagnosed with stage 2 colon cancer were evaluated retrospectively. It was evaluated whether the patients' age, gender, tumor differentiation, tumor node metastasis (TNM) stage, overall survival rate, and disease-free survival rate had any correlation with horizontal tumor diameter and tumor sidedness. In the ROC analysis performed to determine the cut-off value for the tumor diameter, which we think will predict survival, no significant results were obtained with maximum sensitivity and specificity. Therefore, the median value of the tumor diameter, which is 5 cm, was accepted as the cut-off value. Kaplan-Meier method and Cox regression analysis were used for survival analysis and determination of prognostic factors. RESULTS When the patients were evaluated in terms of tumor localization, 189 (37.7%) patients had right colon tumors and 312 (62.3%) patients had left colon tumors. There was no statistically significant difference in terms of disease-free survival and overall survival according to tumor localization. When the patients were analyzed by dividing them into two groups according to the horizontal tumor size (<5 cm and ≥5 cm), no statistically significant difference was found between the groups in terms of disease-free survival (DFS) and overall survival (OS) p=0.085, p=0.699, respectively. CONCLUSIONS Our results suggest that the management of patients with stage 2 colon cancer requires a better understanding of tumor biology rather than features such as tumor size and localization.
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Affiliation(s)
- H Demir
- Department of Internal Medicine and Medical Oncology, Afyonkarahisar Health Sciences University School of Medicine, Afyonkarahisar, Turkey.
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İlhan A, Eraslan E, Yildiz F, Arslan ÜY, Alkiş N. Factors affecting prognosis and treatment strategies in metastatic soft tissue sarcomas: twenty years of experience. Eur Rev Med Pharmacol Sci 2021; 25:6465-6472. [PMID: 34787850 DOI: 10.26355/eurrev_202111_27090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In this study, we aimed to reveal the general clinicopathological features, treatment features, and factors that could predict overall survival in metastatic soft tissue sarcomas, a very rare and heterogeneous disease group. PATIENTS AND METHODS This study was a retrospective cohort study. Patients monitored with metastatic soft tissue sarcoma between January 2001 and January 2021 were evaluated retrospectively. Patients aged 18 years and over, histopathologically diagnosed with metastatic STS, and unsuitable for operations, such as local curative surgery or metastasectomy, were included in the study. RESULTS A total of 179 patients in the metastatic stage and monitored in our center were included in the study. The median follow-up period was 8.4 months (IQR, 3.4-14.4). 58 (32.4%) patients were de-novo metastatic, and 121 (67.6%) patients developed metastasis later. The median age was 53.2 (Range: 18.8-87.6 years), and 101 (56.4%) patients were male. The most common primary location was the lower extremity (87) (48.6%). The most common histological subtypes were synovial sarcoma (38) (21.2%), pleomorphic sarcoma (37) (20.7%), and liposarcoma (26) (14.5%). The majority were grade 3 tumors (n=131, 73.2%). Having ECOG PS 2-3 (HR=2.829, 95% CI 1,667-4.800, p<0.001), having tumor grade as 3 (HR=1.748, 95% CI 1.150-2.656, p<0.009), receiving palliative chemotherapy (HR=0.294, 95% CI 0.144-0.600, p<0.001), and receiving two or more lines of chemotherapy among those palliative receivers (HR=2.505 95% CI 1.696-3.700, p<0.001) were independent predictive factors of mortality. CONCLUSIONS Survival in metastatic soft tissue sarcoma is better in patients with good ECOG performance status, low tumor grades, and who have received palliative chemotherapy. Receiving more than one line of palliative systemic treatment for progressive disease improves survival.
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Affiliation(s)
- A İlhan
- University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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Onal C, Yuce Sari S, Yavas G, Guler O, Yigit E, Oymak E, Gultekin M, Yildiz F. PH-0446 The impact of lymph node ratio in patients with stage IIIC endometrial carcinoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Biltekin F, Gultekin M, Akyol H, Yildiz F. PO-1578 Low-cost 3D-printed phantom for in-air calibration of high-dose rate 192Ir brachytherapy source. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tascilar K, Bayindir O, Dogru A, Tinazzi I, Kimyon G, Ozisler C, Erden A, Dalkilic E, Cetin GY, Yılmaz S, Solmaz D, Bakirci S, Omma A, Kasifoglu T, Kucuksahin O, Cinar M, Kilic L, Can M, Tarhan EF, Bilgin E, Ersozlu ED, Duruoz T, Yavuz S, Pehlevan S, Tufan MA, Gonullu E, Yildiz F, Esmen SE, Kucuk A, Tufan A, Balkarli A, Mercan R, Yazisiz V, Erten S, Akar S, Aksu K, Aydin SZ, Kalyoncu U. Association of disease characteristics with the temporal sequence of skin and musculoskeletal disease onset in psoriatic arthritis. Br J Dermatol 2021; 184:1202-1203. [PMID: 33481249 DOI: 10.1111/bjd.19826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- K Tascilar
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - O Bayindir
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Dogru
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - I Tinazzi
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - G Kimyon
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - C Ozisler
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Erden
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E Dalkilic
