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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/6
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Publication Open Access Liver transplantation in hepatic myelopathy(Kare Yayıncılık, 2022) Acar, Sencan; Dinçkan, Ayhan; Akyıldız, Murat; Faculty Member; School of Medicine; 123080Hepatic myelopathy (HMy) is a rare neurological complication of liver cirrhosis that involves spastic paraplegia caused by lateral cord demyelination especially due to the accumulation of some metabolites such as ammonia and manganese. We report a young adult woman presenting with spasticity and paraparesis in extremities after intrahepatic portosystemic shunting (TIPS) application and underwent deceased liver transplantation (LT). A 39-year-old woman underwent deceased LT because of cryptogenic liver cirrhosis. She underwent a TIPS procedure 5 years ago. After that, hepatic encephalopathy and spasticity appeared. She was on the waiting list for 3 years. Neurological findings after LT significantly decreased, but did not return to normal. After the emergence of neurological findings, the earlier LT can provide improvement in neurological findings.Publication Open Access REM-predominant obstructive sleep apnea in patients with coronary artery disease(Multidisciplinary Digital Publishing Institute (MDPI), 2022) Newitt, Jennifer; Strollo, Patrick J., Jr.; Balcan, Mehmet Baran; Çelik, Yeliz; Peker, Yüksel; Researcher; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; Koç University Hospital; N/A; N/A; 234103Obstructive sleep apnea (OSA) is common in adults with coronary artery disease (CAD). OSA that occurs predominantly during rapid-eye movement (REM) sleep has been identified as a specific phenotype (REM-predominant OSA) in sleep clinic cohorts. We aimed to examine the association of REM-predominant OSA with excessive sleepiness, functional outcomes, mood, and quality of life in a CAD cohort, of whom 286 OSA patients with total sleep time >= 240 min, and REM sleep >= 30 min, were included. REM-predominant OSA was defined as a REM-apnea-hypopnea-index (AHI) /non-REM (NREM) AHI >= 2. In all, 73 (25.5%) had REM-predominant OSA. They were more likely to be female (26.0% vs. 9.9%; p = 0.001), and more obese (42.5% vs. 24.4%; p = 0.003) but had less severe OSA in terms of AHI (median 22.6/h vs. 36.6/h; p < 0.001) compared to the patients with non-stage specific OSA. In adjusted logistic regression models, female sex (odds ratio [OR] 4.64, 95% confidence interval [CI] 1.85-11.64), body-mass-index (BMI; OR 1.17; 95% CI 1.07-1.28) and AHI (OR 0.93, 95% CI 0.91-0.95) were associated with REM-predominant OSA. In univariate linear regression models, there was a dose-response relationship between REM-AHI and Zung Self-rated Depression Scale but not excessive sleepiness, functional outcomes, and anxiety scores. Among the Short Form-36 subdomains, Vitality, Mental Health, and Mental Component Summary (MCS) scores were inversely correlated with REM-AHI. In multivariate linear models, only MCS remained significantly associated with REM-AHI after adjustment for age, BMI, and sex (beta-coefficient -2.20, %95 CI [-0.56, -0.03]; p = 0.028). To conclude, female sex and BMI were related to REM-predominant OSA in this revascularized cohort. MCS was inversely associated with REM-AHI in the multivariate model.Publication Open Access Quadrant and dermatomal analysis of sensorial block in ultrasound-guided erector spinae plane block(Aves, 2022) Selvi, Onur; Tulgar, Serkan; Şerifsoy, Talat Ercan; Lance, Robert; Thomas, David Terence; Gürkan, Yavuz; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; 154129Objective: as a novel procedure now gaining popularity, erector spinae plane block has been the subject of many studies. However, dermatomal coverage of the sensory block caused by erector spinae plane block has been rarely studied. The goal of this study is to evaluate the sensory block resulting from erector spinae plane block applied at the T9 vertebral level. Materials and methods: this observational, prospective, blinded study was conducted on 50 adult patients undergoing laparoscopic abdominal surgery. All patients underwent bilateral erector spinae plane block at the T9 level after completion of the surgery while under general anesthesia. In order to further evaluate the sensory blockade, we divided the hemiabdomen-hemithorax region into 4 quadrants: dorsal-medial, dorsallaterel, ventral-lateral, and ventral-medial. The sensorial evaluation was performed using the pinprick test, 2 hours following the application of erector spinae plane block. Results: a total of 28 female and 22 male patients were examined in this study. Complete failure of the block was recorded in 7 patients, with no thoracic/lumbar segmental or quadrant involvement. Successful sensory block was achieved in 67% of the dorsolateral quadrants, 58% of the dorsomedial quadrants, 69% of the ventrolateral quadrants, and 55% of the ventromedial quadrants. Conclusion: