Davut Unsal Capkan

Background: Coronary artery calcium score (CACS) is a well-established marker of coronary atherosclerotic burden and cardiovascular risk. While its association with left ventricular dysfunction has been extensively investigated, the relationship between CACS and right ventricular (RV) function remains insufficiently explored. This study aimed to evaluate the association between CACS and echocardiographic RV function parameters and to explore the discriminatory ability of CACS for identifying patients meeting predefined echocardiographic thresholds of RV dysfunction in patients with suspected stable coronary artery disease (CAD). Methods: This retrospective observational study included 96 patients who underwent coronary computed tomography angiography and transthoracic echocardiography within a 3-month interval. CACS was calculated using the Agatston method. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC), and tissue Doppler-derived systolic velocity (S′). Correlation analyses, subgroup comparisons, multivariable linear regression, receiver operating characteristic (ROC) analyses, decision curve analysis (DCA), and calibration analyses were performed. Results: CACS demonstrated significant inverse correlations with TAPSE (r = −0.42, p < 0.001), RV-FAC (r = −0.36, p = 0.002), and S′ (r = −0.31, p = 0.006). Patients with higher CACS values exhibited progressively impaired RV systolic function. In multivariable regression analyses, higher CACS remained associated with lower TAPSE, RV-FAC, and S′ after adjustment for age, hypertension, and diabetes mellitus. Exploratory ROC analyses demonstrated moderate discriminatory performance, with AUC values ranging from 0.70 to 0.76. DCA suggested a potential net benefit across a range of threshold probabilities, while bootstrap calibration analysis demonstrated acceptable agreement between predicted and observed outcomes. Conclusions: In this retrospective single-center cohort, higher CACS values were associated with lower conventional echocardiographic measures of right ventricular systolic function. However, given the selected study population, relatively small sample size, limited clinical and instrumental characterization, potential residual confounding, and absence of external validation, these findings should be considered exploratory. The present data do not establish CACS as a clinical predictor of right ventricular dysfunction or support its use for clinical decision-making.

Background: Systemic inflammation plays an important role in the pathogenesis and progression of coronary artery disease (CAD). The systemic immune-inflammation index (SII) reflects inflammatory and immune status, whereas the platelet-to-lymphocyte ratio (PLR) represents a simpler hematological inflammatory index. This study aimed to compare the cross-sectional associations of SII and PLR with coronary computed tomography angiography (CCTA)-derived coronary anatomical complexity among selected patients with established obstructive CAD. Methods: In this single-center retrospective cross-sectional study, 197 patients who underwent CCTA were screened. Of these, 104 were excluded, including 68 patients with p < 0.001), whereas PLR was not significantly associated (p = 0.104). In the Firth models, both SII (per 100-point increase: OR = 1.15, 95% CI: 1.07–1.25) and PLR (per 10-point increase: OR = 1.06, 95% CI: 1.01–1.12) were associated with high complexity. The data-derived SII cut-off of ≥850 yielded 83.3% sensitivity and 76.0% specificity. Optimism-corrected AUCs were 0.82 for age plus SII and 0.70 for age plus PLR. Conclusions: In this selected single-center cohort of patients with CCTA-defined obstructive CAD, SII showed a stronger cross-sectional association with concurrently assessed coronary anatomical complexity than PLR. The exploratory ROC estimates apply only to discrimination between high and lower anatomical complexity within the included cohort and do not establish clinical utility.

