Akif Koç

This study aimed to evaluate the concordance between treatment recommendations generated by LLMs and decisions made by a multidisciplinary uro-oncology tumor board. Forty-eight consecutive prostate cancer cases previously discussed at a multidisciplinary tumor board were retrospectively analyzed. For each case, treatment recommendations were generated using five LLM platforms (ChatGPT-4o, ChatGPT, Perplexity, Copilot, and DeepSeek) based on standardized clinical summaries. Four independent urology specialists evaluated the concordance between LLM recommendations and tumor board decisions using a 5-point Likert scale. Differences among models were assessed using the Friedman test followed by Bonferroni-corrected Wilcoxon signed-rank tests. Inter-rater agreement was calculated using the intraclass correlation coefficient. Significant differences in concordance were observed among the evaluated AI platforms (χ² = 32.16, p < 0.001). Perplexity and ChatGPT-4o demonstrated the highest alignment with tumor board decisions, each achieving a median Likert score of 4.75, whereas Copilot showed the lowest concordance (median 3.00). DeepSeek and ChatGPT demonstrated intermediate performance. Post hoc analyses revealed that Perplexity significantly outperformed several lower-performing platforms; however, no statistically significant difference was observed between Perplexity and ChatGPT-4o (p = 0.149). Expert evaluations showed strong inter-rater agreement (ICC = 0.82). Large language models can demonstrate substantial concordance with multidisciplinary tumor board decisions in prostate cancer management. However, variability among models and the risk of hallucinated information indicate that LLMs should function as clinical decision-support tools under expert supervision rather than as autonomous decision-makers.

Purpose: The aim of this study was to investigate whether lipid profiles and atherogenic indices differ between patients with erectile dysfunction (ED) and men without ED. Methods: This cross-sectional observational study included 142 patients diagnosed with ED and 54 men without ED men serving as the men without ED group. The presence and severity of ED were assessed using the International Index of Erectile Function questionnaire (IIEF-5). The Atherogenic Index of Plasma (AIP) was calculated as the logarithm of the ratio of plasma triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C). Results: No significant differences were observed between men with and without erectile dysfunction regarding lipid parameters or atherogenic indices, including AIP. The overall comparison of IIEF-5 scores across AIP categories was not statistically significant, although a modest difference between the lowest and highest AIP groups emerged in an exploratory, unadjusted subgroup analysis. Testosterone levels showed weak but statistically significant inverse correlations with AIP and the TyG index. Conclusion: In this cohort, atherogenic indices, including AIP, were not independently associated with the presence of erectile dysfunction. Exploratory analyses suggest that higher AIP values may reflect an unfavorable metabolic profile rather than a direct marker of ED severity. These findings should be interpreted cautiously and considered hypothesis-generating.

This study aimed to investigate the relationship between the the Modified Early Warning Score, the National Early Warning Score 2, the Rapid Emergency Medicine Score (REMS), and the Emergency Department Triage Early Warning Score, and shock index at presentation to the emergency department in patients with hematuria presenting to the emergency department, and mortality on days 28 and 90. Patients presenting with hematuria to a single-center, tertiary emergency department were retrospectively analyzed. Mortality on days 28 and 90 after the emergency department discharge was analyzed. A total of 179 patients were included in the study. The median age of the patients was 69 years [Inter Quartile Range (IQR), 25-75: 61-79)], and 137 (76.5%) were male. In the receiver operating characteristic analysis (ROC) performed for the 28- and 90-day mortality prediction values of the patients, only the REMS score was found to be statistically significant. The area under the curve (AUC) value of the REMS score for 28-day mortality prediction was 0.740 [95% Confidence interval (CI) (0.538-0.943)], (p

Erectile dysfunction (ED) is one of the most common complaints in the male sexual health field, with a multifactorial etiology yet to be fully elucidated. Nucleobindin 2 (NUCB2)/nesfatin-1, known for its regulatory role in food intake, can also regulate the vascular, neural and hormonal systems, all of which are of great importance in the etiology of ED. The present study included 43 men with ED and 40 healthy individuals without ED. The participants were assessed using the Turkish version of the International Index of Erectile Function (IIEF-5) to determine the presence and severity of ED. Serum NUCB2/nesfatin-1, total testosterone, fasting blood glucose, hemoglobin A1c, total cholesterol, low-density lipoprotein, high-density lipoprotein, very low-density lipoprotein, triglyceride and total prostate-specific antigen levels were all measured. The mean age of the participants was 46.77 +/- 9.87 years with an age range of 25-67 years. The mean ages of the ED and non-ED groups were 47.47 +/- 11.19 and 46.03 +/- 8.30 years, respectively. Patient age and serum biochemical parameters were found to be comparable between the two groups. The serum NUCB2/nesfatin-1 levels of the ED group were also revealed to be significantly lower compared with those of the non-ED group (P=0.019). There was a weak negative correlation between the serum NUCB2/nesfatin-1 level and the severity of ED according to the IIEF-5 score (r=-0.306; P=0.005). The receiver operating characteristic curve analysis of serum NUCB2/nesfatin-1 revealed a cut-off value of 1.25 ng/ml for distinguishing between the ED and non-ED groups (P=0.019). These findings suggest that reduced serum NUCB2/nesfatin-1 values may be implicated in the etiology of ED. Further studies are required to clarify the effect of NUCB2/nesfatin-1 on vascular physiology and erectile physiology or pathophysiology.