cutaneous sensory block of erector spinae plane block at T9 vertebral level revealed variable results and low failure rates. Administration of erector spinae plane block for postoperative analgesia in thoracoabdominal surgeries requires further randomized controlled trials to confirm its effectiveness and convenience.Publication Open Access The MHC class I MICA gene is a histocompatibility antigen in kidney transplantation(Springer Nature, 2022) Carapito, Raphael; Aouadi, Ismail; Verniquet, Martin; Untrau, Meiggie; Pichot, Angelique; Beaudrey, Thomas; Bassand, Xavier; Meyer, Sebastien; Faucher, Loic; Posson, Juliane; Morlon, Aurore; Kotova, Irina; Delbos, Florent; Walencik, Alexandre; Aarnink, Alice; Kennel, Anne; Suberbielle, Caroline; Taupin, Jean-Luc; Matern, Benedict M.; Spierings, Eric; Congy-Jolivet, Nicolas; Essaydi, Arnaud; Perrin, Peggy; Blancher, Antoine; Charron, Dominique; Cereb, Nezih; Maumy-Bertrand, Myriam; Bertrand, Frederic; Garrigue, Valerie; Pernin, Vincent; Weekers, Laurent; Naesens, Maarten; Kamar, Nassim; Legendre, Christophe; Glotz, Denis; Caillard, Sophie; Ladriere, Marc; Giral, Magali; Anglicheau, Dany; Bahram, Seiamak; Süsal, Caner; Other; School of MedicineThe identity of histocompatibility loci, besides human leukocyte antigen (HLA), remains elusive. The major histocompatibility complex (MHC) class I MICA gene is a candidate histocompatibility locus. Here, we investigate its role in a French multicenter cohort of 1,356 kidney transplants. MICA mismatches were associated with decreased graft survival (hazard ratio (HR), 2.12; 95% confidence interval (CI): 1.45-3.11; P < 0.001). Both before and after transplantation anti-MICA donor-specific antibodies (DSA) were strongly associated with increased antibody-mediated rejection (ABMR) (HR, 3.79; 95% CI: 1.94-7.39; P < 0.001; HR, 9.92; 95% CI: 7.43-13.20; P < 0.001, respectively). This effect was synergetic with that of anti-HLA DSA before and after transplantation (HR, 25.68; 95% CI: 3.31-199.41; P = 0.002; HR, 82.67; 95% CI: 33.67-202.97; P < 0.001, respectively). De novo-developed anti-MICA DSA were the most harmful because they were also associated with reduced graft survival (HR, 1.29; 95% CI: 1.05-1.58; P = 0.014). Finally, the damaging effect of anti-MICA DSA on graft survival was confirmed in an independent cohort of 168 patients with ABMR (HR, 1.71; 95% CI: 1.02-2.86; P = 0.041). In conclusion, assessment of MICA matching and immunization for the identification of patients at high risk for transplant rejection and loss is warranted.Publication Open Access TFOS European Ambassador meeting: unmet needs and future scientific and clinical solutions for ocular surface diseases(Elsevier, 2020) Erickson, Susan; Sullivan, Ammy Gallant; Barabino, Stefano; Begovic, Enesa; Benitez-del-Castillo Jose M.; Bonini Stefano; Borges Jose Salgado; Brzheskiy, Vlademir; Bulat, Nina; Cerim, Alma; Craig, Jennifer P.; Cușnir, Valeriu Jr.; Cusnir, Valeriu; Cusnir, Vitalie; Doan Serge; Dülger, Erol; Farrant, Sarah; Geerling, Gerd; Goldblum, David; Golubev, Sergey; Gomes, Jose A.P.; González-Méijome, Jose Manuel; Grupcheva, Christina N.; Gündüz, Ömür Uçakhan; Horwath-Winter, Jutta; Källmark, Fredrik; Karanadze, Nino; Karcic, Huda Hajjir; Karcic, Suvad; Kontadakis, Georgious; Messmer, Elisabeth M.; Mrugacz, Malgorzata; Murphy, Conor; O'Leary, Olivia E.; Procopciuc, Vitalie; Pult, Heiko; Raus, Peter; Setälä, Niko; Stanila, Adrina; Stanila, Den Mircea; Utheim, Toor Paeske; Vehof, Jelle; Versura, Piera; Villani, Edoardo; Willcox, Mark D. P.; Wolffsohn, James S.; Zagórski, Zebigniew; Zoega, Gunnar Mar; Sullivan, David A.; Şahin, Afsun; Faculty Member; School of Medicine; 171267The mission of the Tear Film & Ocular Surface Society (TFOS) is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface. Fundamental to fulfilling this mission is the TFOS Global Ambassador program. TFOS Ambassadors are dynamic and proactive experts, who help promote TFOS initiatives, such as presenting the conclusions and recommendations of the recent TFOS DEWS II™, throughout the world. They also identify unmet needs, and propose future clinical and scientific solutions, for management of ocular surface diseases in their countries. This meeting report addresses such needs and solutions for 25 European countries, as detailed in the TFOS European Ambassador meeting in Rome, Italy, in September 2019.Publication Open Access Interfascial plane blocks as shortcut alternatives for regional anesthesia and pain management for SARS-CoV-2 days: not deeper, not longer. Be safe for everyone(Elsevier, 2020) Tulgar, Serkan; Ahıskalıoğlu, Ali; Thomas, David Terence; Gürkan, Yavuz; Faculty Member; School of MedicinePublication Open Access Appropriate use of tocilizumab in COVID-19 infection(Elsevier, 2020) Keske, Şiran; Sait, Bilgin; Çimen, Cansu; Çelebi, İrfan; Palaoğlu, Erhan; N/A; Tekin, Süda; İrkören, Pelin; Kapmaz, Mahir; Ergönül, Önder; Uğur, Semra; Şentürk, Evren; Çakar, Nahit; Çağlayan, Benan Niku; Tabak, Levent; Bakır, Veli