Publications by authors named "Atilla Elhan"

140 Publications

Does the power of the laser devices matter for a successful HoLEP procedure? A prospective comparative study.

Int J Clin Pract 2021 Jun 15:e14531. Epub 2021 Jun 15.

Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.

Background: The objectives of this prospective study were to evaluate the efficiency, safety and applicability of medium-power (MP) holmium laser devices in the endoscopic enucleation of the enlarged prostate (HoLEP) compared with high-power (HP) laser devices.

Methods: From October 2019 to July 2020, a total of 120 consecutive patients planned for HoLEP were divided randomly into two groups formed in terms of the power of the device used. While patients in group 1 were treated with a MP device (50 W) at 39.6 W (2.2 J/18 Hz), patients in group 2 were treated with HP (100 W) device at 42 W (1.2 J/35 Hz). Preoperative patient characteristics, perioperative measures and 3-month functional outcomes were evaluated in both groups with an emphasis on enucleation efficiency (EE) and haemoglobin decrease in a comparative manner.

Results: All patients underwent successful HoLEP surgery with no severe perioperative and postoperative complications. No statistically significant differences were observed in terms of preoperative patient characteristics and perioperative measures in the two groups. The median EE values in groups 1 and 2 were 1.15 (interquartile range [IQR]: 0.33-2.2) and 1.11 (IQR: 0.4-2.8), respectively (P = .775). Haemoglobin decrease values in groups 1 and 2 were 1.3 (IQR: 0.1-4) and 1.4 (IQR: 0.4-3.1), respectively (P = .736). There was no difference in terms of either catheterisation time or hospital stay in the groups. In the model created to predict haemoglobin decrease, only biopsy was detected to be the independent predictive factor among the data from laser device, biopsy and antithrombotic use. Functional outcomes markedly improved in all patients without any statistically significant difference between the groups in the 3-month follow-up.

Conclusion: Our comparative study indicated that HoLEP can be performed safely and effectively with MP laser devices without any technical difficulties and with comparable results achieved in HP laser devices.
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http://dx.doi.org/10.1111/ijcp.14531DOI Listing
June 2021

A comparison of the fusion model of deep learning neural networks with human observation for lung nodule detection and classification.

Br J Radiol 2021 Jul 11;94(1123):20210222. Epub 2021 Jun 11.

Department of Thoracic Surgery, School of Medicine, Ankara University, Ankara, Turkey.

Objectives: To compare the diagnostic performance of a newly developed artificial intelligence (AI) algorithm derived from the fusion of convolution neural networks (CNN) versus human observers in the estimation of malignancy risk in pulmonary nodules.

Methods: The study population consists of 158 nodules from 158 patients. All nodules (81 benign and 77 malignant) were determined to be malignant or benign by a radiologist based on pathologic assessment and/or follow-up imaging. Two radiologists and an AI platform analyzed the nodules based on the Lung-RADS classification. The two observers also noted the size, location, and morphologic features of the nodules. An intraclass correlation coefficient was calculated for both observers and the AI; ROC curve analysis was performed to determine diagnostic performances.

Results: Nodule size, presence of spiculation, and presence of fat were significantly different between the malignant and benign nodules ( < 0.001, for all three). Eighteen (11.3%) nodules were not detected and analyzed by the AI. Observer 1, observer 2, and the AI had an AUC of 0.917 ± 0.023, 0.870 ± 0.033, and 0.790 ± 0.037 in the ROC analysis of malignity probability, respectively. The observers were in almost perfect agreement for localization, nodule size, and lung-RADS classification [κ (95% CI)=0.984 (0.961-1.000), 0.978 (0.970-0.984), and 0.924 (0.878-0.970), respectively].

Conclusion: The performance of the fusion AI algorithm in estimating the risk of malignancy was slightly lower than the performance of the observers. Fusion AI algorithms might be applied in an assisting role, especially for inexperienced radiologists.

Advances In Knowledge: In this study, we proposed a fusion model using four state-of-art object detectors for lung nodule detection and discrimination. The use of fusion of deep learning neural networks might be used in a supportive role for radiologists when interpreting lung nodule discrimination.
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http://dx.doi.org/10.1259/bjr.20210222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248221PMC
July 2021

Prognostic implications of visceral obesity on gastric adenocarcinoma: does it really matter?

Clin Imaging 2021 Aug 14;76:228-234. Epub 2021 Apr 14.

Ankara University, School of Medicine, Department of Biostatistics, Talatpaşa Bulvarı, Sıhhiye, 06100 Ankara, Turkey.

Purpose: To evaluate the association of visceral adiposity measured on computed tomography (CT) in preoperative period with lymph node (LN) metastasis and overall survival in gastric adenocarcinoma patients.

Methods: Preoperative CT scans of 246 gastric adenocarcinoma patients who did not receive neoadjuvant chemoradiotherapy were evaluated. Visceral fat area (VFA), subcutaneous fat area (SFA) and Total fat area (TFA), VFA/TFA ratio were quantified by CT. VFA/TFA > 29% was defined as visceral obesity. The differentiation, t-stage, n-stage and the number of harvested-metastatic LNs were noted. The maximum thickness of tumor and localization were recorded from CT. Chi-square, Student's t-test, multiple Cox regression, Spearman's correlation coefficient, and Kaplan-Meier algorithm were performed.

Results: The overall survival (OS) rates and N-stage were not different significantly between viscerally obese and non-obese group (p = 0.994, p = 0.325). The number of metastatic LNs were weakly inversely correlated with VFA (r = -0.144, p = 0.024). Univariate analysis revealed no significant association between visceral obesity and OS or LN metastasis (p = 0.377, p = 0.736). In multivariate analyses, OS was significantly associated with poorly differentiation (HR = 1.72, 95% CI =1.04-2.84, p = 0.035), higher pathologic T and N stage (T4 vs T1 + T2 HR = 2.67, 95% CI =1.18-6.04, p = 0.019; T3 vs T1 + T2 HR = 1.98, 95% CI = 0.90-4.33, p = 0.089; N3b vs N0 HR = 2.97, 95% CI1.45-6.0, p = 0.003; N3 (3a+ 3b) vs N0 HR = 2.24 95% CI =1.15-4.36, p = 0.018).

