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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only Protein convertase subtilisin/kexin type 9 biology in nephrotic syndrome: implications for use as therapy(Oxford University Press (OUP), 2020) Busuioc, Ruxandra Mihaela; Covic, Adrian; Banach, Maciej; Burlacu, Alexandru; Mircescu, Gabriel; N/A; Kanbay, Mehmet; Faculty Member; School of Medicine; 110580Low-density lipoprotein cholesterol (LDL-C) levels almost constantly increased in patients with nephrotic syndrome (NS). Protein convertase subtilisin/kexin type 9 (PCSK9) [accelerates LDL-receptor (LDL-R) degradation] is overexpressed by liver cells in NS. Their levels, correlated inversely to LDL-R expression and directly to LDL-C, seem to play a central role in hypercholesterolaemia in NS. Hypersynthesis resulting from sterol regulatory element-binding protein dysfunction, hyperactivity induced by c-inhibitor of apoptosis protein expressed in response to stimulation by tumour necrosis factor-a produced by damaged podocytes and hypoclearance are the main possible mechanisms. Increased LDLC may damage all kidney cell populations (podocytes, mesangial and tubular cells) in a similar manner. Intracellular cholesterol accumulation produces oxidative stress, foam cell formation and apoptosis, all favoured by local inflammation. The cumulative effect of cellular lesions is worsened proteinuria and kidney function loss. Accordingly, NS patients should be considered high risk and treated by lowering LDLC. However, there is still not enough evidence determining whether lipid-lowering agents are helpful in managing dyslipidaemia in NS. Based on good efficacy and safety proved in the general population, therapeutic modulation of PCSK9 via antibody therapy might be a reasonable solution. This article explores the established and forthcoming evidence implicating PCSK9 in LDL-C dysregulation in NS.Publication Metadata only Colchicine in renal medicine: new virtues of an ancient friend(Karger Publishers, 2017) Solak, Yalçın; Siriopol, Dimitrie; Yildiz, Abdulmecit; Yilmaz, Mahmut Ilker; Ortiz, Alberto; Covic, Adrian; N/A; Kanbay, Mehmet; Faculty Member; School of Medicine; 110580Colchicine is a plant-derived alkaloid that disrupts the cell microtubule system and accumulates in neutrophils, inhibiting neutrophil adhesion and recruitment. Colchicine has been used extensively in the prevention and treatment of gouty arthritis attacks, familial Mediterranean fever attacks and resultant AA amyloidosis, and recurrent pericarditis. Colchicine also disrupts the intracellular traffic of additional inflammatory and fibrosis mediators. Renal fibrosis is the final common pathway of chronic renal disease. Colchicine had anti-fibrotic effects in experimental diabetic nephropathy, renal mass reduction, and cyclosporine nephrotoxicity among others and is undergoing clinical trials for non-diabetic metabolic syndrome and diabetic nephropathy. In this review, we summarize the anti-inflammatory and anti-fibrotic properties of colchicine in experimental and clinical studies in renal diseases or other fibrotic disease processes with renal consequences. We also discuss the potential future uses of colchicine in renal medicine and challenges faced with its use in patients with impaired kidney function.Publication Metadata only Outcomes of fecal carriage of extended-spectrum beta-lactamase after transrectal ultrasound-guided biopsy of the prostate(Elsevier, 2014) Tigen, Elif Tukenmez; Tandogdu, Zafer; Altinkanat, Gulsen; Gunaydin, Bilal; Ozgen, Mahir; Sariguzel, Nevin; Sengel, Buket Erturk; Odabasi, Zekaver; Cek, Mete; Tokuc, Resit; Turkeri, Levent; Mulazimoglu, Lutfiye; Korten, Volkan; N/A; Ergönül, Önder; Faculty Member; School of Medicine; 110398Objective: to determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (PE) fecal carriage in patients that undergo transrectal ultrasonography-guided biopsy (TRUSbx) and its relationship with post-biopsy infections. Methods: a prospective clinical study in 4 different tertiary hospitals between 2008 and 2010 was conducted. Four hundred men with sterile urine who were to undergo a TRUSbx because of the suspicion of prostate cancer were included and followed for 14 days after biopsy. Rectal swab culture specimens were acquired immediately before the procedure. Demographic data, prophylaxis choice, quinolone or any other antibiotic consumption within the past 2 months, history of prostatitis, repeat biopsy, intensive care unit admission, hospitalization, urethral catheterization, diabetes mellitus (DM), and steroid usage were recorded. Results: ESBL carriage was detected in 19% of patients and quinolone use within the last 2 