Memorial Ankara Hospital

The standard method for transporting tissues during limb transplantation and replantation is cold ischemic transport (CIT). However, CIT cannot completely prevent ischemia-reperfusion injury (IRI). As an alternative, extracorporeal perfusion (ECP) methods that provide an adequate metabolic environment for ischemic tissues could be considered. In this study, we investigated the differences between CIT and ECP in terms of their effects on IRI. An ischemia-reperfusion model was used to compare the CIT and ECP groups. This model includes a 6-hour ischemia period followed by a one-hour reperfusion period. Superoxide dismutase, catalase, total antioxidant status, total oxidant status, and total thiol levels in muscle and blood samples were biochemically analyzed to determine oxidative damage levels. TNF-α, NF-κB, and IL-10 levels were measured in the same samples to evaluate the degree of inflammation. Apoptosis was evaluated by measuring the levels of Bax and Bcl-2 proteins in muscle samples. Histopathologic examination was performed for tissue damage and mitochondria were evaluated by Cox staining. It was found that the ECP causes less oxidative and inflammatory damage than the CIT. Bax and bcl-2 levels did not differ between the 2 groups. Biochemical parameters were found to be higher in the CIT group. More mitochondrial damage was observed in the CIT system. ECP caused less inflammatory and oxidative damage compared with CIT. The promising results of our experimental study suggest that the clinical use of extracorporeal circulation machines for extremity transport may reduce histopathologic damage.

The global incidence of syphilis has been rising, and atypical clinical presentations are increasingly recognized. Human immunodeficiency virus (HIV)-induced immune changes can alter syphilis progression and complicate diagnosis. Otosyphilis is a rare but potentially reversible cause of sensorineural hearing loss (SNHL). This study investigates otologic involvement in patients co-infected with syphilis and HIV. Medical records of patients diagnosed with both syphilis and HIV infection at Etlik City Hospital between January 2023 and June 2025 were retrospectively reviewed. Adults aged ≥ 18years with audiometry-confirmed SNHL were included. Other causes of hearing loss were excluded. Demographic, clinical, laboratory, radiologic, and treatment data were collected and analyzed. Among 591 patients diagnosed with syphilis, 152 were HIV-positive, and five met inclusion criteria. Four had newly diagnosed HIV infection. None reported hearing loss spontaneously; symptoms were identified through systematic questioning or physical examination. Serologic profiles varied: three showed combined TPHA and VDRL positivity, one had isolated TPHA positivity, and one had isolated VDRL positivity. Lumbar puncture (LP) in four patients revealed abnormalities in two, including one with cerebrospinal fluid VDRL positivity. One patient who declined LP had magnetic resonance imaging findings compatible with neurosyphilis. All patients received intravenous penicillin G and progressively tapered prednisone treatment for 14days, and clinically significant hearing improvement was observed in all cases; four of them were documented with audiometric measurements. Otosyphilis should be considered in individuals with HIV infection presenting with auditory symptoms, and syphilis testing should be performed in unexplained SNHL. Early recognition and appropriate treatment are critical to preventing irreversible hearing loss.

We report a rare case of contralateral invasive lobular carcinoma (ILC) diagnosed three years after initial treatment for invasive ductal carcinoma (IDC). The new lesion, detected incidentally on screening MRI, mimicked an intramammary lymph node on MRI and ultrasound due to its well-circumscribed appearance and hilar-like echogenicity. Shear-wave elastography revealed high stiffness values, raising suspicion for malignancy. Core biopsy confirmed ILC. This case underscores the critical role of MRI in detecting clinically occult cancers and highlights elastography’s potential to unmask malignancies mimicking benign structures.