Oğuzalp; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Graduate School of Sciences and Engineering; N/A; N/A; N/A; 110398; N/A; 48359; N/A; 230719; N/A; N/AObjective: this study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. Methods: all patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, D-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. Results: forty-three patients were included: 70% were male; the median age was 64 years (minimum– maximum: 27–94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, D-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. Conclusion: earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and D-dimer, and decrease in % lymphocytes.Publication Open Access Extensive androgen receptor enhancer heterogeneity in primary prostate cancers underlies transcriptional diversity and metastatic potential(Nature Portfolio, 2022) Kneppers, J.; Severson, T.M.; Siefert, J.C.; Schol, P.; Joosten, S.E.P.; Yu, I.P.L.; Huang, C.F.; Morova, T.; Giambartolomei, C.; Seo, J.H.; Baca, S.C.; Carneiro, I.; Emberly, E.; Pasaniuc, B.; Jerónimo, C.; Henrique, R.; Freedman, M.L.; Wessels, L.F.A.; Bergman, A.M.; Zwart, W.; N/A; Lack, Nathan Alan; Altıntaş, Umut Berkay; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; Graduate School of Sciences and Engineering; 120842; N/AAndrogen receptor (AR) drives prostate cancer (PCa) development and progression. AR chromatin binding profiles are highly plastic and form recurrent programmatic changes that differentiate disease stages, subtypes and patient outcomes. While prior studies focused on concordance between patient subgroups, inter-tumor heterogeneity of AR enhancer selectivity remains unexplored. Here we report high levels of AR chromatin binding heterogeneity in human primary prostate tumors, that overlap with heterogeneity observed in healthy prostate epithelium. Such heterogeneity has functional consequences, as somatic mutations converge on commonly-shared AR sites in primary over metastatic tissues. In contrast, less-frequently shared AR sites associate strongly with AR-driven gene expression, while such heterogeneous AR enhancer usage also distinguishes patients’ outcome. These findings indicate that epigenetic heterogeneity in primary disease is directly informative for risk of biochemical relapse. Cumulatively, our results illustrate a high level of AR enhancer heterogeneity in primary PCa driving differential expression and clinical impact.Publication Open Access COVID-19 in kidney transplant recipients: a multicenter experience in Istanbul(Wiley, 2020) Demir, Erol; Uyar, Murathan; Parmaksız, Ergün; Sinangil, Ayşe; Dirim, Ahmet Burak; Merhametsiz, Özgür; Yadigar, Serap; Atan Uçar, Zuhal; Uçar, Ali Rıza; Demir, Mehmet Emin; Meşe, Meral; Akın, Emin Barış; Garayeva, Nurana; Şafak, Seda; Oto, Özgür Akın; Yazıcı, Halil; Yelken, Berna; Türkmen, Aydın; Doctor; School of MedicineIntroduction: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19. Material and Methods: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation. Results: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up. Discussion: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period.Publication Open Access A telerehabilitation approach to chronic facial paralysis in the COVID-19 pandemic scenario: what role for electromyography assessment?(Multidisciplinary Digital Publishing Institute (MDPI), 2022) de Sire A., Marotta N., Agostini F., Drago Ferrante V., Demeco A., Ferrillo M., Inzitari M.T., Pellegrino R., Russo I., Taskiran O.O., Bernetti A., Ammendolia A.; Taşkıran, Özden Özyemişçi; Faculty Member; School of Medicine; 133091There is a lack of data on patient and diagnostic factors for prognostication of complete recovery in patients with peripheral facial palsy. Thus, the aim of this study was to evaluate the role of a telerehabilitave enhancement through the description of a case report with the use of short-wave diathermy and neuromuscular electrical stimulation combined to facial proprioceptive neuromuscular facilitation (PNF) rehabilitation in unrecovered facial palsy, in a COVID-19 pandemic scenario describing a paradigmatic telerehabilitation report. A 43-year-old woman underwent a facial rehabilitation plan consisting of a synergistic treatment with facial PNF rehabilitation, short-wave diathermy, and neuromuscular electrical stimulation (12 sessions lasting 45 min, three sessions/week for 4 weeks). Concerning the surface electromyography evaluation of frontal and orbicularis oris muscles, the calculated ratio between amplitude of the palsy side and normal side showed an improvement in terms of movement symmetry. At the end of the outpatient treatment, a daily telere-habilitation protocol with video and teleconsultation was provided, showing a further improvement in the functioning of a woman suffering from unresolved facial paralysis. Therefore, an adequate telerehabilitation follow-up seems to play a fundamental role in the management of patients with facial palsy.