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Item Metadata only Impact of adding pertuzumab to trastuzumab plus chemotherapy in neoadjuvant treatment of HER2 positive breast cancer patients: a multicenter real-life HER2PATH study(Taylor and Francis Ltd, 2023) 0000-0002-1273-1674; Bilici, Ahmet; Olmez, Omer Fatih; Kaplan, Muhammed Ali; Oksuzoglu, Berna; Sezer, Ahmet; Karadurmus, Nuri; Cubukcu, Erdem; Sendur, Mehmet Ali Nahit; Aksoy, Sercan; Erdem, Dilek; Basaran, Gul; Cakar, Burcu; Shbair, Abdallah T. M.; Arslan, Cagatay; Sumbul, Ahmet Taner; Sezgin Goksu, Sema; Karadag, Ibrahim; Cicin, Irfan; Gumus, Mahmut; Harputluoglu, Hakan; Demirci, Umut; N/A; Selçukbiricik, Fatih; Faculty Member; School of Medicine; 202015AimTo investigate the pathological complete response (pCR) achieved after neoadjuvant therapy with versus without adding pertuzumab (P) to trastuzumab (H) plus neoadjuvant chemotherapy (NCT) in HER2+ breast cancer (BC) patients in a real-life setting.MethodsA total of 1528 female HER2+ BC patients who received NCT plus H with or without P were included in this retrospective real-life study. Primary endpoint was pCR rate (ypT0/Tis ypN0). Clinicopathological characteristics, event-free survival (EFS) time, and relapse rates were evaluated with respect to HER2 blockade (NCT-H vs. NCT-HP) and pCR.ResultsOverall, 62.2% of patients received NCT-H and 37.8% received NCT-HP. NCT-HP was associated with a significantly higher pCR rate (66.4 vs. 56.8%, p < 0.001) and lower relapse (4.5 vs. 12.2%, p < 0.001) in comparison to NCT-H. Patients with pCR had a significantly lower relapse (5.6 vs. 14.9%, p < 0.001) and longer EFS time (mean(SE) 111.2(1.9) vs. 93.9(2.7) months, p < 0.001) compared to patients with non-pCR. Patients in the NCT-HP group were more likely to receive docetaxel (75.0 vs. 40.6%, p < 0.001), while those with pCR were more likely to receive paclitaxel (50.2 vs. 40.7%, p < 0.001) and NCT-HP (41.5 vs. 32.1%, p < 0.001). Hormone receptor status and breast conservation rates were similar in NCT-HP vs. NCT-H groups and in patients with vs. without pCR. Invasive ductal carcinoma (OR, 2.669, 95% CI 1.596 to 4.464, p < 0.001), lower histological grade of the tumor (OR, 4.052, 95% CI 2.446 to 6.713, p < 0.001 for grade 2 and OR, 3.496, 95% CI 2.020 to 6.053, p < 0.001 for grade 3), lower T stage (OR, 1.959, 95% CI 1.411 to 2.720, p < 0.001) and paclitaxel (vs. docetaxel, OR, 1.571, 95% CI 1.127 to 2.190, p = 0.008) significantly predicted the pCR.ConclusionsThis real-life study indicates that adding P to NCT-H enables higher pCR than NCT-H in HER2+ BC, while pCR was associated with lower relapse and better EFS time.Item Metadata only Long-term efficacy of gamma knife radiosurgery on pain control in trigeminal neuralgia(Turkish Neurosurgical Soc, 2023) 0000-0003-3057-3355; 0000-0001-8952-6866; Ozturk, Gulsah; N/A; N/A; Peker, Selçuk; Samancı, Mustafa Yavuz; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 11480; 275252AIM: To investigate the efficacy of Gamma Knife radiosurgery (GKRS) in patients with Burchiel type 1 and 2 trigeminal neuralgia (TN). MATERIAL and METHODS: A retrospective analysis of prospectively collected data of 163 patients who underwent GKRS between December 2006 and December 2021 was performed. The median follow-up was 37 (range, 6-168) months. The target was the cisternal portion of the trigeminal nerve, and the median prescribed dose was 85 (range, 75-90) Gy. Pain severity was evaluated using the Barrow Neurological Institute (BNI) pain intensity score. All patients had BNI IV or V before GKRS. BNI IIIb or better was defined as adequate pain relief. Logistic regression analysis was conducted to determine the prognostic significance of different pretreatment and treatment variables. RESULTS: The initial pain relief rate was 85%, with a median period of 25 (range, 1-90) days. At the final follow-up, 62.5% of patients had adequate pain relief. BNI I was achieved in 8% of patients within the first 24 h after GKRS; this rate was 22% at the final follow-up. The pain-free interval was significantly shorter in the 75 Gy group than in the 90 Gy group (p=0.04). The predicted adequate pain relief rates at the 3rd and 6th month and 1st, 3rd, 5th, and 7th year were 84%, 79%, 76%, 67%, 59%, and 55%, respectively. The complication rate was 8%, with disturbing facial sensorial dysfunction in four patients, decreased corneal reflex in three patients, and masseter dysfunction in six patients. Univariate