Publications by authors named "Mehmet Ozeren"

46 Publications

Can the Cell-free DNA Test Predict Placenta Accreta Spectrum or Placenta Previa Totalis?

Z Geburtshilfe Neonatol 2021 Aug 25. Epub 2021 Aug 25.

Department of Obstetrics and Gynecology, Division of Perinatology, Izmir Bakircay University Faculty of Medicine, Izmir, Turkey.

Background: Following the discovery that fetal DNA originates from the trophoblastic cells of the placenta, the contribution of the cell-free DNA test in placenta-related obstetric complications has begun to be investigated. Compared to uncomplicated pregnancies, higher fetal fractions were detected in placenta accreta spectrum and placenta previa, which are among placenta-related obstetric complications. However, this data applies only to advanced gestational weeks.

Aim: To investigate the possible predictive value of fetal fraction in cell-free DNA tests in pregnancies with placenta previa and placenta accreta spectrum in early gestational ages.

Materials And Methods: This study was conducted in women who were screened via cell-free DNA tests for common aneuploidies in the first and second trimester and subsequently diagnosed with placenta previa or placenta accreta spectrum. After the diagnosis was confirmed with a C-section, fetal fractions were retrospectively compared to a control group with a history of an uncomplicated C-section who were also previously screened by cell-free DNA test.

Results: The median and interquartile range (IQR) of fetal fractions for placenta previa (n=19), placenta accreta spectrum (n=7), and control groups (n=85) were 8.1 (6-10), 6.8 (6.7-10.7), and 7.1 (4.7-9.65), respectively. No statistically significant difference was observed among the three groups in terms of fetal fractions (p=0.587).

Conclusions: According to our data, we did not observe any relationship between placental invasion abnormalities vs. control group or placenta previa vs. control group using the fetal fractions of the cell-free DNA test. Furthermore, we could not confirm a predictive role and/or any additional clinical contribution. We believe that future studies focusing on placental mRNA might be more helpful than cell-free fetal DNA testing.
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http://dx.doi.org/10.1055/a-1579-1338DOI Listing
August 2021

PET Parameters are Useful in Predicting Endometrial Cancer Risk Classes and Prognosis.

Nuklearmedizin 2021 Feb 26;60(1):16-24. Epub 2020 Oct 26.

Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.

Aim:  We investigate the role of preoperative PET parameters to determine risk classes and prognosis of endometrial cancer (EC).

Methods:  We enrolled 81 patients with EC who underwent preoperative F-18 FDG PET/CT. PET parameters (SUV, SUV, MTV, TLG), grade, histology and size of the primary tumor, stage of the disease, the degree of myometrial invasion (MI), and the presence of lymphovascular invasion (LVI), cervical invasion (CI), distant metastasis (DM) and lymph node metastasis (LNM) were recorded. The relationship between PET parameters, clinicopathological risk factors and overall survival (OS) was evaluated.

Results:  The present study included 81 patients with EC (mean age 60). Of the total sample, 21 patients were considered low risk (endometrioid histology, stage 1A, grade 1 or 2, tumor diameter < 4 cm, and LVI negative) and 60 were deemed high risk. All of the PET parameters were higher in the presence of a high-risk state, greater tumor size, deep MI, LVI and stage 1B-4B. MTV and TLG values were higher in the patients with non-endometrioid histology, CI, grade 3 and LNM. The optimum cut-off levels for differentiating between the high and low risk patients were: 11.1 for SUV (AUC = 0.757), 6 for SUV (AUC = 0.750), 6.6 for MTV(AUC = 0.838) and 56.2 for TLG(AUC = 0.835). MTV and TLG values were found as independent prognostic factors for OS, whereas SUV and SUV values were not predictive.

Conclusions:  The PET parameters are useful in noninvasively differentiating between risk groups of EC. Furthermore, volumetric PET parameters can be predictive for OS of EC.
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http://dx.doi.org/10.1055/a-1267-8976DOI Listing
February 2021

Transabdominal ultrasonography: A non-invasive method for diagnosing vaginal atrophy.

Post Reprod Health 2020 Dec 26;26(4):220-226. Epub 2020 Apr 26.

Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey.

Objective: Genitourinary syndrome of menopause is a definition of all symptoms caused by hypoestrogenemia in menopausal age and one of the most common symptoms is vaginal atrophy. The diagnosis methods which are used for vaginal atrophy may be painful. A novel method total vaginal thickness and total mucosal thickness measuring could be determine vaginal atrophy.

Material And Methods: This is a prospective case-control study involving 60 women in each group of 120 patients. One of the groups is comprised postmenopausal, histopathologically diagnosed vaginal atrophic women and the other group comprised 24-35 aged women who were no symptoms of vaginal atrophy and vaginal swab samples are not compatible with vaginal atrophy. All women who participated in the study underwent transabdominal ultrasound and total vaginal thickness and total mucosal thickness were measured.

