Medical Bulletin of Sisli Etfal Hospital最新文献

{"title":"Comment on Ozler et al.: \"Interscalene Block Versus Posterior Suprascapular Block for Postoperative Analgesia in Arthroscopic Shoulder Surgery\".","authors":"Raghuraman M Sethuraman, Gayathri Ramesh","doi":"10.14744/SEMB.2026.85520","DOIUrl":"https://doi.org/10.14744/SEMB.2026.85520","url":null,"abstract":"","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"431-432"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Massage with Topical Corticosteroids on Recurrent Curvature in Staged Repair of Proximal Hypospadias: A Retrospective Study.","authors":"Hilmican Ulman, Sumeyye Sozduyar, Sibel Tiryaki, Ali Tekin, Ibrahim Ulman","doi":"10.14744/SEMB.2026.58260","DOIUrl":"https://doi.org/10.14744/SEMB.2026.58260","url":null,"abstract":"<p><strong>Objectives: </strong>Ventral penile curvature often accompanies severe hypospadias and poses a risk of recurrence after repair. We postulated that altered myofibroblastic activity at the repair site contributes to recurrent curvature. To address this mechanism, we adopted a specific clinical strategy in 2017. We instructed patients to apply upward massage to the ventral side of the penis using a topical corticosteroid ointment between the two stages of Bracka repair. The aim of this study was to assess the impact of this intervention on the recurrence of curvature after surgery.</p><p><strong>Methods: </strong>A retrospective review of the medical records of all patients who underwent Bracka repair for hypospadias between January 2009 and May 2023 by a single senior surgeon was conducted. Patients were divided into two groups according to whether they received steroid treatment, and complication rates were compared. In the steroid group, parents applied Betnovate® 0.1% (betamethasone valerate) ointment twice daily with upward massage to the ventral penile surface, beginning in the second postoperative week after Bracka stage 1 surgery and continuing for three months. The primary outcome was recurrence of curvature during the second stage and at long-term follow-up, while secondary outcomes included dehiscence and fistula formation.</p><p><strong>Results: </strong>The review included 60 patients (median age: 14 months [5-171]) who underwent Bracka repair for hypospadias, with 40 in the steroid group and 20 in the control group. The mean degrees of curvature at presentation were similar (91 and 89 degrees, respectively; p>0.05). Compared with the control group, the steroid group had a significantly smaller mean degree of curvature both at the second-stage operation (17 vs. 26 degrees, p=0.04) and during long-term follow-up (15 vs. 25 degrees, p=0.03). There were no steroid-related complications, and no significant differences in the incidences of dehiscence and fistula formation were observed between the groups (p>0.05).</p><p><strong>Conclusion: </strong>Our findings suggest that the application of a topical corticosteroid ointment with upward massage to the ventral graft site between stages 1 and 2 of Bracka hypospadias repair may reduce the recurrence of curvature both during the second stage of repair and at long-term follow-up.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"346-351"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Determinants and Mortality Predictors of Acute Kidney Injury in Neonates: A Five-Year Retrospective Cohort Study.","authors":"Hasan Avsar, Ali Bulbul, Evrim Kiray Bas, Alper Divarci, Ahmet Yasar Tellioglu","doi":"10.14744/SEMB.2026.92480","DOIUrl":"https://doi.org/10.14744/SEMB.2026.92480","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) is a frequent and clinically significant complication in critically ill neonates and is associated with increased morbidity and mortality. Although awareness of neonatal AKI has increased in recent years, data on mortality predictors and the trajectory of renal recovery remain limited, particularly in single-center cohorts. This study aimed to comprehensively evaluate the incidence, antenatal, perinatal, and postnatal risk factors, clinical characteristics, and short-term outcomes of neonates diagnosed with AKI in a neonatal intensive care unit, with a particular focus on deaths attributable to AKI during the neonatal intensive care unit (NICU) stay.