Background/Objectives: Left ventricular (LV) geometry reflects structural adaptation to aging and biological sex. While cardiac magnetic resonance (CMR) provides precise morphologic assessment, most prior studies have focused on volumetric and mass-based parameters rather than routinely reported linear indices. This study aimed to evaluate the influence of age and sex on LV geometry using wall thickness, LV end-diastolic diameter (LVEDD), and proportional indices derived from standard CMR reports. Methods: In this retrospective cross-sectional study, 95 adult patients who underwent clinically indicated CMR were included. LV wall thickness, LVEDD, relative wall thickness (RWT), and wall thickness-to- LVEDD ratio (WT/LVEDD) were recorded. Participants were stratified by sex and age groups (18–40, 41–60, >60 years). Group comparisons, correlation analysis, multivariable linear regression, logistic regression, and Age × Sex interaction testing were performed to evaluate independent associated parameters of LV morphology and concentric remodeling. Results: The mean age was 34.94 ± 16.00 years; 60.0% were male. Males had significantly larger LVED (43.12 ± 6.83 mm vs. 39.76 ± 6.11 mm, p = 0.014) and greater wall thickness measurements (p < 0.05 for septal and posterior wall thickness). Age showed a significant positive correlation with mean LV wall thickness (r = 0.275, p = 0.007) and WT/LVEDD ratio (r = 0.241, p = 0.019), but not with LVEDD (p = 0.414). In multivariable analysis, male sex was independently associated with larger LVED (B = 3.345, p = 0.017), whereas age was independently associated with WT/LVEDD ratio (B = 0.0018, p = 0.019). Logistic regression demonstrated that age independently increased the odds of concentric remodeling (OR = 1.041 per year, 95% CI: 1.011–1.072, p = 0.006). No significant Age × Sex interaction was observed. Conclusions: Advancing age was independently associated with proportional LV geometric remodeling, whereas male sex primarily influenced absolute ventricular dimensions. Routine CMR report-derived linear measurements were sufficient to detect these distinct structural patterns. These findings highlighted the feasibility of using standardized morphologic indices in daily clinical practice to identify early age-related concentric remodeling.

Background: In this study, it was aimed to compare transrectal ultrasound (TRUS)- and magnetic resonance imaging (MRI)-derived prostate-specific antigen density (PSAD) in patients with gray-zone PSA levels (4–10 ng/mL), evaluate their diagnostic performance for clinically significant prostate cancer (csPCa), and assess the clinical implications of reclassification across commonly used thresholds. Methods: We retrospectively analyzed 202 men who underwent both TRUS and multiparametric MRI between January 2020 and June 2025. Prostate volume was measured using the ellipsoid formula for TRUS and contour-based planimetry for MRI. PSA density (PSAD) was calculated as total PSA (tPSA, ng/mL) divided by prostate volume (mL) for each modality: TRUS-PSAD and MRI-PSAD. Agreement between modalities was evaluated using Bland–Altman plots and correlation analyses. Reclassification at PSAD thresholds of 0.15, 0.20, and 0.30 ng/mL/mL was assessed using Cohen’s κ and net reclassification improvement (NRI). Diagnostic performance for csPCa (ISUP grade group ≥ 2) was evaluated with ROC analysis and the DeLong test. Inter- and intra-observer reproducibility was determined using intraclass correlation coefficients (ICC) and Cohen’s κ. Clinical utility was assessed by decision curve analysis (DCA). Results: MRI-derived prostate volumes were significantly lower than TRUS-derived volumes (median 47.0 vs. 52.5 mL, p < 0.001), resulting in higher MRI-PSAD values (median 0.14 vs. 0.12 ng/mL/mL, p < 0.001). Bland–Altman analysis demonstrated a negative bias for prostate volume (−3.2 mL) and a positive bias for PSAD (+0.03). Strong correlations were observed between TRUS and MRI measurements (r = 0.96 for volume and r = 0.94 for PSAD). MRI-PSAD frequently reclassified patients into higher risk categories, yielding positive net reclassification improvement for cancer cases across all thresholds, while introducing some negative reclassification among non-cancer cases. ROC analysis showed comparable overall diagnostic performance between TRUS-PSAD and MRI-PSAD (AUC 0.681 vs. 0.679, p = 0.91). However, MRI-PSAD demonstrated higher sensitivity at predefined thresholds at the expense of reduced specificity, reflecting a threshold-dependent shift rather than improved discrimination. Reproducibility was higher for MRI-derived measurements (ICC = 0.94; κ = 0.83) compared with TRUS (ICC = 0.86; κ = 0.71). Decision curve analysis indicated that MRI-PSAD, particularly when combined with PI-RADS ≥ 3, provided the greatest net clinical benefit at lower threshold probabilities (5–15%). Conclusions: MRI-derived PSA density produces systematically higher values than TRUS-based measurements due to inherent differences in prostate volume estimation. While this results in increased sensitivity at standard thresholds, overall discrimination remains unchanged. These findings support the use of modality-specific PSAD thresholds rather than uniform cutoffs across imaging techniques. In clinical practice, MRI-PSAD may provide additional value when interpreted in conjunction with PI-RADS, primarily through improved threshold calibration rather than enhanced diagnostic accuracy.

