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Item Open Access Diagnostic performance of EBUS-TBNA and its interrelation with PET-CT in patients with extra-thoracic malignancies(Türk Tüberküloz ve Toraks Derneği, 2020-10-03) Güçlü, Özge Aydın; Demirdöğen, Ezgi; Ursavaş, Ahmet; Öztürk, Nilüfer Aylin Acet; Özkaya, Güven; Karadağ, Mehmet; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0002-9027-1132; 0000-0002-7400-9089; 0000-0002-6375-1472; 0000-0003-0297-846X; AAG-8744-2021; AAH-9812-2021; Z-1424-2019; AAI-3169-2021; A-4421-2016; 14062849300; 8329319900; 57203790565; 57200859646; 16316866500; 6601970351Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment follow-up. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM. Materials and Methods: Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological follow-up. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis. Results: Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 +/- 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUS-TBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively. Conclusion: EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results.Item Metadata only Do patients have responsibilities in a free-market system? A personal perspective(Sage Publications, 2008-03) Arda, Berna; Civaner, Murat; Uludağ Üniversitesi/Tip Fakültesi/Deontoloji Anabilim Dalı.; 24075622600The current debate that surrounds the issue of patient rights and the transformation of health care, social insurance, and reimbursement systems has put the topic of patient responsibility on both the public and health care sectors' agenda. This climate of debate and transition provides an ideal time to rethink patient responsibilities, together with their underlying rationale, and to determine if they are properly represented when being called 'patient' responsibilities. In this article we analyze the various types of patient responsibilities, identify the underlying motivations behind their creation, and conclude upon their sensibleness and merit. The range of patient responsibilities that have been proposed and implemented can be reclassified and placed into one of four groups, which are more accurate descriptors of the nature of these responsibilities. We suggest that, within the framework of a free-market system, where health care services are provided based on the ability to pay for them, none of these can properly be justified as a patient responsibility.Item Metadata only The effectiveness of local anesthetics in preventing postoperative adhesions in rat models(Springer-Verlag Italia SRL, 2010-12) Öztürk, Ersin; Yılmazlar, Aysun; Berhuni, Sait; Yılmazlar, Tuncay; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 35070171400; 55899579900; 37076610600; 6701800362Intra-abdominal adhesions are fibrous bands that develop after abdominal surgery or inflammation and cause significant surgical morbidity and mortality. In this study, the effectiveness of lidocaine, prilocaine and bupivacaine in preventing experimental intra-abdominal adhesions in rats was studied. After obtaining the approval of our local institutional review board, 50 female Wistar-Albino rats weighing 250-320 g underwent laparotomy via a standard 5-cm midline incision under intramuscular anesthesia with ketamine (40 mg/kg) and xylazine (10 mg/kg). The cecal serosa and adjacent abdominal wall were superficially injured using sterile gauze. The laparotomy incision was closed after irrigation of the peritoneal cavity with the following: 5 ml saline in Group II, (the sham group), 7 mg/kg prilocaine in Group III, 3 mg/kg lidocaine in Group IV or 2 mg/kg bupivacaine in Group V. No irrigation was performed in Group I rats (the control group). After laparotomy closure, all rats were allowed to wake spontaneously. Two weeks after the initial experimental procedure, all rats underwent a second laparotomy, and adhesions were scored using the Linsky scale. The adhesion quantity and quality were comparable among all groups (P > 0.05); however, adhesion severity scores were significantly lower in the prilocaine and bupivacaine groups vs. the other groups (P < 0.05). Prilocaine and bupivacaine were found to decrease the severity of intra-peritoneal adhesions.Item Metadata only Experimental subarachnoid haemorrhage models in rats(Springer-Verlag Wien, 2002) Kanpolat, Y.; Alkan, Tülin; Korfalı, Ender; Kahveci, Nevzat; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 