Browsing by Author "Bekar, Ahmet"
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Publication A rare cause of epilepsy: Ulegyria revisited in a series of 10 patients(Sage Publications, 2021-09-17) Demir, Aylin Bican; Eser, Pınar; Bekar, Ahmet; Hakyemez, Bahattin; Bora, İbrahim; BİCAN DEMİR, AYLİN; Eser, Pınar; BEKAR, AHMET; HAKYEMEZ, BAHATTİN; BORA, İBRAHİM HAKKI; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı/Epilepsi Merkezi.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-6739-8605; 0000-0003-0132-9927; 0000-0002-3425-0740; ABX-9081-2022; AAI-2073-2021; V-7170-2017; AAI-2318-2021; ENI-7759-2022Introduction. Ulegyria results from perinatal hypoxic-ischemic brain injury in term infants. The specific mushroom-shaped configuration of ulegyria results from small atrophic circumvolutions at the bottom of a sulcus underlying an intact gyral apex. Clinically, ulegyria is generally associated with epilepsy. Here, we aimed to delineate the characteristics of patients with ulegyria and the epileptic seizures they experience. Material and methods. Medical records including radiology and pathology reports, video-electroencephalographic (EEG) analysis, operative notes, hospital progress and outpatient clinic notes were reviewed retrospectively in a total of 10 ulegyria patients. Results. Patients ages ranged between 24 and 58 years (mean, 32 +/- 9.8 years). Past medical history was confirmed for neonatal asphyxia in 2 (20%). Neurological examination was remarkable for spastic hemiparesis in 1 (10%) patient with perisylvian ulegyria and for visual field deficits in 2 patients (20%) with occipital ulegyria. Ulegyria most commonly involved the temporoparietal region (n = 5, 50%) followed by the perisylvian area (n = 2, 20%). Except the one with bilateral perisylvian ulegyria, all patients had unilateral lesions (n = 9, 90%). Hippocampal sclerosis accompanied ulegyria in 2 patients (20%). All patients experienced epileptic seizures. Mean age at seizure onset was 8.8 +/- 5.4 years (range, 2-20 years). Interictal scalp EEG and EEG-video monitoring records demonstrated temporoparietal and frontotemporal activities in 5 (50%) and 2 (20%) patients, respectively. The seizures were successfully controlled by antiepileptic medication in 8 patients (n = 8, 80%). The remaining 2 patients (%20) with concomitant hippocampal sclerosis required microsurgical resection of the seizure foci due to medically resistant seizures. Discussion. Ulegyria is easily recognized with its unique magnetic resonance imaging characteristics and clinical presentation in the majority of cases. It is highly associated with either medically resistant or medically controllable epileptic seizures. The treatment strategy depends on the age at onset and extends of the lesion that has a significant impact on the severity of the clinical picture.Publication Anti-apoptotic and anti-oxidant effects of systemic uridine treatment in an experimental model of sciatic nerve injury(Türk Nöroloji Derneği, 2021-01-01) Khezri, Marzieh Karimi; Turkkan, Alper; Khezri, Marzieh Karimi; Koç, Cansu; KOÇ, CANSU; Salman, Berna; SALMAN, BERNA; Levent, Pinar; Cakir, Aysen; Kafa, Ilker Mustafa; Cansev, Mehmet; Bekar, Ahmet; ÇAKIR, AYŞEN; KAFA, İLKER MUSTAFA; CANSEV, MEHMET; BEKAR, AHMET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Farmakoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; 0000-0002-6097-5585; 0000-0001-8309-0934; 0000-0003-2918-5064; AAA-4754-2022; ABX-9081-2022; A-6819-2018AIM: To investigate the anti-apoptotic and anti-oxidant effects of systemic uridine treatment in a rat model of sciatic nerve injury.MATERIAL and METHODS: Thirty-two adult male rats were equally randomized to Sham, Control, U100, and U500 groups. Sham rats received a sham operation by exposing the right sciatic nerve without transection, while those in the Control, U100, and U500 groups underwent right sciatic nerve transection followed by immediate primary anostomosis. Sham and Control groups received saline (0.9% NaCl) injections intraperitoneally (i.p.), while U100 and U500 groups received 100 mg/kg and 500 mg/kg uridine injections (i.p.), respectively, once a day for 7 days after the surgery. Rats in all the groups were sacrificed on the eighth day; sciatic nerve samples were analyzed for apoptosis by Western Blotting and for oxidation parameters including myeloperoxidase (MPO), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) by Enzyme-Linked Immunosorbent Assay (ELISA).RESULTS: Uridine treatment at the dose of 500 mg/kg significantly decreased as apoptosis determined by Caspase-3/Actin ratio and exhibited significant anti-oxidant effects as determined by decreased levels of MPO and MDA as well as increased levels of SOD, GPx, and CAT compared to controls. Uridine at 100 mg/kg was only found to decrease the Caspase-3/Actin ratio, although it significantly decreased MDA and increased CAT levels compared to controls.CONCLUSION: Treatment with uridine reduces apoptosis and oxidation in a rat model of sciatic nerve injury dose-dependently. Thus, uridine may be beneficial in peripheral nerve regeneration by exhibiting anti-apoptotic and anti-oxidant effects.Item Assesment of perfusion in glial tumors with arterial spin labeling; comparison with dynamic susceptibility contrast method(Elsevier Ireland, 2014-10) Öztürk, Esin Işık; Gümüş, Caner; İnecikli, Mehmet Fatih; Cebeci, Hakan; Aydın, Ömer; Bekar, Ahmet; Kocaeli, Hasan; Hakyemez, Bahattin; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0002-3425-0740; AAI-2318-2021; 56033553000; 55933661900; 6603677218; 6603500567; 6602527239Purpose: Arterial spin labeling perfusion imaging (ASL-PI) is a non-invasive perfusion imaging method that can be used for evaluation and quantification of cerebral blood flow (CBF). Aim of our study was to evaluating the efficiency of ASL in histopathological grade estimation of glial tumors and comparing findings with dynamic susceptibility contrast perfusion imaging (DSC-PI) method. Methods: This study involved 33 patients (20 high-grade and 13 low-grade gliomas). Multiphase multislice pulsed ASL MRI sequence and a first-passage gadopentetate dimeglumine T2*-weighted gradient-echo single-shot echo-planar sequence were acquired for all the patients. For each patient, perfusion relative signal intensity (rSI), CBF and relative CBF (rCBF) on ASL-PI and relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values on DSC-PI were determined. The relative signal intensity of each tumor was determined as the maximal SI within the tumor divided by SI within symetric region in the contralateral hemisphere on ASL-PI. rCBV and rCBF were calculated by deconvolution of an arterial input function. Relative values of the lesions were obtained by dividing the values to the normal appearing symmetric region on the contralateral hemisphere. For statistical analysis, Mann-Whitney ranksum test was carried out. Receiver operating characteristic curve (ROC) analysis was performed to assess the relationship between the rCBF-ASL, rSI-ASL, rCBV and rCBF ratios and grade of gliomas. Their cut-off values permitting best discrimination was calculated. The correlation between rCBV, rCBF, rSI-ASL and rCBF-ASL and glioma grade was assessed using Spearman correlation analysis. Results: There was a statistically significant difference between low and high-grade tumors for all parameters. Correlation analyses revealed significant positive correlations between rCBV and rCBF-ASL (r=0.81, p<0.001). However correlation between rCBF and rCBF-ASL was weaker (r=0.64, p<0.001). Conclusion: Arterial spin labeling is an employable imaging technique for evaluating tumor perfusion non-invasively and may be useful in differentiating high and low grade gliomas.Item Bel ağrısında acil bir durum: kauda equina sendromu ile kendini gösteren lomber disk hernisi(Uludağ Üniversitesi, 2008-01-21) Doğan, Şeref; Türkan, Alper; Caner, Başak; Kaplan, Tolga; Bekar, Ahmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirurji Anabilim Dalı.Lomber disk herniasyonları nedeni ile ortaya çıkan kauda ekuina sendromu (KES) nadir görülür ve kesin cerrahi tedavi gerektirir. KES bulguları ile başvuran lomber disk herniasyonu olan 10 olgu retrospektif olarak incelendi. 8’i kadın, 2’si erkek ve yaş ortalamaları 52.4±11.8 yıldı. Major semptom şiddetli bel ve/veya bacak ağrısıydı. Hastalar acil operasyona alındı. Ortalama takip süresi 2,65 ±0,9 yıl idi. Semptomların başlamasından ilk 48 saat içinde operasyona alınan 5 olgunun 4’ünde (%80) idrar inkontinansı, 3’ünde (%60) perianal his kusuru tamamen düzeldi. 4 olgunun 3’ünde (%75) kuvvet kaybı ve bir olgunun seksüel disfonksiyonu tamamen düzeldi. 