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Permanent URI for this collectionhttps://ada.atilim.edu.tr/handle/123456789/19

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Fistulectomy and Primary Sphincteroplasty for Transsphincteric Fistula
(College of Physicians and Surgeons Pakistan, 2025) Emral, A.C.; Gulen, M.; Ege, B.
Objective: To evaluate the results of patients treated with fistulectomy and primary sphincteroplasty for uncomplicated perianal fistula. Study Design: Observational study. Place and Duration of the Study: Medicana International Hospital affiliated with Atilim University, Faculty of Medicine, Ankara, Turkiye, from January 2020 to September 2023. Methodology: In this study, patients who were operated on for perianal fistula between 2020 and 2023 were retrospectively examined. Data were obtained retrospectively. All patients underwent preoperative perianal MRI. Clinical notes were evaluated with the Cleveland Clinic Incontinence Score (CCIS) by physical examination. All patients were followed up on the first postoperative day, 1st week, 1st and 3rd postoperative months. Results: A total of 44 patients who underwent fistulectomy with primary sphincteroplasty were included in the study. Twenty-six patients (59.1%) had a history of perianal abscesses. It was observed that 34 (77.3%) of the patients had posterior, 7 (15.9%) anterior, and 3 (6.8%) lateral fistulas. A total of 3 patients (6.8%) were observed to have minor worsening in their incontinence scores. There was no statistically significant difference between the preoperative and postoperative 3rd month Cleveland Clinic Incontinence Score values of the patients (CCIS mean 1.6 vs. 1.7, respectively, p >0.05). Recurrence was observed in 1 patient (2.3%) during follow-ups. Conclusion: Fistulectomy with primary sphincteroplasty is an effective and reliable method to preserve anal continence and improve quality of life. © 2025 College of Physicians and Surgeons Pakistan. All rights reserved.
Analytical Modeling of Nh3 Gas Sensing Using Zigzag Graphene Nanoscrolls: Energy Band Structure and Electrical Properties
(Springer, 2025) Hosseingholipourasl, A.
Graphene nanoscrolls (GNSs), a unique nanostructure of graphene, have garnered considerable attention due to their distinctive properties such as a rolled-up papyrus-like structure, adjustable core geometry, increased inner wall area, and enhanced surface-to-volume ratio. These properties make GNS a promising candidate for various nanoelectronic applications, including gas sensing devices. Despite its potential, GNS has been relatively underexplored in the context of gas sensing applications. In this study, we present a series of analytical models to characterize the behavior of zigzag graphene nanoscrolls (ZGNS)-based gas sensors in the presence of NH3 gas. The tight-binding technique, employing nearest neighbor approximation, is utilized to formulate the energy dispersion relation of GNS, incorporating the influence of gas molecule adsorption through parameters such as the hopping integral between GNS and gas and the on-site energy of adsorbed gas molecules. Furthermore, the derived energy equation is employed to establish the conductance relation and explore the impact of gas adsorption on the electrical conductance of GNS. Subsequently, the I-V characteristics of the GNS sensor are formulated, and the variations in current due to NH3 gas exposure are analyzed. The gate voltage is modeled as a function of NH3 concentration, and a sensing parameter is proposed based on current variations across different concentrations. Validation of the model is performed by comparing the obtained results with data extracted from previous studies. The findings demonstrate good agreement, underscoring the effectiveness of the proposed ZGNS-based sensor model for NH3 detection under varying environmental conditions. © The Author(s) 2025.
Recent Studies on Use of Waste Plastics in Integrated Ironmaking
(Springer Science and Business Media Deutschland GmbH, 2025) Keskinkilic, E.
Around 7% of CO2 emissions are originated from the steel production. Nearly, three-quarters of the steel produced annually are obtained from the integrated route (BF-BOF). It is known that use of coke in BF results in 1700 kg CO2 emission per ton of hot metal. In relation to zero CO2 emission target, many investigations have been conducted in steelmakingSteelmaking industry for many years. One of them in blast furnaceBlast furnace process can be regarded as replacing coke with certain alternatives. In this respect, substitution of coal and coke with biomassBiomass, use of coke oven gas (COG), use of pure H2 gas, and use of waste plasticsWaste plastics are some examples to the efforts to reduce CO2 emissions. In this paper, the studies aiming to substitute coke with waste plasticsWaste plastics are reviewed. © The Minerals, Metals & Materials Society 2025.