Conclusion: Visceral obesity may not be a prognostic factor in resectable gastric adenocarcinoma patients.
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http://dx.doi.org/10.1016/j.clinimag.2021.03.035DOI Listing
August 2021

Does extracorporeal shock wave therapy decrease spasticity of ankle plantar flexor muscles in patients with stroke: A randomized controlled trial.

Clin Rehabil 2021 Apr 28:2692155211011320. Epub 2021 Apr 28.

Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey.

Objective: To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle.

Design: Randomized controlled trial.

Setting: Inpatient neuro-rehabilitation clinic of a university hospital.

Participants: Stroke patients with ankle flexor spasticity.

Interventions: Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation.

Main Measures: The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up.

Results: Fifty-one participants were enrolled (active therapy  = 17, sham  = 17, control  = 17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47 ± 0.72 to 1.41 ± 0.62) compared to sham (from 2.19 ± 1.05 to 2.06 ± 1.12) and control (from 2.06 ± 0.85 to 2.00 ± 0.73) groups immediately after the treatment ( < 0.001). Tardieu results were also in concordance ( < 0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index ( < 0.001). However, there was no difference among the groups in terms of improvement in elastography.

Conclusion: Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.
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http://dx.doi.org/10.1177/02692155211011320DOI Listing
April 2021

Elastography and Doppler May Bring a New Perspective to TIRADS, Altering Conventional Ultrasonography Dominance.

Acad Radiol 2021 Mar 13. Epub 2021 Mar 13.

Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey.

Rationale And Objectives: The main aim of ultrasonography (US) examining thyroid nodules is to differentiate malignant nodules from benign nodules. Several professional societies and groups of investigators have defined guidelines such as Thyroid Imaging Reporting and Data System (TIRADS) to provide the standardized language and approach to thyroid nodules. This study is aimed to investigate the compatibility of such classification systems with the pathological diagnosis of nodules and evaluate the contribution of the Shear-wave elastography (SWE) and Doppler ultrasonography (DUS) findings.

Materials And Methods: This is a prospective study. Patients with thyroid US exams between December 2017 and April 2019 were included. In the study, eligible 210 nodules from 210 patients were enrolled. For stratification, the conventional B-mode US, SWE and DUS were performed. According to Kwak, American College of Radiology (ACR), and European (EU)-TIRADS, Nodules were classified separately, and a new scoring system whose the criteria was put defined in the study has developed.

Results: For SWE; Emean cut-off value was 33 kPa with a sensitivity and specificity of 95,6% (95% CI: 0,85-0,98) and 95% (95% CI:0,90-0,97) respectively (p <0.001). For spectral DUS; resistivity index (RI) cut-off value was 0.64 with a sensitivity and specificity of 73,3% (95% CI:0,59-0,83) and 80% (95% CI:0,73-0,85) respectively (p <0.001). Kwak TIRADS, American College of Radiology TIRADS, EU-TIRADS, and new system were compared by ROC curve analysis. The new system has the highest sensitivity, specificity, PPV, NPV, accuracy, and AUC compared to others.

Conclusions: The new scoring system has shown that SWE and DUS findings may alter the categorization in TIRADS and increase sensitivity and specificity.
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http://dx.doi.org/10.1016/j.acra.2021.02.011DOI Listing
March 2021

Evaluation of the early cervical structural change in patients with non-radiographic axial spondyloarthropathy.

Rheumatol Int 2021 Mar 6. Epub 2021 Mar 6.

Department of Biostatistics, Ankara University School of Medicine, Çankaya, Ankara, Turkey.

In this double-blind, controlled, cross-sectional study, we compared structural changes in the cervical vertebrae of patients with nonradiographic axial spondyloarthropathy (nr-axSpA), patients with ankylosing spondylitis (AS), and a control group. We used the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) to determine whether the involvement of the cervical spine occurs earlier and is more severe than that of the lumbar spine in axial spondyloarthropathy (axSpA). A statistically significant difference was found in the total mSASSS between the AS and nr-axSpA groups (p = 0.038), but not in the cervical and lumbar mSASSS. Although the duration of the symptoms was shorter in the nr-axSpA group than in the AS group, no statistically significant difference was found in the cervical mSASSS between the AS and nr-axSpA groups. In both the AS and nr-axSpA groups, the cervical mSASSS values were found to be higher than the lumbar mSASSS values for the majority of the patients (82.8 and 89.5%, respectively). This may indicate that structural changes in the cervical spine occur during an early period of axSpA.
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http://dx.doi.org/10.1007/s00296-021-04807-5DOI Listing
March 2021

Natural History of Cirrhosis: Changing Trends in Etiology Over the Years.

Dig Dis 2021 3;39(4):358-365. Epub 2020 Nov 3.

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.

Background And Goals: The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis.

Methods: Between January 2001 and January 2018, a total of 1,341 patients had been diagnosed with cirrhosis and were included.

Results: A total of 898 cirrhotic patients, who were followed up for at least 6 months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have nonalcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8 to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p < 0.001), male gender (p < 0.001), viral etiology (p = 0.026), and baseline high aspartate aminotransferase level (p = 0.01). Overall, 104 cirrhotic patients died.

Conclusion: HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized as a growing burden.
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http://dx.doi.org/10.1159/000512746DOI Listing
July 2021

The Greulich-Pyle and Gilsanz-Ratib atlas method versus automated estimation tool for bone age: a multi-observer agreement study.

Jpn J Radiol 2021 Mar 16;39(3):267-272. Epub 2020 Oct 16.