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - G Y Cetin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Yılmaz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - D Solmaz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Bakirci
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Omma
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - T Kasifoglu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - O Kucuksahin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - M Cinar
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - L Kilic
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - M Can
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E F Tarhan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E Bilgin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E D Ersozlu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - T Duruoz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Yavuz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Pehlevan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - M A Tufan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E Gonullu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - F Yildiz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S E Esmen
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Kucuk
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Tufan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Balkarli
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - R Mercan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - V Yazisiz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Erten
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Akar
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - K Aksu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Z Aydin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - U Kalyoncu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
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Gultekin M, Beduk Esen C, Balci B, Alanyali S, Yildirim BA, Ergen S, Sahinler I, Cetin IA, Onal C, Yildiz F, Ozsaran Z. Adjuvant Radiotherapy in Cervical Cancer Patients: TROD Gynecologic Group Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bilgin E, Bayindir Ö, Kasapoğlu E, Bakirci S, Solmaz D, Kimyon G, Doğru A, Dalkiliç E, Özişler C, Can M, Akar S, Tarhan EF, Yavuz Ş, Kiliç L, Küçükşahin O, Omma A, Gönüllü E, Yildiz F, Ersözlü D, Tufan A, Çinar M, Erden A, Yilmaz S, Pehlevan S, Duruöz T, Aydin S, Kalyoncu U. AB0743 DISEASE CHARACTERISTICS OF PSORIATIC ARTHRITIS PATIENTS MAY DIFFER ACCORDING TO AGE AT PSORIASIS ONSET: CROSS-SECTIONAL ANALYSIS OF PSORIATIC ARTHRITIS-INTERNATIONAL DATABASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriasis and psoriatic arthritis (PsA) are heterogenous diseases with various disease manifestations and phenotypes. Psoriasis has a bimodal age of onset being early (before the age of 40, type 1) and late. The impact of this classification on the PsA features is not well understood.Objectives:To compare the PsA characteristics of patients with early- and late-onset psoriasis in a large, multicenter databaseMethods:PSART-ID (Psoriatic Arthritis-International Database) is a prospective, multicenter web-based registry (www.trials-network.org) of patients with PsA. A detailed data collection was performed including demographics (sex, age, duration of education, smoking status, BMI), skin features (psoriasis onset date, type, initially involved site of skin, nail involvement (ever) and family history) and PsA characteristics (type of articular involvement and presence of axial, dactylitis (ever), enthesitis (ever), family history) and indices for disease activity and function (DAPSA, Leeds enthesitis index, BASDAI, BASFI, patient and physician global assessment, pain, HAQ-DI). We grouped according to the age at psoriasis onset (early onset, psoriasis before the age of 40 (EOPsO); late-onset, psoriasis after the age of 40 (LOPsO)), patient and disease characteristics of the groups were compared (1). Due to the differences among groups, following adjustments weer made: BMI for age, nail involvement for PsO disease duration, axial PsA for PsA disease duration.Results:A total of 1634 (62.8% females; EOPsO, 1108 (67.8%); LOPsO, 526 (32.2%)) patients with PsA was recruited. Rate of over-weight patients was higher in LOPsO group (66.8% vs. 86.8%, p<0.001; adjusted for age - aOR 1.55 (1.11-2.20; % 95 CI)). The EOPsO group had the scalp involvement as the initial site of skin disease more often than the LOPsO group (56.7% vs. 43.0%, p<0.001), whereas extremity involvement was more frequent as the initial finding in the LOPsO group (EOPsO vs. LOPsO 63.8% vs. 74.2%, p<0.001). Nail involvement (ever) was more prominent in EOPsO group, however, the significance was disappeared when adjusted for psoriasis duration. Interaction between gender and both axial disease and psoriatic disease family history were found (axial disease in man; EOPsO vs LOPsO; 38.0% vs. 25.4%; p=0.005; adjusted for PsA duration - aOR 0.56 (0.38-0.84; %95 CI) // psoriatic disease family history in females; EOPsO vs LOPsO; 39.5% vs. 30.1%; p=0.003; OR 0.65 (0.50-0.86; %95 CI)). Duration between PsO and PsA was significantly longer in EOPsO group (148 vs. 24 months, p<0.001). In EOPsO group, more patients had PsO preceeding PsA than LOPsO group (81.8% vs. 60.6%, p<0.001), however, synchronous disease -defined as the diagnosis of PsO and PsA within the same year- was more common in LOPsO group (16.6% vs. 30.3%, p<0.001) (Table 1). Psoriatic disease activity parameters, patient and physician reported outcomes and HAQ-DI scores were similar in both groups.Table 1.Comparison of psoriatic arthritis patients‘ characteristics according to age at psoriasis onsetConclusion:Clinical features of PsA may be affected by the age at the onset of psoriasis. As the genetic background is different in early and late-onset psoriasis, this may suggest a different pathogenetic mechanism based on the psoriasis phenotype, also affecting the PsA features. Further prospective studies are needed to define whether the classification of PsA requires including psoriasis phenotypes as well.References:[1]Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450-6.Disclosure of Interests:Emre Bilgin: None declared, Özün Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Şule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB
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Ergulu Eşmen S, Bayindir O, Kasapoğlu E, Bakirci S, Solmaz D, Kimyon G, Doğru A, Dalkiliç E, Özişler C, Can M, Akar S, Tarhan EF, Yavuz S, Kiliç L, Küçükşahin O, Omma A, Gönüllü E, Yildiz F, Ersözlü D, Tufan A, Çinar M, Erden A, Yilmaz S, Pehlevan S, Duruöz MT, Aydin S, Kalyoncu U. AB0761 DEMOGRAPHIC AND CLINICAL FEATURES OF JUVENILE-ONSET PSORIATIC ARTHRITIS: RESULTS FROM PsART-ID REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Although psoriatic arthritis (PsA) may be seen at any decades, juvenil onset PsA is relatively rare. Moreover, there were no more data about clinical features, treatments, and course in juvenile PsA when they reached to adult age.Objectives:The objective of this study was to assess and compare demographic and clinical features for juvenile onset PsA and adult onset PsA.Methods:PsART-ID is a multicenter, international database, investigating the disease characteristic in real life (1). Briefly, demographic data, PsA subtypes, uveitis, enthesitis, dactylitis, Co-morbidities, disease activity scores (TJC, SJC, VAS-pain, VAS patients and physician global assessments, VAS-fatigue, BASDAI), and functional status (HAQ-DI, BASFI) were recorded. Psoriasis and PsA starting age were noted, as well. Patients were classified as juvenile PsA or juvenile PsO (under 18 years old). Results were compared regarding to juvenile versus adult onset age.Results:Overall, 1644 PsA patients were included to study, 301/1644 (18.3%) patients had juvenile onset psoriasis. Of 39/1644 (2.4%) patients had juvenile onset PsA, as well. As expected, juvenile onset PsA patients were younger, however PsA disease duration were longer than adult onset PsA patients. There were no any difference between demographic and clinical data, except BMI and enthesitis were less frequently at the juvenile onset PsA groups. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used more frequently bDMARDs.Table.Comparison of demographic and clinical characteristics of juvenile and adult-onset psoriatic arthritisJuvenile onsetAdult onsetpN (%)39 (2.4)1605 (97.6)Female Sex n (%)24 (61.5)1006 (62.7)0.884PsA beginning age mean (SD)13.3 ± 3.8542.3 ± 12.9<0.001Current age mean (SD)26.6 ±10.747.3 ±13.07<0.001Duration of psoriasis (years)17.10 ± 11.2614.75 ± 11.780.124Duration of psoriatic arthritis (years)13.5 ±115.06 ± 6.7<0.001Cigarette smoking (ever) n (%)15/38641/14940.72Education duration/year (mean,SD)10.09 ± 3.679.52 ± 4.810.464BMI (kg/m2) (mean, SD)24.5 ±5.128.3 ± 5.21<0.001Family history of PsO/PsA n (%)15 (38.5)559 (34.9)0.642Nail involvement n (%)18 (46.2)762 (47.5)0.864Dactilitis n (%)9 (23.7)367 (24)0.958Entesitis n (%)3 (7.9)384 (25.7)0.013Uveitis n (%)-13 (4.3)0.713Axial involvement (%)15 (38.5)464 (29)0.199Methotrexate36 (92.3)1348 (84)0.162Sulfasalazine17 (43.6)612 (38.1)0.488Leflunomide14 (35.9)379 (23.6)0.076Biologic DMARDs102 (33.9)358 (26.8)0.013Conclusion:Although psoriasis may be seen frequently in the juvenile age, juvenile onset PsA was not so frequent in our PsA cohort. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used bDMARDs more frequently.References:[1]Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.Disclosure of Interests:Serpil ERGULU EŞMEN: None declared, Ozun Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Sule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Mehmet Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB
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Bavbek S, Malhan S, Mungan D, Misirligil Z, Erdinc M, Gemicioglu B, Kivilcim Oguzulgen I, Oksuz E, Yildiz F, Yorgancioglu A. Economic burden of severe asthma in Turkey: a cost of illness study from payer perspective. Eur Ann Allergy Clin Immunol 2020; 53:128-137. [PMID: 32372589 DOI: 10.23822/eurannaci.1764-1489.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Objective. To estimate economic burden of severe asthma in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods. This cost of illness study was based on identification of per patient annual direct medical costs for the management of sever easthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications. Results. Based on total annual per patient costs calculated for outpatient admission ($ 177.91), laboratory and radiological tests ($ 82.32), hospitalizations/interventions ($ 1,154.55), drug treatment/equipment ($ 2,289.63) and co-morbidities ($ 665.39) cost items, total per patient annual direct medical costrelated to management of severe asthma was calculated to be $ 4,369.76 from payer perspective. Drug treatment/equipment (52.4%) was the main cost driver in the management of severe asthma in Turkey, as followed by hospitalizations/interventions (26.4%) and co-morbidities (15.2%). Conclusions. In conclusion, our findings indicate that managing patients with severe asthma pose a considerable burden to health economics in Turkey, with medications as the main cost driver.