Mild Solutions for Conformable Fractional Order Functional Evolution Equations Via Meir-Keeler Type Fixed Point Theorem
(University of Nis, 2025) Berrighi, F.; Medjadj, I.; Karapınar, E.
In this study, we delve into the realm of mild solutions for conformable fractional order functional evolution equations, focusing on cases where the fractional order is strictly greater than 1 and less than 2 within a separable Banach space. We demonstrate the existence, uniqueness, attractivity, and con-trollability of these solutions under local conditions. Our approach involves leveraging a contribution of Meir-Keeler’s fixed point theorem alongside the principle of measures of noncompactness. To demonstrate the practical ramifications of our theoretical finds, we provide a specific example that underscores the relevance and applications of the established results.
Large Deflection Analysis of Functionally Graded Reinforced Sandwich Beams With Auxetic Core Using Physics-Informed Neural Network
(Taylor and Francis Ltd., 2025) Nopour, R.; Fallah, A.; Aghdam, M.M.
This paper aims to investigate the large deflection behavior of a sandwich beam reinforced with functionally graded (FG) graphene platelets (GPL) together with an auxetic core, rested on a nonlinear elastic foundation. The nonlinear governing equations of the problem are derived using Hamilton’s principle based on the Euler-Bernoulli beam theory for large deflections. Five different distributions are considered to describe the dispersion of GPL in the top and bottom faces of the sandwich beam. The Physics-Informed Neural Network (PINN) method is employed to model the nonlinear deflection of the beam under various boundary conditions. This study highlights the effectiveness of PINN in handling the complexities of nonlinear structural analyses. The findings underscore the impact of the core auxeticity, GPL amount and distribution, and elastic foundation coefficient on the nonlinear deflection of the sandwich beam under different loading scenarios. For instance, using Type I configuration can reduce the deflection of the beam by nearly half compared to using Type IV. Furthermore, a nonlinear foundation with a unit coefficient results in a 48% reduction in deflection compared to the scenario without an elastic foundation. © 2025 Taylor & Francis Group, LLC.
The Impact of the “Newborn Gang” Scandal on Türkiye’s Neonatal Healthcare Community
(Taylor and Francis Ltd., 2025) Yüksel, D.
The Individual Readiness and Risk-Related Concerns of It Professionals for Blockchain Adoption
(Zhejiang University, 2025) Turhan, C.; Akman, I.
Blockchain has gained remarkable momentum since its introduction in 2008, drawing the attention of industries, individuals, and governments on a global scale. This technology has been studied in the literature, with a focus on technical aspects, application areas, and emerging research challenges. However, few studies address individuals’ perceptions of and concerns with respect to blockchain adoption. This study aims to investigate the attributes affecting blockchain adoption intention. A sample of IT professionals was used for this purpose since they are expected to have earlier and greater awareness of new digital technologies. The perceptions of this group of users regarding attributes such as innovativeness, self-efficacy, social pressure, and awareness, as well as their perceptions of privacy, security, and complexity, were examined through a survey of 208 responses. The results indicate that among the individual attributes, personal innovativeness, awareness, and social pressure positively affect blockchain acceptance, whereas security and privacy concerns fuel the reluctance to adopt blockchain. The findings hopefully provide insight for developers and management of enterprises to ensure a smooth transition into blockchain and present evidence to forecast its future. © 2024
An Investigation of the Effect of Free-Players on Global Cooperative Behavior in a Spatial Prisoner’s Dilemma Game Environment
(Springer Science and Business Media Deutschland GmbH, 2025) Efe, B.; Çerkez, E.; Kılıç, H.