Results: Total vaginal thickness and total mucosal thickness were found lower in the postmenopausal group compared to premenopausal women ( = 0.005 and  = 0.07, respectively). The cutoff value was determined as 8.55 mm for total vaginal thickness and 1.52 mm for total mucosal thickness, and the diagnostic power of these values is a specificity of 88.89% (95% confidence interval: 51.75-99.72%) and a ppv of 92.86% (95% confidence interval: 66.53-98.84%) for total vaginal thickness and a specificity of 80.95% (95% confidence interval: 58.09-94.55%) and a ppv of 89.47% (95% confidence interval: 71.10-96.71%) for total mucosal thickness.

Conclusion: Vaginal atrophy is a painful symptom for menopausal women and the diagnostic methods may be invasive and painful too. Total vaginal thickness and total mucosal thickness measuring with transabdominal ultrasound could be an alternative method for diagnosis and treat vaginal atrophy easily.
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http://dx.doi.org/10.1177/2053369120921079DOI Listing
December 2020

Interseismic strain build-up on the submarine North Anatolian Fault offshore Istanbul.

Nat Commun 2019 07 8;10(1):3006. Epub 2019 Jul 8.

Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER), Département Ressources Physiques et Ecosystèmes de Fond de Mer, Unité des Géosciences Marines, Plouzané, France.

Using offshore geodetic observations, we show that a segment of the North Anatolian Fault in the central Sea of Marmara is locked and therefore accumulating strain. The strain accumulation along this fault segment was previously extrapolated from onshore observations or inferred from the absence of seismicity, but both methods could not distinguish between fully locked or fully creeping fault behavior. A network of acoustic transponders measured crustal deformation with mm-precision on the seafloor for 2.5 years and did not detect any significant fault displacement. Absence of deformation together with sparse seismicity monitored by ocean bottom seismometers indicates complete fault locking to at least 3 km depth and presumably into the crystalline basement. The slip-deficit of at least 4 m since the last known rupture in 1766 is equivalent to an earthquake of magnitude 7.1 to 7.4 in the Sea of Marmara offshore metropolitan Istanbul.
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http://dx.doi.org/10.1038/s41467-019-11016-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614505PMC
July 2019

Targeted fetal cell-free DNA screening for aneuploidies in 4,594 pregnancies: Single center study.

Mol Genet Genomic Med 2019 07 8;7(7):e00678. Epub 2019 May 8.

Perinatology Clinic, Department of Obstetrics and Gynaecology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey.

Background: Next-generation sequencing (NGS) and discovery of fetal cell-free DNA (cfDNA) in the maternal circulation render possible prenatal screening for trisomy 21 (Down syndrome), trisomy 18, trisomy 13, and sex chromosome aneuploidies. The approach is called "fetal cfDNA screening" and in contrast to noninvasive conventional serum screening, it provides the identification of 98%-99% of fetuses with Down syndrome.

Methods: Retrospective analysis of targeted noninvasive prenatal testing (NIPT) (Clarigo Test) pregnancies with moderate risk, which we have reported between 2016 and 2018 years is presented. Two separate laboratory workflows and NGS platforms are used for the same targeted NIPT analysis.

Results: In total, 4,594 pregnant women were investigated. Initial 3,594 cases are studied by MiSeq platform, the last 1,000 cases by NextSeq. Failure rate for MiSeq platform is 10.9% and for NextSeq is 8.7%. Automatically reported cases constitute 75% of the MiSeq group and 87% of the NextSeq group.

Conclusions: Targeted NIPT results suggest that MiSeq platform could be used for NIPT which would be an essential option particularly for laboratories with low sample flow. And, the NextSeq platform has easier wet lab process and also increased success rate in automatic reporting which is suitable for centers with high number of NIPT cases.
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http://dx.doi.org/10.1002/mgg3.678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625369PMC
July 2019

Modified posterior intravaginal slingplasty: does the additional bilateral tape attachment to the sacrospinous ligament improve the results?

Cent European J Urol 2018 25;71(3):326-333. Epub 2018 Jun 25.

Carpe Vitam, Center of Reconstructive Pelvic Floor Surgery, Hannover, Germany.

Introduction: High failure and recurrent prolapse remains an important issue for pelvic organ prolapse (POP) surgery. The posterior intravaginal slingplasty (PIVS) is a minimally invasive, transperineal technique providing level I support, by creating neo-sacrouterine ligaments using a mesh. In order to reduce the POP recurrence rate, achieve a safer apical support and thereby better functional outcomes, we attached PIVS tape to the sacrospinous ligament bilaterally and compared the anatomical and functional outcomes for our modified technique versus the original PIVS.

Material And Methods: We evaluated 368 patients, with a symptomatic pelvic organ prolapse in various grades, who had undergone a total pelvic floor reconstruction. Seventy-seven of 368 (21%) patients underwent the original PIVS, 291 (79%) patients were treated by the modified PIVS. When necessary, the following procedures were added: anterior transobturator mesh, posterior wall repair, perineal body repair and suburethral transobturator sling. All had follow-up checks for at least one year. The primary outcome was an objective cure, defined as grade 0 or grade 1 according to Baden-Walker. Secondary outcomes were prolapse recurrence, symptoms, visual analogue scales for satisfaction, quality of life, recommendation, reoperation rates and presence of complications.