48 sonra operasyona alınan 5 olgunun 3’ünde (%60) idrar inkontinansında iyileşme olmadı. Seksüel disfonksiyon olan 1 olguda da düzelme gözlenmedi. Cerrahi alınma süresi tartışmalı olsa da, 48 saat içinde cerrahi dekompresyon yapılan olgularda duyu, motor ve üriner fonksiyonlarda belirgin iyileşme olmaktadır.Item Bilateral high-level percutaneous cervical cordotomy in cancer pain due to lung cancer: A case report(Elsevier Science, 2006-07-11) Bekar, Ahmet; Kocaeli, Hasan; Abaş, Faruk; Bozkurt, Merlin; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 6603677218; 6603500567; 8546184300; 16202046200Background: Computed tomography–guided high-level percutaneous cordotomy has been used unilaterally or bilaterally for the treatment of localized intractable pain in malignancies. Case Description: A 57-year-old man was admitted to the hospital with the complaint of intractable pain involving the left side of the chest, axillary region, and shoulder. He was operated for small cell lung cancer on the left side in December 2003 and received radiotherapy and chemotherapy. His neurological examination was normal. Magnetic resonance imaging of the thorax revealed contrast- enhancing lesions on the left side extending to mediastinum and pleura. His pain was relieved completely after the first cordotomy procedure, and he was discharged from the hospital on the second postoperative day. The patient was readmitted to the hospital with the complaint of severe unilateral chest pain like the initial pain on the right side 4 days after cordotomy. The CT-guided bilateral high-level percutaneous cordotomy was performed with a 15-day interval. Conclusion: The CT-guided bilateral high-level percutaneous cordotomy can be used in the treatment of intractable upper trunk pain in patients with cancer without pulmonary dysfunction.Item A case of primary spinal intramedullary lymphoma(Elsevier Science, 2001-05) Bekar, Ahmet; Cordan, Teoman; Evrensel, Türkkan; Tolunay, Şahsene; Uludağ Üniversitesi/Tıp Fakültesi/Cerrahi Bilimler Bölümü/Tıbbi Patoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021; 6603677218; 7801648865; 6603942124; 15745843100A 41-year-old male presented to our clinic with a 1-month history of left hemiparesis. He had marked left arm weakness. The diagnostic work-up revealed an intramedullary mass at spinal level C2-4. Laminectomies were performed at C2-3-4 and the tumor was subtotally resected. Histological examination identified the mass as a non-Hodgkin's diffuse B-cell lymphoma. The patient was treated with corticosteroids, chemotherapy, and adjuvant radiotherapy. The residual tumor tissue had completely disappeared by 6 months of follow-up; however, the patient presented with intraventricular metastasis at 11 months postsurgery.Item CDP-choline and its endogenous metabolites, cytidine and choline, promote the nerve regeneration and improve the functional recovery of injured rat sciatic nerves(Taylor & Francis, 2011-09) Ulus, İsmail Hakkı; Arslan, Erhan; Kocaeli, Hasan; Bekar, Ahmet; Tolunay, Şahsine; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; AAI-1612-2021; 7004957314; 6603500567; 6603677218; 6602604390Objective: Topical cytidine-5'-diphosphocholine (CDP-choline) has been shown to improve the functional recovery and promote the nerve regeneration of injured sciatic nerves in rats. The aims of this study were to test whether CDP-choline was effective at promoting nerve healing when the surgery to repair an injury was delayed and to determine whether the cytidine and/or the choline moieties of CDP-choline contribute to its beneficial actions. Methods: One hundred and fifty Sprague-Dawley rats underwent a surgical procedure that involved damaging the right sciatic nerve and suturing the epineurium. The injured sciatic nerve was either repaired immediately (on the first day) or on the third day after surgery. Rats were assigned to one of five groups and received a topical application of either 0.4 ml of saline (control) or 0.4 ml of 100 mu M CDP-choline, cytidine, choline, or cytidine+choline. Results: The sciatic function index (SFI) of the rats in both groups (those who had their nerve repair immediately versus those on day 3) improved gradually by 4, 8, and 12 weeks after surgery. The percentage recovery in SFI score was significantly higher in rats treated with CDP-choline or cytidine+choline at all time points. Axon count increased by similar to 50% in rats treated either with CDPcholine or cytidine+choline. Treatment with CDP-choline or cytidine+choline reduced scar formation and decreased nerve adherence when the sciatic nerve was repaired immediately, and rats treated with CDPcholine or cytidine+choline had better axonal organization than control rats. Treatment with choline or cytidine