In this research, we introduced the concept of Free-Player who rejects to play the dictated rational strategy Defect of the original Prisoner’s Dilemma game setup. Then, we investigated whether Free-Players have any impact on the persistent and stable cooperative behavior of the Players in the context of two dimensional spatial Prisoner’s Dilemma game environment. In simulations, two different Player strategy update setups are considered: State-based Majority and Payoff-driven Stochastic. The results for both setups showed that Free-Players have impact on global cooperative behavior of the system. According to the obtained State-based Majority setup results, the increased number of Free-Players has no direct regulative impact on the control of global cooperative behavior of the proposed system. For the Payoff-driven Stochastic strategy update setup, the increased number of Free-Players has an observable regulative impact on the control of global cooperative behavior of the proposed system. However, the net effect of Free-Players on the cooperativeness of the environment was only in the range 0.007 < Net_Coop(α, β) < 0.036 while the attained cooperation ratio results are mostly not sensitive to the initial cooperation ratios. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2025.
Selection of Dna Aptamers Against Parathyroid Hormone for Electrochemical Impedimetric Biosensor System Development
(John Wiley and Sons Inc, 2025) Didarian, R.; Bargh, S.; Gülerman, A.; Özalp, V.C.; Erel, Ö.; Yildirim-Tirgil, N.
This work presents the pioneering development of an aptamer-based electrochemical biosensor for real-time monitoring of parathyroid hormone (PTH) levels, with a focus on intraoperative assessment during parathyroid surgery. It introduces, for the first time, the selection and characterization of aptamers targeting distinct segments of the PTH peptide. The study demonstrates the feasibility and efficacy of the biosensing platform through a precisely designed experimental framework, including SELEX-based aptamer selection, aptamer–peptide interaction analysis, and biosensor fabrication. The SELEX process yields aptamers with notable binding affinities to different fragments of PTH, with the PTH (53–84) aptamer showing particularly sensitive binding to the hormone's C terminus, allowing for precise PTH analysis. Electrochemical characterization reveals significant changes in electrochemical impedance spectroscopy (EIS) signals upon exposure to varying PTH concentrations, highlighting the sensor's sensitivity and selectivity. The increase in charge transfer resistance (Rct) values with rising PTH concentrations underscores the biosensor's capability to detect PTH-induced structural changes, validating its potential for accurate measurement. The biosensor shows remarkable selectivity in the presence of common interferents in serum samples, ensuring precise PTH detection. Stability assessments over a 45-day storage period demonstrate the biosensor's robustness and long-term reliability, affirming its practical suitability. In summary, the developed aptamer-based biosensor represents a promising tool for sensitive and selective PTH detection, with potential applications in biomedical research and clinical diagnostics, particularly for intraoperative PTH analysis during parathyroidectomy. Continued research and optimization efforts hold promise for enhancing its performance and expanding its utility in diverse healthcare settings. © 2025 The Author(s). Biotechnology and Applied Biochemistry published by Wiley Periodicals LLC on behalf of International Union of Biochemistry and Molecular Biology.
Investigating of Dynamic Compressive Response of Plain and Fiber-Reinforced Concrete Structures at Various Strain Rates
(SAGE Publications Ltd, 2025) Gunay, A.R.; Hafizoglu, H.; Akdeniz, E.; Kaya, C.
Across the world, studies on building design are conducted at various scales. The behavior of structures under static loading has been the subject of various studies in the modern era, leading to the development of significant standards and application techniques. However, studies on the behavior of structures under dynamic loading have remained limited. This study investigated the dynamic compressive behavior of plain and fiber-reinforced C60 and C80 concrete samples through experimental studies at room temperature. In addition, this study also investigated dynamic deformation and fracture behavior of plain concrete samples by numerical studies. For this purpose, plain and fiber-reinforced C60 and C80 concrete samples were produced. Experimental studies covered both static and dynamic compression tests. Following the static tests, dynamic test samples with a diameter and length of 10 mm were produced from the static test samples by water jet cutting method and were dynamically compressed in the Split Hopkinson Pressure Bar (SHPB) test setup. Dynamic compression test results showed that the strength of plain and fiber-reinforced C60 and C80 concretes were obtained in the range of 74–162 MPa at an average strain rate of between 139 and 650 s−1. Experimental results also showed that the fiber addition affected the dynamic increase factor (DIF) and impact toughness of both C60 and C80 concretes in a good manner. To compare experimental and numerical results, a dynamic compression test condition was visualized with a high-speed camera and simulated with the Ls-Dyna software using the finite-element method. Numerical studies indicated a good correlation with dynamic compression results in terms of crack formation and fracture progress. © IMechE 2025.
