GATA Haydarpaşa Eğitim Hastanesi

With the rapid rise of artificial intelligence tools, applications like ChatPDF are seen as promising for supporting academic tasks in neurosurgery, such as literature review, summarization, and question generation. However, its accuracy and relevance remain to be critically assessed. This study assesses ChatPDF’s accuracy in interpreting neurosurgical research articles, aiming to identify its strengths and limitations. Articles from the 10 highest-ranked neurosurgical journals were reviewed by selecting the first original research article from each journal’s 2023 volume. Ten detailed questions were independently generated by 2 researchers based on each article’s content. Each article was then uploaded to ChatPDF, which generated its own questions and provided responses to both its questions and those posed by the researchers. Responses were categorized as completely correct, partially correct, or incorrect. Source reliability was also evaluated to determine ChatPDF’s performance. An overall accuracy rate of 89% was achieved by ChatPDF across 100 questions, with 89% of responses classified as completely correct, 5% as partially correct, and 6% as incorrect. Source reliability averaged 83%, although variability was noted, particularly in journals such as the Journal of Neurosurgery: Spine and Neurosurgery Clinics, which showed lower reliability rates. Substantial accuracy and potential were demonstrated by ChatPDF as a supplementary tool for neurosurgical literature review. However, limitations such as inconsistent source reliability and lack of visual content analysis highlight the need for ongoing refinement. While promising, ChatPDF should be used alongside manual verification to ensure comprehensive and accurate literature interpretation in neurosurgical research.

Coronary artery bypass grafting (CABG) in octogenarians remains a challenging but increasingly common procedure due to extended life expectancy and the growing burden of coronary artery disease in the elderly. This study aimed to evaluate sex-specific differences in perioperative characteristics and early outcomes in patients aged ≥80 years undergoing isolated CABG. A total of 104 patients aged ≥80 years who underwent isolated CABG between 2017 and 2023 were retrospectively analysed. Patients were stratified by gender, and comparisons were made regarding preoperative comorbidities, intraoperative variables, and postoperative outcomes. The primary endpoint was in-hospital mortality. The mean age was 82.01 ± 2.04 years, with 64.4% male and 35.6% female patients. While body surface area was significantly higher in males (p < 0.001), EuroSCORE II was numerically higher in females (p = 0.18). Chronic obstructive pulmonary disease (COPD) and smoking were more prevalent in males (p = 0.039 and p < 0.001, respectively), whereas CABG x5 was more frequent in females (p = 0.043). ICU stay was significantly longer in males (p = 0.014).Overall mortality was low (3.8%) and not significantly different between genders. CABG in patients aged ≥80 years is associated with low early mortality and acceptable complication rates regardless of gender. Preoperative and intraoperative gender based differences may inform individualised perioperative management strategies in this growing patient population.

Background/Objectives: Epithelial ovarian cancer (EOC) is a leading cause of death among forms of gynecologic cancer. Significant causes of mortality include high recurrence rates and the development of resistance to platinum-based chemotherapy. This highlights the need for reliable prognostic biomarkers to improve patient stratification and inform treatment decisions. Claudin-4, a tight junction protein frequently overexpressed in epithelial tumors, has been associated with tumor progression and resistance to chemotherapy. Methods: We retrospectively analyzed 83 patients with EOC who underwent debulking surgery. Claudin-4 expression was assessed by immunohistochemistry and categorized as high or low based on a semi-quantitative scoring system. Survival outcomes were evaluated using Kaplan-Meier analysis and Cox regression. Predictors of platinum resistance were examined using logistic regression. Results: High Claudin-4 expression was observed in 55.4% of cases and was associated with significantly shorter disease-free survival (DFS) (23 vs. 66 months, p = 0.00024) and overall survival (OS) (85 months vs. NR, p = 0.0031). In multivariable analysis, platinum resistance (DFS; HR 4.99, OS; HR 4.27) and high Claudin-4 expression (DFS; HR 2.46, OS; HR 3.59) were independent predictors of poor outcomes. Logistic regression further demonstrated that high Claudin-4 expression and interval debulking surgery were independent predictors of platinum resistance. Conclusions: High Claudin-4 expression was associated with inferior survival and an increased risk of platinum resistance in EOC. Our findings suggest that Claudin-4 may serve as a negative prognostic biomarker and a potential therapeutic target. Future prospective studies are warranted to further elucidate the underlying mechanisms and validate Claudin-4's clinical utility.

Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short- and long-term stroke risk. This study evaluated the prognostic value of the left atrial diameter index (LADI) for predicting cerebrovascular events (CVE) in patients undergoing isolated CABG who developed POAF, had no prior atrial fibrillation (AF), and were discharged in sinus rhythm. Among 2094 patients undergoing isolated CABG between June 2015 and June 2022, 392 consecutive patients with POAF and discharge in sinus rhythm met inclusion criteria. LADI was calculated preoperatively, and an optimal cutoff (21.2 mm/m²) was determined via receiver operating characteristic (ROC) curve and Youden index. Patients were classified as low (≤21.2 mm/m²) or high (>21.2 mm/m²) LADI. The association between LADI and CVE was assessed over a mean follow-up of 42.4±20.0 months using Cox proportional hazards modeling. Thirty patients (7.7%) experienced a CVE, including 8 in-hospital cases (2.0%). CVE incidence was higher in the high LADI group compared to the low LADI group (19.8% vs. 2.8%). Multivariable analysis identified older age, hypertension, congestive heart failure, and high LADI as independent CVE predictors. Kaplan-Meier analysis confirmed significantly higher CVE rates in the high LADI group (log-rank p<0.001). In patients developing POAF after isolated CABG, LADI is a simple, easily obtainable parameter that independently predicts long-term CVE risk and may aid in postoperative risk stratification.

<bold>Aim:</bold> We aimed to compare the clinical and laboratory features of siblings with cystic fibrosis (CF) registered in the Cystic Fibrosis Registry of Turkiye (CFRT-TR) in 2023, both before and after newborn screening (NBS) and modulatory treatment. <bold>Method:</bold> Siblings with two or more CF diagnoses were included. A comparison was made based on clinical and laboratory characteristics before and after NBS (before 2015) and modulatory treatment. <bold>Results:</bold> A total of 240 siblings from 113 families were included (47% female), with a mean age of 9 years. The median age at diagnosis was 0.33 years. Of these, 135 were born before NBS. Among those not receiving modulatory treatment, the mean age of diagnosis for older siblings was (2.97±4.36 years), compared to (1.00±2.29 years) for younger siblings (p<0.001). No significant differences in weight, height, BMI z-scores, colonization status, or FEV1% were found between older and younger siblings (p>0.05), though liver disease was more common in older siblings (p=0.011). Younger siblings diagnosed after NBS were diagnosed earlier (0.59±1.10 years) than older siblings diagnosed before NBS (2.84±4.37 years) (p=0.003). No significant differences in clinical parameters were found between the two groups (p>0.05). No differences were noted in FEV1 changes, growth parameters, colonization status, or complications before and after modulatory treatment between the older and younger siblings. <bold>Conclusions:</bold> Younger siblings were diagnosed earlier with NBS. Having more than two CF siblings did not affect clinical follow-up. Modulatory treatment improved clinical and laboratory outcomes, consistent with existing CF literature.