Background/Objectives: Post-cholecystectomy syndrome (PCS) remains diagnostically challenging due to overlapping biliary and non-biliary causes. This study aimed to evaluate whether common bile duct (CBD) diameter measured by MRCP can serve as a practical triage parameter in symptomatic PCS patients and to define a data-supported threshold for predicting clinically relevant biliary pathology. Secondary objectives included assessing correlations between MRCP findings and upper endoscopic features. Methods: In this retrospective single-center study, symptomatic adults undergoing upper endoscopy and MRCP were analyzed. Demographic, clinical, biochemical, radiologic, and endoscopic variables were recorded. Diagnostic performance was assessed using ROC analysis, and independent predictors of biliary dilatation were evaluated with multivariable logistic regression. Results: We analyzed 141 symptomatic post-cholecystectomy patients (mean age 58.2 ± 16.3 years; 67.4% female; median time since surgery 18 [9–36] months). Major symptoms: abdominal pain 84.9%, dyspepsia/bloating 47.5%, nausea/vomiting 22.3%, diarrhea 15.1%. CBD diameter measurements were available in the MRCP subgroup (n = 45); ERCP was performed selectively (n = 12). MRCP findings: CBD ≥ 7 mm 31.9%, biliary dilatation 14.9%, stricture 2.8%, suspected Oddi dysfunction 11.3%, postoperative complications 39.7%. Endoscopy: mucosal inflammation 91.5%; normal 8.5%. Significant correlations included CBD diameter vs. mucosal inflammation (r = 0.32, p = 0.001), dilatation vs. bile reflux (r = 0.28, p = 0.004), and Oddi dysfunction vs. papillary edema (r = 0.41, p = 0.001). CBD diameter showed the best diagnostic performance (AUC 0.82, 95% CI 0.74–0.90; cut-off ≥ 8.0 mm; sensitivity 78.3%; specificity 81.5%; p < 0.001). In multivariable analysis, age independently predicted biliary dilatation (OR 1.05 per year; 95% CI 1.01–1.09; p = 0.007). Conclusions: In symptomatic post-cholecystectomy patients, MRCP-measured CBD diameter provides a useful metric for risk stratification, with a threshold of ≥8 mm identifying patients more likely to harbor biliary pathology. These findings support a structured diagnostic approach that prioritizes noninvasive imaging while reserving ERCP for selected cases. Further prospective validation is warranted.

Kanıta dayalı tıp (KDT), en iyi mevcut bilimsel kanıtın klinik uzmanlık ve hasta değerleriyle bütünleştirilmesini hedefleyen bir yaklaşımdır. Birinci basamakta KDT; geniş hasta popülasyonuna ilk temas noktası olması nedeniyle klinik sonuçların iyileştirilmesi, gereksiz müdahalelerin azaltılması ve maliyet etkinliğin artırılmasında kritik rol oynar. Bu bölüm, KDT’nin kuramsal temellerini (kanıt hiyerarşisi, GRADE), birinci basamaktaki önemini ve başlıca uygulama alanlarını (klinik rehberler, kronik hastalık yönetimi, tarama programları, aşılama ve antimikrobiyal dirençle mücadele) özetlemektedir. Kanıta dayalı rehberlerin hipertansiyon, diyabet, astım ve KOAH gibi hastalıklarda morbidite ve mortaliteyi azalttığı; servikal, meme ve kolorektal kanser taramalarının erken tanı ve prognozu iyileştirdiği vurgulanmaktadır. Uygulamadaki engeller arasında zaman kısıtı, güncel kanıtlara erişim güçlüğü, rehberlerin yerel uyarlanması, dil bariyerleri ve mesleki alışkanlıklar öne çıkmaktadır. Çözüm olarak, özet rehberler, mobil karar destek araçları, elektronik sağlık kayıtlarına gömülü uyarılar ve sürekli tıp eğitimi önerilmektedir. Dijitalleşme, kanıtın bakım noktasında hızlı ve bağlama duyarlı biçimde kullanılmasını kolaylaştırırken, veri güvenliği ve mahremiyet gibi riskler dikkatle yönetilmelidir. Sonuç olarak KDT, birinci basamakta hasta güvenliği ve hizmet kalitesini artırmanın vazgeçilmez yoludur; sistem düzeyinde destek, eğitim ve güvenilir dijital altyapı başarı için gereklidir.