Clinic of Pediatric Radiology, UCSF Benioff Children's Hospital, Oakland, CA, USA.

Purpose: To evaluate the agreement between observers using Greulich-Pyle (GP) and Gilsanz-Ratib (GR) methods, between four specialities (radiology, pediatrics, pediatric endocrinology and pediatric radiology) and between observers and automated tool in the bone age estimation.

Materials And Methods: A total of 99 observers participated in this questionnaire-based study. BoneXpert was used for the automated tool. Experienced, senior, and junior observers were defined by their experience, and the bone age determined by experienced observers was regarded as the ground truth. Agreement between observers was evaluated using the coefficient of variance (CV) and intraclass correlation coefficient (ICC), and they were reevaluated after adding BoneXpert to the observers. Agreement of BoneXpert, the senior, and the junior observers was also evaluated using the root-mean-square-error (RMSE) values and Blant Altman method by comparing with the ground truth.

Results: The CV ranged from 4.98% to 22.08%. The ICC were 0.980 for GP, 0.980 for GP and BoneXpert, 0.973 for GR, and 0.976 for GR and BoneXpert, and the ICC between four specialities ranged form 0.963 to 0.990. BoneXpert tool had the lowest RMSE values (0.504 years for GP atlas).

Conclusion: Automated bone age estimation showed comparable results with GP and GR methods and its utilization may decrease inter-observer variability.
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http://dx.doi.org/10.1007/s11604-020-01055-8DOI Listing
March 2021

Cross-diagnostic scale-banking using rasch analysis: Developing a common reference metric for generic and health condition-specific scales in people with rheumatoid arthritis and stroke.

J Rehabil Med 2020 Oct 1;52(10):jrm00107. Epub 2020 Oct 1.

Objectives: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions.

Design: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ) and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model.

Participants: Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke.

Results: Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created.

Conclusion: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0).
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http://dx.doi.org/10.2340/16501977-2736DOI Listing
October 2020

Diagnostic Accuracy of Mapping Techniques and Postprocessing Methods for Acute Myocarditis.

AJR Am J Roentgenol 2020 07 14;215(1):105-115. Epub 2020 Apr 14.

Department of Radiology, Ankara University School of Medicine, Adnan Saygun St, No 35, 06100 Ankara, Turkey.

Many T1 mapping sequences and measurement methods have been reported in the literature. To obtain accurate results, the most appropriate T1 and T2 mapping sequences and postprocessing methods should be used. The aim of the present study is to compare the T1 and T2 mapping sequences and measurement methods used to diagnose acute myocarditis. Fourteen patients with an interval of 7 days or less between symptom onset and MRI examination were included in the study. The control group consisted of 22 healthy individuals. T1 mapping images acquired using four different methods (modified Look-Locker inversion recovery [MOLLI] 3[3]3[3]5, MOLLI 3[2]3[2]5, MOLLI 5[3]3 heart rate-corrected, and MOLLI 5[3]3 heart rate-uncorrected sequences) and T2 mapping images obtained using two different methods (FLASH and true fast imaging with steady-state precession) in the area from the short axis through the basal slice were retrospectively evaluated. The mean T1 and T2 values were significantly higher in the patient group than in the control group for all sequences in SAX measurements and segmental measurements (segments 1, 4, 5, and 6). Measurements from segments 2 and 3 were not statistically significant between patient and control groups. The segment with the highest AUC value of T1 and T2 mapping values was the inferior segment, followed by the inferolateral segment. The highest diagnostic performance for short-axis measurements was obtained using the MOLLI 3(2)3(2)5 sequence (AUC value = 0.902). According to the results of this study and many other studies, pathologic changes in the myocardium can be detected by native T1 and T2 mapping. The accuracy of mapping methods will increase with increased knowledge of the advantages and disadvantages of currently used sequences and measurement methods.
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http://dx.doi.org/10.2214/AJR.19.22028DOI Listing
July 2020

Prediction of degree of carotid stenosis with the transluminal attenuation difference ratio.

Diagn Interv Radiol 2020 May;26(3):249-254

Department of Radiology, Ankara University School of Medicine, Ankara, Turkey.

Purpose: We aimed to assess the diagnostic performance of transluminal attenuation difference (TAD) in predicting the severity of internal carotid artery (ICA) stenosis.

Methods: The study cohort consisted of 48 patients with <50% stenosis, 50%-69% stenosis, 70%-99% stenosis, and 51 controls without plaque development in ICA. A total of 143 measurements were performed through right and left internal and common carotid arteries. The TAD ratio was calculated as the difference between the mean attenuation values of the common carotid artery (CCA) and ICA, divided by the MAV of the CCA, multiplied by 100.

Results: TAD ratio was significantly higher in severe (>70%) stenosis compared with control arteries and low-moderate stenosis. A TAD ratio cutoff of 4.5 predicted 70%-99% stenosis with a sensitivity of 100% and specificity of 93%. The inter- and intraobserver agreements in TAD measurements were almost perfect (ICC, 0.89-0.86).

Conclusion: Assessment of TAD ratio predicts the degree of stenosis in concordance with NASCET system.
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http://dx.doi.org/10.5152/dir.2019.19259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239356PMC
May 2020

Clinical characteristics and outcome of childhood vesicoureteral reflux.

Arch Argent Pediatr 2020 02;118(1):e16-e21

Ankara University School of Medicine, Department of Pediatrics, Division of Nephrology.

Introduction: The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade.

Population And Methods: Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted.

Results: Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05).

Conclusions: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.
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http://dx.doi.org/10.5546/aap.2020.eng.e16DOI Listing
February 2020

Can we differentiate histologic subtypes of neuroendocrine tumour liver metastases at a single phase contrast-enhanced CT-correlation with Ga-68 DOTATATE PET/CT findings.

