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Article Citation - WoS: 1Citation - Scopus: 2The Detailed Transseptal Puncture Technique for Optimal Closure in Patients With a Patent Foramen Ovale(Frontiers Media Sa, 2024) Ilkay, Erdogan; Saricam, Ersin; Kacmaz, Fehmi; Yakici, Aysel; Koca, Cigdem; Ozeke, Ozcan; Onal, Mehmet ZulkufBackground The closure of a patent foramen ovale (PFO) using transseptal puncture has particular advantages and disadvantages. Thus, transseptal puncture should be re-evaluated in detail. Aims We aimed to assess the effectiveness of the detailed transseptal puncture technique in patients who underwent PFO closure due to cryptogenic stroke or transient ischemic attack in terms of residual shunts and atrial fibrillation. Methods We prospectively analyzed 144 consecutive patients who underwent PFO closure by the detailed transseptal puncture technique between February 2013 and April 2023 in two centers. All of the patients had a >10 mm long-tunnel PFO. Results The procedural success rate was 100%. However, after the procedure, moderate pericardial effusion developed in one patient (0.7%) and an acute pulmonary embolism related to femoral vein thrombosis was observed in one patient (0.7%) during the first month. Complications related to the procedure were noted in two patients (1.4%) during the first month of follow-up. Residual shunts were observed in 1.4% of cases after PFO closure. Conclusion We demonstrated that the detailed transseptal technique is safe and effective for PFO closure. The detailed transseptal PFO closure technique significantly reduced the risk of atrial fibrillation, and the occurrence of residual shunts was significantly low following the closure.Article Citation - WoS: 6Citation - Scopus: 6Quantitative Lipidomic Analysis of Takotsubo Syndrome Patients' Serum(Frontiers Media Sa, 2022) Karnati, Srikanth; Guntas, Gulcan; Rajendran, Ranjithkumar; Shityakov, Sergey; Hoering, Marcus; Liebisch, Gerhard; Foerster, Carola Y.Takotsubo syndrome (TTS), also known as the transient left ventricular apical ballooning syndrome, is in contemporary times known as novel acute cardiac syndrome. It is characterized by transient left ventricular apical akinesis and hyperkinesis of the basal left ventricular portions. Although the precise etiology of TTS is unknown, events like the sudden release of stress hormones, such as the catecholamines and the increased inflammatory status might be plausible causes leading to the cardiovascular pathologies. Recent studies have highlighted that an imbalance in lipid accumulation might promote a deviant immune response as observed in TTS. However, there is no information on comprehensive profiling of serum lipids of TTS patients. Therefore, we investigated a detailed quantitative lipid analysis of TTS patients using ES-MSI. Our results showed significant differences in the majority of lipid species composition in the TTS patients compared to the control group. Furthermore, the computational analyses presented was able to link the altered lipids to the pro-inflammatory cytokines and disseminate possible mechanistic pathways involving TNF alpha and IL-6. Taken together, our study provides an extensive quantitative lipidome of TTS patients, which may provide a valuable Pre-diagnostic tool. This would facilitate the elucidation of the underlying mechanisms of the disease and to prevent the development of TTS in the future.Review Citation - WoS: 11Citation - Scopus: 13Current Surgical Techniques for the Management of Pediatric Glaucoma: a Literature Review(Frontiers Media Sa, 2023) Aktas, Zeynep; Ikiz, Gokcen Deniz Gulpinar; Surgical Sciences; Surgical SciencesPediatric glaucoma surgery is challenging due to its diverse and complex pathophysiology, altered anterior segment anatomy, greater potential for failure, and complications compared to adult patients. Moreover, numerous challenges are associated with long-term postoperative management. Thus, when dealing with childhood glaucoma, it is important to consider the potential complications in addition to the benefits of each intervention. The purpose of this article is to review recently published literature to shed light on the most recent surgical techniques for the safe and effective treatment of childhood glaucoma. Current literature shows that goniotomy and trabeculotomy are the first choices for the management of primary congenital glaucoma. Although older children with phakic eyes seem to benefit from trabeculectomy with adjunctive mitomycin C, it carries a long-term risk of bleb-related endophthalmitis. Glaucoma drainage devices may be preferred for patients with secondary or refractory glaucoma. However, hypotony or tube-related complications are common and encountered more often in children than in adults. Cyclodestructive procedures are also an option for cases in which filtering surgery has failed, but they can also be used as a temporizing measure to reduce the rate of complications in high-risk patients. However, their outcomes can be unpredictable, in terms of efficiency and complications. Finally, minimally invasive glaucoma surgery (MIGS) as the sole alternative treatment or as an adjunctive surgical procedure is a relatively new path for pediatric patients.Article Citation - WoS: 10Citation - Scopus: 12Distinguishing Intermediate and Novice Surgeons by Eye Movements(Frontiers Media Sa, 2020) Menekse Dalveren, Gonca Gokce; Cagiltay, Nergiz ErcilSurgical skill-level assessment is key to collecting the required feedback and adapting the educational programs accordingly. Currently, these assessments for the minimal invasive surgery programs are primarily based on subjective methods, and there is no consensus on skill level classifications. One of the most detailed of these classifications categorize skill levels as beginner, novice, intermediate, sub-expert, and