Izmir Tepecik Eğitim ve Araştırma Hastanesi

Abstract Aim: Although the irinotecan–bevacizumab (IB) combination is a frequently used treatment option in recurrent brain tumors, clinical benefit shows heterogeneity among patient subgroups. This study aimed to evaluate clinical and prognostic factors associated with early-stage mortality and overall survival (OS) in patients receiving IB treatment. Material and Methods: Seventy-eight brain tumor patients who received IB treatment between 2015 and 2023 were retrospectively evaluated. Patients with complete clinical and radiological data were included in the study. The demographic, clinical, and pathological characteristics of the patients were recorded. The timing of the initiation of IB therapy was categorized according to whether it was started at the first recurrence or at the second and subsequent recurrences. Factors associated with early-stage mortality (≤6 months) were determined using log-linear regression analysis, while independent prognostic factors affecting GSK were determined using the Cox proportional hazards regression model. Results: The mean age of patients was 53.01±12.78 years, and the mean follow-up period was 9.47 months. The mortality rate within the first 6 months was determined to be 44.9%. Early-stage mortality was found to be significantly associated with multilobular tumor localization (p=0.037) and initiation of IB therapy at ≥2nd stage (p=0.036). In the log-linear regression analysis, the probability of survival beyond 6 months was 5.05 times lower (RR=0.198, 95% CI: 0.054-0.735) in multilobular localization, while in those who started IB at ≥2nd node, it was 4.40 times lower (RR=0.227, 95% CI: 0.069-0.748). In the multivariate Cox regression analysis, starting IB at ≥2nd line (HR: 2.35, 95% CI: 1.09-5.07, p=0.029), the presence of IDH mutation (HR: 1.98, 95% CI: 1.09-3.58, p=0.025), and age (HR: 1.03, 95% CI: 1.01-1.05, p=0.015) were identified as independent prognostic factors for GSK. Conclusion: This retrospective cohort study based on real-world data demonstrates that the clinical benefit of the IB combination shows significant heterogeneity across patient subgroups. Multilobar tumor location and initiation of IB therapy in the late stages of recurrence are associated with early mortality and poorer survival. Our findings emphasize that IB therapy in recurrent brain tumors should be administered in a personalized manner, considering patient selection and treatment sequence, rather than as a routine approach.

Abstract Fetal cerebral ventriculomegaly (VM) is a commonly observed anomaly on prenatal ultrasound, and its prognosis varies depending on the severity and associated anomalies. It may be an isolated and sole finding in some patients. The neurodevelopmental outcomes of patients diagnosed with isolated VM are controversial, and different results are available. The aim of the study was to evaluate the neurodevelopmental outcomes of isolated fetal cerebral VM. A retrospective analysis of 99 cases of isolated VM diagnosed between January 2021 and October 2023 at a tertiary center was performed. Cases were categorized based on VM severity, gestational age at diagnosis, and laterality. Neurodevelopmental outcomes were assessed via structured interviews and medical records. Normal neurodevelopmental outcomes were found in 95.4% of mild, 66.6% of moderate, and 20% of severe VM cases. Bilateral VM was significantly associated with abnormal outcomes. Early diagnosis (< 24 weeks) was more likely in severe cases. Even isolated mild VM may be associated with adverse neurodevelopmental outcomes. Detailed postnatal follow-up is recommended, especially for early-diagnosed and bilateral cases.

Distinguishing mild (Hinchey 1a/1b/2) from severe (Hinchey 3/4) diverticulitis is critical for appropriate management. This study evaluated the predictive value of inflammatory biomarkers and imaging features for early risk stratification. We conducted a retrospective analysis of patients with acute diverticulitis between 2017 and 2024 at the hospital's general surgery department. Receiver operating characteristic analysis was used to determine optimal cut-off values for C-reactive protein (CRP) and procalcitonin, while computed tomography (CT) findings were assessed for their discriminative capacity. A total of 72 patients were included in the study. There were 59 patients in the mild diverticulitis group and 13 patients in the severe diverticulitis group. Patient demographics were similar between the groups. Procalcitonin demonstrated superior predictive performance [area under the curve (AUC) 0.795] compared to CRP (AUC 0.755). The cut-off values for procalcitonin and CRP were 0.095 and 104.5, respectively. Specific CT patterns showed high specificity for severe disease. The combination of biomarkers and imaging criteria significantly improved diagnostic accuracy, with pelvic abscess localization emerging as a key indicator of severity. A biomarker-guided approach incorporating procalcitonin and targeted CT evaluation enables reliable early identification of severe diverticulitis. This strategy may enhance clinical decision-making regarding antibiotic selection and surgical consultation while reducing unnecessary interventions in mild cases.