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Affiliation(s)
- S Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - S Malhan
- Department of Health Care Management, Faculty of Medical Sciences, Baskent University, Ankara, Turkey
| | - D Mungan
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Z Misirligil
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - M Erdinc
- Department of Chest Diseases, School of Medicine, Ege University, Izmir, Turkey
| | - B Gemicioglu
- Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - E Oksuz
- Department of Family Medicine, School of Medicine, Baskent University, Ankara, Turkey
| | - F Yildiz
- Department of Chest Diseases, School of Medicine, Dr. Suat Günsel University of Kyrenia Hospital, Kyrenia, Cyprus
| | - A Yorgancioglu
- Department of Chest Diseases, School of Medicine, Celal Bayar University, Manisa, Turkey
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Evren H, Unal Evren E, Bardak Ozcem S, Ozer Yazgan Z, Argun Baris S, Yildiz F. The Knowledge Level of Hospital Staff about Influenza and Pneumococcal Vaccination. Cyprus J Med Sci 2019. [DOI: 10.5152/cjms.2019.878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Evren H, Unal Evren E, Bardak Ozcem S, Argun Baris S, Yildiz F. Awareness of Tuberculosis among Healthcare Workers in a University Hospital in Northern Cyprus. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gelener P, Gelener P, Yildiz F. The Awareness Level of Obstructive Sleep Apnea Syndrome among the Primary Care Medical Staff. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ciftci T, Argun Baris S, Yildiz F, Basyigit I, Boyaci H, Ilgazli A. Effect of Vitamin D Levels on Asthma Control in Adults. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Aydin O, Celebi Sozener Z, Mungan D, Yildiz F, Argun Baris S, Gemicioglu B, Yorgancioglu A, Havlucu Y, Kizilirmak D, Cerci P, Zergeroglu AM, Ozbey U, Balaban S, Gokmen D, Celik G, Calisma Grubu SY. Determination of Physical Activity and Dietary Attitudes in Asthma Patients and Evaluation of Their Relationship with Asthma Control: A National Multicenter Study. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dagli E, Güner M, Elbek O, Yildiz F, Gezer T, Ay P, Ceyhan M. Tobacco industry activities in Turkey: through media monitoring. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Esin E, Oksuzoglu BO, Markoc F, Bilgetekin I, Yildiz F, Guntekin S, Yukruk F, Atalay R. Abstract P3-08-23: Prosigna assay for treatment decisions in early breast cancer: A single center, decision impact study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-08-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Therapeutic decisions in early breast cancer (EBC) are based on clinical and pathological features, which are subject to intra- and inter-observer variability. Hence, in the era of precision medicine, there is growing need for predictive biomarkers. The Prosigna assay utilizes Prediction Analysis of Microarray, a test based on the analysis of 50 intrinsic subtype-linked gene clusters. This single center decision impact study aimed to evaluate the effect of Prosigna test results on physicians' adjuvant treatment choices.
Methods: Between September 2017 and February 2018, FFPE tumor samples from 53 newly diagnosed, postmenopausal, hormone receptor-positive, HER2-negative EBC (T1-T2; pN0-N1a) patients were analyzed. Pre-test clinical judgments and Prosigna test results were compared.
Results: Mean age was 59 (42-77). Invasive ductal carcinoma (79.2%), grade 2 (52.8%) and T1c-N0 tumors (43.4%) represented the majority. Before the Prosigna test, 65.4% of the patients were classified as luminal A and 34.6% as luminal B. Of the pre-test risk groups, 40.4% were low-risk, 40.4% were intermediate risk and 19.2% were high risk. Prosigna assay grouped 50% of patients as luminal A, 44.2% as luminal B, 3.8% as basal type and 1.9% as HER2-expressing. Post-test ROR score-based groups were distributed as 25% low-risk, 40.4% intermediate risk and 34.6% high risk. There was a statistically significant correlation between clinically defined and molecularly assessed intrinsic BC subtypes (kappa:0.334, p=0.007). Similarly, pre-test and post-test recurrence risk groups were correlated (kappa:0.397, p=0.001). Before the Prosigna test, endocrine treatment was physicians' primary choice in 20 patients (39.2%), chemotherapy was recommended to 31 patients (60.8%). Overall, the Prosigna assay led to a change in choice of treatment for one patient (2%). There was 40.4% discordance between pre- and post-test recurrence risk groups. In addition, intrinsic subtypes were 34.6% discordant, which is largely driven by the reclassification of pre-test luminal A tumors into Prosigna luminal B group.
Table 1.Impact of Prosigna Results on Final Treatment Decision Prosigna low risk N=13 (%24.5)Prosigna intermediate risk N=21 (%39.6)Prosigna high risk N=18 (%34)Total N=51 (%100)Treatment choice before Prosigna CT+HT0121729 (56.9)HT only127120 (39.2)CT offered, not accepted by the patient0202 (3.9)Treatment choice after Prosigna CT+HT0121830 (58.8)HT only127019 (37.3)CT offered, not accepted by the patient0202 (3.9)Change in treatment choice HT to CT001100 (0)CT to HT0000 (0)CT: Chemotherapy HT: Hormonotherapy
Conclusions: Although conventional risk assessment methods are relatively inexpensive with shorter turnaround times, their accuracy for risk assessment and value for risk reduction are suboptimal. According to our results, Prosigna assay was found as a relevant tool for clinical decision-making process. In cases where there is a discrepancy between the clinical assessment results and the Prosigna assay, tumor boards may guide treatment recommendations. Long term follow-up of these patients will elucidate the potential benefits of using multigene molecular tests as biomarkers for EBC treatment.
Citation Format: Esin E, Oksuzoglu BO, Markoc F, Bilgetekin I, Yildiz F, Guntekin S, Yukruk F, Atalay R. Prosigna assay for treatment decisions in early breast cancer: A single center, decision impact study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-23.