Fostering Prosperity: Unveiling the Impact of Governance Quality on Gdp Per Capita in Oecd Nations
(IGI Global, 2024) Kayral, I˙.E.; Altan, H.P.; Gontijo, T.S.
This study aims to investigate the influence of the quality of governance on economic development among 38 OECD countries using a panel data approach. The data was gathered from the World Bank database for the period of 2002-2021 and consists of six governance indicators and two macroeconomic variables. The independent variables are the six governance indicators (WGI): control of corruption (CC), government effectiveness (GE), political stability and absence of violence/terrorism (PS), rule of law (RL), regulatory quality (RQ), and voice and accountability (VA). The dependent variable is the natural logarithm of GDP per capita, and inflation and real interest rates are control variables. The research identifies a direct and significant relationship between GDPPC and GE, PS, RL, RQ, and VA in OECD countries. These findings suggest that the existence of mechanisms for GE, PS, RL, RQ, and VA contribute positively to economic development. Moreover, interest rates and inflation are found to be significant and negatively related to GDPPC. © 2025, IGI Global. All rights reserved.
Which Fiscal Instruments Do Corrupt Governments Prefer During Fiscal Consolidation Episodes
(IGI Global, 2024) Arin, K.P.; Boduroğlu, E.; Celik, E.U.; Spagnolo, N.
This study investigates the fiscal policy choices of corrupt governments during periods of fiscal consolidation. By using the same dataset by Arin et al. (2011), our analysis of pooled observations for 18 OECD countries reveals two key findings: (i) corrupt governments tend to raise indirect taxes rather than reduce expenditures during fiscal adjustments, and (ii) they yield to political lobbying and pressure by lowering corporate taxes and increasing social benefits and subsidies during substantial fiscal adjustment episodes. © 2025, IGI Global. All rights reserved.
Software Product System Model: a Customer-Value Oriented, Adaptable, Devops-Based Product Model
(Springer, 2022) Altunel, H.; Say, B.
DevOps pipelines have brought notable advantages, such as fast and frequent software delivery to software production paradigms, but dynamically dealing with quality attributes desired by the customer employing a DevOps pipeline remains a challenge. This work aims to define the design of a systems thinking inspired model, called Software Product System Model (SPSM), applying a customer-value oriented, holistic approach for implementing quality requirements, and its application and evaluation in a large software house. The main features include dynamic control of quality gates, the parameters of which are driven by customer requirements and feedback from surveys. All of the inputs are collected in a product backlog and fed forward to the quality gates over the DevOps pipeline. SPSM was successfully deployed in a large software house extending a DevOps pipeline with an accompanying improvement of customer-value oriented key performance indicators for projects. In a 2-year-long case study, security and code quality were the main quality attributes, with the metrics on security vulnerabilities and unit test coverage. At the end of the 2020, the DevOps pipeline within SPSM provided a 69.50% decrease of security vulnerabilities of all software products, and a 29.43% increase in unit test coverage for the whole code base for increasing code quality. At the end of 2020, the project completion ratio was measured to be 99.50% and the Schedule Performance Index (SPI) was measured to be 99.78% as the average of 762 projects delivered. The flexibility of SPSM allowed the software house to adapt to changing customer expectations. A checklist is provided for the replicability of the model application. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd 2021.