Br J Radiol 2020 Feb 16;93(1106):20190735. Epub 2020 Jan 16.

Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.

Objective: To assess the usefulness of a single-phase contrast-enhanced CT to differentiate subtypes of neuroendocrine tumour (NET) liver metastases and to evaluate the correlation between CT features and Ga-68 DOTATATE positron emission tomography/CT (PET/CT) findings.

Methods: Between December 2017 and April 2019 patients with liver metastases of neuroendocrine tumours who underwent CT and Ga-68 DOTATATE PET/CT were enrolled in the study. All patients involved in the study had undergone a standardised single-phase contrast-enhanced CT. Whole body PET/CT images were obtained with a combined PET/CT scanner. All CT images were retrospectively analysed by two radiologists. Enhancement patterns of lesions were assessed. For quantitative examination; CT attenuation values of metastatic lesions, liver parenchyma and aorta were measured using a freehand ROI and tumour-to-liver ratio [T-L = (Tumour-Liver) / Liver] and tumour-to-aorta ratio [T-A = (Tumour-Aorta) / Aorta] were calculated. The lesion with the highest Ga-68 DOTATATE uptake in the liver was used for calculations. The metabolic tumour volume (MTV), maximum standardised uptake value (SUV ) and SUV were calculated for the target liver lesion.

Results: A total of 137 NET liver metastases divided into in three groups: 49 (35.7%) pancreatic, 60 (44.5%) gastroenteric and 26 (18.9%) lung NET liver metastases were analysed. Gastroenteric NET metastases often showed heterogeneous enhancement which was significantly higher than in the pancreas and lung NET liver metastases ( < 0.001). 96.72% ( = 59) of the gastroenteric NET liver metastases were hypoattenuating whereas the most frequent presentation for the pancreatic group was hyperattenuation (63.26%, = 31). The difference in enhancement patterns of the liver metastases was statistically significant ( < 0.001) with respect to the location of the primary tumour. For quantitative analysis; tumour CT values were significantly different between the groups ( < 0.001). The T-L ratio was statistically different between gastroenteric and pancreatic NET liver metastases and pancreatic and lung NET groups ( < 0.001). The T-A ratio was significantly higher in the pancreatic NET metastases ( < 0.001). SUV, SUV and MTV values, however, were not significantly different between the subgroups. There was a weak positive correlation between T-L ratio and SUV values.

Conclusion: We noticed statistically significant differences in both qualitative and quantitative CT features between histologic subgroups of neuroendocrine tumour liver metastases at a single phase contrast-enhanced CT.

Advances In Knowledge: Our study will be the first in the literature which extensively focus on assessing the CT features of liver metastases of NETs at a single phase CT and Ga-68DOTATATE PET/CT. As the different histological subtypes of NET liver metastases exhibit different clinical outcomes, these features might help to identify the primary tumour to provide optimal treatment.
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http://dx.doi.org/10.1259/bjr.20190735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055452PMC
February 2020

Evaluation of Extramural Venous Invasion by Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography in Rectal Adenocarcinoma.

Can Assoc Radiol J 2019 Nov 30;70(4):457-465. Epub 2019 Sep 30.

Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey.

Purpose: The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma.

Materials And Methods: Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI.

Results: Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger (P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10 mm/s vs 1.026 ± 0.246 × 10 mm/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10 mm/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients (P < .001).

Conclusion: The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.
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http://dx.doi.org/10.1016/j.carj.2019.06.006DOI Listing
November 2019

Is There a Correlation with Pre-donation Kidney Volume and Renal Function in the Renal Transplant Recipient?: A Volumetric Computed Tomography Study.

Transplant Proc 2019 Sep 7;51(7):2312-2317. Epub 2019 Aug 7.

Department of General Surgery, Ankara University Medical School, Ankara, Turkey.

Purpose: The aim of this study is to determine the correlation between the predonation computed tomography (CT)-based calculated kidney volume and post-transplant renal function in recipients of renal transplants and to compare two different CT techniques.

Material And Methods: The study group is comprised of 55 paired living kidney donor-recipients transplants. The total parenchymal renal volumes were calculated by using two CT-based techniques (3-dimensional renal volume [3DRV] and voxel-based volume calculation). Post-transplant creatinine and estimated glomerular filtration rate (eGFR) levels for the recipients at hospital discharge and sixth month were obtained. We tested the association with eGFR and creatinine by adjusting the renal volume to body weight and body mass index. For the creatinine levels above 1.5 mg/dL at discharge, a threshold value for renal volume-to-weight ratio on receiver operating characteristic curve (ROC) analysis and odds ratio (OR) were calculated.

Results: The renal volumes adjusted to weight were found to be moderately correlated with eGFR and creatinine levels at discharge (r = 0.51 and r = -0.54 for voxel-based calculation; r = 0.52 and r = -0.52 for 3DRV calculation, P < .001, respectively) and at sixth month (r = 0.55 and r = -0.58 for voxel-based calculation; r = 0.51 and r = -0.54 for 3DRV calculation, P < .001 respectively). A threshold value of 1.84 mL/kg was calculated for parenchymal volume-to-recipient weight ratio on ROC analysis (AUC±SE, 0.760 ± 0.078, P = .008). The likelihood of creatinine elevation above 1.5 mg/dL was found to be nine times greater for smaller renal volume-to-recipient weight ratios (OR = 9.6; 95% CI, 1.8-50.6) CONCLUSIONS: Predonation renal volume adjusted to recipient weight may estimate the renal function at discharge and 6 months after transplantation.
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http://dx.doi.org/10.1016/j.transproceed.2019.02.039DOI Listing
September 2019

Risk Factors for Predicting Osteoporosis in Patients Who Receive Thyrotropin Suppressive Levothyroxine Treatment for Differentiated Thyroid Carcinoma

Mol Imaging Radionucl Ther 2019 Jun;28(2):69-75

Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey

Objectives: Endogenous hyperthyroidism accelerates bone and shortens the normal bone cycle, which results in reduced bone density. It is estimated that suppressive levothyroxine (LT4) therapy also decreases bone density. The aim of this study was to define risk factors for osteoporosis development in patients under thyrotropin-stimulating hormone (TSH) suppressive treatment for differentiated thyroid cancer (DTC).