and multivariate logistic regression analyses revealed Burchiel type 1 TN (p=0.001) and male gender (p=0.037) as predictors of increased initial pain relief rate and shorter time to initial pain relief day, respectively. CONCLUSION: Appropriate patient selection is the key to successful TN treatment. GKRS can be recommended, especially for patients with Burchiel type 1 TN, with low complication rates and effective long-term pain relief.Item Metadata only Assessing the impact of distortion correction on gamma knife radiosurgery for multiple metastasis: volumetric and dosimetric analysis(Elsevier B.V., 2024) 0000-0003-3057-3355; 0000-0001-8952-6866; 0000-0001-7126-6373; 0000-0002-2535-9832; N/A; N/A; N/A; Peker, Selçuk; Samancı, Mustafa Yavuz; Askeroğlu, Mehmet Orbay; Düzkalır, Ali Haluk; Faculty Member; Faculty Member; Other; Doctor; School of Medicine; School of Medicine; N/A; N/A; Koç University Hospital; 11480; 275252; N/A; N/AIntroduction: Magnetic resonance imaging (MRI) is a robust neuroimaging technique and is the preferred method for stereotactic radiosurgery (SRS) planning. However, MRI data always contain distortions caused by hardware and patient factors. Research question: Can these distortions potentially compromise the effectiveness and safety of SRS treatments? Material and methods: Twenty-six MR datasets with multiple metastatic brain tumors (METs) used for Gamma Knife radiosurgery (GKRS) were retrospectively evaluated. A commercially available software was used for distortion correction. Geometrical agreement between corrected and uncorrected tumor volumes was evaluated using MacDonald criteria, Euclidian distance, and Dice similarity coefficient (DSC). SRS plans were generated using uncorrected tumor volumes, which were assessed to determine their coverage of the corrected tumor volumes. Results: The median target volume was 0.38 cm3 (range,0.01–12.38 cm3). A maximum displacement of METs of up to 2.87 mm and a median displacement of 0.55 mm (range,0.1–2.87 mm) were noted. The median DSC between uncorrected and corrected MRI was 0.92, and the most concerning case had a DSC of 0.46. Although all plans met the optimization criterion of at least 98% of the uncorrected tumor volume (median 99.55%, range 98.1–100%) receiving at least 100% of the prescription dose, the percent of the corrected tumor volume receiving the total prescription dose was a median of 95.45% (range,23.1–99.5%). Discussion and conclusion: MRI distortion, though visually subtle, has significant implications for SRS planning. Regular utilization of corrected MRI is recommended for SRS planning as distortion is sometimes enough to cause a volumetric miss of SRS targets. © 2024 The AuthorsItem Metadata only Minimizing total weighted latency in home healthcare routing and scheduling with patient prioritization(Springer, 2023) 0000-0001-6833-2552; Akbari, Vahid; Sadati, Ihsan; Shiri, Davood; Department of Industrial Engineering; Salman, Fatma Sibel; Faculty Member; College of Engineering; 178838We study a home healthcare routing and scheduling problem, where multiple healthcare service provider teams should visit a given set of patients at their homes. The problem involves assigning each patient to a team and generating the routes of the teams such that each patient is visited once. When patients are prioritized according to the severity of their condition or their service urgency, the problem minimizes the total weighted waiting time of the patients, where the weights represent the triage levels. In this form, the problem generalizes the multiple traveling repairman problem. To obtain optimal solutions for small to moderate-size instances, we propose a level-based integer programming (IP) model on a transformed input network. To solve larger instances, we develop a metaheuristic algorithm that relies on a customized saving procedure and a general variable neighborhood search algorithm. We evaluate the IP model and the metaheuristic on various small-, medium- and large-sized instances coming from the vehicle routing literature. While the IP model finds the optimal solutions to all the small- and medium-sized instances within three hours of run time, the metaheuristic algorithm achieves the optimal solutions to all instances within merely a few seconds. We also provide a case study involving Covid-19 patients in a district of Istanbul and derive insights for the planners by means of several analyses.Item Metadata only Selected-lesion