Results: The total reconstructions we made, using each technique, were successful. We achieved an apical success rate of 97 to 96%, on average, with the modified and original IVS respectively. We found a statistically significant improvement in urge incontinence and frequency symptoms than the original PIVS with our modified technique.

Conclusions: Modified PIVS in combination with concomitant procedures generates high anatomical and functional cure rates with low complications and recurrences.
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http://dx.doi.org/10.5173/ceju.2018.1685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202626PMC
June 2018

Role of lymphadenectomy in disease-free and overall survival on low risk endometrium cancer patients.

Ginekol Pol 2018 ;89(6):311-315

Department of Obstetrics and Gynecology, Erzincan University, Turkey; Izmir Tepecik Teaching and Research Hospital, Department of Obstetrics and Gynecology, yenişehir, 35150 izmir, Turkey.

Objectives: Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer.

Material And Methods: Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, myometrial invasion < 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenec-tomy was performed in 184 cases, and not performed in 73 cases.

Results: There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histo-logic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer.

Conclusions: Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only.
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http://dx.doi.org/10.5603/GP.a2018.0053DOI Listing
November 2018

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

Turk J Med Sci 2018 Jun 14;48(3):602-610. Epub 2018 Jun 14.

Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligament fixation (SSLF), and iliococcygeus fixation due to apical prolapse. Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgery performed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeus fixations. Patients' short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed. Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in the SSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter in the iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period, no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominal sacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332). Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedures were not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-related morbidity.
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http://dx.doi.org/10.3906/sag-1712-203DOI Listing
June 2018

Identification of preterm birth in women with threatened preterm labour between 34 and 37 weeks of gestation.

J Obstet Gynaecol 2018 Jul 9;38(5):652-657. Epub 2018 Feb 9.

a Department of Obstetrics and Gynecology , Tepecik Training and Research Hospital , Izmir , Turkey.

The aim of this study was to assess whether serum markers would be useful as a new predictor of preterm birth in patients with spontaneous, late preterm labour. Patients diagnosed with late preterm labour were divided into preterm delivery (229 patients) and term delivery (178 patients) groups. The two groups were compared in terms of clinical characteristics and levels of serum markers (leukocyte subtypes, platelet, C-reactive protein [CRP], neutrophil to lymphocyte ratio [NLR] and platelet to lymphocyte ratio [PLR]), which were obtained at admission. The levels of leukocyte (p < .001), neutrophil (p < .001), CRP (p = .001), NLR (p < .001) and PLR (p = .003) were significantly higher, whereas lymphocytes (p = .012) were significantly lower in the preterm delivery group, compared to the term delivery group. On multivariate regression analysis, NLR positive was the most powerful predictive variable (OR = 1.41; 95%CI: 1.32-1.51; p = .005). NLR had the highest area under curve (0.711; 95%CI 0.662-0.760) in predicting preterm birth and a NLR >6.2 had the highest sensitivity (65.1%) and specificity (62.5%). High NLR at admission is an independent predictor of preterm birth in patients with spontaneous, late preterm labour. Impact statement What is already known on this subject: Preterm birth accounts for 5-12% of all births, and is a major factor associated with perinatal morbidity and mortality worldwide. However, more than 70% of preterm births occur at late preterm between 34 and 36 weeks of gestation. The central role of systemic and subclinical infections in preterm labour is well documented. Intrauterine infection leading to delivery can be measured by using a variety of laboratory parameters. What do the results of this study add: Neutrophil to lymphocyte ratio is an inexpensive, easily interpretable and promising haematologic parameter that is widely available. This study explored the association of high neutrophil to lymphocyte ratio with the risk of preterm birth in women with preterm labour between 34 and 37 weeks of gestation. What are the implications of these findings for clinical practice and/or further research: Neutrophil to lymphocyte ratio could be used in combination with existing markers to improve detection rates of preterm birth. Concomitant use of markers could be more powerful than measuring any of the individual markers alone.
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http://dx.doi.org/10.1080/01443615.2017.1399990DOI Listing
July 2018

MicroRNA Expression Profile in the Prenatal Amniotic Fluid Samples of Pregnant Women with Down Syndrome.

Balkan Med J 2018 03 8;35(2):163-166. Epub 2017 Dec 8.

Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey.

Background: Down syndrome, which is the most common human chromosomal anomaly that can affect people of any race and age, can be diagnosed prenatally in most cases. Prenatal diagnosis via culture method is time-consuming; thus, genetic analysis has thus been introduced and is continually being developed for rapid prenatal diagnosis. For this reason, the effective use of microRNA profiling for the rapid analysis of prenatal amniotic fluid samples for the diagnosis of Down syndrome was investigated.