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, the medical records of neonates admitted to the NICU between January 2019 and January 2024 were retrospectively reviewed. Neonates diagnosed with AKI according to the KDIGO criteria were included, and relevant demographic, clinical, laboratory, and outcome data were collected. Survivors and non-survivors were compared. Univariate and multivariable logistic regression analyses were performed to identify predictors of mortality, and model performance was assessed using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Among 3,456 NICU admissions, 121 neonates (3.5%) were diagnosed with AKI. The mean gestational age was 31.0±5.5 weeks, and 78.5% of patients were preterm. The overall in-hospital mortality rate among neonates with AKI was 30.6%. Sepsis (54.5%) and perinatal asphyxia (40.5%) were common risk factors. Non-survivors had significantly lower gestational age and birth weight and higher serum creatinine levels on postnatal day 7 (p=0.04). In multivariable analysis, sepsis (adjusted OR: 2.64, 95% CI: 1.19-5.86) and serum creatinine on postnatal day 7 (adjusted OR: 7.98, 95% CI: 2.47-25.80) were independent predictors of mortality. The multivariable model demonstrated good discrimination, with an AUC of 0.857.</p><p><strong>Conclusion: </strong>Neonatal acute kidney injury-related mortality in the neonatal intensive care unit remains high. In this cohort, sepsis and persistently elevated serum creatinine levels on postnatal day 7 were identified as independent predictors of in-hospital mortality. The observed divergence in creatinine trajectories between survivors and non-survivors highlights the prognostic value of serial renal function assessment for risk stratification. These findings underscore the importance of early identification of high-risk neonates and support the need for future prospective studies to determine whether targeted monitoring and intervention strategies can improve clinical outcomes.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"379-388"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Opening-Wedge High Tibial Osteotomy Delivers Meaningful Early Outcomes Even in KL-3 Osteoarthritis: A 24-Month Stratified Cohort Analysis.","authors":"Yusuf Altuntas, Enver Ipek, Raffi Armagan, Gungor Alibakan, Ismail Demirkale, Osman Tugrul Eren","doi":"10.14744/SEMB.2026.25936","DOIUrl":"https://doi.org/10.14744/SEMB.2026.25936","url":null,"abstract":"<p><strong>Objectives: </strong>Medial opening-wedge high tibial osteotomy (MOWHTO) is a joint-preserving procedure designed to correct varus malalignment and reduce medial compartment overload in knee osteoarthritis (OA). Although historically reserved for early-stage disease, recent evidence suggests that patients with more advanced radiographic degeneration may still benefit from the procedure. However, the relationship between Kellgren-Lawrence (KL) grade and postoperative clinical outcomes remains controversial. This study aimed to evaluate early-term pain reduction and functional improvement following MOWHTO by comparing patients with low-grade OA (KL1-2) and moderate OA (KL3).</p><p><strong>Methods: </strong>This retrospective observational study analyzed 73 consecutive adults who underwent standardized biplanar MOWHTO between May 2020 and May 2023 at a single tertiary center. Patients were stratified into KL1-2 (n=58) and KL3 (n=15) groups. Pain and function were assessed preoperatively and at 6, 12, and 24 months using the Visual Analog Scale (VAS), KOOS, and WOMAC index. Radiographic alignment parameters and complications were recorded.</p><p><strong>Results: </strong>Preoperative VAS scores were high in both groups (KL1-2: 7.79±0.89; KL3: 8.27±0.70; p=0.066). At 24 months, VAS scores decreased significantly (KL1-2: 3.33±1.15; KL3: 1.87±0.74), with KL3 patients exhibiting greater pain reduction (ΔVAS: 6.40±1.06 vs. 4.47±1.52; p<0.001). KOOS scores improved substantially in both groups (KL1-2: 53.1±8.2 to 85.4±5.8; KL3: 43.9±7.6 to 76.7±6.3), with similar functional gains (ΔKOOS: 32.3±6.0 vs. 32.8±8.9; p=0.85). WOMAC scores improved significantly (KL1-2: 51.9±3.6 to 30.8±7.1; KL3: 61.4±4.3 to 34.9±5.6), with greater improvement in KL3 (ΔWOMAC: 26.5±8.2 vs. 21.2±7.4; p=0.034). The overall complication rate requiring surgery was 12.3%, and 24-month arthroplasty-free survival was 96.0%.</p><p><strong>Conclusion: </strong>MOWHTO provides meaningful early-term improvements in pain and function across all KL grades. Despite worse baseline status, KL3 patients achieved comparable or greater symptomatic relief. These findings support MOWHTO as a viable option for carefully selected patients with moderate OA seeking to delay arthroplasty.