0000-0003-0841-8201; AAG-7070-2021; 6601953747; 7004641343; 6602597846There is no comprehensive and reliable model available in small animals that are suitable for the study of subarachnoid haemorrhage (SAH). In the study we reviewed the advantages and disadvantages of available SAH models in rats and presented our model. Experimental SAH was induced in a group of 350-450 g SpragueDawley rats. A 2 mm-diameter burr hole was drilled and, working under a microscope, haemorrhage was produced by transclival puncture of the basilar artery with a 20 mum thick piece of glass. The rats were assigned to either the experimental group (n: 7) or the control group (n: 7). Local cerebral blood flow (LCBF), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) were measured for 60 min after SAH, after which the rats were decapitated. Microscopic examinations were done on three different segments of the basilar artery. There was a significant and sharp drop in LCBF just after SAH was induced (56.17 +/- 12.80 mILD/min/100 g and 13.57 +/- 5.85 mILD/min/100 g for baseline and post-SAH, respectively; p < 0.001), the flow slowly increased by the end of the experiment but never recovered to pre-SAH values (43,63 +/- 7.6 mILD/min/ 100 g, p < 0.05). ICP (baseline 7.33 +/- 0.8 mmHg) increased acutely to 70.6 +/- 9.2 mmHg, and also returned to normal levels by 60 min after SAH. CPP (baseline 75.1 +/- 4.9 mmHg) dropped accordingly (to 21.0 +/- 6.3 mmHg) and then increased, reaching 70.1 +/- 4.9 mmHg at 60 min after SAH. Examinations of the arteries revealed decreased inner luminal diameter and distortion of the elastica layer. We present an inexpensive and reliable model of SAH in the rat that allows single and multiple haemorrhages and to study the early and late course of pathological changes.Item Metadata only Growth and characterisation of electrodeposited Co/Cu superlattices(American Scientific Publishers, 2008-02) Koçkar, Hakan; Şafak, Mürşide; Alper, Mürsel; Uludağ Üniversitesi/Fen-Edebiyat Fakültesi/Fizik Bölümü.; AAG-8795-2021; 13613646100; 7005719283Ferromagnetic/non-ferromagnetic Co/Cu superlattices were grown on polycrystalline Titanium (Ti) W from a single electrolyte by electrodeposition. Microstructure and magnetoresistance (MR) of the superlattices were investigated as a function of the electrolyte pH as well as the layer thicknesses. Structural characterisation by X-ray diffraction (XRD) showed that the superlattices have face-centred cubic (fcc) structure with a strong (111) texture at the studied pH levels, but the texture degree is affected by the electrolyte pH. The scanning electron microscope (SEM) studies revealed that the superlattices grown at low pH (2.0) have smoother surfaces compared to those grown at high pH (3.0). The superlattices exhibited either anisotropic magneto resistance (AMR) or giant magnetoresistance (GMR) depending on the Cu layer thickness. The shape of MR curves changes depending on the combination of Co and Cu layer thicknesses. The superlattices with Co layers less than 3 nm and Cu layers less than 2 nm have broad and non-saturating curves, indicating the predominance of a superparamagnetic contribution, possibly due to the discontinuous nature of the ferromagnetic (Cc) layer. For superlattices with the same bilayer and total thicknesses, the GMR magnitude decreased as the electrolyte pH increased. Besides possible structural differences such as the texture degree and the surface roughness, this may arises from the variation in the Cu content of the ferromagnetic layers caused by the electrolyte pH.Item Metadata only Investigation of APC mutations in a Turkish familial adenomatous polyposis family by heterodublex analysis(Lippincott Williams & Wilkins, 2005-03) Menigatti, Mirco; Benatti, Piero; Pedroni, Monica; Scarselli, Alessandra; Borghi, Francesca; Sala, Elisa; Ponz de Leon, Maurizio; Tunca, Berrin; Egeli, Ünal; Çeçener, Gülşah; Yılmazlar, Tuncay; Zorluoǧlu, Abdullah; Yerci, Ömer; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyoloji ve Genetik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0001-7904-883X; 0000-0002-1619-6680; 0000-0002-3820-424X; AAH-1420-2021; ABI-6078-2020; AAP-9988-2020; 6602965754; 55665145000; 6508156530; 6701800362; 6602076843; 6603810549PURPOSE: Familial adenomatous polyposis is an autosomal dominant disease characterized by the presence of 100 or more colorectal adenomatous