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Affiliation(s)
- E Esin
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - BO Oksuzoglu
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - F Markoc
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - I Bilgetekin
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - F Yildiz
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - S Guntekin
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - F Yukruk
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
| | - R Atalay
- University of Health Sciences Dr.A.Y. Ankara Oncology Hospital, Ankara, Turkey; Middle East Technical University, Ankara, Turkey
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Akkus Yildirim B, Onal C, Sari SY, Yavas G, Gultekin M, Guler O, Yildiz F, Akyurek S. The Utility of Dissected Lymph Node Number and Lymph Node Metastasis Ratio In Stage IIIC Endometrium Adenocarcinoma: A Multicentric Analysis. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sari SY, Gultekin M, Rahatli S, Altundag O, Turker A, Kars A, Yuce K, Ayhan A, Ozyigit G, Yildiz F. Patterns of Recurrence and Survival Rates in Endometrial Cancer According to ESMO-ESGO-ESTRO Risk Classification. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pece Sonmez U, Güner M, Dagli E, Gezer T, Yildiz F, Elbek O, Ay P, Ceyhan M. How is the use of e-cigarettes sustained in the customers with serious health symptoms? Tob Induc Dis 2018. [DOI: 10.18332/tid/84684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dagli E, Ay P, Gezer T, Elbek O, Guner M, Yildiz F. Is "hookah cafe" a tool to bypass smoke-free law? Tob Induc Dis 2018. [DOI: 10.18332/tid/84015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gezer T, Dagli E, Yildiz F, Ay P, Elbek O, Ceyhan M, Güner M. Why does tobacco consumption increase in a MPOWER-compliant country? Tob Induc Dis 2018. [DOI: 10.18332/tid/84057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Elbek O, Dagli E, Yildiz F, Gezer T, Güner M. Measuring sustainability of tobacco control by market and consumption data in Turkey. Tob Induc Dis 2018. [DOI: 10.18332/tid/84056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Güner M, Pece Sonmez U, Dagli E, Gezer T, Yildiz F, Elbek O, Ay P, Ceyhan M. Use of social media to circumvent sales and advertising ban of electronic cigarettes. Tob Induc Dis 2018. [DOI: 10.18332/tid/84130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yildiz F, Deniz PO, Capaci B, Arikan A, Abacigil F, Beser E. Health promotion behaviours in medical students and research assistants, Aydın, Turkey. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Yildiz
- Adnan Menderes University, Aydin, Turkey
| | | | - B Capaci
- Adnan Menderes University, Aydin, Turkey
| | - A Arikan
- Adnan Menderes University, Aydin, Turkey
| | - F Abacigil
- Adnan Menderes University, Aydin, Turkey
| | - E Beser
- Adnan Menderes University, Aydin, Turkey
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Sari SY, Gultekin M, Yuce K, Gungor T, Tulunay G, Ayhan A, Yildiz F. Recurrence Patterns in Patients with Uterus-Confined Endometrial Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sari SY, Gultekin M, Gungor T, Tulunay G, Yuce K, Ayhan A, Yildiz F. Prognosis in Very Elderly Patients With Endometrial Cancer: Can It be Different From Patients With 60-75 Years of Age? Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Akmanlar M, Gultekin M, Yildiz F, Gurkaynak M. A Hybrid Electron and Photon IMRT Planning Technique in Vulvar Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ünal AA, Parabas A, Arora A, Ehrler J, Barton C, Valencia S, Bali R, Thomson T, Yildiz F, Kronast F. Laser-driven formation of transient local ferromagnetism in FeRh thin films. Ultramicroscopy 2017; 183:104-108. [PMID: 28396080 DOI: 10.1016/j.ultramic.2017.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/13/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
The antiferromagnetic to ferromagnetic phase transition in FeRh can be induced globally by either heating the material above its phase transition temperature or applying a combination of external stimuli (such as mechanical strain, electric/magnetic fields) on the material preheated close to its transition temperature. On the other hand, to locally induce this phase transition is more desirable for applications and requires a confined source of energy such as a focused laser beam. Here we combine laser excitation with X-ray magnetic imaging to determine the effect of laser heating on the local and transient magnetization of FeRh using time-resolved photoelectron emission microscopy. Excitation by an ultrashort laser pulse generates a local ferromagnetic state within 0.6ns which recovers its initial antiferromagnetic state after a further 2ns. The form of the domains during the growth and diminution of ferromagnetic ordering suggests an intrinsic speed limit for magnetic and structural changes.
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Affiliation(s)
- A A Ünal
- Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, D-12489 Berlin, Germany.
| | - A Parabas
- Gebze Teknik Üniversitesi, Temel Bilimler Fakültesi, Fizik Bölümü, TR-41400 Gebze/Kocaeli, Turkey
| | - A Arora
- Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, D-12489 Berlin, Germany
| | - J Ehrler
- Institut für Ionenstrahlphysik und Materialforschung, Helmholtz-Zentrum Dresden-Rossendorf, D-01328 Dresden, Germany
| | - C Barton
- School of Computer Science, University of Manchester, Manchester M13 9PL, United Kingdom
| | - S Valencia
- Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, D-12489 Berlin, Germany
| | - R Bali
- Institut für Ionenstrahlphysik und Materialforschung, Helmholtz-Zentrum Dresden-Rossendorf, D-01328 Dresden, Germany
| | - T Thomson
- School of Computer Science, University of Manchester, Manchester M13 9PL, United Kingdom
| | - F Yildiz
- Gebze Teknik Üniversitesi, Temel Bilimler Fakültesi, Fizik Bölümü, TR-41400 Gebze/Kocaeli, Turkey
| | - F Kronast
- Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Str. 15, D-12489 Berlin, Germany.
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Turker S, Dogru M, Yildiz F, Yilmaz SB. The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment. Allergol Immunopathol (Madr) 2017; 45:115-120. [PMID: 28153353 DOI: 10.1016/j.aller.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND After the bronchodilator effect of magnesium was shown, the use of magnesium in treatment of asthma exacerbations became common. With the results of recent studies, the use of intravenous magnesium in severe asthma exacerbations took its place. We aimed to examine the effects of adding isotonic magnesium sulphate instead of isotonic saline into nebulised salbutamol on the Modified Pulmonary Index Score (MPIS) and the hospitalisation rate in moderate asthma exacerbations. METHODS Our study population included 100 children age between 3 and 15 years with asthma admitted to emergency department due to moderate asthma exacerbations. The patients were randomised to placebo or magnesium, with 50 patients in each arm. All patients received 1mg/kg of systemic methylprednisolone at the beginning of treatment and thereafter received either nebulised salbutamol (0.15mg/kg/dose) and 1ml magnesium sulphate (15%)+1.5ml isotonic saline on three occasions at roughly 20min intervals (Magnesium group) or nebulised salbutamol (0.15mg/kg/dose) and 2.5ml isotonic saline mixture on three occasions at roughly 20min intervals (Placebo group). The MPIS of patients on 0th min, 20th min, 40th and 120th min were calculated and compared. The primary outcome was to compare MPIS values at the end of 120th min. RESULTS Both groups have similar demographic, allergic characteristics and baseline MPIS scores. When the MPIS scores in the 120th min and admission rates in the 200th min, there was no significant difference between the two groups. CONCLUSIONS The use of nebulised magnesium sulphate in moderate asthma exacerbation as adjuvant treatment showed no benefit to standard treatment in our study.