months; other antibiotic use within the last 2 months and DM were found to be significantly associated (P < .05). Symptomatic urinary tract infection (UTI) on the third day after biopsy was seen in 9% of patients and was associated with fluoroquinolone (FQ) consumption before biopsy. Although ESBL-PE carriage was associated with post-biopsy UTI symptoms, it was not found to be associated with post-biopsy symptomatic UTI. Urosepsis was seen in 2 patients (0.5%) after biopsy, and both the patients were ESBL-PE carriers. Cpnclusion: the presence of ESBL-PE was associated with DM and FQ consumption before biopsy. ESBL-PE carriage was associated with a high rate of post-biopsy UTI symptoms requiring further elucidation; however, it was not associated with microbiologically proven infections. FQ consumption before TRUSbx was also associated with post-biopsy infections.Publication Metadata only Comment reply: outcomes of fecal carriage of extended-spectrum b-lactamase after transrectal ultrasound-guided biopsy of the prostate(Elsevier, 2014) Tigen, Elif Tukenmez; Tandogdu, Zafer; Altinkanat, Gulsen; Gunaydin, Bilal; Ozgen, Mahir; Sariguzel, Nevin; Sengel, Buket Erturk; Odabasi, Zekaver; Cek, Mete; Tokuc, Resit; Turkeri, Levent; Mulazimoglu, Lutfiye; Korten, Volkan; N/A; Ergönül, Önder; Faculty Member; School of Medicine; 110398N/APublication Metadata only Pathologic outcomes of candidates for active surveillance undergoing radical prostatectomy: results from a contemporary Turkish patient cohort(Karger Publishers, 2018) Tinay, Ilker; Aslan, Guven; Kural, Ali Riza; Ozen, Haluk; Akdogan, Bulent; Yildirim, Asif; Ongun, Sakir; Ozkan, Alp; Zorlu, Ferruh; Dillioglugil, Ozdal; Bekiroglu, Nural; Turkeri, Levent; N/A; Esen, Tarık; Faculty Member; School of Medicine; 50536Introduction: To evaluate the pathological outcomes of Turkish men meeting the criteria for Active Surveillance (AS), who elected to undergo immediate radical prostatectomy (RP). Material and Methods: Retrospective analysis including 1,212 patients with clinically localized prostate cancer (PCa) who met the eligibility criteria for AS. The primary outcomes were pathological upstaging and pathological upgrading. Results: Nine hundred ninety-one patients were eligible for analysis after the central review of the submitted data. The mean prostate-specific antigen (PSA) level was 6.89 (0.51-15) ng/mL and the mean biopsy core number was 12 (8-47). The mean tumor positive core on final biopsy pathology was 1.95 (1-6) (16.6% [2.1-33.3%]). Overall, 30.6% of the men experienced a Gleason sum (GS) upgrade and 13.2% had pathological upstaging. For GS upgrade, the percentage of tumor-positive cores and free-to-total-PSA ratio were significant both in univariate analysis and multivariate logistic regression analysis. Variables predicting pathological upstaging were percentage of tumor-positive cores and PSA density, which were significant in univariate analysis. However, only PSA density was significant in multivariate logistic regression. Although biochemical recurrence-free survival was longer in patients without GS upgrade, it was not statistically significant between patients with and without any GS upgrade (mean 133.7 vs. 148.2 months, p = 0.243). A similar observation was made for patients with or without pathological upstaging (mean 117.1 vs. 148.3 months, p = 0.190). Conclusions: Upgrading and upstaging at RP are quite common among Turkish men with clinically low-risk PCa, who are candidates for AS, and a great majority of them experienced long-term PSA control. (c) 2017 S. Karger AG, BaselPublication Metadata only Pharmacologic and interventional paradigms of diuretic resistance in congestive heart failure: a narrative review(Springer, 2021) Afsar, Baris; Sag, Alan A.; Kuwabara, Masanari; Covic, Adrian; Ortiz, Alberto; N/A; Acar, Simge; Şanlı, Şüeda; Öztosun, Çınar; Kanbay, Mehmet; Undergraduate Student; Undergraduate Student; Undergraduate Student; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; N/A; N/A; 110580Diuretic volume reduction continues to be the mainstay of congestive heart failure (CHF) management globally. However, diuretic resistance is a critical topic that lacks standardized evidence-based management guidelines accounting for mechanisms of diuretic resistance, renal function, and co-morbidities. Major healthcare utilization consequences result from this. The authors herein reconcile the definition of renal functional decline with emphasis on biomarker-driven assessment. Novel goal-directed treatment approaches are reviewed including hypertonic saline, acetazolamide, sodium-glucose transporter inhibition, sequential nephron blockade and Elabela-APJ axis targeting are