stereotactic radiosurgery (SL- SRS) as a novel strategy in the treatment of patients with multiple brain metastases(Springernature, 2023) 0000-0003-3057-3355; 0000-0001-8952-6866; Theriault, Brianna C.; Singh, Charu; Yu, James; Knisely, Jonathan; Shepard, Matthew; Wegner, Rodney E.; Warnick, Ronald E.; Trifiletti, Daniel M.; Lee, Cheng-chia; Yang, Huai-che; Bernstein, Kenneth; Kondziolka, Douglas; Tripathi, Manjul; Mathieu, David; Mantziaris, Georgios; Pikis, Stylianos; Sheehan, Jason; Chiang, Veronica L.; N/A; N/A; Peker, Selçuk; Samancı, Mustafa Yavuz; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 11480; 275252Introduction: With the diminishing use of whole-brain radiotherapy (WBRT), there is increasing debate regarding the maximum number of brain metastases that should be treated with stereotactic radiosurgery (SRS). In patients with >10-15 lesions, some groups are proposing a new approach -selected-lesion SRS (SL -SRS) -where only a subset of intracranial lesions are chosen for irradiation. This study is an initial look into this practice.Methods: This is a cross-sectional exploratory survey study. A survey of 19 questions was created by the International Radiosurgery Research Foundation (IRRF) using open-ended and multiple-choice style questions on SL-SRS practices and indications with the goal of qualitatively understanding how SL-SRS is being implemented worldwide. The survey was distributed to physicians in the United States (US) and internationally who are members of the IRRF and who perform SRS frequently. Ten out of 50 IRRF institutions provided responses reflecting the practices of 16 physicians.Results: SL-SRS is being performed at 8/10 institutions. The most common reasons for using SL-SRS included patients with prior WBRT, patients with progressing systemic disease with central nervous system (CNS)-penetrating or immunotherapies available, specific requests from medical oncology, and cooperative studies using this approach. Lesion size was cited as the most important factor when choosing to irradiate any single lesion. The majority of respondents reported 30 mm and 40 mm as size cutoffs (by largest dimension) for treatment of a lesion in eloquent and non-eloquent locations, respectively. Eloquence of lesion location and attributable symptoms were also considered important. Progression of untreated lesions was the most common reason reported for bringing patients back for additional treatment.Conclusion: The responses to this survey show that SL-SRS is being used, allowing for small/asymptomatic brain metastases to be left safely unirradiated. It is currently used in patients who have >10-15 lesions with prior WBRT, those with progression of extracranial disease but with acceptable systemic treatment options, and those with poor functional status. The incorporation of this new approach into clinical trials should be considered for the safe study of the efficacy of new CNS-penetrating systemic therapies.Item Metadata only Domestic violence in childhood and the associated risk of spousal violence in adulthood: cultural ınfluence on women's experience(Sage Publications Inc., 2023) 0000-0001-9192-1478; Al-Modallal, Hanan; Mrayan, Lina; Khait, Abdallah Abu; Mudallal, Rola; Hamaideh, Shaher; N/A; Salameh, Taghreed Nayel Mohammad; Faculty Member; School of Nursing; 329120Purpose: To examine the association between childhood violence and spousal violence within the culture of women visiting primary health care centers. Methods: In this cross-sectional study, participants were approached in waiting areas of health care centers. Data about five types of childhood violence and four types of spousal violence were investigated. Chi square was implemented to study the association between spousal violence and women's demographic characteristics. Further, logistic regression associated with 95% CI was implemented to study the risk of spousal violence based on women's exposure to childhood abuse. Results: It was found that women in general were subjects to domestic violence in childhood and during adulthood. Emotional and physical types of childhood violence were the most prevalent in our participants. Regarding spousal violence experience, two-thirds of the women reported control by the spouse. In addition, half of them reported being physically victimized using different violence tactics. Except for sexual abuse, all other types of childhood violence were, generally, significant risk factors for spousal violence