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Publication Open Access Management of hypoglycemia in newborn: Turkish Neonatal and Pediatric Endocrinology and Diabetes Societies consensus report(Turkish Pediatric Association, 2019) Aliefendioğlu, Didem; Çoban, Asuman; Hatipoğlu, Nihal; Ecevit, Ayşe; Arısoy, Ayşe Engin; Baş, Firdevs; Bideci, Aysun; Özek, Eren; N/A; Yeşiltepe Mutlu, Rahime Gül; Faculty Member; School of Medicine; 153511Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30th minute alter feeding. The threshold value for hypoglycemia is 40 mg/dL for the first 24 hours in symptomatic babies. In asymptomatic babies, this value is considered 25 mg/dL for 0-4 hours, 35 mg/dl for 4-24 hours, 50 mg/dL alter 24 hours and 60 mg/dL after 48 hours. Screening should be performed with bed-side test sticks. When values near the limit value are obtained, confirmation with laboratory method should be done and treatment should be initiated, if necessary. The level targeted with treatment is considered 50 mg/dL in the postnatal first 48 hours before feeding, 60 mg/dL after 48 hours in babies with high risk and above 70 mg/dL in babies with permanent hypoglycemia. In cases in which the blood glucose level is below the threshold value and can not be increased by feeding, a glucose infusion of 6-8 mg/kg/min should be initiated. If symptoms accompany, a mini bolus of 10% dextrose (2 ml/kg/min) should accompany. Incements (2 mg/kg/min) should be performed, if the target level can not be achieved and decrements (2 ml/kg/min) should be performed, if nutrition and stabilization is provided. The infusion should be discontinued, if the infusion rate decreases to 3-5 mg/kg/min. If necessary, blood samples should be obtained during hypoglycemia in terms of differential diagnosis and the investigation should be performed following a 6-hour fasting period in babies fed enterally and at any time when the plasma glucose is <50 mg/dL in babies receiving parenteral infusion. The hypoglycemic babies in the risk group whose infusions have been terminated can be discharged, if the plasma glucose level is found to be at the target level for two times before feeding and babies with permanent, severe or resistant hypoglycemia can be discharged, if the plasma glucose level is >60 mg/dL following a 6-hour fast. / Hipoglisemi, uzun sürmesi ve tekrarlaması durumunda nörolojik zedelenme riski nedeniyle, yenidoğanın en önemli ve en sık metabolik sorunlarından birisidir. Bu nedenle, hipoglisemi riski taşıyan yenidoğanlar, doğum sonrası hemen beslenmeli ve beslenme sonrası 30. dakikadan itibaren 2-3 saat aralıklarla kan glukozuna bakılmalıdır. Hipoglisemi eşik değerleri, ilk 24 saat için belirtisi olanlarda 40 mg/dL, belirtisiz olanlarda 0 - 4 saatte 25 mg/dL, 4-24 saat aralığında 35 mg/dL, 24 saatten sonra 50 mg/ dL, 48 saatten sonra ise 60 mg/dL olarak kabul edilebilir. Tarama hastabaşı test çubukları ile yapılmalı, sınıra yakın değerlerde, laboratuvar yöntemi ile doğrulama yapılırken, gerekliyse tedavi başlanmalıdır. Tedavi ile ulaşılması hedeflenen düzeyler, beslenme öncesi postnatal ilk 48 saatte 50 mg/dL, 48 saatten sonra riskli olanlarda 60 mg/dL, kalıcı hipoglisemili olgularda ise 70 mg/dL’nin üstü olarak kabul edilebilir. Kan glukozu eşik değerin altında olan ve beslenme ile yükseltilemeyen durumlarda, 6-8 mg/kg/dk glukoz infüzyonu başlanmalı, belirti eşlik etmesi durumunda ise 2 ml/kg %10 dekstroz minibolus eşlik etmelidir. Hedef düzeye ulaşılamaması durumunda artışlar ve beslenme ile stabilizasyonun sağlanması durumunda azaltmalar 2 mg/kg/dk olarak yapılmalı, infüzyon hızının 3-5 mg/kg/dk’ye inmesi durumunda ise infüzyon sonlandırılmalıdır. Gerekliyse ayırıcı tanı açısından