Methods: Patients with a diagnosis of low or intermediate risk group DTC according to the American Thyroid Association 2015 guidelines and who have been receiving LT4 suppression therapy and were physically fit to undergo femur and lumbar vertebra bone density study were included in the study. Patients lacking information on demographic data, medical history, preoperative thyroid hormone status, or routine follow-up data were excluded from the study. A study form consisting of patient information on possible risk factors for osteoporosis such as gender, age, menopausal status, smoking, family history of osteoporosis, preoperative thyroid hormone status, postoperative hypoparathyroidism history, mean serum TSH levels, and duration of TSH suppression was created and filled out for each participant. Bone mineral densitometries of the femur and lumbar vertebrae were measured along with serum vitamin D and parathyroid hormone levels.

Results: During TSH suppression (mean 7.2±4.5 years, range: 1-26), osteoporosis was detected in 89 (9.6%) patients. The mean time to develop osteoporosis was significantly different in patients with or without a family history of osteoporosis (15.3±0.4 versus 20.3±0.6 years; p=0.002). Similarly, the mean time to develop osteoporosis for was found to be significantly shorter in postmenopausal patients than that for premenopausal women (18.6±0.7 versus 20.4±0.4 years; p<0.001). Male gender (p<0.001), a family history of osteoporosis (p=0.001) and menopausal state (p<0.001) were identified as independent predictive factors for developing osteoporosis.

Conclusion: Postmenopausal women, men, and patients with a family history who receive TSH-suppression treatment have a tendency to develop osteoporosis.
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http://dx.doi.org/10.4274/mirt.galenos.2019.89410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592313PMC
June 2019

Clinical Features and HSCT Outcome for SCID in Turkey.

J Clin Immunol 2019 04 28;39(3):316-323. Epub 2019 Mar 28.

Department of Pediatric Immunology, Hacettepe University Medical School, Ankara, Turkey.

Severe combined immunodeficiency (SCID) is the most serious PID, characterized by T cell lymphopenia and lack of antigen-specific T cell and B cell immune responses, inevitably leading to death within the first year of life if hematopoietic stem cell transplantation (HSCT) is not performed.

Purpose And Methods: Since SCID is a common type of PID with an estimated incidence of 1/10.000 in Turkey, a retrospective analysis of HSCT characteristics, survival, immune recovery, and the major clinical features of SCID prior to HSCT is the aim of this multi-transplant center-based analysis.

Results: A total of 234 SCID patients transplanted between the years 1994 and 2014 were included in the study. Median age at diagnosis was 5 months, at transplantation, 7 months, B- phenotype and RAGs were the most common defects among others. Immune phenotype did not seem to have an effect on survival rate (p > 0.05), Immunoglobulin (Ig) requirement following HSCT did not differ between B+ and B- phenotypes (p > 0.05). Overall survival rate was 65.7% over a period of 20 years. It increased from 54% (1994-2004) to 69% (p = 0.052) during the last 10 years (2005-2014). Ten-year survival after HSCT has improved over time although the difference was not significant. Infection at the time of transplantation (p = 0.006), mismatched related donor (MMRD) (haploidentical parents), and matched unrelated donor (MUD) donor transplants p < 0.001 were the most important factors, significantly affecting the outcome.

Conclusions: This is the first multicenter study with the largest data obtained from transplanted SCID patients in Turkey. Early diagnosis with newborn screening (NBS) together with emerging referrals, treatment by transplantation centers, and specialized teams are mandatory in countries with high parental consanguinity such as Turkey.
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http://dx.doi.org/10.1007/s10875-019-00610-xDOI Listing
April 2019

Liver metastases of neuroendocrine tumors: is it possible to diagnose different histologic subtypes depending on multiphasic CT features?

Abdom Radiol (NY) 2019 06;44(6):2147-2155

Department of Radiology, Ankara University School of Medicine, 06100, Ankara, Turkey.

Purpose: To assess and compare the multiphasic computed tomography (CT) features of neuroendocrine tumor (NET) liver metastases and to investigate the possibility to predict the histologic subtype of the primary tumor.

Materials And Methods: Between January 2013 and December 2017 patients with biopsy proven NET with at least one liver metastasis who underwent multiphasic CT were enrolled in this study. All cases were acquired using a standardized multiphasic liver CT protocol, arterial, portal, and hepatic venous phases were obtained. Images were retrospectively analyzed in consensus by two abdominal radiologists blinded to clinical data and histologic subtype. The size, number, and location of lesions were noted. Enhancement patterns of each lesion on arterial, portal, and hepatic venous phases were assessed. For quantitative analysis, CT attenuation of tumors, liver parenchyma, and aorta were measured using a circular region of interest (ROI) on arterial, portal, and hepatic venous phases for reflecting the blood supply of the tumor. Tumor-to-aorta and tumor-to-liver ratio were calculated in all three phases. Differences between subtypes of NET liver metastases were studied using ROC analysis of clustered data.