Millimeter-Wave Sar Imaging for Sub-Millimeter Defect Detection With Non-Destructive Testing
(Mdpi, 2025) Yalcinkaya, Bengisu; Aydin, Elif; Kara, Ali
This paper introduces a high-resolution 77-81 GHz mmWave Synthetic Aperture Radar (SAR) imaging methodology integrating low-cost hardware with modified radar signal characteristics specifically for NDT applications. The system is optimized to detect minimal defects in materials, including low-reflectivity ones. In contrast to the existing studies, by optimizing key system parameters, including frequency slope, sampling interval, and scanning aperture, high-resolution SAR images are achieved with reduced computational complexity and storage requirements. The experiments demonstrate the effectiveness of the system in detecting optically undetectable minimal surface defects down to 0.4 mm, such as bonded adhesive lines on low-reflectivity materials with 2500 measurement points and sub-millimeter features on metallic targets at a distance of 30 cm. The results show that the proposed system achieves comparable or superior image quality to existing high-cost setups while requiring fewer data points and simpler signal processing. Low-cost, low-complexity, and easy-to-build mmWave SAR imaging is constructed for high-resolution SAR imagery of targets with a focus on detecting defects in low-reflectivity materials. This approach has significant potential for practical NDT applications with a unique emphasis on scalability, cost-effectiveness, and enhanced performance on low-reflectivity materials for industries such as manufacturing, civil engineering, and 3D printing.
Predictive Factors of Cardiac Function Recovery and Mortality in Patients With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Implantation
(Mdpi, 2025) Guney, Murat Can; Suygun, Hakan; Polat, Melike; Ayhan, Huseyin; Keles, Telat; Ertop, Zeynep Seyma Turinay; Bozkurt, Engin
Background and Objectives: Patients with reduced left ventricular ejection fraction (LVEF) are reported to have unfavorable outcomes following transcatheter aortic valve implantation (TAVI). This study aims to evaluate outcomes and identify predictive factors for LVEF recovery following TAVI in patients with reduced LVEF. Materials and Methods: This retrospective study analyzed 114 patients with symptomatic severe aortic stenosis (AS) with LVEF < 40% who underwent TAVI between 2011 and 2023 at two centers. Echocardiographic parameters, including LVEF, ventricular dimensions, and relative wall thickness (RWT), were assessed at baseline and during follow-up. The outcomes and predictors of substantial LVEF improvement and mortality were analyzed using univariate and multivariate logistic regression methods. Results: Anemia (OR = 4.345, 95% CI: 1.208-15.626, p = 0.024), RWT (OR = 1.224, 95% CI: 1.064-1.407, p = 0.005), and early post-procedural changes in left ventricular end-systolic dimension (LVESD) (OR = 1.297, 95% CI: 1.037-1.622, p = 0.023) and left ventricular end-diastolic dimension (LVEDD) (OR = 1.346, 95% CI: 1.034-1.753, p = 0.027) at one-month follow-up were identified as significant factors associated with LVEF recovery at one year. Regarding factors related to mortality, higher baseline AVMG levels were associated with a lower probability of death after one year (OR = 0.926, 95% CI: 0.875-0.979, p = 0.007). Conversely, a more limited increase in LVEF from baseline to the final follow-up was linked to poor prognosis and higher mortality at one year (95% CI: 1.045-1.594, p = 0.018). Conclusions: This study demonstrated that TAVI in patients with AS and reduced LVEF can be performed with high procedural success, low mortality, and significant improvement in cardiac function during follow-up. Additionally, anemia, baseline RWT, and early post-procedural changes in LVESD and LVEDD were identified as factors associated with LVEF recovery. Baseline AVMG and changes in LVEF at the final follow-up were found to be significant predictors of total mortality.