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Affiliation(s)
- S Turker
- Zeynep Kamil Woman and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - M Dogru
- Zeynep Kamil Woman and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey.
| | - F Yildiz
- Zeynep Kamil Woman and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
| | - S Bozkaya Yilmaz
- Zeynep Kamil Woman and Children's Diseases Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey
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Baris SA, Onyilmaz T, Basyigit I, Boyaci H, Yildiz F. Frequency of Exacerbations and Hospitalizations in COPD Patients Who Continue to Smoke. Acta Med Okayama 2017; 71:11-17. [PMID: 28238005 DOI: 10.18926/amo/54820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We evaluated the frequency of exacerbations and hospitalizations in chronic obstructive pulmonary disease (COPD) patients who continue to smoke.: We retrospectively analyzed the medical records of the COPD patients treated in Chest Diseases Clinic of Kocaeli University School of Medicine in 2007-2013. Their demographic characteristics, smoking status (non-smoker, current smoker, ex-smoker), Charlson Comorbidity Index (CCI), and history of COPD exacerbation and hospitalizations were evaluated. The cases of 120 patients (11 females, 9.2%; 109 males, 90.8%) were analyzed. Sixteen (13.3%) of the patients were current smokers, and 104 patients were ex-smokers (n=99) or non-smokers (n=5). The mean age was 69.7±7.9 years in the ex-smokers and 62.94±6.8 years in the current smokers. There were no significant differences between the current and ex-smokers regarding smoking history, FEV1 value, frequencies of exacerbations and hospitalization per year, or duration of follow-up. The initial stage of the COPD and the frequency of exacerbations were significantly correlated (p=0.003). The CCI values were significantly higher in the ex-smokers compared to current smokers (p=0.02). A correlation analysis of age, hospitalization and CCI revealed that age was significantly correlated with the hospitalization rate (p=0.02). Older age and the presence of comorbidities in ex-smokers might explain the similar rates of exacerbation and hospitalization between these current and ex-smokers.
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Affiliation(s)
- Serap Argun Baris
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Kocaeli 41380,
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Yavas G, Gultekin M, Yildiz O, Seyrek M, Demirkol S, Toy H, Sargon MF, Ozkayar O, Uner A, Yildiz F, Akyol F. Assessment of concomitant versus sequential trastuzumab on radiation-induced cardiovascular toxicity. Hum Exp Toxicol 2016; 36:1121-1130. [PMID: 27932539 DOI: 10.1177/0960327116680276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are limited data regarding effect of trastuzumab on radiation-induced cardiovascular toxicity when used sequentially or concomitantly. This experimental study aims to investigate effect of trastuzumab on radiation-induced cardiovascular toxicity with respect to the treatment sequence. One hundred and eight female Wistar albino rats were divided into six groups (G): G1 was control, G2 was trastuzumab, and G3 was radiotherapy (RT); G4 and G6 were sequential RT and trastuzumab; and G5 was concomitant RT and trastuzumab groups, respectively. Rats were killed at 6th h, 21st and 70th days after RT; thoracic aorta and heart samples were obtained. Transthoracic echocardiography and functional studies evaluating relaxation of thoracic aorta were performed. Subendothelial edema scores of thoracic aorta samples at 21st and 70th days were higher in RT groups (G3, G4, G5, and G6) ( p < 0.001). There was a deterioration of relaxation responses of thoracic aorta samples in RT groups ( p < 0.001). Cardiac fibrosis (CF) scores revealed detrimental effect of RT beginning from 6th h and trastuzumab from 21st day. RT groups showed further deterioration of CF at 70th day. Ejection fraction, left ventricular mass, and fractional shortening were significantly decreased in G4, G5, and G6. Trastuzumab may increase pathological damage in cardiovascular structures when used with RT regardless of timing.