Abstract Purpose The curative therapy of patients with end stage liver disease is liver transplantation (LTx). End stage liver disease leads to cirrhotic cardiomyopathy which is cardiac dysfunction in the absence of heart disease .Based on current literature , patients undergoing liver Tx develop heart failure during the perioperative period with 7% to 21% mortality . In the present study we aimed to assess LV systolic function in patients 12 months after LTx and compare them to the baseline measurements. Methods We included 30 patients (age 53.65±10.8 years, 25% male) with preserved LV EF and normal dobutamin stress echocardiography results, without any signs or symptoms of systolic heart failure . All of the patients had end stage liver disease and underwent LTx 12 months ago. We compared LV systolic function based on conventional echocardiographic measurements, tissue Doppler imaging (TDI) and strain imaging. Results LV ejection fraction (EF) and systolic pulmonary artery pressure did not change significantly at the end of first year after Ltx (p=0.47 and p=0.43 respectively). Regarding TDI analysis, septal (IVS Sa) and lateral peak systolic velocities (L Sa) slightly decreased but it was not significant (0,08 ± 0,013 to 0,08 ± 0,011, p=1,00 for IVS Sa; 0,08 ± 0,019 to 0,08 ± 0,016, p=0.82 for L Sa). Based of deformation analysis we observed that LV global longitudinal strain (LV GLS) was significantly impaired one year after LTx, compared to the measurements before the operation (19,53 ± 3,64 % to 14,48 ± 2,12 %, p< 0.001). Conclusion In the present study we observed that LV systolic function is impaired one year after LT, based on tissue Doppler and strain imaging parameters. None of the patients developed clinical signs or symptoms of systolic heart failure in the follow up period. LTx challenges the cardiovascular system immediately after the operation and also in the following months. Longer-term post operatively, more sedentary life style, increased obesity and immunosupressants may affect LV function. Pre operative detailed analysis of LV function is important to predict cardiovasular events after LTx and to improve graft survival.

Rapid Geriatric Assessment is a practical screening tool for common geriatric syndromes that can be administered in under five minutes, even by inexperienced healthcare professionals. The study aimed to validate the Turkish version of the Rapid Geriatric Assessment in hospitalized older adults. This cross-sectional study was conducted in the internal medicine inpatient unit of a university hospital among patients aged ≥65 years. 145 patients were evaluated. The Rapid Geriatric Assessment includes four brief instruments (FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire, and Rapid Cognitive Screen) plus two items on incontinence and constipation. Comparator measures included the Clinical Frailty Scale, Mini Nutritional Assessment-Short Form, Mini Mental State Examination, handgrip strength, Activities of Daily Living, Instrumental Activities of Daily Living, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-2 . A total of 145 patients (57.9% women, 74.7 ± 7.9 years) were included. Rapid Cognitive Screen, Simplified Nutritional Appetite Questionnaire, and FRAIL showed strong significant positive correlations with Mini-Mental State Examination (0.822; p < .001), Mini Nutritional Assessment-Short Form (0.703; p < .001), and Clinical Frailty Scale (0.626; p < .001), respectively, while SARC-F correlated strongly and negatively with handgrip strength (-0.625; p < .001). Discriminant validity was demonstrated for the incontinence item, which was significantly associated with higher Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 scores and lower Activities of Daily Living and Instrumental Activities of Daily Living scores (all p < .001), constipation showed no associations. Convergent validity was supported by significant correlations of the frailty and sarcopenia domains with Instrumental Activities of Daily Living (r = 0.614 and r = -0.753, respectively; p < .001). The Turkish version of the Rapid Geriatric Assessment is valid and feasible for hospitalized older adults, supporting its use as a rapid screening tool for geriatric syndromes. Cite this article as: Çavdar, S., Kayhan Koçak, F. Ö., Çakmak, B., Altun, M. A., Bahadır, A., & Savaş, S. (2025). Validation of the Turkish version of rapid geriatric assessment in hospitalized older adults: a preliminary study. Florence Nightingale Journal of Nursing, 33, 0087, doi:10.5152/FNJN.2025.25087.

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.

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.

<title>Abstract</title> Background: Gestational diabetes mellitus (GDM) is an increasingly common pregnancy complication associated with adverse maternal–fetal outcomes and long-term risk of type 2 diabetes. Artificial intelligence (AI) tools such as ChatGPT have emerged as potential instruments for patient education, yet their reliability and safety in obstetric counseling remain underexplored. This study aimed to evaluate the educational quality of ChatGPT-5 responses to frequently asked questions about GDM. Methods: This cross-sectional study was conducted between January and June 2025 at İzmir Tepecik Training and Research Hospital, Türkiye, following STROBE guidelines. Twenty patient-derived GDM questions were entered into ChatGPT-5 using a standardized prompt. Thirty obstetrics and gynecology specialists from Türkiye, the United Kingdom, Canada, and Germany independently rated the AI-generated answers on a 5-point Likert scale across five domains: accuracy, comprehensiveness, clarity, safety, and appropriateness. Reliability was analyzed using Cronbach’s α and intraclass correlation coefficient (ICC). Comparative analyses were performed using Friedman and Dunn–Bonferroni tests. Results: Overall, ChatGPT-5 achieved high ratings for accuracy (4.23 ± 0.32), clarity (4.18 ± 0.27), and appropriateness (4.09 ± 0.31), while comprehensiveness (3.92 ± 0.29) and safety (3.88 ± 0.34) scored lower. Internal consistency was strong (Cronbach’s α = 0.87) and interrater reliability was good (ICC = 0.79). Among thematic domains, “Definition, causes, and risk factors” received the highest scores (4.20 ± 0.30), whereas “Follow up and Treatment” scored the lowest (3.96 ± 0.33). Safety ratings were significantly lower than accuracy and clarity (p = 0.018). Conclusion: ChatGPT-5 demonstrated high accuracy and understandability in GDM counseling, suggesting potential use as a physician-supervised educational support tool. However, limitations in comprehensiveness and safety highlight the need for guideline-based refinement and human oversight to ensure ethical and reliable integration of AI in obstetric patient education. Trial registration Not applicable. This study is an observational crosssectional design and did not involve patient enrollment or intervention.

The incidence of inflammatory bowel disease (IBD) is rising in newly industrialized nations, yet nationally representative data from Türkiye are limited. We characterized recent epidemiologic trends, clinical features, and geographic distribution of newly diagnosed IBD across Türkiye. This retrospective multicenter cohort included adults (≥18 y) with newly diagnosed IBD at 24 gastroenterology centers spanning all 7 Turkish regions (2010-2022). Demographics, disease behavior/extent, smoking status, family history, and province of residence were collected. Temporal and regional patterns were analyzed using χ2 tests and segmented regression. Among 3463 patients, 51.1% had UC, 44.0% CD, and 0.7% IC. Males comprised 57.7%; median age at diagnosis was 30 years for CD and 32 years for UC. Annual IBD diagnoses more than doubled from 2010 to 2021. The UC-to-CD ratio increased from 0.94:1 (2010-2016) to 1.29:1 (2016-2022, P < 0.001). CD most often showed inflammatory behavior (55.5%) and ileocolonic involvement (37.1%); UC frequently presented as pancolitis (39.3%). Smoking (24.2% vs 10.9%) and family history (6.8% vs 4.5%) were more common in CD than UC (both P <0.01). Choropleth mapping revealed a west-to-east gradient, with Marmara and Aegean regions bearing the highest burden. Multivariable analysis showed UC diagnosis was independently associated with state-hospital care, residence in Central Anatolia or the Black Sea, and age ≥60 years. Incident IBD in Türkiye has risen steadily, with UC now exceeding CD. Patients predominantly present in early adulthood. Regional and hospital-level differences highlight the need for a national registry and targeted resource allocation.