Acıbadem Üniversitesi Açık Erişim Sistemi
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Long-term results of coronary surgery with endoscopic vein harvesting
No full textBackground: In this study, we aimed to evaluate early and long-term outcomes of both isolated or concomitant coronary artery bypass grafting with the endoscopic vein harvesting technique. Methods: Between November 2012 and May 2017, a total of 324 patients (259 males, 65 femalesmean age: 63.2 +/- 9.8 yearsrange, 36 to 91 years) who underwent coronary artery bypass grafting, with or without concomitant procedures, using the endoscopic vein harvesting technique were retrospectively analyzed. Early postoperative outcomes and long-term follow-up data of the patients, such as cardiovascular or cerebral events, cardiac reinterventions, and the images of coronary angiography were recorded. Results: Median logistic EuroSCORE and in hospital mortality was 3.99 (0.8-81) vs. 0.9\% for isolated coronary surgery and 13.34 (1.5-76.4) vs. 1.5\% for concomitant procedures. The long-term data could be obtained in 288 patients with a median of 59.6 (7-90) months of follow-up. During this period, 22 (7.6\%) patients underwent coronary angiography for control or treatment, 12 (4.2\%) patients needed revascularization, and none of the patients underwent redo coronary surgery. Conclusion: Our study results suggest that the endoscopic vein harvesting technique during coronary artery bypass grafting is safe in experienced hands.4OCT443-4482
Impact of intestinal ultrasound with a portable system in the management of Crohn's disease
No full textBackground: Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn's disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients. Methods: A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients' clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD). Results: The initial clinical-management decision was changed in 47 patients (40.2\%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2\% to 90.6\% in comparison to reference decisions (P = 3) assessment was shown to be comparable to that of IUS (94\% vs 91\%). The sensitivity for disease presence was 95\% with colonoscopy and 94\% with the IUS assessment. Conclusion: IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.5OCT418-426
Comparison of different pulmonary valve reconstruction techniques during transannular repair of tetralogy of fallot
No full textBackground Transannular patch, which results in pulmonary insufficiency (PI), is usually required during repair of tetralogy of fallot (TOF). In this study, we compared three types of pulmonary valve reconstruction techniques during transannular repair of TOF. Methods Between February 2014 and January 2018, 50 patients with TOF underwent primary repair with transannular patch. These patients were divided into three groups. In Group 1, (n = 15), a single gluteraldehyde-treated autologous pericardial patch (standard method) was reconstructed as monocusp. In Group 2, (n = 16) Nunn's bileaflet pulmonary valve reconstruction technique was used with pericardial patch. In Group 3, (n = 19), Nunn's bileaflet technique was performed with expanded polytetrafluoroethylene membrane. The outcomes of the patients and early and midterm competency of the pulmonary valves were analyzed. Results These techniques were significantly effective in early postoperative period. Freedom from moderate to severe PI were 73.3\%100\% and 89.4\%, respectively. Mortality, duration of intensive care unit and hospital stay were similar between the groups. The mean follow-up period was 17.5 +/- 13.0 (3-57) months. Freedom from moderate to severe PI decreased to 40\%81.2\% and 73.7\%, respectively at the end of the follow-up period. Presence of moderate to severe PI was significantly higher in Group 1 (p = .018 between Groups 1 and 2, p = .048 between Groups 1 and 3). Conclusion All three pulmonary valve reconstruction techniques provided competent pulmonary valves. Nunn's bileaflet technique had better outcome at midterm. It has a potential to delay right ventricular dysfunction at long-term.1JAN56-613
A cross-sectional overview of SARS-CoV-2 genome variations in Turkey
No full textObjectives: We assessed SARS-CoV-2 genome diversity and probable impact on epidemiology, immune response and clinical disease in Turkey. Materials and methods: Complete genomes and partial Spike (S) sequences were accessed from the Global Initiative on Sharing Avian Influenza Data (GISAID) database. The genomes were analysed for variations and recombinations using appropriate softwares. Results: Four hundred ten complete genomes and 206 S region sequences were included. Overall, 1,200 distinct nucleotide variations were noted. Mean variation count was 14.2 per genome and increased significantly during the course of the pandemic. The most frequent variations were identified as A23403G (D614G92.9,\%), C14408T (P323L, 92.2\%), C3037T (89.8\%), C241T (83.4\%) and GGG28881AAC (RG203KR, 62.6\%). The A23403G mutation was the most frequent variation in the S region sequences (99\%). Most genomes (98.3\%) belonged in the SARS-CoV-2 haplogroup A. No evidence for recombination was identified in genomes representing sub-haplogroup branches. The variants B.1.1.7, B.1.351 and P.1 were detected, with a statistically-significant time-associated increase in B.1.1.7 prevalence. Conclusions: We described prominent SARS-CoV-2 variations as well as comparisons with global virus diversity. Continuing a molecular surveillance in agreement with local disease epidemiology appears to be crucial, as vaccination and mitigation efforts are ongoing.5OCT491-4984
Temporary Implant Irradiation: Survey of Turkish Society of Radiation Oncology Breast Cancer Study Group