Acute liver failure is a life-threatening condition that may result in death if liver transplant is not performed. The aim of our study was to evaluate patients with acute liver failure or acute-on-chronic liver failure who were followed and treated with therapeutic plasma exchange in a pediatric intensive care unit until they achieved clinical recovery or underwent liver transplant. In this retrospective, singlecenter study, we included patients with acute liver failure or acute-on-chronic liver failure who received therapeutic plasma exchange between April 2020 and December 2021. Clinical findings, laboratory findings, extracorporeal therapies, Pediatric Risk of Mortality III and liver injury unit scores and pretherapy and posttherapy hepatic encephalopathy scores, Model for End-Stage Liver Disease score, and Pediatric End-Stage Liver Disease score were retrospectively analyzed. Nineteen patients were included in the study. One patient was excluded because of positivity for COVID-19. The mean age of children was 62.06 months, ranging from 5 months to 16 years (12 boys, 6 girls). Thirteen patients (72.2%) had acute liver failure, and 5 patients (27.8%) had acute-on-chronic liver failure. No significant difference was shown for mean liver injury unit score (P = .673) and Pediatric Logistic Organ Dysfunction score (P = .168) between patients who died and patients who received treatment at the inpatient clinic and transplant center. However, Pediatric Risk of Mortality score and the mean Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores before therapeutic plasma exchange and after therapeutic plasma exchange (after 3 consecutive days of treatment) were statistically significant (P = .001 and P = .004). Therapeutic plasma exchange may assist bridge to liver transplant or assist with spontaneous recovery of liver failure in pediatric patients with acute liver failure or acute-on-chronic liver failure.

Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

Amaç: Bu çalışmada fibrozis ciddiyetini öngörmede, serum aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) seviyeleri, platelet sayısı, INR değeri veya serum Hepatit B virüs (HBV) deoksiribonükleik asit (DNA) seviyelerinin, özellikle AST-platelet oranı (APRI), FIB-4 indeks ve King’s skoru gibi skorlama sistemleri içinde değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Yüzelli karaciğer iğne biyopsisi olan tedavi naif erkek HBV hastaları geriye dönük olarak değerlendirildi. Değişkenler arasında farkı değerlendirmek amacıyla, hastalar minimal fibrozisi olanlar (fibrozis skoru<2) ve anlamlı fibrozisi olanlar (fibrozis skoru≥2) olmak üzere iki gruba ayrıldı. Bulgular: Minimal fibrozisi olan 79 hasta (52.7%) ve anlamlı fibrozisi olan 71 hasta (42.3%) vardı. Anlamlı fibrozisi tanımlayan optimal değeri, HBV DNA seviyesi için 4.5 log10 IU/ml (duyarlılık:71.8%, özgüllük:70.9%), APRI için 0.45 (duyarlılık:63.4%, özgüllük:63.3%), FIB-4 indeks için 0.45 (duyarlılık:64.8%, özgüllük:64.3%) ve son olarak King’s skor için 4.00 (duyarlılık: 67.6%, özgüllük:60.8%) olarak belirledik. Sonuç: Tedavi görmemiş sirozu olmayan HBV enfeksiyonu olan erkek hastalarda fibrozis ciddiyetini öngörmede APRI, FIB-4 index ve King’s skorun birbirlerine üstünlüğünün olmadığını, ancak serum HBV DNA seviyelerinin bu skorlara kıyasla biraz daha iyi olduğunu değerlendirmekteyiz.

Quantitative hepatitis B surface antigen (HBsAg) is a valuable tool in hepatitis B virus (HBV) disease diagnosis and management for evaluating the effectiveness of antiviral therapy. The aim of the current research was to compare the performances of the Elecsys HBsAg II and Abbott Architect HBsAg assays in chronic hepatitis B (CHB) patients. Between May 2014 and December 2014, 72 CHBs were tested using Abbott Architect HBsAg QT and Roche Elecsys HBsAg II assay. After transformation to log (10) IU/mL, the results of the two assays were compared using the interclass correlation test, the Pearson correlation test and Bland-Altman analyses. We also analyzed all the parameters in on-treatment patients and naive patients with Pearson correlation test. There was a significant overall correlation between the Elecsys and Architect assays. We also analyzed all the parameters in naive and on-treatment patients. There was a significantly good correlation between the two assays in untreated patients and on-treatment patients. In this study, there was a significant correlation between the results of the Elecsys HBsAg II and Abbott Architect HBsAg assays in the overall and naive/on-treatment CHB patients. Additionally, we found that mean HBsAg levels resulting from the Architect assay were higher than those obtained by Elecsys assay.