This study evaluated the inter-method agreement of an in-house qualitative CMV real-time PCR assay for the detection of cytomegalovirus (CMV) DNA in various non-plasma clinical specimen types, in comparison with a commercially available comparator assay. In this prospective comparative study, 186 clinical specimens-including bronchoalveolar lavage fluid (BALF), stool, urine, colonoscopic biopsy, amniotic fluid, and intraocular fluid-were analyzed. A total of 166 samples with valid results from both test systems were included in the inter-method comparison. CMV DNA was detected using the in-house qualitative PCR assay in parallel with the comparator assay (artus® CMV QS-RGQ kit). Agreement was assessed using positive percent agreement (PPA), negative percent agreement (NPA), overall percent agreement (OPA), and Cohen's kappa coefficient (κ), in accordance with CLSI EP12-A2 recommendations. Substantial overall inter-method agreement was observed when all specimens were evaluated collectively (κ = 0.66). Agreement metrics were highest in stool, urine, and invasive specimens, whereas BALF samples demonstrated comparatively lower agreement, reflecting potential matrix-related analytical variability. The laboratory-developed qualitative CMV PCR assay demonstrated substantial inter-method agreement with the comparator assay across multiple non-plasma specimen types. The findings highlight specimen-specific variability in qualitative CMV DNA detection and represent analytical concordance between two molecular assays rather than definitive clinical diagnostic accuracy or viral load quantification.

Colorectal cancer (CRC) screening uptake in Türkiye remains suboptimal, despite the presence of a national screening program. Understanding whether barriers arise primarily from patient-related factors or system-level constraints is essential for effective policy planning. This study aimed to evaluate barriers to CRC screening across the screening pathway using patient, procedural, and provider perspectives. A descriptive cross-sectional study was conducted between January and June 2025 at a tertiary training and research hospital. Three distinct groups were surveyed: 100 screening-naïve outpatients aged 50-70 years, 100 patients undergoing diagnostic or screening colonoscopy, and 50 general surgeons performing or referring for colonoscopy. Study-specific questionnaires, pilot-tested for clarity but not formally validated, were used to assess screening awareness, attitudes, perceived barriers, and strategies for improvement. The data were analyzed descriptively. Among screening-naïve outpatients, 54% had no prior awareness of CRC screening, and only 28% had received a physician recommendation for screening. Fear of a serious diagnosis (45%) and pain or discomfort (40%) were commonly reported concerns; however, most respondents indicated that these would not deter screening. Among patients undergoing colonoscopy, 77% underwent the procedure for symptoms rather than preventive screening, while post-procedure satisfaction was high. Surgeons predominantly identified system-level barriers, particularly long waiting times (90%) and an insufficient number of trained endoscopists (92%), as major limitations in effective screening delivery. The primary perceived barrier to CRC screening in Türkiye appears to be limited system capacity rather than patient reluctance. Improving screening uptake will likely require coordinated public awareness efforts, structured national reminder systems, and expansion of the number of adequately trained endoscopists, alongside endoscopy infrastructure.

AimIMpower133 was designed with 4 cycles of chemoimmunotherapy with atezolizumab, unlike many other studies permitted 6-cycle induction. This study aimed to compare the efficacy and safety of a 4-cycle regimen with an extended 6-cycle regimen of carboplatin, etoposide, and atezolizumab in the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC).MethodsThis retrospective multicenter study was conducted across 13 oncology centers in Turkey. A total of 181 patients with ES-SCLC who received first-line treatment with chemotherapy plus atezolizumab were analyzed and grouped into those receiving 4 cycles (n = 101) and 6 cycles (n = 80) of treatment.ResultsThe median follow-up time was 20.9 months. The objective response rates were similar between the 4- and 6-cycle groups (79.2% vs 78.8%, P = .940). The disease control rates were also comparable (84.2% vs 86.3%, P = .940). The median progression-free survival (PFS) was 6.3 months in the 4-cycle and 8.1 months in the 6-cycle group (P = .357). The median overall survival (OS) was 16.6 months for the 4-cycle and 13.6 months for the 6-cycle group (P = .583). Intracranial progression was higher in the 4-cycle group (50.0% vs 25.5%, P = .007). Immune-related adverse events were similar between the groups.ConclusionThis is one of the largest real-world datasets comparing the efficacy and safety of 4 versus 6 cycles of induction chemoimmunotherapy. Although there were no significant improvements in PFS or OS, the 6-cycle regimen was associated with a lower observed rate of intracranial progression, predominantly among patients without baseline brain metastases. Further studies are needed to identify this subject in future.