Aims: To evaluate the expression levels of 14 microRNAs encoded by chromosome 21 in amniotic fluid samples and their utility for prenatal diagnosis of Down syndrome.

Study Design: Case-control study.

Methods: We performed invasive prenatal testing for 56 pregnant women; 23 carried fetuses with Down syndrome, and 33 carried fetuses with a normal karyotype. Advanced maternal age and increased risk for Down syndrome in the screening tests were indications for invasive prenatal testing. The age of gestation in the study and control groups ranged between 17 and 18 weeks. The expression levels of microRNA were measured by real-time polymerase chain reaction.

Results: The expression levels of , and were significantly higher in the study group than in the control group.

Conclusion: The presence of significantly dysregulated microRNAs may be associated with either the phenotype or the result of abnormal development. Further large-scale comparative studies conducted in a variety of conditions may bring novel insights in the field of abnormal prenatal conditions.
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http://dx.doi.org/10.4274/balkanmedj.2017.0511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863254PMC
March 2018

QF-PCR in invasive prenatal diagnosis: a single-center experience in Turkey.

Turk J Med Sci 2017 Feb 27;47(1):142-147. Epub 2017 Feb 27.

Genetic Diagnostic Center, Tepecik Training and Research Hospital, İzmir, Turkey.

Background/aim: QF-PCR has been used for more than 20 years. It is based on investigation of polymorphic short tandem repeats (STRs) and is widely used for prenatal rapid aneuploidy detection.

Materials And Methods: We report retrospectively our prenatal diagnosis results between January 2012 and May 2014 in Tepecik Training and Research Hospital Genetic Diagnostic Center. Prenatal diagnosis was recommended in 6800 high-risk pregnancies and 2883 patients agreed to invasive diagnosis. Chromosome analysis and QF-PCR were performed in all patients.

Results: Normal results were reported in 2711 cases by fetal karyotyping and in 2706 cases by QF-PCR. Anomaly detection rates were similar for the two methods (5.09% for karyotyping and 4.02% for QF-PCR).

Conclusion: QF-PCR is a fast and reliable prenatal diagnosis method in all indication groups and may be preferred as the sole prenatal investigation in patients without fetal ultrasonographic findings.
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http://dx.doi.org/10.3906/sag-1511-157DOI Listing
February 2017

Can the Myocardial Performance Index Be Used as a New Predictive Factor for a Poor Prognosis in Fetuses With Idiopathic Polyhydramnios?

J Ultrasound Med 2016 Dec 7;35(12):2649-2657. Epub 2016 Nov 7.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.

Objectives: The purpose of this study was to determine whether there are any changes in cardiac function in fetuses with idiopathic polyhydramnios and also to evaluate the value of the myocardial performance index for prediction of adverse perinatal outcomes.

Methods: A prospective case-control study was conducted with a total of 134 fetuses between 24 and 40 weeks' gestation. Polyhydramnios was defined as an amniotic fluid index of greater than 24 cm. Seventy-three fetuses of healthy mothers were assigned as the control group whereas 36 fetuses with an amniotic fluid index of 24 to 34 cm constituted the nonsevere polyhydramnios group, and 31 fetuses with an amniotic fluid index of 35 cm or greater constituted the severe polyhydramnios group. Fetal echocardiography was performed to compare cardiac function parameters among groups. To determine which perinatal outcomes were independently associated with an increased myocardial performance index, a multivariate logistic regression analysis was performed.

Results: The myocardial performance index was significantly higher in polyhydramnios groups compared with controls (P < .001). Among fetuses with polyhydramnios, the myocardial performance index was significantly higher in severe polyhydramnios compared with nonsevere polyhydramnios (P = .003). An increased myocardial performance index in polyhydramnios was independently associated with nonreassuring fetal status (odds ratio, 2.12; 95% confidence interval, 1.41-4.53; P = .005), emergency cesarean delivery (odds ratio, 1.54; 95% confidence interval, 1.12-2.37; P= .025), and respiratory distress syndrome (odds ratio, 1.79; 95% confidence interval, 1.21-3.87; P = .012).

Conclusions: An increased myocardial performance index is an early indicator of adverse perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.
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http://dx.doi.org/10.7863/ultra.15.11086DOI Listing
December 2016

Quantitative Evaluation of the Fetal Cerebellar Vermis Using the Median View on Two-Dimensional Ultrasound.

Iran J Radiol 2016 Apr 26;13(2):e34870. Epub 2016 Mar 26.

Department of Obstetrics and Gynecology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.

Background: Evaluation of the cerebellum and vermis is one of the integral parts of the fetal cranial anomaly screening.

Objectives: The aim of this study was to create a nomogram for fetal vermis measurements between 17 and 30 gestational weeks.

Patients And Methods: This prospective study was conducted on 171 volunteer pregnant women between March 2013 and December 2014. Measurements of the fetal cerebellar vermis diameters in the sagittal plane were performed by two-dimensional transabdominal ultrasonography.