Results: A total of 255 neuroendocrine tumor liver metastases divided into 101 (39.6%) pancreatic, 60 (23.5%) gastroenteric and 94 (36.8%) lung NET liver metastases were analyzed. Contrast enhancement of lesions was homogeneous in 78% of patients (n = 199), which was significantly more frequent in patients with pancreatic group than in those with gastroenteric origin (n = 90, 89.1% vs. n = 28, 46.7%; p < 0.001). Gastroenteric NET metastases frequently showed heterogeneous enhancement, which was significantly higher than in the other two groups (50% vs. 3% and 2%). With respect to the location of the primary tumor, the difference in enhancement patterns of the liver lesions was statistically significant (p < 0.001). Pancreatic NET metastases were mostly hyperdense on arterial images and isodense on portal and hepatic venous phase images (79.2%, n = 80). Gastroenteric NET metastases were mostly hyperdense on arterial phase images and hypodense on portal and hepatic venous phase images (n = 28, 46.7%). The most frequent pattern for lung NET metastases was hypoattenuation on all three phase images (n = 44, 46.8%). ROC analysis of clustered data revealed statistically significant differences between pancreatic NET liver metastases, gastroenteric NET liver metastases, and lung NET liver metastases in terms of tumor-to-aorta (T-A) ratio and tumor-to-liver (T-L) ratio (p < 0.001).

Conclusion: We observed statistically significant differences in multiphasic CT features (enhancement pattern, T-A ratio, and T-L ratio) between histologic subtypes of NET liver metastases. As the difference in histological subtypes of NET liver metastases results in a different prognosis and different management strategy, these CT features might help to identify the primary tumor when it is not known to ensure accurate tumor staging and to provide optimal treatment.
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http://dx.doi.org/10.1007/s00261-019-01963-yDOI Listing
June 2019

Clinical features and disease severity of Turkish FMF children carrying E148Q mutation.

J Clin Lab Anal 2019 May 4;33(4):e22852. Epub 2019 Feb 4.

Department of Pediatric Rheumatology and Nephrology, Ankara University School of Medicine, Ankara, Turkey.

Background: Familial Mediterranean fever (FMF) is the most common hereditary monogenic autoinflammatory disease caused by mutations in the MEFV gene. It is controversial whether E148Q alteration is an insignificant variant or a disease-causing mutation. The aim of this study was to evaluate the clinical features and disease severity of FMF patients carrying E148Q mutation.

Methods: Files of FMF patients were retrospectively evaluated. Patients with at least one E148Q mutation were included to the study. The clinical characteristics and disease severity of the patients who were carrying only E148Q mutation were compared with the patients who were compound heterozygous for E148Q and homozygous for M694V mutation.

Results: The study group comprised 33 patients who were homozygous or heterozygous for E148Q; 34 with compound heterozygous E148Q mutations and 86 patients who had homozygous M694V mutation. Patients who had only E148Q mutation were found to have the oldest mean age of disease onset and lowest mean disease severity score. Attack frequency and colchicine doses were lower in patients with only E148Q mutation as compared with the other two groups. The frequency of clinical findings such as fever, abdominal pain, arthralgia, and arthritis among the three groups was similar.

Conclusion: Familial Mediterranean fever patients with only E148Q mutation are presenting with late-onset and milder disease course despite having similar clinical findings as compared with patients who had other mutations. Finally, we imply that E148Q is a mutation and colchicine treatment should be given.
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http://dx.doi.org/10.1002/jcla.22852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528560PMC
May 2019

Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations.

Arch Rheumatol 2018 Sep 9;33(3):251-271. Epub 2018 Jul 9.

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey.

Patients And Methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected.

Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance.

Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.
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http://dx.doi.org/10.5606/ArchRheumatol.2018.6911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328226PMC
September 2018

Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties.

RMD Open 2018 16;4(2):e000715. Epub 2018 Dec 16.

Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Introduction: Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task.

Methods: The study included a systematic search for PROMs that have been in use over 17 years (period 2000-2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion.

Results: 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence.

Conclusion: A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.
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http://dx.doi.org/10.1136/rmdopen-2018-000715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307597PMC
December 2018

Prognostic factors for stage I lung adenocarcinoma and surgical management of subsolid nodules.

Turk Gogus Kalp Damar Cerrahisi Derg 2018 Oct 16;26(4):614-620. Epub 2018 Sep 16.

Department of Thoracic Surgery, Ankara University School of Medicine, Ankara, Turkey.

Background: This study aims to identify the prognostic factors for stage I lung adenocarcinoma and to evaluate the surgical management of subsolid nodules.

Methods: The study included 133 patients (90 males, 43 females; mean age 64.9 years; range, 29 to 82 years) who had undergone operation in our clinic for stage I lung adenocarcinoma between January 2007 and December 2015. Clinical, radiological and pathological data were retrospectively evaluated and their effects on recurrence and survival were examined by Kaplan-Meier and Cox regression analyses.

Results: Comparing the histopathological tumor types according to the pathological tumors size, we determined that the prevalence of invasive adenocarcinoma significantly increased with increasing tumor size (p<0.001). For all nodules, a tumor disappearance rate lower than 25% negatively influenced disease-free survival and a maximum standardized uptake value higher than 5.6 negatively influenced overall survival (p=0.027 for both). The grouping, which was performed considering the maximum standardized uptake value 5.6 as the cut-off value, was an independent prognostic factor for overall survival (hazard ratio: 5.973, 95% confidence interval: 1.186-30.073, p=0.03). Five-year overall survival rate was statistically significantly higher in patients who underwent wedge resection or segmentectomy for subsolid nodules compared to those who underwent lobectomy (100% vs. 79.3%, p=0.044).

Conclusion: Sublobar resections can be safely performed in subsolid nodules smaller than 2 cm in diameter with tumor disappearance rate ≥25% and maximum standardized uptake value ≤5.6.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2018.15846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018191PMC
October 2018

Investigation of the frequency of iron insufficiency among infants in a population in which routine iron supplementation is implemented.

Turk J Pediatr 2018 ;60(1):22-31

Divisions of Neonatology, Ankara University Faculty of Medicine, Ankara.