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Affiliation(s)
- G Yavas
- 1 Department of Radiation Oncology, Selcuk University, Konya, Turkey
| | - M Gultekin
- 2 Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - O Yildiz
- 3 Department of Pharmacology, Gulhane Military Medical Academy, Ankara, Turkey
| | - M Seyrek
- 3 Department of Pharmacology, Gulhane Military Medical Academy, Ankara, Turkey
| | - S Demirkol
- 4 Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - H Toy
- 5 Department of Pathology, Necmettin Erbakan University, Konya, Turkey
| | - M F Sargon
- 6 Department of Anatomy, Hacettepe University, Ankara, Turkey
| | - O Ozkayar
- 7 Department of Pathology, Hacettepe University, Ankara, Turkey
| | - A Uner
- 7 Department of Pathology, Hacettepe University, Ankara, Turkey
| | - F Yildiz
- 2 Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - F Akyol
- 2 Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
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Baris SA, Tuncel D, Ozerdem C, Kutlu H, Onyilmaz T, Basyigit I, Boyaci H, Yildiz F. The effect of positive airway pressure therapy on neurocognitive functions, depression and anxiety in obesity hypoventilation syndrome. Multidiscip Respir Med 2016. [DOI: 10.4081/mrm.2016.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in Obesity Hypoventilation Syndrome (OHS) patients. Methods: Ten healthy normal and obese controls, 10 OHS and 10 OSAS patients were included in the study. Short form-36, Beck Depression Scale and State-Trade Anxiety Inventory (STAI 1-2) were performed. Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MOCA), Enhanced Cued Recall (ECR) and Mini Mental Test (MMT) were used for neurocognitive evaluation. All tests were repeated after one night PAP therapy in OHS and OSAS groups. Results: OHS patients had the lowest scores of physical (PF) and social functioning (SF) in SF-36. The total number of persistent errors and incorrect answers were the highest in OHS group in WCST. The scores of MOCA, ECR and MMT were lower; depression and anxiety scores were higher in OHS group than in controls (p = 0,00). There was a significant increase in the completed categories in OHS after PAP therapy (p = 0,03). There were also significant increases in MOCA, ECR and MMT scores and significant decreases in depression and anxiety scores with respect to PAP therapy. Conclusions: Cognitive dysfunction, depression and anxiety are important under-recognized comorbidities in OHS. It is suggested that short term PAP therapy had positive effects on neurocognitive functions, depression and anxiety but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of long term PAP therapy on these parameters.
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Argun Baris S, Tuncel D, Ozerdem C, Kutlu H, Onyilmaz T, Basyigit I, Boyaci H, Yildiz F. The effect of positive airway pressure therapy on neurocognitive functions, depression and anxiety in obesity hypoventilation syndrome. Multidiscip Respir Med 2016; 11:35. [PMID: 27766147 PMCID: PMC5057438 DOI: 10.1186/s40248-016-0071-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/18/2016] [Indexed: 01/22/2023] Open
Abstract
Background The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in Obesity Hypoventilation Syndrome (OHS) patients. Methods Ten healthy normal and obese controls, 10 OHS and 10 OSAS patients were included in the study. Short form-36, Beck Depression Scale and State-Trade Anxiety Inventory (STAI 1-2) were performed. Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MOCA), Enhanced Cued Recall (ECR) and Mini Mental Test (MMT) were used for neurocognitive evaluation. All tests were repeated after one night PAP therapy in OHS and OSAS groups. Results OHS patients had the lowest scores of physical (PF) and social functioning (SF) in SF-36. The total number of persistent errors and incorrect answers were the highest in OHS group in WCST. The scores of MOCA, ECR and MMT were lower; depression and anxiety scores were higher in OHS group than in controls (p = 0,00). There was a significant increase in the completed categories in OHS after PAP therapy (p = 0,03). There were also significant increases in MOCA, ECR and MMT scores and significant decreases in depression and anxiety scores with respect to PAP therapy. Conclusions Cognitive dysfunction, depression and anxiety are important under-recognized comorbidities in OHS. It is suggested that short term PAP therapy had positive effects on neurocognitive functions, depression and anxiety but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of long term PAP therapy on these parameters.
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Affiliation(s)
- Serap Argun Baris
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Umuttepe, İzmit, Kocaeli Turkey
| | - Dilek Tuncel
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Umuttepe, İzmit, Kocaeli Turkey
| | - Cigdem Ozerdem
- Department of Neurology, Derince Training and Research Hospital, İzmit, Kocaeli Turkey
| | - Huseyin Kutlu
- Department of Pyschiatry, Kocaeli University School of Medicine, İzmit, Kocaeli Turkey
| | - Tugba Onyilmaz
- Department of Pulmonary Diseases, Private Konak Hospital, İzmit, Kocaeli Turkey
| | - Ilknur Basyigit
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Umuttepe, İzmit, Kocaeli Turkey
| | - Hasim Boyaci
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Umuttepe, İzmit, Kocaeli Turkey
| | - Fusun Yildiz
- Department of Pulmonary Diseases, Kocaeli University School of Medicine, Umuttepe, İzmit, Kocaeli Turkey
