Efficacy of Optic Nerve Sheath Fenestration in Patients with Increased Intracranial Pressure

Objectives:To evaluate the effectiveness of optic nerve sheath fenestration (ONSF) on visual functions in patients with increased intracranial pressure (İİP).Materials and Methods:The medical records of 24 eyes of 17 patients who had İİP due to idiopathic intracranial hypertension, cerebral venous sinus thrombosis, or intracranial cyst and underwent ONSF surgery to prevent visual loss were evaluated. Pre- and postoperative visual acuity, optic disc images, and visual field findings were reviewed.Results:The mean age of the patients was 30.4±8.5 years, and 88.2% were female. The patients’ mean body mass index was 28.67±6.1 kg/m2. The mean follow-up time was 24±12.1 months (range: 3-44). At postoperative 3 months, the mean best-corrected distance visual acuity had improved in 20 eyes (83.3%) and stabilized in 4 eyes (16.7%) compared to preoperative values. In visual field mean deviation, an improvement was observed in 10 eyes (90.9%), while 1 eye (9.1%) eye remained stable. Optic disc edema decreased in all patients.Conclusion:This study indicates that ONSF has beneficial effects on visual function in patients with rapidly progressive visual loss caused by increased intracranial pressure

Yeni Ortadoğu: Toplum, Siyaset ve Ekonomi Konferansı

Ortadoğu asırlar boyu uluslararası siyasetin merkezinde yer almış, araştırmacı ve siyaset yapıcıların ilgi odağı olmuştur. Bu ilgiye rağmen, 2010 yılında başlayan ve ‘Arap Baharı’ olarak adlandırılan halk ayaklanmaları ve bu çerçevede yaşanan siyasal, ekonomik ve sosyal dönüşümler siyasetçiler ve sosyal bilimciler tarafından öngörülememiş ve mevcut varsayımları derinden sarsmıştır. Bir yandan demokratikleşme hareketleri ve ekonomik bir dönüşüm yaşayan bölge, diğer yandan iç çatışmaların, darbelerin ve vekalet savaşlarının merkezi haline gelmiş, ve tüm bu gelişmeler yeni yaklaşımları ve analizleri gerekli kılmıştır. Bu çerçevede Işık Üniversitesi Uluslararası İlişkiler Bölümü, Arap Baharı’yla başlayan süreçte bölgede gözlemlenen yeni toplumsal, ekonomik, iç ve dış siyasal dinamikleri akademik alanda tartışmaya açmak amacıyla ‘Yeni Ortadoğu’ başlıklı bir konferans düzenledi. Bu konferans çerçevesinde 24-25 Mart 2016 tarihlerinde Maslak Kampüsü’nde bizzat sunulan ve tam metin olarak bize iletilen bildirilerden bu kitabı oluşturduk.Publisher's Versio

Programmed Cell Death 1 and Hepatocellular Carcinoma: An Epochal Story

In recent years, immune-based therapies have emerged as novel pillars for hepatocellular carcinoma (HCC). The rationale of immune-checkpoint inhibitors (ICIs) trial in HCC originated from the fact that the tumor cells and the infiltrating stromal and immune cells promote an immunosuppressive tumor microenvironment, including the up-regulation of immune checkpoint molecules on their surface. Antibody-based blockage targeting inhibitory checkpoint molecules on cytotoxic T cells, including programmed cell death-1 (PD-1) or its counterpart on antigen-presenting cells has shown strong anti-tumor activity in a subset of HCC patients. Single nucleotide polymorphisms (SNP) of PD-1 gene may affect the PD-1 expression or function, which eventually can cause dysfunctionality of immune balance. Based on the inhibitory role of PD-1 in anti-tumor responses, it has been investigated in several studies as a candidate to test for genetic susceptibility of individuals to HCC. The present paper highlights the knowledge on cross-talks for liver immunology and HCC course, recent studies investigating the role of functional SNPs of PD-1 gene in Turkish HCC population, and the data on already investigated PD-1 inhibitor molecules in clinical trials

Dominant ve dominant-olmayan el ile fakoemülsifikasyon (katarakt cerrahisi) sonuçları

Aim: The aim was to present the outcomes of phacoemulsification surgery with dominant and non-dominant hands. Methods: Eighty eyes of 72 patients undergoing phacoemulsification with a temporal clear corneal incision were included in the study by reviewing their medical records and were divided into two groups. Forty of operated eyes were right eyes and forty were left ones. We operated right eyes with dominant (right) hand, and left eyes with non-dominant (left) hand through a temporal clear corneal tunnel. The patients were followed up at week 1 st and month 1 st and 3rd. Keratometry and specular microscopy were performed preoperatively, at month 1 st and 3rd after surgery. We recorded the total volume of fluid used, phaco time and cumulative dissipated energy. We calculated surgically-induced astigmatism using vector analysis. Results: There was no statistically significant difference in intraoperative and postoperative outcomes between phacoemulsification surgeries performed with dominant and non-dominant hands. Conclusion: Phacoemulsification surgeries can be carried out with non-dominant hand and with excellent outcomes.Amaç: Sağ ve sol el ile yapılan fakoemülsifikasyon sonuçlarımızı sunmaktır. Yöntemler: Kliniğimizde temporal korneal insizyonla katarakt operasyonu olan 72 hastanın 80 gözü dahil edilmiştir. Kırk göz sağ el ile, 40 göz sol el ile opere edilmiştir. Hastaların 1 hafta,1 ay ve 3 ay sonra takipleri yapılmıştır. Hastalar 1. ve 3. ay kontrollerinde keratometri ve speküler mikroskopi ile değerlendirilmiştir. Fakoemülsifikasyon zamanı, kümülatif kullanılan enerji, total kullanılan sıvı kaydedilmiştir. Cerrahi ile indüklenen astigmatizma vektör analizi kullanılarak karşılaştırılmıştır. Bulgular: Sağ ve sol el ile yapılan fakoemülsifikasyonlarda; intra ve postoperatif sonuçlar istatistiksel farklılık göstermemiştir. Sonuç: Fakoemülsifikasyon; dominant-olmayan el ile de yapıldığı zaman iyi sonuçlar çıkabilir