Çullas-İlarslan NE, Günay F, İleri DT, Elhan AH, Ertem M, Arsan S. Investigation of the frequency of iron insufficiency among infants in a population in which routine iron supplementation is implemented. Turk J Pediatr 2018; 60: 22-31. Iron deficiency anemia (IDA) represents the most common cause of anemia worldwide. Because of potential irreversible neurodevelopmental impairment, its prevention during infancy is essential. We aimed to investigate the frequency of iron insufficiency among infants in a population which routine iron supplementation is implemented; and to examine related risks. A total of 501 infants, aged 9-15 months, were screened with complete blood count and serum ferritin. Infants were divided into two groups. [Group 1 (iron insufficient), [Group 1a: Iron deficiency (ID), Group 1b: IDA (IDA)], Group 2 (Iron sufficient (IS)]. Anemia was recognized in 122 (24.3%) infants. Microcytosis was observed in 110 (90.2%) of anemic infants. Group 2 accounted for 49.5% (n=248) whereas 152 (30.3%) and 101 (20.2%) infants belonged to Groups 1a and 1b, respectively. Multiple logistic regression analysis showed that male gender (OR=1.53; 95%CI 1.07 and 2.17), receiving > 500 ml/day cow`s milk (OR=2.77; 95%CI 0.87 and 8.83) and incompliance to iron supplementation (OR=2.51; 95%CI 1.75 and 3.60) were distinctive characteristics of Group 1 while prevalence of iron insufficiency was higher in infants consuming less formula (OR=3.10; 95%CI 2.00 and 4.80). The most frequent reasons for incompliance were consideration of supplementation as unnecessary (n=69, 31.1%) and neglection (n= 59, 26.6%). Our study demonstrated a high frequency of iron insufficiency among infants in a setting utilizing national iron supplementation and `incompliance` to iron as the most evident risk factor for iron insufficiency. Effective counseling of families by health care providers concerning importance of compliance to iron prophylaxis is essential for prevention of iron insufficiency. We also suggest screening of infants for ID as well as IDA in settings with high frequency of iron insufficiency.
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http://dx.doi.org/10.24953/turkjped.2018.01.004DOI Listing
January 2019

Analyzing differential item functioning of the Nottingham Health Profile by Mixed Rasch Model.

Turk J Phys Med Rehabil 2018 Dec 2;64(4):300-307. Epub 2018 Apr 2.

Department of Physical Medicine and Rehabilitation, Ankara University Medical School, Ankara, Turkey.

Objectives: This study aims to evaluate whether items in the Turkish version of the Nottingham Health Profile (NHP) function differently according to age, sex, and duration of pain using the Mixed Rasch Model (MRM).

Patients And Methods: The NHP data of patients with low back pain from a previous study was analyzed. To analyze differential item functioning (DIF) within the items of the NHP, the MRM was used. Age, sex, and duration of pain were considered factors which could cause DIF. The most powerful factor to define latent classes derived from the MRM was estimated using the Rasch tree method.

Results: The two-class mixture version of the nominal response model was identified as the best fitting model for the physical mobility, sleep, and social isolation sections. For the physical mobility dimension, some items showed DIF by age and for the social isolation dimension some items showed DIF by sex. For the sleep dimension, latent classes were unable to be explained by age, sex, and duration of pain. Items in other dimensions of the NHP were DIF-free and no items showed DIF according to age, sex, and duration of pain.

Conclusion: The results of this study may shed light on explaining the different response behavior of patients on the items of the NHP. Age and sex were found to be variables affecting item responses of NHP. Contrary to expectations, duration of pain did not cause DIF for any item. From the perspective of DIF, it can be concluded that NHP scale is a robust scale in terms of validity.
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http://dx.doi.org/10.5606/tftrd.2018.2796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648028PMC
December 2018

Prevalence and sonographic features of ectopic thyroidal thymus in children: A retrospective analysis.

J Clin Ultrasound 2018 Jul 25;46(6):375-379. Epub 2018 Mar 25.

Department of Pediatric Radiology, Faculty of Medicine, Ankara University, Turkey.

Purpose: To assess the prevalence of ectopic thyroidal thymus tissue detected by sonography (US) in children and to analyze the US features.

Methods: We retrospectively reviewed images of 216 children who had undergone a thyroid or neck US examination from February 2015 to June 2015. Lesions within or adjacent to the thyroid gland that showed echopatterns consistent with thymic tissue were diagnosed as ectopic thyroidal thymus tissue. Lesions were reviewed according to their side, location, level, size, shape, echo pattern, internal content, and vascularization.

Results: A total of 216 children (119 girls, 97 boys) with a mean ± SD age of 8.6 ± 5.2 years were enrolled the study.Thirty children (13girls, 17 boys) (13.9%) had 35 lesions compatible with ectopic thyroidal thymus tissue.Nine children had intrathyroidal (4.2%) and 21 children had extrathyroidal (9.7%) ectopic thymus tissue.The mean ± SD ages of the children with and without ectopic thyroidal thymus tissue were 6.0 ± 3.6 years and 9.1 ± 5.2 years, respectively (P = .002). Twenty-five of the lesions were extrathyroidal and 10 were intrathyroidal. All extrathyroidal and most (8/9) intrathyroidal ectopic thymuses had fusiform shape with well demarcated contours. Ectopic thymuses were located either in the midportion (n = 23) or lower portion of the neck (n = 12). Both extrathyroidal and intrathyroidal ectopic thymuses showed typical hypoechoic (n = 22/25, n = 9/10, respectively) or hyperechoic (n = 3/25, n = 1/10, respectively) echo patterns with internal linear and punctate echoes.

Conclusions: Ectopic thyroidal thymic tissue is common in children. Radiologists should be vigilant about the unique US features of ectopic thyroidal thymus, including a hypo- and hyper-echoic echo pattern with multiple linear and punctate echoes, a fusiform shape, well-demarcated contours, and middle or low-lying location to differentiate it from other neck or thyroid lesions.
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http://dx.doi.org/10.1002/jcu.22590DOI Listing
July 2018

Publisher Correction: Evaluation of the level of dynamic thiol/disulphide homeostasis in adolescent patients with newly diagnosed primary hypertension.