polyps. Mutations in the adenomatous polyposis coli gene are primarily responsible for the development of this disease. This study was designed to investigation of adenomatous polyposis coli (APC) gene mutations in members of familial adenomatous polyposis family to identify individuals at risk of the disease. METHODS: We examined one patient with familial adenomatous polyposis and 21 family members including one affected person from familial adenomatous polyposis and 20 nonsymptomatic persons. We studied E, D, F, and G segments of exon 15 of the adenomatous polyposis coli gene by heteroduplex analysis. RESULTS: We used silver staining method for staining. We found a mutation for five persons at segment F of exon 15 of the adenomatous polyposis coli gene. Two of them were affected by colorectal cancer, one of whom was the proband, and the other three were non-symptomatic family members. The pathogenetic mutation was a T deletion at codon 1172, causing a frameshift in the adenomatous polyposis coli gene, as a result of the sequencing analysis of these cases. CONCLUSIONS: Investigation of adenomatous polyposis coli gene mutations is very important for the identification of genetic susceptibility to colorectal cancer and for the definition of tumor developing at an early stage. Furthermore, the identification of this mutation for the first time in a Turkish family will be useful to foster further studies on familial adenomatous polyposis in Turkey.Item Open Access Molecular identification of HIV-1 in the presence of hepatitis B virus and hepatitis C virus Co-infections(Galenos Yayıncılık, 2020-02-24) Sayan, Murat; Özgüler, Müge; Yıldırım, Figen; Yıldırmak, Taner; Gündüz, Alper; Dokuzoğuz, Başak; Çelen, Mustafa Kemal; İnan, Dilara; Ersöz, Gülden; Karaoğlan, İlkay; Ceran, Nurgül; Heper, Yasemin; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0002-6635-5416; AAH-6506-2021; 56191003300Background: Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design: Retrospective cross-sectional study. Methods: The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency vim were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg andior anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results: We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-I infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion: Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative.Item Metadata only Non-invasive evaluation of voiding function in asymptomatic primary school children(Springer, 2008-07) Akpınar, Burcu; Gürocak, Serhat; Akata, Deniz; Bakkaloğlu, Mehmet; Tekgül, Serdar; Doğan, Hasan Serkan; Uludağ Üniversitesi/Tıp Fakültesi/Üroloji Anabilim Dalı.; ABH-5513-2020; 7005856022This study aimed to evaluate the voiding characteristics of primary school children by using questionnaires and non-invasive diagnostic tools. The voiding characteristics of 212 healthy children in two primary schools were evaluated with ultrasound for bladder wall thickness (BWT) in association with the Pediatric Lower Urinary Tract Symptom Score (PLUTSS), familial questionnaire, uroflowmetry (UF) and urinalysis. Most of the children (70%) had achieved urinary and fecal continence between the ages of 18 months and 36 months. Twenty-five per cent of heathy children void fewer than four times or more than seven times per day. Ninety percent of children had a PLUTSS within normal ranges (< 9). Fifteen percent of patients had a uroflowmetric pattern other than bell-shaped. The peak and average flow rates were higher in girls. Enuresis nocturna was detected in 10% of children. None of the children had documented urinary tract infection. The average BWT from posterior wall at full bladder in healthy children was 1.1 mm. The anterior and posterior BWT measurements before and after micturition were found to be thicker in boys. Regarding the UF pattern, in post-voiding measurements in children with abnormal UF pattern, the bladder walls were thicker. Non-invasive tests in non-symptomatic children showed a range of variability, and these deviations should be kept in mind during the evaluation of voiding characteristics of a child. The symptom scoring system, with the high sensitivity and specificity rates it possesses, is one of the promising tools for this purpose.Item Open Access Pathological complete response after neoadjuvant/induction treatment: Where is its place in the lung cancer staging system?