expert. To properly integrate skill assessment into minimal invasive surgical education programs and provide skill-based training alternatives, it is necessary to classify the skill levels in as detailed a way as possible and identify the differences between all skill levels in an objective manner. Yet, despite the existence of very encouraging results in the literature, most of the studies have been conducted to better understand the differences between novice and expert surgical skill levels leaving out the other crucial skill levels between them. Additionally, there are very limited studies by considering the eye-movement behaviors of surgical residents. To this end, the present study attempted to distinguish novice- and intermediate-level surgical residents based on their eye movements. The eye-movement data was recorded from 23 volunteer surgical residents while they were performing four computer-based simulated surgical tasks under different hand conditions. The data was analyzed using logistic regression to estimate the skill levels of both groups. The best results of the estimation revealing a 91.3% recognition rate of predicting novice and intermediate surgical residents on one scenario were selected from four under the dominant hand condition. These results show that the eye-movements can be potentially used to identify surgeons with intermediate and novice skills. However, the results also indicate that the order in which the scenarios are provided, and the design of the scenario, the tasks, and their appropriateness with the skill levels of the participants are all critical factors to be considered in improving the estimation ratio, and hence require thorough assessment for future research.Article Evaluation of the Relationship Between Dietary Acid Load and Cardiovascular Risk Factors in Patients With Type 2 Diabetes: a Case-Control Study(Frontiers Media Sa, 2024) Gungor, Sedef; Saka, MendaneBackround Diets high in dietary acid load are thought to be associated with metabolic diseases. However, the number of studies examining the relationship between dietary acid load and metabolic diseases in Turkey is insufficient. The aim of this study was to investigate the relationship between cardiovascular disease risk factors and dietary acid load in individuals with type 2 diabetes.Materials and methods In this case-control study, 51 participants aged 30-65 years with type 2 diabetes and 59 participants in the control group were included. Blood pressure and biochemical findings were measured. Anthropometric measurements and body composition measurements were made. Dietary intake was assessed using a 3-day (1 day on weekends, 2 days on weekdays) food consumption record. Dietary acid load scores, including potential renal acid load (PRAL) and net endogenous acid production (NEAP), were calculated based on dietary intake. NEAP and PRAL scores were categorized as low and high according to the median value. Smoking status, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), trigylceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL), waist-hip ratio (WHR), waist-to- height ratio (WtHR), hemoglobin and fat mass (%) were evaluated as cardiovascular risk factors.Results The cut-off values of PRAL and NEAP were 3.61 and 44.78 mEq/d, respectively. After adjustment for various covariates, a significant positive association between PRAL and TG levels was observed in the diabetic group [odds ratio (OR), 5.98; 95% CI, 1.45-24.67; p = 0.013]. In contrast, a negative association was found between PRAL and SBP in the control group [odds ratio (OR), 0.21; 95% CI, 0.05-0.83; p = 0.026]. However, these associations were not observed for NEAP values in either group.Conslusions A higher PRAL value was consistently associated with higher TG level, but other cardiovascular risk factors were not. More longitudinal and interventional studies are needed to better establish a causal effect between dietary acid load and cardiovascular risk factors in individuals with diabetes.Article Citation - WoS: 6Citation - Scopus: 5Evaluating Efficacy and Outcomes: Comparison of Laser Treatment and Crystallized Phenol in Pilonidal Sinus Disease(Frontiers Media Sa, 2025) Emral, Ahmet Cihangir; Gulen, Merter; Ege, BahadirObjective The aim of this study is to comprehensively evaluate the efficacy of laser ablation and crystallized phenol application in the treatment of pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and the patients' return to normal life.Material and method Data from patients treated for pilonidal sinus disease with laser ablation and crystallized phenol application at our clinic between January 2020 and September 2023 were retrospectively reviewed. Preoperative data including pit counts, disease stage, preoperative pilonidal abscess history, disease duration (week), treatment success, recurrence/persistent disease, postoperative complications, healing time (days), and visual analogue scale (VAS) scores on postoperative days 1 and 7, as well as return to normal life (days), were analyzed.Results A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application. The postoperative outcomes revealed that the wound healing period and postoperative VAS values were statistically significantly better in the laser ablation group.Conclusion Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group. According to this study, both methods can successfully treat the disease in selected cases.Article Investigation of Hepatitis E Virus Seroprevalence and Risk Factors in Hemodialysis Patients(Frontiers Media Sa, 2025) Ozturk, Hakki; Ozsoy, Metin; Tuna, Aysegul; Varlibas, Artuner; Cesur, Salih; Aksoy, Altan; Demir, Mehmet EminBackground: Hemodialysis patients are at increased risk for hepatitis E virus (HEV) infection due to their immunocompromised status and frequent exposure to invasive medical