Surveillance Strategies for Hepatocellular Carcinoma: Recent Advances and the Shifting Paradigm

Currently, international liver societies recommend screening at-risk individuals for HCC (patients with cirrhosis regardless of etiology, and/or chronic hepatitis B virus, and/or advanced liver fibrosis) with biannual abdominal ultrasound (USG) with or without alpha-fetoprotein (AFP). The global acceptance of USG in surveillance relies on the absence of risks, non-invasiveness, and lower costs. However, the suboptimal performance of USG +/- AFP in reaching direct and indirect goals of HCC surveillance highlights the need for alternative surveillance strategies. Several studies targeted contrast-enhanced magnetic resonance imaging techniques, but the main barriers for their entrance to surveillance programs have been concerns about cost-effectivity and long scan times. Overall, the HCC risk stratification appears at hand by several validated multiple score systems, but their optimal performance is obtained only in populations who show highly homogenous clinical, pathological, epidemiologic, etiologic, and therapeutic characteristics, and this limitation poses a major drawback to their sustainable use in clinical practice. We need globally validated and molecular integrated risk stratification tools to shape the future tailored HCC surveillance decision algorithms. A dynamic process for HCC surveillance algorithms awaits us owing to the expected further prospective studies focusing on risk-stratified screening strategy

Characteristics of patients with hepatocellular carcinoma: A multicenter study

Background and Aim: The aim of the present study was to examine the etiology of hepatocellular carcinoma (HCC) by underlying cause and determine the characteristics and clinical features of patients with HCC. Materials and Methods: The study comprised 1802 HCC patients diagnosed and followed up by Liver Diseases Outpatient Clinics in 14 tertiary centers in Turkey between 2001 and 2020. Results: The mean age was 62.3±10.7 years, and 78% of them were males. Of the patients, 82% had cirrhosis. Hepatitis B virus (HBV) infection was the most common etiology (54%), followed by hepatitis C virus (HCV) infection (19%) and nonalcoholic fatty liver disease (NAFLD) (10%). Of the patients, 56% had a single lesion. Macrovascular invasion and extrahepatic spread were present in 15% and 12% of the patients, respectively. The median serum alpha-fetoprotein level was 25.4 ng/mL. In total, 39% of the patients fulfilled the Milan Criteria. When we compared the characteristics of patients diagnosed before and after January 2016, the proportion of NAFLD-related HCC cases increased after 2016, from 6.6% to 13.4%. Conclusion: Chronic HBV and HCV infections remain the main causes of HCC in Turkey. The importance of NAFLD as a cause of HCC is increasin

Proposal and Validation of a Novel Scoring System for Hepatocellular Carcinomas Beyond Curability Borders

Optimal scoring system for clinical prognostic factors in patients with unresectable hepatocellular carcinoma (HCC) is currently uncertain. We aimed to develop and externally validate an easy to use tool, particularly for this population, and named it the unresectable hepatocellular carcinoma prognostic index (UHPI). We evaluated the data of patients with treatment-naive unresectable HCC who were diagnosed in the training center from 2010 to 2019 (n = 209). A simple prognostic model was developed by assigning points for each covariate in proportion to the beta coefficients in the Cox multivariable model. Predictive performance and distinction ability of the UHPI were further evaluated in an independent European validation cohort (n = 147) and compared with 11 other available models. A simple scoring system was derived, assigning 0.5/1/2 scores for six independent covariates including, the Child-Pugh score, Eastern Cooperative Oncology Group performance status, maximum tumor size, vascular invasion or extrahepatic metastasis, lymph node involvement, and alpha-fetoprotein. The UHPI score, ranging from 0 to 6, showed superior performance in prognosis prediction and outperformed 11 other staging or prognostic models, giving the highest homogeneity (c-index, 6-month and 1-year area under the receiver operator characteristic curves), lowest Akaike information criterion, and -2 log-likelihood ratio values. The UHPI score allocated well the risk of patients with unresectable HCC for mortality within the first year, using two cut-off values (low-risk, 2). Conclusion: The UHPI score can predict prognosis better than other systems in subjects with unresectable HCC and can be used in clinical practice or trials to estimate the 6-month and 1-year survival probabilities for this group