No full textObjective: To understand the clinical approach of radiation oncologists during the treatment of patients with breast reconstruction. Materials and Methods: A questionnaire survey was emailed to 105 active members of the Turkish Radiation Oncology Society, the Breast Cancer Study Group. The factors associated with radiation oncologists and their current practice was identified. Results: Fifty radiation oncologists (47.6\%) responded, and most of the responders (83\%) were physicians who treated >50 new breast cancer patients annually. The majority of the physicians worked in academic hospitals and had more than 15 years of work experience. The early reconstruction rate was noted to be low among patients with mastectomy (<10\% of the mastectomy patients) (p<0.05). Early implant irradiation with temporary tissue expander was noted to be a more common procedure. The majority of the respondents (68\%) preferred to irradiate an inflated implant (20\% total, 80\% partial). In addition, 22\% of the physicians declared that they routinely used bolus and that 60\% of them used it only for patients at a high risk of local recurrence factors. Conclusion: It can thus be concluded that variations exist between experienced radiation oncologists and others. Hypofractionation is not yet commonly practiced for patients with reconstruction in Turkey. A concrete consensus can be helpful to create a homogeneity in treatment decisions and practical applications.1JAN21-271
DIAGNOSTIC ACCURACY OF SENTINEL NODE BIOPSY IN NON-ENDOMETRIOID, HIGH-GRADE AND/OR DEEP MYOINVASIVE ENDOMETRIAL CANCER (TRSGO-SLN-006)
No full text3MARA1203
Mutational landscape of SARS-CoV-2 genome in Turkey and impact of mutations on spike protein structure
No full textThe Coronavirus Disease 2019 (COVID-19) was declared a pandemic in March 2020 by the World Health Organization (WHO). As of May 25th, 2021 there were 2.059.941 SARS-COV2 genome sequences that have been submitted to the GISAID database, with numerous variations. Here, we aim to analyze the SARS-CoV-2 genome data submitted to the GISAID database from Turkey and to determine the variant and clade distributions by the end of May 2021, in accordance with their appearance timeline. We compared these findings to USA, Europe, and Asia data as well. We have also evaluated the effects of spike protein variations, detected in a group of genome sequences of 13 patients who applied to our clinic, by using 3D modeling algorithms. For this purpose, we analyzed 4607 SARS-CoV-2 genome sequences submitted by different lab centers from Turkey to the GISAID database between March 2020 and May 2021. Described mutations were also introduced in silico to the spike protein structure to analyze their isolated impacts on the protein structure. The most abundant clade was GR followed by G, GH, and GRY and we did not detect any V clade. The most common variant was B.1, followed by B.1.1, and the UK variant, B.1.1.7. Our results clearly show a concordance between the variant distributions, the number of cases, and the timelines of different variant accumulations in Turkey. The 3D simulations indicate an increase in the surface hydrophilicity of the reference spike protein and the detected mutations. There was less surface hydrophilicity increase in the Asp614Gly mutation, which exhibits a more compact conformation around the ACE-2 receptor binding domain region, rendering the structure in a ``down{''} conformation. Our genomic findings can help to model vaccination programs and protein modeling may lead to different approaches for COVID-19 treatment strategies.121
Preclinical efficacy and safety analysis of gamma-irradiated inactivated SARS-CoV-2 vaccine candidates
No full textCOVID-19 outbreak caused by SARS-CoV-2 created an unprecedented health crisis since there is no vaccine for this novel virus. Therefore, SARS-CoV-2 vaccines have become crucial for reducing morbidity and mortality. In this study, in vitro and in vivo safety and efficacy analyzes of lyophilized vaccine candidates inactivated by gamma-irradiation were performed. The candidate vaccines in this study were OZG-3861 version 1(V1), an inactivated SARS-CoV-2 virus vaccine, and SK-01 version 1 (V1), a GM-CSF adjuvant added vaccine. The candidate vaccines were applied intradermally to BALB/c mice to assess toxicity and immunogenicity. Preliminary results in vaccinated mice are reported in this study. Especially, the vaccine models containing GM-CSF caused significant antibody production with neutralization capacity in absence of the antibody-dependent enhancement feature, when considered in terms of T and B cell responses. Another important finding was that the presence of adjuvant was more important in T cell in comparison with B cell response. Vaccinated mice showed T cell response upon restimulation with whole inactivated SARS-CoV-2 or peptide pool. This study shows that the vaccines are effective and leads us to start the challenge test to investigate the gamma-irradiated inactivated vaccine candidates for infective SARS-CoV-2 virus in humanized ACE2+ mice.1MAR 111
Fertility-sparing in cancer patients
No full textObjective: This review aimed to investigate and summarize the current evidence on fertility-sparing options in cancer patients. Mechanism: Fertility preservation methods are becoming popular through the improved prognosis of cancer patients at a younger age and early diagnostic tools. However, currently, more and more women are suffering from iatrogenic ovarian failure and fertility loss because of cancer treatment. Most treatments have been used for hematological malignancies, but different gynecological cancers can be eligible. Findings in brief: Fertility preserving strategies such as oocyte and embryo cryopreservation, ovarian tissue preservation, ovarian transposition, and aspiration of ovarian follicles are the methods that could be suggestedto the patients. The current knowledge supports oocyte and embryo cryopreservation as feasible, safe, and effective treatment approaches for cancer patients seeking fertility preservation. Conclusions: Robust evidence is still needed to prove the effectiveness of cryopreservation of the ovarian tissue and ovarian follicle aspiration approaches since these techniques are still in early their steps.4AUG 15787-7944
An analysis of the learning curve for robotic-assisted mitral valve repair
No full textBackground Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. Method Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. Result There were 23 (38.3\%) men and 37 (61.7\%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0\%), anterior leaflet prolapsus (n = 8, 13.3\%), Barlow disease (n = 3, 5\%), and annular dilatation (n = 7, 11.6\%). The patients underwent notochordal implantation (n = 27, 45\%), quadrangular or triangular resection (n = 23, 38.3\%), isolated ring annuloplasty (n = 7, 11.7\%), resection, and leaflet reduction (n = 2, 3.3\%) or edge to edge repair (n = 1, 1.7\%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min {[}p = .00], 102.3 vs. 80 min {[}p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. Conclusion The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.2FEB624-6283