(Oxford University Press, 2019-01-30) Melek, Hüseyin; Çetinkaya, Gamze; Özer, Erhan; Yentürk, Eylem; Sevinç, Tolga Evrim; Bayram, Ahmet Sami; Gebitekin, Cengiz; Bursa Uludağ ÜniversitesiTıp Fakültesi/Cerrahi Tıp Bilimleri/Göğüs Cerrahisi Bölümü.; 0000-0003-0684-0900; 0000-0003-1822-8153; ABB-7580-2020; AAE-1069-2022; AAI-5039-2021; 9639938400; 56404505600; 57210821941; 57210816877; 57208345597; 8347194000; 6602156436OBJECTIVES: Prognosis for patients with non-small-cell lung cancer (NSCLC) who, after neoadjuvant/induction and surgery, have a pathological complete response (pCR) is expected to be improved. However, the place of the pCR patients in the context of the tumour, lymph node and metastasis (TNM) staging system is still not defined. The aim of this study is to investigate the long-term survival of NSCLC patients with pCR and to find their appropriate staging category within the TNM staging system. METHODS: We retrospectively reviewed the prospectively recorded data of 1076 patients undergoing surgery (segmentectomy or more) for NSCLC between 1996 and 2016. Patients were divided into 2 groups. Group 1: clinical early-stage patients who underwent direct surgical resection (n = 660); group 2: patients who received neoadjuvant/induction treatment before surgical resection for locally advanced NSCLC (n = 416). Morbidity, mortality, survival rates and prognostic factors were analysed and compared. RESULTS: Postoperative histopathological evaluation revealed pCR in 72 (17%) patients in group 2. Overall 5-year survival was 58.7% (group 1 = 62.3%, group 2 = 52.8%, P = 0.001). Of note, 5-year survival was 72.2% for pCRs. In addition, 5-year survival for stage 1a disease was 82.6% in group 1 and 63.2% in group 2 ( P = 0.008); 70.3% in group 1 and 60.5% in group 2 for stage 1b (P = 0.08). Patients with stage II had a 5-year survival of 53.9% in group 1 and 51.1% in group 2 (P = 0.36). CONCLUSIONS: This study shows that patients with locally advanced NSCLC developing a pCR after neoadjuvant/induction treatment have the best long-term survival and survival similar that of to stage Ib patients.Item Metadata only Tear function and ocular surface changes with topical mitomycin (MMC) treatment for primary corneal intraepithelial neoplasia(Lippincott Williams & Wilkins, 2003-10) Shimazaki, Jun; Tsubota, Kazuo; Gül, Murat; Doǧru, Murat; Ertürk, Haluk; Uludağ Üniversitesi/Tıp Fakültesi/Göz Hastalıkları Anabilim Dalı.; 7006540932; 7003716972Purpose: To evaluate the tear function and ocular surface alterations in patients with primary CIN before and after treatment with topical mitomycin (MMC). Patients and Methods. We describe seven patients with unilateral CIN treated with 0.04% topical MMC three times daily until full eradication of the lesion. The patients underwent tear and ocular surface examinations including Cochet-Bonnet corneal sensitivity measurements, tear film break-up time (BUT), Schirmer test, and Rose-Bengal staining before, at the time of resolution of the CIN, and at the final follow-up. Conjunctival impression cytology was performed before treatment and at the last visit. Results: The mean pretreatment corneal sensitivity was 30.3 +/- 7.4 nun and improved to 55 +/- 5 mm at the final visit (P < 0.05). There were no aqueous-deficient eyes. The BUT values and Rose-Bengal staining scores also showed significant improvement at the last follow-up compared with the pretreatment values (P < 0.05). initial impression cytology specimens showed goblet cell loss, higher grades of squamous metaplasia, areas of isolated keratinized, binucleated, and actively mitotic disfigured epithelial cells in all patients. The mean goblet cell density and squamous metaplasia grade were observed to improve significantly at the last visit (P < 0.05). MMC-induced cytologic changes were seen to persist long after cessation of treatment in some patients. All eyes remained free of recurrence and complications during the follow-up period. Conclusion: We found 0.04% topical MMC treatment tid until full eradication to be effective in the management of CIN. The ocular surface disease of CIN was characterized by disturbance of tear film stability, goblet cell loss, and increased squamous metaplasia in all patients. impression cytology proved useful in attaining the diagnosis of CIN, evaluating the effect of treatment, and showing MMC-related long-term changes on the ocular surface.