Association Between the Degree of Nonalcoholic Fatty Liver Disease and Nocturnal Hypertension
(Lippincott Williams & Wilkins, 2025) Astan, Ramazan; Kacmaz, Fehmi; Saricam, Ersin; Ozyer, Esref Umut; Ilkay, Erdogan
Nighttime blood pressure (BP) decreases have prognostic significance owing to circadian patterns. The prevalence of nonalcoholic fatty liver disease (NAFLD) has rapidly increased in recent years. We aimed to investigate circadian blood pressure changes in patients with NAFLD. The present study included 114 patients diagnosed with nonalcoholic fatty liver disease and no previous hypertension diagnosis. Thirty patients comprised the control group (no hepatosteatosis and no hypertension). The patients were divided into 3 groups based on nocturnal BP dipping. Blood pressure patterns using night-day ratios were classified as dipper (ratio <= 0, 9), nondipper (0, 9 < ratio <= 1, 0), or nocturnal hypertension (ratio > 1, 0). There were no significant differences in sex, age, presence of diabetes, or biochemical test results between the groups. According to the blood pressure pattern, the nondipper rate in the hepatosteatosis group was significantly higher than that in the control group. Patients were compared in terms of the presence and severity of hepatosteatosis according to night blood pressure patterns. A significant difference was observed between the groups (P < .001 and P = .001, respectively). We found an association between hepatosteatosis severity and night blood pressure patterns. Patients with nonalcoholic fatty liver disease have a higher incidence of nocturnal hypertension. We observed impaired circadian blood pressure changes in patients with nonalcoholic fatty liver disease.
Moocs and Economic Disadvantage: a Path Analysis of 3.5 Million Mitx Learners
(Routledge Journals, Taylor & Francis Ltd, 2025) Cagiltay, Nergiz Ercil; Toker, Sacip; Cagiltay, Kursat
Massive Online Open Courses (MOOCs) are offered by universities and companies to provide quality education to anyone, anyplace and at any time. The impact of economic disadvantage on these courses has not been fully explored despite several studies. This study aimed to investigate the impact of country's income level on the success of 3,523,692 learners from 204 countries enrolled in 174 MITx MOOCs. The countries were classified as low- and lower-middle-income (L&LM) or high- and upper-middle-income (H&UM). A structural equation modelling with multigroup analysis conducted. The findings revealed that learners in the L&LM group performed better academically. Completion rates were 66% for L&LM and 25% for H&UM, and certification rates were 95% for L&LM and 99% for H&UM. This shows that L&LM learners may be more motivated because they believe MOOCs might help their careers. These results are essential for creating MOOCs that fit diverse learner demographics.
Does Dexmedetomidine Induce Bone Regeneration in Cranial Defects in Rabbits
(Taylor & Francis Ltd, 2025) Erkan, Gozde Nur; Tekin, Umut; Boyacioglu, Ozge; Korkusuz, Petek; Orhan, Kaan; Kirman, Betul; Onder, Mustafa Ercument
Dexmedetomidine has been shown to exert protective and curative effects on various tissues and organs in different pathological processes. This study aimed to investigate the effect of dexmedetomidine on the regeneration process after making holes in the parietal bones of rabbits. Twenty-four male Oryctolagus cuniculus rabbits were allocated to three groups, and an 8-mm circular parietal critical-sized bone defect was induced in each animal. Group_C (control) received saline; Group_LD (low dose) was given dexmedetomidine 2.75 mu g/kg; Group_HD (high dose), dexmedetomidine 5.5 mu g/kg; all were administered intraperitoneally for 7 days. After 8 weeks the bones were examined by micro-computed tomography (micro-CT) and histomorphometry. The results indicated that regeneration was improved in both the dexmedetomidine-treated groups. The lower dose increased the bone volume ratio (BV/TV) more than the higher dose. Trabecular thickness, connectivity value, and connectivity density were also higher in Group_LD than in Group_HD. Significant intramembranous ossification was observed in the dexmedetomidine-treated groups, and active osteoblasts were seen at the margins of new bone trabeculae. We conclude that dexmedetomidine, especially at the lower dosage, increases osteoblastic activity and regeneration quality.