kan örnekleri hipoglisemi sırasında alınmalı ve araştırma, enteral beslenen bebeklerde 6 saatlik beslenmeme periyodu sonrasında, parenteral infüzyon alanlarda ise plazma glukozunun 60 mg/dL olması durumunda taburcu edilebilirler.Publication Open Access Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy : a case report(Elsevier, 2016) Sağlıcan, Yeşim; N/A; N/A; N/A; N/A; Acar, Ömer; Sağ, Alan Alper; Falay, Fikri Okan; Selçukbiricik, Fatih; Tabak, Levent; Esen, Tarık; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; School of Medicine; 237530; N/A; N/A; N/A; N/A; N/A; 50536INTRODUCTION: Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far. CASE PRESENTATION: A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the [18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor. DISCUSSION: Late recurrence of RCC has been reported to occur in 10-20% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition. CONCLUSION: To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnosticPublication Open Access Engineering human stellate cells for beta cell replacement therapy promotes in vivo recruitment of regulatory T cells(Elsevier, 2019) N/A; Department of Chemical and Biological Engineering; Oran, Dilem Ceren; Lokumcu, Tolga; Bal, Tuğba; İnceoğlu, Yasemin; Albayrak, Özgür; Erkan, Murat Mert; Kurtoğlu, Metin; Can, Füsun; Önder, Tuğba Bağcı; Kızılel, Seda; Akolpoğlu, Mükrime Birgül; Faculty Member; Faculty Member; Master Student; Department of Chemical and Biological Engineering; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); Graduate School of Sciences and Engineering; Graduate School of Health Sciences; College of Engineering; School of Medicine; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 103165; 184359; 28376; N/AType 1 diabetes (T1D) is an autoimmune disease characterized by destruction of pancreatic β cells. One of the promising therapeutic approaches in T1D is the transplantation of islets; however, it has serious limitations. To address these limitations, immunotherapeutic strategies have focused on restoring immunologic tolerance, preventing transplanted cell destruction by patients’ own immune system. Macrophage-derived chemokines such as chemokine-ligand-22 (CCL22) can be utilized for regulatory T cell (Treg) recruitment and graft tolerance. Stellate cells (SCs) have various immunomodulatory functions: recruitment of Tregs and induction of T-cell apoptosis. Here, we designed a unique immune-privileged microenvironment around implantable islets through overexpression of CCL22 proteins by SCs. We prepared pseudoislets with insulin-secreting mouse insulinoma-6 (MIN6) cells and human SCs as a model to mimic naive islet morphology. Our results demonstrated that transduced SCs can secrete CCL22 and recruit Tregs toward the implantation site in vivo. This study is promising to provide a fundamental understanding of SC-islet interaction and ligand synthesis and transport from SCs at the graft site for ensuring local immune tolerance. Our results also establish a new paradigm for creating tolerable grafts for other chronic diseases such as diabetes, anemia, and central nervous system (CNS) diseases, and advance the science of graft tolerance.Publication Open Access Silicon photonics with microspheres(Society of Photo-optical Instrumentation Engineers (SPIE), 2006) Department of Physics; N/A; Serpengüzel, Ali; Akatlar, Onur; Kurt, Adnan; Faculty Member; Teaching Faculty; Department of Physics; College of Sciences; College of Engineering; 27855; N/A; 194455Silicon microspheres coupled to optical fibers have been used for optical channel dropping in the near-IR. The observed morphology dependent resonances had quality factors of 100000. These