procedures. HEV can lead to chronic infections and severe complications, particularly in high-risk populations. This study aimed to determine HEV-IgG seroprevalence among hemodialysis patients in Ankara, Turkey, and evaluate associated risk factors. Methods: A total of 160 hemodialysis patients from three private dialysis centers in Ankara were included in this prospective, cross-sectional study. Anti-HEV-IgG antibodies were detected using the ELISA method. Demographic characteristics and potential risk factors, including dialysis duration, comorbidities, blood transfusion history, drinking water source, dietary habits, and involvement in animal husbandry, were assessed via structured surveys. Statistical analyses were conducted using SPSS Version 22.0, with Pearson's chi-square and Fisher's exact tests applied to categorical variables. Logistic regression analysis was performed to identify independent risk factors for HEV seropositivity. Results: HEV-IgG seropositivity was detected in 42 patients (26.25%). Seroprevalence increased significantly with age, rising from 6.7% in patients under 55 years to 47.4% in those over 65 years (p < 0.001). Extended dialysis duration (>5 years) was also significantly associated with HEV seropositivity (p = 0.02). However, no significant associations were found between HEV seropositivity and gender, blood transfusion history, source of drinking water, consumption of raw meat, or involvement in animal husbandry (p > 0.05). Conclusion: The HEV-IgG seroprevalence among hemodialysis patients in Ankara was higher than previously reported rates in Turkey. Age and prolonged dialysis duration emerged as significant risk factors, underscoring the importance of screening and preventive strategies in this vulnerable population. Further multi-regional studies are needed to better understand HEV transmission dynamics and improve management strategies in hemodialysis patients.Editorial Editorial: Quality Assurance and Workflow Optimization for the Diagnosis and Treatment of Head and Neck Cancer(Frontiers Media Sa, 2024) Elicin, Olgun; Hosal, Sefik[No Abstract Available]Article Evaluation of Anti-Tetanus IgG Antibody Levels and Influencing Factors in Patients Undergoing Hemodialysis(Frontiers Media Sa, 2025) Ozsoy, Metin; Ozturk, Hakki; Tuna, Aysegul; Varlibas, Artuner; Cesur, Salih; Aksoy, Altan; Demir, Mehmet EminAim: This study aimed to assess anti-tetanus IgG antibody levels and identify determinants of inadequate tetanus immunity among maintenance hemodialysis (HD) patients. Methods: In this cross-sectional study, anti-tetanus IgG levels were measured by quantitative ELISA in 162 adult HD patients from two dialysis centers in Ankara, Turkey. Protective immunity was evaluated using both international (>= 0.1 IU/mL) and robust (>= 0.5 IU/mL) cut-offs. Demographic and clinical factors associated with immunity were analyzed by multivariate logistic regression. Results: Only 16.7% of HD patients achieved robust protection (>= 0.5 IU/mL), whereas 49.8% had minimal protection (>= 0.1 IU/mL). Protective immunity was independently associated with younger age (OR 1.07 per year; p = 0.004), shorter dialysis duration (OR 1.07; p = 0.030), male sex (female OR 2.92; p = 0.048), and recent booster vaccination within 10 years (OR 0.11; p < 0.001). Diabetes mellitus was not an independent factor. Conclusion: Most HD patients lacked durable tetanus immunity, particularly older females on long-term dialysis. The findings highlight the need for regular antibody monitoring, early revaccination, and structured booster programs to maintain adequate protection in this high-risk population.Article Citation - WoS: 1Citation - Scopus: 1Adaptive Stimulus Design for Dynamic Recurrent Neural Network Models(Frontiers Media Sa, 2019) Doruk, R. Ozgur; Zhang, KechenWe present an adaptive stimulus design method for efficiently estimating the parameters of a dynamic recurrent network model with interacting excitatory and inhibitory neuronal populations. Although stimuli that are optimized for model parameter estimation should, in theory, have advantages over nonadaptive random stimuli, in practice it remains unclear in what way and to what extent an optimal design of time-varying stimuli may actually improve parameter estimation for this common type of recurrent network models. Here we specified the time course of each stimulus by a Fourier series whose amplitudes and phases were determined by maximizing a utility function based on the Fisher information matrix. To facilitate the optimization process, we have derived differential equations that govern the time evolution of the gradients of the utility function with respect to the stimulus parameters. The network parameters were estimated by maximum likelihood from the spike train data generated by an inhomogeneous Poisson process from the continuous network state. The adaptive design process was repeated in a closed loop, alternating between optimal stimulus design and parameter estimation from the updated stimulus-response data. Our results confirmed that, compared with random stimuli, optimally designed stimuli elicited responses with significantly better likelihood values for parameter estimation. Furthermore, all individual parameters, including the time constants and the connection weights, were recovered more accurately by the optimal design method. We also examined how the errors of different parameter estimates were correlated, and proposed heuristic formulas to account for the correlation patterns by an approximate parameter-confounding theory. Our results suggest that although adaptive optimal stimulus design incurs considerable computational cost even for the simplest excitatory-inhibitory recurrent network model, it may potentially help save time in experiments by reducing the number of stimuli needed for network parameter estimation.