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"304-312"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of the Effects of Switching from Bosentan to Macitentan in Pediatric Pulmonary Hypertension Patients.","authors":"Mustafa Mertkan Bilen, Timur Mese, Murat Muhtar Yilmazer, Gamze Vuran, Cem Dogan, Yusuf Ilker Dur, Ozan Hira","doi":"10.14744/SEMB.2026.78803","DOIUrl":"https://doi.org/10.14744/SEMB.2026.78803","url":null,"abstract":"<p><strong>Objectives: </strong>Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary vascular resistance and reduced exercise capacity. Bosentan, an endothelin receptor antagonist, is commonly used in pediatric PAH, but standardized guidelines for its use are lacking. Macitentan, another endothelin receptor antagonist, offers advantages such as a longer duration of action, greater tissue penetration, and lower hepatotoxicity.</p><p><strong>Methods: </strong>This retrospective study evaluated 21 pediatric patients (≥12 years) who transitioned from bosentan to macitentan due to worsening functional class and increased pulmonary artery pressure. Patients received 10 mg of macitentan daily after obtaining regulatory approval. Clinical assessments, including WHO functional class, NT-proBNP levels, transthoracic echocardiographic systolic pulmonary artery pressure (sPAP), and six-minute walk test (6MWT) distances, were conducted before and 6 months after the switch.</p><p><strong>Results: </strong>At follow-up, the prevalence of WHO functional class III decreased from 66% to 19% (p=0.001). Median NT-proBNP levels significantly decreased from 1361.01 pg/mL to 906.06 pg/mL (p=0.009). Median sPAP also showed a statistically significant reduction (p=0.001). Additionally, 6MWT distances improved significantly (p=0.002). No adverse events, hospitalizations, or significant changes in liver function tests were observed.</p><p><strong>Conclusion: </strong>Macitentan demonstrated favorable efficacy and safety in pediatric patients with PAH, particularly those with idiopathic PAH. Its once-daily regimen may improve adherence and clinical outcomes. These findings are consistent with adult studies and highlight macitentan as a promising treatment option for pediatric PAH. Larger-scale studies are needed to establish its role in clinical guidelines.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"405-411"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axial Back Pain Secondary to Ligamentum Flavum Ossification in a Patient with Hypoparathyroidism: A Rare Case Report.","authors":"Hasanali Gilan, Rekib Sacaklidir, Gunay Er, Hatice Kaplan, Tulay Sahin, Yuksel Altuntas","doi":"10.14744/SEMB.2026.97957","DOIUrl":"https://doi.org/10.14744/SEMB.2026.97957","url":null,"abstract":"<p><p>The ligamentum flavum is a structure that connects adjacent laminae and plays a role in maintaining upright posture. Hypoparathyroidism can rarely cause ligamentum flavum ossification (LFO). LFO can cause symptoms due to spinal cord compression. A 48-year-old man was evaluated for complaints of widespread back pain, a burning sensation, and numbness in the lower extremities. Imaging revealed spinal stenosis at the T10-T11 level due to LFO. Following facet joint block and duloxetine treatment, the VAS score decreased from 8 to 3. Early diagnosis and appropriate treatment of LFO in patients with hypoparathyroidism are critical for symptom control and functional recovery.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"421-423"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Clinical Warning Signs of Inborn Errors of Immunity in the Neonatal Intensive Care Unit: A Retrospective Observational Study.","authors":"Fatma Iyigun, Derya Colak, Ozlem Sahin, Omer Guran, Funda Yavanoglu Atay, Hayrunnisa Bekis Bozkurt, Ilke Mungan Akin","doi":"10.14744/SEMB.2026.47639","DOIUrl":"https://doi.org/10.14744/SEMB.2026.47639","url":null,"abstract":"<p><strong>Objectives: </strong>Inborn errors of immunity (IEI) may manifest in neonates as severe or unusual infections and syndromic features, yet early recognition remains challenging, especially in settings without routine newborn screening. Early clinical warning signs-including recurrent or atypical infections, absent thymic shadow, unexplained hydrops fetalis, or treatment-resistant metabolic disturbances-can facilitate timely diagnosis. This study aimed to determine the prevalence and subtypes of IEI in a tertiary neonatal intensive care unit (NICU) and to characterize early diagnostic indicators that guide life-saving interventions.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of neonates diagnosed with IEI between August 2023 and August 2025 in a 61-bed, level 4 NICU. Seventeen infants meeting IUIS and ESID criteria were identified through the immunology-neonatology council registry. Demographic, clinical, laboratory, and outcome data were analyzed descriptively, with an emphasis on early warning signs.