optical resonances provide the necessary narrow linewidths, that are needed for high resolution optical filtering applications in the near-IR. In addition to filtering, detection, and switching applications of this photonic system is studied in the near-IR as well as far-IR. The silicon microsphere shows promise as a building block for silicon photonics in the near-IR as well as, mid-IR, and far-IR.Publication 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 Does resection of heterotopic ossification of the elbow result in satisfactory functional outcomes?(Galenos Yayınevi, 2019) Kapıcıoğlu, Mehmet; Sağlam, Yavuz; Ersen, Ali; Atalar, Ata, Can; Durmaz, Hayati; N/A; Demirhan, Mehmet; Faculty Member; School of Medicine; 9882Objective: heterotopic ossification (HO) is a common cause of elbow stiffness following surgical treatment of elbow trauma. In this study, our aim was to evaluate the mid-term functional outcomes of open surgical procedures for HO. Methods: in this retrospective study approved by the institutional review board (IRB), all patients who were diagnosed as having stiff elbow due to HO and underwent surgical resection at a single institution from 2006 to 2013 were included. Intrinsic (inside the joint) pathologies were excluded. Range of motion (ROM) in sagittal and coronal planes, complications, functional scores such as Quick Disabilities of the Arm, Shoulder and Hand Score (Q-DASH), and Mayo Elbow Performance Score (MEPS) were evaluated before and after surgery. Results: there were 19 patients (16 males, 3 females) with a mean age of 38.6 (range 15-69) years. At an average follow-up of 36 +/- 8 months, the mean flexion-extension arc was improved from 27.4 degrees to 99.2 degrees (p<0.001) and mean supination-pronation arc was improved from 48.9 degrees to 102.3 degrees (p<0.001). The mean Q-DASH score was decreased from 68.2 to 17.1 (p<0.001) and mean MEPS was improved from 37.5 to 85.6 (p<0.001). Conclusion: excision of heterotopic bone and releasing contracted tissues around elbow can provide a substantial increase in range of motion and improvement in clinical scores.Publication Open Access Views of Turkish people on oocyte and sperm donation(Çukurova Üniversitesi, 2019) Şenol, Derya Kaya; Yılmaz, Sema Dereli; Bal, Meltem Demirgöz; Beji, Nezihe Kızılkaya; Çalışkan, Seval; N/A; Urman, Cumhur Bülent; Faculty Member; School of Medicine; 12147Purpose: the aim of the study is to determine the views of the Turkish people on oocyte/sperm donation. Materials and methods: following informed consent, a questionnaire was given to women and their spouses who presented to obstetrics and gynecology outpatient clinics of a university hospital. The data collection form consists of 35 questions about the demographics of the participants and their thoughts about oocyte/sperm donation. A total of 428 women, including 323 women and 105 men, agreed to participate in the sampling study. Results: sixty-four-point three percent of the women and 71.4% of males found use of donated oocytes/sperms in infertile couples unacceptable. Sixty-three-point one percent of the participants said that both couples receiving, and those donating oocytes/sperms should get counseling. Twenty-one point-five percent of the participants approved of infertile couples' receiving oocytes/sperms donated by their relatives (e.g. sister) and friends and 31,8% agreed about getting them from strangers. Eighty-eight-point seven percent of the primary school graduates, 73.4% of the university graduates and postgraduates, 76.7% of the employed participants, 86.2% of the participants with an income lower than their expenses and 85.1% of the participants with live children reported to unaccept