Results: Optimal median planes were obtained in 117 of the cases. Vermian diameters as a function of gestational age were expressed by regression equations and the correlation coefficients were found to be highly statistically significant (P < 0.001). The normal mean (± standard deviation) for each gestational week was also defined.

Conclusion: This study presents the normal range of the two-dimensional fetal vermian measurements between 17 and 30 gestational weeks. In the absence of a three-dimensional ultrasonography, two-dimensional ultrasonography could also be used confidently with more time and effort.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037970PMC
http://dx.doi.org/10.5812/iranjradiol.34870DOI Listing
April 2016

Urinary Incontinence in Puberty: A Rare Clinical Presentation of the Herlyn-Werner-Wunderlich Syndrome.

J Pediatr Adolesc Gynecol 2016 Dec 9;29(6):e101-e103. Epub 2016 Aug 9.

Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey.

Background: We report on an unusual presentation of Herlyn-Werner-Wunderlich syndrome in two 11-year-old girls within a year of menarche. The setting was a training and research hospital.

Case: We present two patients in the pubertal period with cyclic abdominal pain and urinary incontinence who received hysteroscopic septal resection. Menstrual flow was resumed and the complaints of incontinence were eliminated after the hysteroscopic resection of the vaginal septum.

Summary And Conclusion: Overflow incontinence was completely resolved after septum resection in two patients. The risk of stricture is high in Herlyn-Werner-Wunderlich syndrome if the septum is partially excised to open the obstruction, whereas the risk of stricture is low if a complete or wide excision is performed. In the presence of abdominal pain and urinary incontinence in puberty, Herlyn-Werner-Wunderlich syndrome must be considered in the differential diagnosis, and a detailed evaluation of the urinary system and pelvic anatomy must be performed.
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http://dx.doi.org/10.1016/j.jpag.2016.07.013DOI Listing
December 2016

High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia.

Ginekol Pol 2016 ;87(6):431-5

Objectives: The aim of our study is to determine whether first-trimester neutrophil-to-lymphocyte ratio (NLR) and plate-let-to-lymphocyte ratio (PLR) would be useful as new predictors of subsequent preeclampsia.

Material And Methods: Medical records of women with preeclampsia and healthy controls from a tertiary referral center were retrospectively evaluated. The two groups were compared in terms of clinical characteristics and first-trimester levels of hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, NLR and PLR. Receiver operating characteristic curve (ROC) analysis was performed to identify the optimal NLR and PLR levels predicting preeclampsia.

Results: Neutrophil (p < 0.001), platelet (p < 0.001), NLR (p < 0.001) and PLR (p < 0.001) levels were significantly elevated, whereas hemoglobin concentration (p = 0.003) was significantly lower in the group with preeclampsia as compared to the control group. On multivariate regression analysis, NLR (OR 1.43; 95% CI 1.21-1.76; p = 0.005) and PLR (OR 1.38; 95% CI 1.15-1.63; p = 0.008) were the most powerful predictive variables. The area under the ROC was 0.716 and 0.705 for NLR and PLR, respectively. The cut-off values of NLR ≥ 3.08 and PLR ≥ 126.8 predicted preeclampsia with the sensitivity of 74.6% and 71.8% and specificity of 70.1% and 72.4%, respectively.

Conclusions: High NLR and PLR during the first trimester are independent predictors of subsequent preeclampsia.
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http://dx.doi.org/10.5603/GP.2016.0021DOI Listing
July 2018

Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?

Ginekol Pol 2016 ;87(1):54-8

Tepecik Education and Research Hospital , Department of gynecology and obstetrics.

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http://dx.doi.org/10.17772/gp/57833DOI Listing
July 2018

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques.

J Perinat Med 2017 Feb;45(2):199-203

Objective: To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.

Methods: In this case-control study, 412 women who underwent CVS at 11-14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.

Results: The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4-2.7, P=0.008].

Conclusion: The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.
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http://dx.doi.org/10.1515/jpm-2015-0360DOI Listing
February 2017

Prenatal Evaluation of MicroRNA Expressions in Pregnancies with Down Syndrome.

Biomed Res Int 2016 24;2016:5312674. Epub 2016 Mar 24.

Department of Medical Genetics, Faculty of Medicine, Ege University, 35100 Izmir, Turkey.

Background: Currently, the data available on the utility of miRNAs in noninvasive prenatal testing is insufficient in the literature. We evaluated the expression levels of 14 miRNAs located on chromosome 21 in maternal plasma and their utility in noninvasive prenatal testing of Down Syndrome.

Method: A total of 56 patients underwent invasive prenatal testing; 23 cases were carrying Down Syndrome affected fetuses, and 33 control cases carrying unaffected, normal karyotype fetuses were included for comparison. Indications for invasive prenatal testing were advanced maternal age, increased risk of Down Syndrome in screening tests, and abnormal finding in the sonographic examination. In both the study and control groups, all the pregnant women were at 17th and 18th week of gestation. miRNA expression levels were measured using real-time RT-PCR.