victimization. Conclusion: Experiencing childhood violence, witnessing parental violence, tendency to compensate for the deprivation in childhood, and inherited beliefs about spousal violence were factors expected to explain the association between childhood violence and spousal violence in women. Traumatic events in childhood are under-recognized factors in the development of spousal violence in the current population. Therefore, efforts to prevent these forms of violence need to be emphasized by health professionals who are in direct contact with women in different health care facilities. © The Author(s) 2022.Item Metadata only Comparison of the dosimetric planning efficiency of dynamic conformal arc and volumetric modulated arc therapy techniques for stereotactic body radiotherapy of lung cancer using ınternal target volume(Erciyes Univ Sch Medicine, 2023) 0000-0003-1151-4616; N/A; Sağlam, Yücel; Doctor; School of MedicineObjective: This retrospective study constitutes a feasibility assessment of dynamic conformal arc (DCA) therapy as an alter-native to volumetric-modulated arc therapy (VMAT) for stereotactic body radiation therapy (SBRT) of lung cancer (LC) with the free breathing technique using internal target volume. DCA is to create a more efficient treatment reducing beam-on time (BOT) and monitor unit (MU) without interplay errors except for complex tumor geometries when compared to volumetric modulated arc therapy (VMAT).Materials and Methods: CT images and plans of forty patients treated with 50 Gy prescription in four fractions using VMAT technique for SBRT treatment of LC selected. Plans were re-planned with using DCA technique. VMAT and DCA plans compared via The Radiation Therapy Oncology Group (RTOG) Protocol 0915 for conformity and efficient having pass rate of gamma index in quality assurance (QA), MU and BOT.Results: The study included 40 patients. The mean value of QA pass rate 99.10 +/- 1.49 in DCA and 92.34 +/- 1.96 in VMAT. The rate was higher in DCA (p<0.001 and t=8.98). The values of BOT and MU were 4.68 min and 3296 in the VMAT tech-nique and they were 3.58 min and 2395 in DCA. These values were significantly improved with DCA (p<0.001 and p<0.001).Conclusion: DCA can potentially minimize multi-leaf collimator errors from respiratory motion and small-field dosimetry. It delivery similar doses of treatment quality to tumor while providing faster treatment by significantly reducing MU and BOT compared to VMAT and moreover offers same-day SBRT treatments without the need for specific QA.Item Metadata only The effect of coffee consumption after colorectal surgery on bowel movements and duration of hospital stay(S. Karger Ag, 2023) 0000-0002-5993-9536; Bildirici, Ciǧdem; Kula Sahin, Sennur; N/A; Rencüzoğulları, Ahmet; Faculty Member; School of Medicine; 130887Background: Postoperative ileus after colorectal surgery is a common problem that significantly prolongs hospital stay and increases perioperative costs. The ability of postoperative coffee consumption to produce bowel movement is unclear and needs to be studied. Objective: The objective of this study was to evaluate the effect of coffee consumption on bowel movements and duration of hospital stay after laparoscopic colorectal surgery. Methods: This nonrandomized prospective study examined a population of patients who underwent laparoscopic colorectal surgery between November 2018 and June 2019. The study sample consisted of 51 patients, including the experimental group (25 patients who consumed coffee) and the control group (26 patients). The first bowel sounds, the first flatulence and defecation times, and duration of hospital stay were examined in this study. There was a statistically significant (p < 0.021) difference between the experimental group and the control group when the first flatulence (13.8 times/h) and defecation (14.8 times/h) times were examined. However, the results were not significantly different between the groups despite the earlier start of the first bowel sounds (2.5 times/h) and the shorter duration of hospital stay (mean 1.1/day) in the experimental group (p > 0.05). Conclusion: Postoperative coffee consumption is believed to be an effective, enjoyable, easy, and economical method for increasing bowel movements after surgery and is likely to be added to rapid recovery protocols in the future. Further studies with larger samples will confirm this. © 2022 S. Karger AG, Basel. Copyright: All rights reserved.Item Metadata only Cardiac magnetic resonance T2* mapping in patients with COVID-19 pneumonia is associated with serum ferritin level?