donated sperms if their spouses had a problem preventing them from having a child. Conclusion: more than half of the participants declared that it was not appropriate to have children through infertile-donated oocyte/sperm. / Amaç: bu çalışmanın amacı, Türk halkının oosit / sperm bağışı hakkındaki görüşlerini belirlemektir. Gereç ve Yöntem: tanımlayıcı kesitsel tipteki bu çalışma bir üniversite hastanesinin kadın hastalıkları ve doğum polikliniğine, kadınlar ve eşlerine veri toplama formu uygulanarak yürütüldü. Veri toplama formu katılımcıların demografik özelliklerine ve oosit/sperm bağışı hakkındaki düşüncelerine ilişkin 35 sorudan oluşmaktadır. Örnekleme çalışmaya katılmayı kabul eden 323'ü kadın, 105'i erkek toplam 428 kişi dahil edildi. Bulgular: kadınların %64.3’ü, erkeklerin %71.4’ü infertile çiftlerde bağışlanmış oosit/sperm kullanımını uygun bulmadığını belirtti. Katılımcıların %63.0’ü, oositler/sperm bağışçılarının ve bağışı kabul edenlerin danışmanlık alması gerektiğini söyledi. Uygun bulan kişilerin %21.5’i akraba (örneğin kızkardeşi) ve arkadaş tarafından yapılan oosit/sperm bağışını uygun bulurken, %31.8'i yabancılardan almayı uygun bulmaktadır. İlkokul mezunlarının %88.7’si, üniversite ve üzeri düzeyde mezunların %73.4'ü, çalışanların %76.7'si, gelirleri giderlerinden daha düşük olanların%86.2'si ve yaşayan çocuğu olanların %77,1'i eşlerinde çocuk sahibi olmayı engelleyen bir problem varlığında bağışlanan oosit/sperm yoluyla çocuk sahibi olmayı kabul etmeyeceklerini belirttiler. Sonuç: katılımcıların yarıdan fazlası, infertilitede bağışlanmış oosit/sperm yoluyla çocuk sahibi olmasını uygun bulmadığını beyan etmiştir.Publication Open Access Hybrid arc: combining forward IMRT and double arc VMAT in locally advanced rectum cancer(Akademi Doktorlar Yayınevi, 2019) Sağlam, Yücel; Alpan, Vildan; Bingölbali, Ayhan; N/A; Bölükbaşı, Yasemin; Sezen, Duygu; Selek, Uğur; Faculty Member; Faculty Member; Faculty Member; School of Medicine; 216814; N/A; 27211To investigate the potential of increasing target dose conformity and organ at risk (OAR) sparing of Hybrid Arc approach for patients with locally advanced rectum cancer (LARC) in comparison to VMAT and inverse IMRT. This study consisted of thirteen patients who had LARC, were treated with VMAT in 25Gy in 5 fractions. Two different new plans for each patient were generated on Pinnacle TPS by inverse IMRT (7 fields) and Hybrid Arc technique (combining forward IMRT (3 fields) with 20% weight and VMAT (double full arcs) with 80% weight). Treatment plans; Hybrid Arc, VMAT and inverse IMRT, were assessed using dose-volume histogram (DVH) parameters of OARs doses for bladder, small bowel, femur heads and penile bulb in male patients' cases. Ad-ditionally, monitor units (MU), conformity index (CI) and homogeneity index (HI) for clinical target volumes (CTV) were compared for all three techniques. Most DVH parameters pertaining to OARs significantly favored Hybrid Arc technique compared to VMAT and inverse IMRT. Hybrid Arc provided significantly improved Bladder DVH parameters in comparison to IMRT & VMAT. The Hybrid technique provided significantly lower small bowel doses in comparison to inverse IMRT and VMAT for all DVH pa-rameters. Mean MU of inverse IMRT was the highest one (MUIMRT= 1803, p= 0.001 vs VMAT; p= 0.023 vs Hybrid Arc). The target dose conformity and homogeneity of VMAT were better than the other two techniques. Hybrid technique combined the advantages of forward IMRT and VMAT for better OAR sparing in comparison to VMAT and inverse IMRT. / Lokal ileri rektum kanserli (LİRK) olgularda, Hibrit Ark yaklaşımının, VMAT ve IMRT ile karşılaştırılarak, hedef doz konformalitesini ve risk altındaki organ (OAR) korumasını arttırma potansiyelini araştırmaktır. Çalışmamıza, 5 fraksiyonda 25 Gy VMAT ile tedavi edilen 13 LİRK’li olgu dahil edilmiştir. Her hasta için, yeni IMRT ve Hibrit Ark tekniği (forward IMRT (3 alanlar: 275 °, 80 °, 180 °) %20 ağırlık ile ve VMAT (çift tam ark: 182°-178°) %80 ağırlık ile birleştiren) kullanılarak yapılan planlar, Pinnacle TPS’de oluşturuldu. Tedavi planları; Hibrit Ark, VMAT ve IMRT, mesane (V25Gy %, V20Gy %, V15Gy %, V10Gy % ve Dort), ince bağırsak (V25Gy cc, V15Gy cc, V10Gy cc, Dmaks and Dort), femur başları (V25Gy %, V15Gy %, Dmax and Dmean) ve erkek olgularda penis bulb (Dmax and Dmean) için OAR dozları doz hacim histogramı (DVH) parametreleri kullanılarak değerlendirildi. Ek olarak, klinik hedef hacimleri (CTV) için monitör birimleri (MU), konformalite indeksi (CI) ve homojenite indeksi (HI) her üç teknik için karşılaştırıldı. OAR’larla ilgili DVH parametrelerinin çoğu, VMAT ve IMRT’ye kıyasla önemli ölçüde Hibrit Ark tekniğinden yanaydı. Hibrit Ark yönteminin, IMRT ve VMAT karşılaştırıldığında, Mesane DVH parametrelerini (V25Gy cc, V15Gy cc, V10Gy cc, Dmax and Dmean) azalttığı gösterilmiştir. Hibrit planlama tekniği, ortalama doz dahil olmak üzere listelenen tüm ince bağırsak DVH parametreleri için, IMRT ve VMAT ile karşılaştırıldığında belirgin şekilde daha düşük dozlar sağlamıştır. Hibrit tekniği, VMAT’a kıyasla V20Gy%, V15Gy %’de daha düşük femur başı dozları olduğu saptanmıştır. Penis bulbusun, ortalama ve maksimum dozları her üç teknik için benzerdir. IMRT’nin ortalama MU değeri en yüksektir (MUIMRT= 1803, p= 0.001 vs VMAT; p= 0.023 vs Hybrid Arc). VMAT’ın hedef doz konformalitesi ve homojenitesi diğer iki teknikten daha iyiydi. (CIVMAT=1.16 vs CIHybrid=1.19, p= 0.003; vs CIIMRT= 1.22, p= 0.001 and HIVMAT= 0.33 vs HIHybrid= 0.36, p= 0.01; vs HIIMRT= 0.37, p= 0.012). Hibrit tekniğinin, VMAT ve IMRT’ye kıyasla, daha iyi OAR koruması için ileri IMRT ve VMAT’ın avantajlarını birleştirmektedir.Publication Open Access Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases(Baishideng Publishing Group (BPG), 2016) N/A; N/A; Sağ, Alan Alper; Selçukbiricik, Fatih; Mandel, Nil Molinas; Faculty Member; Faculty Member; Faculty Member; School of MedicineColorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is (limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharma cological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.Publication Open Access Virtual dance mirror: a functional approach to avatar representation through movement in immersive VR(Association for Computing Machinery (ACM), 2022) Öztürk, Aslı; Topal, Onur Sümer; Department of Media and Visual Arts; Department of Psychology; N/A; Yantaç, Asım Evren; Eskenazi, Terry; Akbaş, Saliha; Şemsioğlu, Sinem; Kuşçu, Kemal; Faculty Member; Department of Media and Visual Arts; Department of Psychology; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; School of Medicine; 52621; 258780; N/A; N/A; N/AImmersive Virtual Reality (VR) technologies offer new possibilities for studying embodied interaction with different sets of constraints and affordances for action-taking while using one's physical body. In this study, we designed and prototyped a VR dance experience, Virtual Dance Mirror, where a dancer's bodily movements are reflected on a 3D avatar model using a motion-capture suit. We investigated the novel possibilities for avatar design based on the expression of movements available for dancers in VR environment. After a preliminary briefing session, we conducted a user-study with five dancers with semi-structured interviews. Our findings support HCI literature on virtual body design to facilitate collaboration and non-verbal communication between VR users.