Results: Significantly increased maternal plasma levels of miR-3156 and miR-99a were found in the women carrying a fetus with Down Syndrome.

Conclusion: Our results provide a basis for multicenter studies with larger sample groups and microRNA profiles, particularly with the microRNAs which were found to be variably expressed in our study. Through this clinical research, the utility of microRNAs in noninvasive prenatal testing can be better explored in future studies.
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http://dx.doi.org/10.1155/2016/5312674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823505PMC
December 2016

The increasing of pedicled propeller perforator flap survival by an extra vein anastomosis.

Microsurgery 2017 07 4;37(5):451-452. Epub 2016 Apr 4.

Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey.

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http://dx.doi.org/10.1002/micr.30050DOI Listing
July 2017

Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction.

J Ultrasound Med 2016 Mar 9;35(3):511-7. Epub 2016 Feb 9.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey (A.E., C.G., C.E.T., U.S., M.O.); and Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey (N.S.G.).

Objectives: Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes.

Methods: The transverse diameter of the fetal thymus was prospectively measured in 150 healthy and 143 IUGR fetuses between 24 and 40 weeks' gestation. The fetuses with IUGR were further divided according to normal or abnormal Doppler assessment of the umbilical and middle cerebral arteries and ductus venosus. Measurements were compared with reference ranges from controls. To determine which perinatal outcomes were independently associated with a small fetal thymus, a multivariate logistic regression analysis was performed.

Results: Thymus size was significantly lower in IUGR fetuses compared to controls (P < .05). Among IUGR fetuses, thymus size was significantly smaller in IUGR fetuses with abnormal Doppler flow compared to normal flow (P < .05). A small thymus in IUGR fetuses was independently associated with early delivery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.05-1.49; P= .023), respiratory distress syndrome (OR, 1.36; 95% CI, 1.09-1.78; P= .005), early neonatal sepsis (OR, 1.65; 95% CI, 1.11-2.42; P= .001), and a longer stay in the neonatal intensive care unit (OR, 1.33; 95% CI, 1.08-1.71; P = .017).

Conclusions: Intrauterine growth restriction is associated with fetal thymic involution, and a small fetal thymus is an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.
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http://dx.doi.org/10.7863/ultra.15.05039DOI Listing
March 2016

Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery.

J Turk Ger Gynecol Assoc 2015 2;16(4):231-6. Epub 2015 Nov 2.

Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, İzmir, Turkey.

Objective: The aim of this study was to identify the prevalence of anemia and predisposing factors contributing to anemia in pregnant women prior to delivery.

Material And Methods: A retrospective case-control study was conducted on 1221 women who delivered between 37 and 42 weeks of gestation between July 2014 and January 2015. Data on the subjects' socioeconomic and demographic characteristics, pregnancy outcomes, and hemoglobin levels within 24 h prior to delivery were collected. The study population was divided into two groups on the basis of the presence of anemia within 24 h prior to delivery. Anemia was defined as a hemoglobin level of <11 g/dL. The prevalence of pre-delivery anemia was estimated, and antenatal predictors of anemia were determined using multivariate logistic regression analysis.

Results: The prevalence of anemia in women attending our center for delivery was 41.6% [95% confidence interval (CI) =38.84-44.37]. After multivariate logistic regression analysis, parity >3 [odds ratio (OR) =1.82, 95% CI=1.24-2.96, p=0.002], illiterate (OR=2.23, 95% CI=1.35-3.45, p=0.001) and primary educational level (OR=2.01, 95% CI=1.28-3.39, p=0.008), household monthly income per person <250 Turkish liras (OR=2.34, 95% CI=1.49-3.89, p<0.001), first admission at second (OR=1.63, 95% CI=1.24-2.81, p=0.006) and third trimester (OR=2.45, 95% CI=1.41-4.06, p<0.001), number of antenatal visits <5 (OR=1.45, 95% CI=10.5-2.11) and 5-10 (OR=1.3, 95% CI=1.03-2.09), duration of iron supplementation <3 months (OR=2.62, 95% CI=1.51-4.17) and 3-6 months (OR=1.68, 95% CI=1.13-2.91), and occurrence of preeclampsia (OR=1.55, 95% CI=1.03-2.1, p=0.041) were independently associated with anemia.

Conclusion: Socioeconomic determinants constitute most of the anemia cases and, hence, should be considered as major risk factors of anemia in women attending for delivery at term.
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http://dx.doi.org/10.5152/jtgga.2015.15071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664215PMC
December 2015

Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study.

J Perinat Med 2016 Mar;44(2):243-8

Objectives: To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation.

Methods: Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately.

Results: Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h.

Conclusions: Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.
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http://dx.doi.org/10.1515/jpm-2015-0194DOI Listing
March 2016

Intrahepatic cholestasis of pregnancy may lead to low birth weight.