(Springer Science and Business Media B.V., 2023) 0000-0001-7637-4445; 0000-0002-2176-5278; Ciftci, Hatice Ozge; Keles, Nursen; Karatas, Mesut; Parsova, Kemal Emrecan; Kahraman, Erkan; Durak, Furkan; Kocogulları, Cevdet Ugur; Yiyit, Nurettin; Department of Mechanical Engineering; N/A; Pekkan, Kerem; Özkök, Serçin; Faculty Member; PhD Student; College of Engineering; Graduate School of Sciences and Engineering; 161845; N/AThe coronavirus disease of 2019 (COVID-19)-related myocardial injury is an increasingly recognized complication and cardiac magnetic resonance imaging (MRI) has become the most commonly used non-invasive imaging technique for myocardial involvement. This study aims to assess myocardial structure by T2*-mapping which is a non-invasive gold-standard imaging tool for the assessment of cardiac iron deposition in patients with COVID-19 pneumonia without significant cardiac symptoms. Twenty-five patients with COVID-19 pneumonia and 20 healthy subjects were prospectively enrolled.Cardiac volume and function parameters, myocardial native-T1, and T2*-mapping were measured. The association of serum ferritin level and myocardial mapping was analyzed. There was no difference in terms of cardiac volume and function parameters. The T2*-mapping values were lower in patients with COVID-19 compared to controls (35.37 [IQR 31.67–41.20] ms vs. 43.98 [IQR 41.97–46.88] ms; p < 0.0001), while no significant difference was found in terms of native-T1 mapping value(p = 0.701). There was a positive correlation with T2*mapping and native-T1 mapping values (r = 0.522, p = 0.007) and negative correlation with serum ferritin values (r = − 0.653, p = 0.000), while no correlation between cardiac native-T1 mapping and serum ferritin level. Negative correlation between serum ferritin level and T2*-mapping values in COVID-19 patients may provide a non-contrast-enhanced alternative to assess tissue structural changes in patients with COVID-19. T2*-mapping may provide a non-contrast-enhanced alternative to assess tissue alterations in patients with COVID-19. Adding T2*-mapping cardiac MRI in patients with myocardial pathologies would improve the revealing of underlying mechanisms. Further in vivo and ex vivo animal or human studies designed with larger patient cohorts should be planned. © 2022, The Author(s), under exclusive licence to Springer Nature B.V.Item Metadata only The effects of sex on extinction dynamics of Chlamydomonas reinhardtii depend on the rate of environmental change(Wiley, 2023) Colegrave, Nick; Department of Molecular Biology and Genetics; Petkoviç, Nikola; Teaching Faculty; College of SciencesThe continued existence of sex, despite many the costs it entails, still lacks an adequate explanation, as previous studies demonstrated that the effects of sex are environment-dependent: sex enhances the rate of adaptation in changing environments, but the benefits level off in benign conditions. To the best of our knowledge, the potential impact of different patterns of environmental change on the magnitude of these benefits received less attention in theoretical studies. In this paper, we begin to explore this issue by examining the effect of the rate of environmental deterioration (negatively correlated with population survival rate), on the benefits of sex. To investigate the interplay of sex and the rate of environmental deterioration, we carried out a long-term selection experiment with a unicellular alga (Chlamydomonas reinhardtii), by manipulating mode of reproduction (asexual, facultative or obligate sexual) and the rate of environmental deterioration (an increase of salt concentration). We monitored both the population size and extinction dynamics. The results revealed that the relative advantage of sex increased at the intermediate rate and plateaued at the highest rate of environmental deterioration. Obligate sexual populations had the slowest extinction rate under the intermediate rate of environmental deterioration, while facultative sexuality was favoured under the high rate-treatment. To the best of our knowledge, our study is the first to demonstrate that the interplay of sex and the rate of environmental deterioration affects the probability of survival, which indicates that mode of reproduction may be an important determinant of survival of the anthropogenic-induced environmental change.