Perkütan dilatasyon trakeostomi (PDT), yoğun bakım ünitelerinde yatak başında uygulanan, minimal invaziv bir girişimdir. Uzamış mekanik ventilasyon ihtiyacı veya üst havayolu obstrüksiyonunda tercih edilir. Endotrakeal entübasyona göre; hasta konforunun artması, sedasyon ihtiyacının azalması, sekresyonların daha etkin temizlenmesi ve ağız bakımının kolaylaşması gibi avantajlar sağlar. İşlem öncesi; anatomik işaret noktaları belirlenmeli, laboratuvar parametreleri (özellikle trombosit sayısı ve koagülasyon testleri) değerlendirilmelidir. Ultrasonografi vasküler yapıları ve giriş yerini saptamada yardımcıdır. PDT’nin uygulanmasında en az üç hekimden oluşan deneyimli bir ekip önerilir. Bronkoskopi eşliğinde işlem, komplikasyonları azaltır. Trakeostomi tüpü hastanın özelliklerine göre seçilmeli, farklı boylarda tüpler hazır bulundurulmalıdır. Komplikasyonlar erken ve geç dönemde görülebilir. Erken komplikasyonlar; hemoraji, pnömotoraks, pnömomediastinum ve yanlış tüp yerleşimidir. Geç komplikasyonlar arasında trakeal stenoz, fistül, trakeomalazi ve tüp dislokasyonu bulunur. En sık görülen komplikasyon kanamadır; özellikle vasküler anomaliler dikkatle değerlendirilmelidir. Sonuç olarak, PDT güvenli, düşük maliyetli ve etkili bir yöntemdir. Uygun hasta seçimi, deneyimli ekip, ultrason ve bronkoskopi rehberliği ile komplikasyonlar en aza indirilebilir.

Periodontal cerrahide biyomateryaller, doku iyileşmesini destekleyen ve rejeneratif tedavilerin başarısını artıran temel unsurlardır. Bu materyaller hem kemik greftleri hem de bariyer membranlar olarak farklı biyolojik ve sentetik kaynaklardan elde edilmekte ve periodontal defektlerin tedavisinde geniş bir kullanım alanı bulmaktadır. Kullanılan biyomateryaller; biyouyumluluk, rezorpsiyon davranışı, mekanik dayanıklılık ve klinik uygulanabilirlik gibi özellikleri bakımından çeşitlilik göstermektedir. Rejeneratif tedavilerin başarısı, yalnızca seçilen biyomateryale değil, aynı zamanda defekt tipine, cerrahi tekniğe ve hasta faktörlerine de bağlıdır. Güncel literatür, tek başına kullanılan materyallerin sınırlı etkiye sahip olabileceğini, buna karşın farklı biyomateryallerin ve biyolojik ajanların kombine kullanımının daha öngörülebilir sonuçlar sunduğunu ortaya koymaktadır. Bu nedenle, klinik karar verme sürecinde materyalin avantaj ve sınırlılıklarının dikkatle değerlendirilmesi büyük önem taşır. Sonuç olarak, biyomateryaller periodontal cerrahinin ayrılmaz bir parçasıdır ve tedavi planlamasında kritik bir role sahiptir. Doğru materyalin seçimi ve uygun klinik protokollerle uygulanması, rejeneratif cerrahinin başarısını doğrudan etkilemektedir. Gelecekte yapılacak çalışmalar, biyomateryallerin daha etkili ve güvenilir hale gelmesini sağlayarak periodontal tedavilerde daha yüksek başarı oranlarının elde edilmesine katkı sağlayacaktır.