</p><p><strong>Results: </strong>Among 11,276 live births and 2,942 NICU admissions, 17 neonates were diagnosed with IEI (1.51 per 1,000 live births). Combined immunodeficiencies were the most frequent subtype (58.8%). Diagnostic evaluation was primarily prompted by syndromic features or severe/unusual infections. Four infants (23.5%) died, while survivors remained clinically stable with immunoglobulin replacement therapy and antimicrobial prophylaxis. One infant underwent hematopoietic stem cell transplantation (HSCT). Early recognition facilitated the timely initiation of appropriate management strategies.</p><p><strong>Conclusion: </strong>IEI should be suspected in neonates presenting with syndromic features or atypical infections. Awareness of subtle neonatal warning signs and prompt evaluation for appropriate interventions can improve outcomes, particularly in settings without routine newborn screening.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"389-398"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Functional Outcomes of Bipolar TURP and Bladder Neck Incision in Male Bladder Outlet Obstruction.","authors":"Sezgin Yeni, Mete Kilciler, Nurullah Ay, Behcet Varisli, Sinan Gonullu","doi":"10.14744/SEMB.2026.12979","DOIUrl":"https://doi.org/10.14744/SEMB.2026.12979","url":null,"abstract":"<p><strong>Objectives: </strong>Patients who underwent either transurethral resection of the prostate (TURP) or bladder neck incision (BNI) for bladder outlet obstruction (BOO) were evaluated in this study. The aim was to compare the perioperative characteristics and postoperative outcomes of the two surgical approaches.</p><p><strong>Methods: </strong>Data from 74 patients who underwent surgical treatment for bladder outlet obstruction (BOO) between January and December 2025 were assessed. The study population consisted of 33 patients treated with TURP and 41 patients treated with BNI. Demographic characteristics, prostate volume, and operative time were recorded for all participants. Uroflowmetry parameters, including maximum flow rate (Qmax), average flow rate (Qavg), and post-void residual urine volume (PVR), were evaluated preoperatively and at 6 months postoperatively. Statistical analyses were performed using Student's t-test or the Mann-Whitney U test.</p><p><strong>Results: </strong>Patients in the TURP group were older and had significantly larger prostate volumes than those in the BNI group (both p<0.001). Procedure duration was also longer among patients who underwent TURP. Preoperative PVR values were higher in the TURP group, whereas preoperative Qmax, Qavg, and voided volume did not differ significantly between the groups. Patients treated with BNI demonstrated higher Qmax, Qavg, and voided volume values at 6 months postoperatively, while PVR was lower than that in the TURP group.</p><p><strong>Conclusion: </strong>Postoperative voiding test results were more favorable in the BNI group than in the TURP group. This difference may be related to patient age and the underlying cause of bladder outlet obstruction. These factors should be considered when planning treatment and counseling patients.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"324-328"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline and Longitudinal Pan-Immune-Inflammation Value Compared with Other Inflammatory Indices in Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Cohort Study.","authors":"Nazan Demir, Feyzi Kangul, Yasemin Sagdıc Karateke, Duygu Bayir Garbioglu, Bulent Yildiz, Murat Dincer, Tugrul Burak Genc, Bahadir Koylu, Cevat Ilteris Kikili, Fatih Kemik, Fatih Selcukbiricik, Lutfiye Demir","doi":"10.14744/SEMB.2026.85530","DOIUrl":"https://doi.org/10.14744/SEMB.2026.85530","url":null,"abstract":"<p><strong>Objectives: </strong>The pan-immune-inflammation value (PIV), calculated from neutrophil, platelet, monocyte, and lymphocyte counts, is a peripheral blood biomarker of systemic immune-inflammatory status. We evaluated the prognostic value of baseline PIV and its trajectory over the first six months of treatment for overall survival (OS) and progression-free survival (PFS) in patients receiving immune checkpoint inhibitors (ICIs) and benchmarked PIV against the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII).</p><p><strong>Methods: </strong>We retrospectively analyzed 205 patients treated at a single tertiary center for non-small-cell lung cancer, renal cell carcinoma, melanoma, or other solid tumors who received an ICI (90.2% nivolumab). PIV was measured at baseline, month 3, and month 6. The outcome-independent median value (587.7) defined the PIV-low and PIV-high groups. Cox regression (per doubling of log2-transformed PIV), Kaplan-Meier analysis, 3- and 6-month landmark models, time-updated Cox models, and restricted cubic splines were used, with adjustment for age, sex, and tumor type. Discrimination was assessed using Harrell's C-index, 1000-resample bootstrap internal validation, and time-dependent area under the curve (AUC).</p><p><strong>Results: </strong>The median follow-up was 50.6 months; 168 deaths and 190 progression-or-death events occurred. Each doubling of baseline PIV was independently associated with worse OS (adjusted HR, 1.24; 95% confidence interval [CI], 1.14-1.36; p<0.001) and PFS (HR, 1.18; 95% CI, 1.09-1.28; p<0.001). Median OS was 11.96 vs. 5.62 months, and median PFS was 6.21 vs. 3.45 months, in the PIV-low vs. PIV-high groups (log-rank p<0.001 for both). Month-3 and month-6 absolute PIV values remained prognostic in landmark analyses, whereas the relative change in PIV from baseline to month 3 was not associated with either outcome. The association was approximately log-linear (nonlinearity p>0.05 for OS and PFS). PIV, NLR, PLR, and SII showed similar discrimination (adjusted C-index for OS: 0.650, 0.647, 0.633, and 0.652, respectively); PIV had the lowest Akaike information criterion (AIC) and Bayesian information criterion (BIC) values among the four indices.</p><p><strong>Conclusion: </strong>Baseline and on-treatment absolute PIV values, but not early relative changes in PIV, are independently associated with survival outcomes in patients receiving ICIs, with prognostic performance comparable to that of established inflammatory indices. PIV may serve as a simple, repeatable biomarker to support risk stratification during ICI therapy.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"368-378"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracytoplasmic Sperm Injection Outcomes Using Epididymal Sperm Obtained by Percutaneous Aspiration: An 11-Year Single-Center Experience.","authors":"Selcuk Yetkinel, Cevahir Ozer, Mehmet Vehbi Kayra, Pinar Caglar Aytac, Gulsen Dogan Durdag, Didem Alkas Yaginc, Erhan Simsek","doi":"10.14744/SEMB.2026.76390","DOIUrl":"https://doi.org/10.14744/SEMB.2026.76390","url":null,"abstract":"<p><strong>Objectives: </strong>Percutaneous epididymal sperm aspiration (PESA) is a minimally invasive surgical sperm retrieval technique used in patients unable to provide ejaculated spermatozoa. This study aimed to evaluate fertilization, clinical pregnancy, and live birth outcomes following intracytoplasmic sperm injection (ICSI) using epididymal sperm obtained via PESA over an 11-year period at a single tertiary referral center.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 63 PESA-ICSI cycles performed in 46 male patients between January 2015 and December 2025. Indications for PESA included obstructive azoospermia (n=13 cycles) and medically refractory ejaculatory dysfunction (n=50 cycles). Outcomes were evaluated both at the cycle level and independently per embryo transfer (ET) procedure. Comparative analyses were performed according to PESA indication, embryo developmental stage at transfer, and transfer type.</p><p><strong>Results: </strong>Sperm retrieval was completely successful in all 63 cycles (100%). Of 498 mature (MII) oocytes injected, normal fertilization (2PN) was achieved in 268, yielding an oocyte-level fertilization rate of 53.8%. Total fertilization failure occurred in only one cycle (1.6%). Embryo transfer was performed in 57 cycles, resulting in 68 individual transfer procedures (42 fresh and 26 frozen-thawed). The overall clinical pregnancy rate was 39.7% (25/63) per initiated cycle and 36.8% (25/68) per ET procedure. The overall live birth rate was 33.3% (21/63) per initiated cycle and 30.9% (21/68) per ET procedure. No statistically significant differences were observed between cleavage-stage and blastocyst-stage transfers with respect to clinical pregnancy (p=0.615) or live birth outcomes (p=1.000). No major procedural complications were recorded.</p><p><strong>Conclusion: </strong>PESA combined with ICSI provides favorable reproductive outcomes with a low rate of total fertilization failure. These results were achieved despite a cohort characterized by diminished ovarian reserve and diverse male infertility etiologies. The high sperm retrieval success rate and consistent clinical outcomes support PESA as a reliable and effective sperm retrieval technique in contemporary assisted reproductive practice.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"338-345"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}