Turk J Med Sci 2015 ;45(3):723-8

Background/aim: To evaluate patients hospitalized in our clinic in the last 5 years with the diagnosis of intrahepatic cholestasis of pregnancy (ICP).

Materials And Methods: One hundred and fifty patients hospitalized with a diagnosis of ICP between January 2008 and May 2013 were evaluated retrospectively and age, week at diagnosis, gestational age at delivery, period between diagnosis and delivery, fetal weight, transaminases, and coagulation parameters were recorded. Patients were divided into groups according to their diagnosis weeks and gravida. Accordingly, patients diagnosed before 32 weeks formed group A (n = 49) and those after 32 weeks formed group B (n = 101). Data were evaluated with SPSS 16.0.

Results: There was a significant difference between group A and group B in terms of delivery period and fetal weights (P = 0.001, P 0.035). Accordingly, the period between diagnosis and delivery and fetal weight were found to be longer and lower, respectively, in the early-onset group. In terms of distribution of ICP according to time of diagnosis, patients were diagnosed mostly in the spring season (60 cases, 40%) and in the month of March (27 cases, 18%).

Conclusion: According to our study, the birth weight of fetuses of patients with ICP diagnosed before 32 weeks are lower, although they have the same gestational age at delivery as the fetuses of the patients with ICP diagnosed after 32 weeks.
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http://dx.doi.org/10.3906/sag-1403-7DOI Listing
September 2015

Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes.

J Obstet Gynaecol Res 2015 Nov 14;41(11):1744-51. Epub 2015 Jul 14.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.

Aim: The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes.

Material And Methods: Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as <6, 6-11, 12-17, 18-23, 24-35 and ≥36 months. Adverse outcomes included spontaneous labor leading to preterm birth (n = 265), preterm premature rupture of membranes (n = 245), pre-eclampsia (n = 286), gestational diabetes (n = 302), abnormal placentation (n = 154), anemia (n = 314), congenital anomalies (n = 459), post-partum hemorrhage (n = 326) and small for gestational age (n = 168). Multivariate logistic regression analysis was performed to assess the association of each outcome with the interpregnancy interval categories.

Results: Spontaneous labor leading to preterm birth (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.13-1.97), preterm premature rupture of membranes (OR, 1.69; 95%CI, 1.28-2.39), congenital anomalies (OR, 1.38; 95%CI, 1.09-1.76) and small for gestational age (OR, 1.68; 95%CI, 1.14-2.34) were significantly associated with intervals of <6 months. Among congenital anomalies, short interpregnancy interval represents an increased risk for cardiac defects (OR, 1.55; 95%CI, 1.09-5.46), neural tube defects (OR, 2.06; 95%CI, 1.32-7.64) and central nervous system anomalies (OR, 1.45; 95%CI, 1.12-3.65).

Conclusion: Short interpregnancy interval is an independent risk factor for adverse perinatal outcomes.
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http://dx.doi.org/10.1111/jog.12783DOI Listing
November 2015

Predictors of severity in primary postpartum hemorrhage.

Arch Gynecol Obstet 2015 Dec 4;292(6):1247-54. Epub 2015 Jun 4.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.

Purpose: To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH.

Methods: Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses.

Results: PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006).

Conclusion: Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.
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http://dx.doi.org/10.1007/s00404-015-3771-5DOI Listing
December 2015

Mucocutaneous manifestations and the relationship to CD4 lymphocyte counts among Turkish HIV/AIDS patients in Istanbul, Turkey.

Turk J Med Sci 2015 ;45(1):89-92

Background/aim: Dermatologic findings differ among countries but no sufficient data about Turkish HIV-infected patients exist in the literature. Therefore, our aim in this study was to document the dermatologic manifestations and their relationships with CD4 cell counts among HIV/AIDS patients visiting our clinic for the first time in Istanbul, Turkey.

Materials And Methods: A retrospective analysis of 306 HIV/AIDS patients (260 men, mean age: 38.3 years) was done in a tertiary hospital in Istanbul from January 2006 to September 2012. Information on age, sex, transmission routes, socioeconomic and educational status, CD4 counts, and dermatologic findings was collected retrospectively from medical records.

Results: Our analyses revealed at least 1 dermatologic disease in 111 of the 306 (36.2%) patients. Mean CD4 count of the patients was 393.64 cells/mm3 (range: 4-1270 cells/mm3). Oral candidiasis (12.4%), herpes zoster (5.9%), dermatophytosis (5.4%), hyperpigmentation (5.2%), and folliculitis (4.6%) were the most common skin problems. Statistically significant correlation (P < 0.05) with low CD4 cell counts was found for oral candidiasis, folliculitis, herpes zoster, hyperpigmentation, xerosis, and Kaposi's sarcoma.

Conclusion: Dermatologic manifestations in this study were identical to those described in most studies from Asia, and there were more manifestations as the HIV infection progressed and immune functions declined.
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http://dx.doi.org/10.3906/sag-1308-3DOI Listing
April 2015

The effect of associated structural malformations in the prediction of chromosomal abnormality risk of fetuses with echogenic bowel.