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Biltekin F, Yeginer M, Dogan A, Gultekin M, Ozyigit G, Yildiz F. Two-Dimensional Array–Based Mechanical Quality Control of High-Dose-Rate Brachytherapy Treatment Unit. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sari SY, Yazici G, Sendur M, Altundag K, Gultekin M, Yildiz F, Ozyigit G. Concurrent Trastuzumab Use With Radiation Therapy and the Risk for Cardiotoxicity. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cengiz M, Dauletkazin A, Yildiz F, Yazici G, Akyol F, Zorlu F, Gurkaynak M, Ozyigit G. Hypofractionated Stereotactic Body Radiation Therapy for the Definitive Treatment of Sarcoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Basyigit I, Tugay M, Dilioglugil MO, Yildiz F, Maral H, Sozubir S. Protective effects of N-acetylcysteine on peroxidative changes of the fetal rat lungs whose mothers were exposed to cigarette smoke. Hum Exp Toxicol 2016; 26:99-103. [PMID: 17370867 DOI: 10.1177/0960327107071917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: This experimental study investigated the protective effects of N-acetylcysteine (NAC) on peroxidative changes in fetal lungs in the offspring of rats exposed to cigarette smoke. Methods: Thirty fetal rats used for analysis, were divided into three groups as follows: control group (n = 10), whose mothers were exposed to fresh air; group I (n=10), whose mothers were exposed to cigarette smoke; and group II (n=10), whose mothers were exposed to cigarette smoke and given 10 mg/kg per day NAC. In groups I and II, smoke exposure was started 4 weeks before the pregnancy, and continued to the 14th day of pregnancy, and in Group II, NAC was administered intraperitoneally for 14 days. The mothers and their fetuses were decapitated on the 14th day of pregnancy. Malondialdehyde (MDA) and glutathione (GSH) levels were determined in the lung tissues of fetuses to determine the oxidant-antioxidant balance. Results: While tissue MDA levels in Group I were found significantly higher than the control group (129.7±65.4 versus 63.4±15.4 nmol/100 mg protein, P <0.05), GSH levels were significantly lower (17.1±7.3 versus 45.4±8.1 nmol/mg protein, P <0.01). Furthermore, in Group II, MDA levels were significantly lower (56.9± 20.6 versus 129.7±65.4 nmol/100 mg protein, P <0.05), and GSH levels were significantly higher (34.57±10.7 versus 17.1±7.3 nmol/mg protein, P <0.0001) when compared with Group I. No statistically significant difference was found in tissue MDA and GSH levels between Group II and the control group (P >0.05). Conclusions: These results suggest that smoke exposure during pregnancy causes oxidative damage in fetal lungs. This smoke-induced damage might be prevented by NAC. Human & Experimental Toxicology (2007) 26, 99-103
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Affiliation(s)
- I Basyigit
- Department of Pulmonary Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Yildirim A, Kudas O, Turk I, Yildiz F, Dinkci S, Erken E. FRI0412 Mannose Binding Lectin Gene Polymorphisms in Spondyloarthropathies. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aydin S, Bayindir O, Oksuz M, Dogru A, Kimyon G, Tarhan E, Erden A, Yavuz S, Can M, Cetin G, Kilic L, Kucuksahin O, Omma A, Ozisler C, Solmaz D, Onat A, Kisacik B, Ersozlu Bozkirli D, Aydin M, Akyol L, Cinar M, Pehlevan S, Tufan A, Yildiz F, Balkarli A, Erbasan F, Mercan R, Gunal E, Arslan F, Kasifoglu T, Senel S, Kobak S, Yilmazer B, Yilmaz S, Duruoz T, Kucuk A, Gonullu E, Aksu K, Kabasakal Y, Sahin M, Cakir N, Erten S, Sayarlioglu M, Dalkilic E, Akar S, Acikhel C, Atakan N, Kalyoncu U. FRI0476 Comorbidities in Psoriatic Arthritis: Patient Education Counts. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kalyoncu U, Kasifoglu T, Kisacik B, Oksuz M, Omma A, Bes C, Cinar M, Pamuk O, Kucuksahin O, Akar S, Aksu K, Yildiz F, Onat A, Kanitez N, Erden A, Dalkilic E, Ermurat S, Hayran M. THU0586 Agreement of Patient and Physician Global Assessment of Disease Activity in Adult Onset Still's Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aydin S, Bayindir O, Oksuz M, Dogru A, Kimyon G, Tarhan E, Erden A, Yavuz S, Can M, Cetin G, Kilic L, Kucuksahin O, Omma A, Ozisler C, Solmaz D, Onat A, Kisacik B, Ersozlu Bozkirli D, Tufan M, Akyol L, Cinar M, Pehlevan S, Tufan A, Yildiz F, Balkarli A, Erbasan F, Mercan R, Gunal E, Arslan F, Kasifoglu T, Senel S, Kobak S, Yilmazer B, Yilmaz S, Duruoz T, Kucuk A, Gonullu E, Aksu K, Kabasakal Y, Sahin M, Cakir N, Erten S, Sayarlioglu M, Dalkilic E, Akar S, Acikel C, Atakan N, Kalyoncu U. AB0747 Psoriatic Arthritis Registry of Turkey (PSART): Results of A Multicenter Registry on 1081 Patients:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Argun Baris S, Vural C, Yaprak B, Onyilmaz T, Tuncel D, Vatansever S, Isken T, Basyigit I, Boyaci H, Yildiz F. The effects of sildenafil on smoke induced lung inflammation in rats. Malays J Pathol 2016; 38:39-44. [PMID: 27126663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5 and has anti-inflammatory effects. The aim of the study was to evaluate the effects of sildenafil on smoke-induced lung inflammation. MATERIAL AND METHODS Twenty-nine Wistar-Albino rats were enrolled into 3 groups as control, smoker and sildenafil groups. Smoker and sildenafil groups were exposed to cigarette smoke for 2 hours per day for 8 weeks. Sildenafil 10 mg/kg/day was administered to the sildenafil group by nasogastric lavage after smoke exposure. The degree of lung inflammation was scored histopathologically for each group. RESULTS The inflammation score was 7.25±0.93 in the control group, 8.18±1.21 in the smoker group and 7.08±1.66 in the sildenafil group. There was a non-significant decrease of inflammation score in sildenafil group with respect to control or smoker groups. While there was no significant difference of oedema, hyperemia, hemorrhage and mononuclear cell infiltration scores among the groups, it was found that the thickness of interalveolar septum and alveolar distortion was decreased in sildenafil group. However this decrease was not statistically significant. CONCLUSION This study suggests that sildenafil might reduce smoke-induced inflammation in rat lungs. Future studies are needed in order to investigate the clinical effectiveness of this finding in smoking related lung diseases.
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Affiliation(s)
- S Argun Baris
- Kocaeli University School of Medicine, Department of Pulmonary Diseases, Umuttepe, Kocaeli, Turkey.
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