Erectile dysfunction (ED) is one of the most common complaints about male sexual health. Nesfatin-1 regulates food intake and has many functions in the body. We aimed to determine whether nesfatin-1 is involved in the etiology of ED. Forty-three men with ED (group 1) and 40 healthy men (group 2) were included in the study. The participants were evaluated by the Turkish version of the IIEF-5 (International Index of Erectile Function). Nesfatin-1, total testosterone, fasting blood glucose, hemoglobin A1c, total cholesterol, low-density lipoprotein, high-density lipoprotein, very low-density lipoprotein, triglyceride and total prostate specific antigen (> 45 age) tests were performed on all cases. The mean ages were 47.47 ± 11.19 and 46.03 ± 8.30 (Mean ± Standard deviation) years in groups 1 and 2, respectively. The average IIEF-5 score were 13.14 ± 5.03 and 23.65 ± 1.17 in groups 1 and 2, respectively. Serum Nesfatin-1 levels were 14.521 ± 17.30 ng/ml in group 1 and 22.675 ± 21.03 ng/ml in group 2. A statistically significant difference was found between the groups’ serum nesfatin-1 levels, total cholesterol, LDL, and HDL (p < 0.05). No correlation was found between serum nesfatin-1 levels and the severity of ED. Nesfatin-1 may be involved in erectile physiology. Low serum Nesfatin-1 level may be among the etiological causes of ED.

Primitive neuroectodermal tumors (PNET) are most common in the central nervous system. Peripheral placements are extremely rare. PNET is from the Ewing sarcoma family. Ewing's sarcoma is evaluated in two groups: bone and non-bone origin. Renal PNET is extremely rare. Peripheral PNETs of renal origin are usually seen in young adults, progress with an aggressive clinical picture and have a poor prognosis. in the follow-up imaging of a 62-year-old female patient after gastrectomy due to stomach cancer (adenocarcinoma), a renal mass was detected incidentally in the left kidney. The patient had no identified complaints. In the middle segment of the left kidney, computed tomography (CT) examination untracked 42.5x44.6 mm nodular mass lesion which holds hipodens contrast material was noticed. The patient underwent laparoscopic left radical nephrectomy. On pathological examination, a diagnosis of PNET/Ewing sarcoma was made. Immunohistochemically, membranous/cytoplasmic and nuclear staining with FLI1 and CD99 were observed in the tumor sections. However, staining with LCA was not seen. The patient was scheduled chemotherapy by oncology. At the end of the fourth course of chemotherapy, no recurrence was found in the radiological controls of the patient.

Varenicline is a new most effective drug for smoking cessation. Its effect on kidney functions remains unclear. This study purposed to investigate whether varenicline causes nephrotoxicity in rats. Fifteen rats were randomly assigned to three groups: control, 0.0125 mg kg⁻¹ varenicline and 0.025 mg kg⁻¹ varenicline (single dose for 3 days, i.p.). Before and after experimental period, serum neutrophil gelatinase-associated lipocalin, creatinine and urea levels were measured. Total oxidant and antioxidant status were measured in kidney homogenates. Histological examination was performed in kidney. The nephrotoxic effects of varenicline were detected by histopathological and biochemical examinations in the varenicline treatment groups. No change was observed in the control group. These findings firstly indicate that a 3-day varenicline treatment causes nephrotoxic effects in rats.

To evaluate the effects of selective α1A-adrenoceptor antagonist tamsulosin hydrochloride on choroidal thickness using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). This is a prospective observational study including 29 eyes of 29 patients with newly diagnosed benign prostatic hyperplasia. Choroidal thickness and retrobulbar ocular blood flow measurements were performed at baseline and after 3 months of treatment. Results were analyzed by the masked observer. The mean subfoveal choroidal thickness (275.8-291.9 µm) and thicknesses 750 µm nasal (257.9-270.4 µm) and 750 µm temporal (262.4-277.0 µm) to the fovea were significantly increased after 3 months of treatment (p < 0.001). No statistically significant change was found in retrobulbar ocular blood flow. Tamsulosin causes a significant increase in EDI-OCT-based choroidal thickness measurements. This increase might be associated with choroidal vasodilation in consequence of blockade of sympathetic α1A-adrenoceptors, which is critical for the maintenance of vascular tone and resistance in the choroidal vascular architecture. This should be kept in mind when choroidal disease and its response to treatment are followed by EDI-OCT imaging.