Pediatr Nephrol 2018 06;33(6):1099

Department of Biostatistics, Ankara University Medical School, Ankara, Turkey.

Owing to an error in typesetting, the name of the author Atilla Halil Elhan was rendered wrongly. The original publication has now been corrected in this respect.
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http://dx.doi.org/10.1007/s00467-018-3896-4DOI Listing
June 2018

Fatigue in pediatric patients with familial Mediterranean fever.

Mod Rheumatol 2018 Nov 2;28(6):1016-1020. Epub 2018 Feb 2.

a Department of Pediatrics, Division of Pediatric Rheumatology , Ankara University School of Medicine , Ankara , Turkey.

Objectives: Familial Mediterranean fever (FMF) is characterized by recurrent, self-limited attacks of fever with serositis involving the peritoneum, pleura and joints. Fatigue is a common problem in many pediatric rheumatic diseases; however, has not been evaluated systematically in FMF patients. Accordingly, the aim of this study was to evaluate fatigue and its possible allied factors in patients with FMF.

Methods: Patients with FMF, aged between 10 and 21 years, were assessed by completed validated fatigue questionnaire (Checklist Individual Strength-20). As a control group, patients with chronic rheumatic diseases and healthy children without any chronic disease were included.

Results: The study group comprised 111 patients with FMF, 54 with other chronic rheumatic diseases and 79 healthy subjects. While the CIS-20 total score and subscale scores (including subjective experience of fatigue) were similar between patients with FMF and those with other chronic rheumatic diseases (p > .05); both groups had significantly higher scores when compared with healthy subjects (p < .05). FMF patients with musculoskeletal complaints had significantly higher scores of subjective experiences of fatigue when compared to those without those complaints.

Conclusions: Fatigue is a common but unrecognized complaint in patients with FMF. Familial Mediterranean fever seems to be a chronic disease with inter attack ongoing complaints.
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http://dx.doi.org/10.1080/14397595.2018.1427459DOI Listing
November 2018

Evaluation of the level of dynamic thiol/disulphide homeostasis in adolescent patients with newly diagnosed primary hypertension.

Pediatr Nephrol 2018 05 2;33(5):847-853. Epub 2018 Jan 2.

Department of Biostatistics, Ankara University Medical School, Ankara, Turkey.

Background: Thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defense and detoxification. This study was designed to investigate the impact of thiol/disulfide homeostasis in adolescent patients with recently diagnosed primary hypertension (HT) using a novel and automated method.

Methods: Native thiol/disulphide levels were measured by a novel spectrophotometric method (Cobasc 501, Roche Diagnostics, Mannheim, Germany) in 30 patients with primary HT together with 30 healthy controls.

Results: The levels of native thiol, total thiol, and native thiol/total thiol ratios were significantly lower, while the disulphide level, disulphide/native thiol, and disulphide/total thiol ratios were significantly higher in patients with primary HT compared with the control group. There were significant positive correlations between 24-h mean systolic and diastolic blood pressure and disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios. A multiple linear regression model showed that a disulphide/native thiol ratio above 5 and family history of HT are independent predictors of HT.

Conclusions: Our study showed that dynamic thiol/disulphide homeostasis shifted towards disulphide formation in adolescent patients with primary HT. Understanding the role of thiol/disulfide homeostasis in primary HT might provide new therapeutic intervention strategies for patients.
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http://dx.doi.org/10.1007/s00467-017-3865-3DOI Listing
May 2018

Sonographic evaluation of the endochondral ossification process of the thyroid cartilage in children.

J Clin Ultrasound 2018 Feb 9;46(2):89-95. Epub 2017 Oct 9.

Faculty of Medicine, Department of Pediatric Radiology, Ankara University, Ankara, Turkey.

Purpose: To determine the sonographic appearances of the endochondral ossification process of the thyroid cartilage in children.

Methods: Thyroid cartilage sonography (US) of 420 children was performed with a high-resolution linear-array transducer. Right and left laminae of the thyroid cartilage, including the inferior horns, were examined. Ossification foci were evaluated for their presence, location, shape, size, echo pattern, and number.

Results: Four hundred nineteen children, 239 girls and 180 boys, were enrolled in the study with a mean age of 109.8 ± 60.7 months. Ossification foci were found in 167 children (39.9%). First ossification focus detection age was 72 months in girls and 79 months in boys. On both laminae, the most frequent appearance of the ossification focus was hypoechoic (right: 94.8%, left: 93.5%). Prevalence and number of ossification foci increased with age in each sex. The shape of the ossification foci in both laminae was generally nonexpansile (right: 92.9%, left: 93.5%).

Conclusion: Endochondral ossification process of the thyroid cartilage begins in the first decade with extracellular matrix changes, which can be detected as hypoechoic foci by US. These foci can be expansile, and radiologists should be aware of this entity to avoid misdiagnosing them as abnormal masses.
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http://dx.doi.org/10.1002/jcu.22536DOI Listing
February 2018

Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study.

Dis Colon Rectum 2017 Mar;60(3):303-310

1Department of Surgery, Ankara University, Ankara, Turkey 2Department of Biostatistics, Ankara University, Ankara, Turkey 3Department of Obstetrics and Gynecology, Dr Zekai Tahir Burak Women Health Research and Education Hospital, Ankara, Turkey.

Background: Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation.

Objective: The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders.

Design: This was a prospective and longitudinal study.

Settings: The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women's Health Research and Education Hospital between September 2008 and March 2011.

Patients: The study was performed on patients who underwent hysterectomy for benign pathologies.

Main Outcome Measures: A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years.

Results: Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4.

Limitations: Although the study had several limitations, no comparison with a control population was the most important one.

Conclusions: Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.
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http://dx.doi.org/10.1097/DCR.0000000000000786DOI Listing
March 2017