reviewed, as well as percutaneous visceral splanchnic sympathectomy (converting a volume-focused to a distribution-focused paradigm).Publication Metadata only Laparoscopic sacral colpopexy with polyester fiber suture: Ozerkan modification(Springer, 2020) Ozerkan, Kemal; Orhan, Adnan; Kasapoglu, Isil; Uncu, Gurkan; N/A; Ata, Mustafa Barış; Faculty Member; School of Medicine; 182910Introduction and hypothesis Mesh-related problems are significant complications of laparoscopic sacral colpopexy. The conventional technique precludes performing laparoscopic sacral colpopexy without using a mesh. We describe the Ozerkan modification for laparoscopic sacral colpopexy using a polyester fiber suture instead of a standard mesh and report 1-year objective and subjective outcomes. Methods Women diagnosed with stage >= 2 vaginal vault prolapse were prospectively recruited for the Ozerkan modification between 2015 and 2017. The primary outcome was the anatomic success of the repair, defined by objective parameters using the pelvic organ prolapse quantification system (stage 0 or 1). Secondary outcomes were subjective outcomes assessed with the quality of life scores. Results Twenty-two women underwent the Ozerkan modified laparoscopic sacrocolpopexy. Mean operation time was 85.6 min. Mean estimated blood loss was 71 ml. One patient was lost during the clinical follow-up in the outpatient clinic up to 1 year. Nineteen of 21 patients had stage 0 or 1 prolapse at the end of 1 year. Two patients were not satisfied with their pelvic floor after 1 year. Both the objective and subjective cure rates were 90.4%. There were no bladder or bowel complications during the peri- or postoperative period. Conclusions The new modification of laparoscopic sacral colpopexy seems a feasible and safe option to avoid mesh complications in the treatment of vaginal vault prolapse.Publication Metadata only Fundal pressure in the second stage of labor (Kristeller maneuver) and levator aniavulsion(Springer London Ltd, 2021) Takmaz, Taha; Karasu, Ayşe Filiz Gökmen; N/A; Aydın, Serdar; Faculty Member; School of Medicine; 132535N/APublication Metadata only Accuracy of sampling PI-RADS 4-5 index lesions alone by MRI-guided in-bore biopsy in biopsy-naive patients undergoing radical prostatectomy(Elsevier, 2020) Kılıç, Mert; Vural, Metin; Coskun, Bilgen; Saglican, Yesim; Akpek, Sergin; N/A; Acar, Ömer; Esen, Tarık; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 237530; 50536Background: Targeting multİparametric magnetic resonance imaging (MP-MRI)-suspicious regions alone in biopsy-naive patients is not common practice, since it may miss clinically significant prostate cancer (PCa). Objective: To investigate the accuracy of in-bore MRI-guided biopsy of Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 index lesions alone in biopsy-naive patients undergoing radical prostatectomy (RP). Design, setting and participants: A total of 170 patients underwent MRI-guided in-bore biopsy for PI-RADS 4 and 5 index lesions alone between 2013 and 2018, of whom 136 patients were diagnosed with PCa. Fifty-two patients without prior biopsy who underwent RP were included in this study. MP-MRI findings, biopsy results, and whole-mount step-section specimen evaluation were retrospectively analyzed. Outcome measurements and stAtıştical analysis: Continuous variables were reported as mean (standard deviation) or median (range). Differences in parametric variables were calculated by Student t test. Results and limitations: Overall International Society of Urological Pathology grade group (GG) up- and downgrading rates were 23.0% and 7.6% per patient and 24.5% and 6.5% per focus, respectively. Ten of 12 biopsy-detected GG 1 foci were upgraded in the final pathology. In 30 patients, a total of 43 different tumor foci were identified outside the sampled index lesion. Average biopsied and nonbiopsied tumor volumes were found to be 2.02 and 0.45 cm(3), respectively (p < 0.001). The index lesion was the largest focus of tumor in all patients' final histopathological examination; upgrading was identified in only one nonbiopsied focus in a single patient. Limitations include retrospective design and nonstandard indications of in-bore MRI biopsy. Conclusions: In-bore MRI-guided biopsy of PI-RADS 4-5 index lesions alone in biopsy-naive patients is a safe and accurate diagnostic modality allowing appropriate patient selection for individualized treatment. Patient summary: In-bore magnetic resonance imaging-guided prostate biopsy of suspicious lesions alone allows accurate risk stratification of patients and reduces the detection of insignificant prostate cancer. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.