Exosomes as Biomarkers and Therapeutic Agents in Neurodegenerative Diseases: Current Insights and Future Directions
(Springer, 2025) Dehghani, Sam; Ocakci, Ozgecan; Hatipoglu, Pars Tan; Ozalp, Veli Cengiz; Tevlek, Atakan
Neurodegenerative diseases (NDs) like Alzheimer's, Parkinson's, and ALS rank among the most challenging global health issues, marked by substantial obstacles in early diagnosis and effective treatment. Current diagnostic techniques frequently demonstrate inadequate sensitivity and specificity, whilst conventional treatment strategies encounter challenges related to restricted bioavailability and insufficient blood-brain barrier (BBB) permeability. Recently, exosomes-nanoscale vesicles packed with proteins, RNAs, and lipids-have emerged as promising agents with the potential to reshape diagnostic and therapeutic approaches to these diseases. Unlike conventional drug carriers, they naturally traverse the BBB and can deliver bioactive molecules to affected neural cells. Their molecular cargo can influence cell signaling, reduce neuroinflammation, and potentially slow neurodegenerative progression. Moreover, exosomes serve as non-invasive biomarkers, enabling early and precise diagnosis while allowing real-time disease monitoring. Additionally, engineered exosomes, loaded with therapeutic molecules, enhance this capability by targeting diseased neurons and overcoming conventional treatment barriers. By offering enhanced specificity, reduced immunogenicity, and an ability to bypass physiological limitations, exosome-based strategies present a transformative advantage over existing diagnostic and therapeutic approaches. This review examines the multifaceted role of exosomes in NDDs, emphasizing their diagnostic capabilities, intrinsic therapeutic functions, and transformative potential as advanced treatment vehicles.
A Novel Technique- Subendometrial Autologous Platelet Rich Plasma Injection in Patients With Unresponsive Thin Endometrium Undergoing Frozen-Thawed Embryo Transfer: a Prospective Cohort Study
(BMC, 2025) Cakiroglu, Yigit; Tohma, Yusuf Aytac; Yuceturk, Aysen; Karaosmanoglu, Ozge; Aslan, Ilke Ozer; Kopuk, Sule Yildirim; Tiras, Bulent
Background The purpose of this study was to investigate the effects of subendometrial PRP injection on endometrial thickness and pregnancy outcomes in patients with a history of unresponsive thin endometrium undergoing frozen-thawed embryo transfer (FET). Methods This prospective cohort study was conducted at Acibadem Mehmet Ali Aydinlar University-Istanbul, Turkey. Women with a history of suboptimal endometrial proliferation (< 7 mm) were offered to participate in the study. Group 1 consisted of 100 individuals who consented to subendometrial PRP injection, while Group 2 consisted of 100 individuals who did not accept PRP injection. Within ten days of the menstrual cycle ending, autologous PRP was produced by centrifuging peripheral blood and administered transvaginally into the subendometrial region under ultrasound monitoring. After the PRP procedure, 14 days of oral estradiol supplementation were started as part of the hormonal treatment on the 2-4th day of the second menstrual cycle. Women determined to have adequate endometrial thickness following the initiation were scheduled for embryo transfers. Embryo transfer was scheduled for women who were found to have adequate endometrial thickness after the initiation of progesterone. Pregnancy (positive serum hCG) and livebirth rates were followed. Results A total of 200 women (age 36.4 +/- 5.8) were included in the study. Endometrial thickness increased after PRP therapy as compared to the control group (7.7 +/- 1.9 mm vs. 6.1 +/- 1.2 mm; p < 0.01). Three women (3.0%) in the PRP group conceived spontaneously, whereas 97 women (97.0%) attempted FET; no spontaneous pregnancies occurred in the control group. Compared to 75/100 (75% of the total) in the control group, 33/97 women (34.0%) in the PRP group were unable to undertake ET because of persistently unresponsive thin endometrium or fluid in the endometrial cavity (p < 0.001). The PRP group had a considerably higher percentage of positive serum hCG tests than the control group (25.8% vs. 9.0%; p = 0.002). Additionally, the PRP group had a higher clinical pregnancy rate (22.7% vs. 7.0%; p = 0.002). The live birth rate was significantly higher in the PRP group than the controls (17.5% vs. 2.0%; p < 0.001). Conclusions In women with a history of suboptimal endometrial development, subendometrial PRP injection was associated with improved endometrial thickness and livebirth rate.

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