J Matern Fetal Neonatal Med 2016 5;29(1):41-5. Epub 2014 Dec 5.

a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey.

Objective: Our aim is to determine the frequency of chromosomal abnormalities and also to identify the role of structural malformations on the chromosomal abnormality risk among fetuses with echogenic bowel.

Methods: Over a 6-year period fetuses with echogenic bowel (FEB) were retrospectively evaluated. The pregnancies with intra-amniotic bleeding history, congenital infection, cystic fibrosis and intrauterine growth retardation were excluded from the study. Types and frequency of sonographically detected fetal malformations were identified. Chromosomal abnormality incidences according to association with soft markers and major fetal abnormalities were compared.

Results: Of the 281 fetuses with echogenic bowel, 105 (37.37%) were isolated, 78 (27.76%) were associated with soft markers and 98 (34.87%) were associated with major abnormalities. There were 30 (10.7%) fetuses with abnormal karyotypes. The chromosomal abnormality rate of the groups of isolated FEB, FEB + soft markers and FEB + major abnormalities were 6.7%, 7.7% and 17.4%, respectively.

Conclusions: Chromosomal abnormality risk in fetuses with echogenic bowel should be evaluated according to additional sonographic findings. Association of structural malformations increases the chromosomal abnormality risk, although this risk is not significant with the presence of soft markers alone.
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http://dx.doi.org/10.3109/14767058.2014.986091DOI Listing
September 2016

Perinatal outcomes in pregnancies with oligohydramnios after preterm premature rupture of membranes.

J Matern Fetal Neonatal Med 2015 Nov 28;28(16):1918-22. Epub 2014 Oct 28.

a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey.

Objective: Our purpose was to determine whether singleton pregnancies complicated by preterm premature rupture of membranes (PPROM) and oligohydramnios are at an increased risk of having maternal and neonatal morbidity.

Methods: We performed a retrospective analysis of 389 women with PPROM between 24 and 34 weeks of gestation in a single tertiary center during 2008-2014. Patients were divided into two groups on the basis of amniotic fluid index (AFI) < 5 cm (n = 188) or AFI ≥ 5 cm (n = 201). Perinatal outcomes were compared according to amniotic fluid volume. The Student's t-test and Mann-Whitney U test were used to compare variables with normal and abnormal distribution, respectively. Categorical variables were examined by the chi-square test.

Results: Patients with an AFI < 5 cm demonstrated a significantly shorter latency to delivery (p < 0.001), a higher rate of clinical chorioamnionitis (p = 0.029) and emergency cesarean delivery (p = 0.043) and a lower neonatal Apgar score at first minute (p = 0.004).

Conclusion: Initial oligohydramnios after PPROM is associated with shorter latency to delivery, higher rate of clinical chorioamnionitis, higher rate of emergency cesarean delivery, and lower 1-min Apgar score.
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http://dx.doi.org/10.3109/14767058.2014.972927DOI Listing
November 2015

Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation.

Arch Gynecol Obstet 2014 Sep 3;290(3):449-55. Epub 2014 Apr 3.

Department of Perinatology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey,

Purpose: To identify risk factors and perinatal outcomes associated with the duration of latency period in women who experience preterm premature rupture of membranes (PPROM).

Methods: A retrospective study of women who experienced PPROM between 24 and 34 weeks of gestation was performed in a single tertiary center between 2009 and 2013. Patients were divided into two groups based on the duration of the latency period after PPROM: Group 1 ≤72 h and Group 2 >72 h. Risk factors and perinatal outcomes were compared according to latency period. Student's t test and Chi-square test were used to compare continuous and categorical variables, respectively, between the two groups. Multivariate regression analysis was performed to control for potential confounding variables.

Results: In total, 3,257 patients presented with PPROM during the study period; of these, 204 (6.3 %) met the inclusion criteria. Higher gestational age upon admission (odds ratio [OR] = 0.83, 95 % confidence interval [CI] = 0.79-0.87; p < 0.001), oligohydramnios (OR = 0.47, 95 % CI = 0.25-0.91; p = 0.018), and twin gestation (OR = 0.67, 95 % CI = 0.45-0.89; p = 0.032) were independently associated with a shortened latency period. In addition, prolonged latency significantly increased the occurrence of chorioamnionitis (OR = 2.23, 95 % CI = 1.48-3.14; p = 0.002), placental abruption (OR = 1.9, 95 % CI = 0.95-3.53; p = 0.033), and decreased the length of stay of neonates in the intensive care unit (OR = 0.85, 95 % CI = 0.39-1.79; p = 0.021).

Conclusion: Gestational age at PPROM, twin gestation, and oligohydramnios significantly affected the latency period. Although a latency period >72 h was associated with chorioamnionitis and placental abruption, adverse neonatal outcomes were not affected.
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http://dx.doi.org/10.1007/s00404-014-3227-3DOI Listing
September 2014
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