alone led to a less marked improvement in SFI score and failed to increase axon count. Conclusion: Our results demonstrate that CDP-choline, as well as the combination of its metabolites, cytidine+choline, improves the functional recovery and promotes the regeneration of injured sciatic nerves treated with immediate or delayed surgical repair in rats.Item CDP-choline modulates matrix metalloproteinases in rat sciatic injury(Elsevier, 2015-10-01) Gündoğdu, Elif Başaran; Bekar, Ahmet; Türkyılmaz, Mesut; Gümüş, Abdullah; Kafa, İlker Mustafa; Cansev, Mehmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Eczacılık Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; 0000-0002-9140-4195; 0000-0001-8309-0934; 0000-0003-2918-5064; AAG-7125-2021; M-9071-2019; 57016583400; 6603677218; 56320252500; 56473463900; 8450193200; 8872816100Background: CDP-choline (cytidine-5'-diphosphocholine) improves functional recovery, promotes nerve regeneration, and decreases perineural scarring in rat peripheral nerve injury. The aim of the present study was to investigate the mechanism of action of CDPcholine with regard to matrix metalloproteinase (MMP) activity in the rat-transected sciatic nerve injury model. Materials and methods: Male Wistar rats were randomized into Sham, Saline, and CDPcholine groups. Rats in Sham group received Sham surgery, whereas rats in Saline and CDP-choline groups underwent right sciatic nerve transection followed by immediate primary saturation and injected intraperitoneally with 0.9% NaCl (1 mL/kg) and CDP-choline (600 mg/kg), respectively. Sciatic nerve samples were obtained 1, 3, and 7 d after the surgery and analyzed for levels and activities of MMP-2 and MMP-9, levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) and TIMP-3, and axonal regeneration. Results: CDP-choline treatment decreased the levels and activities of MMP-2 and MMP-9, whereas increasing levels of TIMP-1 and TIMP-3 significantly on the third and seventh day after injury compared to Saline group. In addition, CDP-choline administration resulted in new axon formation and formation and advancement of myelination on newly formed islets (compartments) of axonal regrowth. Conclusions: Our data show, for the first time, that CDP-choline modulates MMP activity and promotes the expression of TIMPs to stimulate axonal regeneration. These data help to explain one mechanism by which CDP-choline provides neuroprotection in peripheral nerve injury.Item Citicoline improves functional recovery, promotes nerve regeneration, and reduces postoperative scarring after peripheral nerve surgery in rats(Elsevier Science, 2007-12) Özay, Rafet; Bekar, Ahmet; Kocaeli, Hasan; Karlı, Necdet; Gülaydan, Filiz; Ulus, İ. Hakkı; Uludağ Üniversitesi/Tıp Fakültesi/Farmakoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirurji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöropatoloji Anabilim Dalı.; D-5340-2015; 13906765700; 6603677218; 6603500567; 6506587942; 6602693514; 7004271086Results: In the control versus citicoline-treated rats, SFI was -90 +/- 1 versus -84 +/- 1 ( P < .001), -76 +/- 4 versus -61 +/- 3 (P < .001), and -66 +/- 2 versus -46 +/- 3 (P < .001) at 4, 8, and 12 weeks after surgery, respectively. At 12 weeks after surgery, axon count and diameter were 16400 +/- 600 number/mm(2) and 5.47 +/- 0.25 mu m versus 22250 +/- 660 number/mm(2) (p < .001) and 6.65 +/- 0.28 mu m (P < .01) in the control and citicoline-treated groups, respectively. In citicoline-treated rats, histomorphological axonal organization score at the repair site was (3.4 +/- 0.1) significantly better than that in controls (2.6 +/- 0.3) (P < .001). Peripheral nerve regeneration evaluated by EMG at 12 weeks after surgery showed significantly better results in the citicoline group (P < .05). Nerves treated with citicoline demonstrated reduced scarring at the repair site (P < .001). Conclusion: Our results demonstrate that citicoline promotes regeneration of peripheral nerves subjected to immediate section suturing type surgery and reduces postoperative scarring.Publication Co-loading of Temozolomide with Oleuropein or rutin into polylactic acid core-shell nanofiber webs inhibit glioblastoma cell by controlled release(Elsevier, 2023-09-03) Erçelik, Melis; Tekin, Çağla; Parin, Fatma Nur; Mutlu, Büşra; Doğan, Hazal Yılmaz; Tezcan, Gülçin; Aksoy, Seçil Ak; Gürbüz, Melisa; Yıldırım, Kenan; Bekar, Ahmet; Kocaeli, Hasan; Taşkapılıoğlu, Mevlüt Özgür; Eser, Pınar; Tunca, Berrin; Erçelik, Melis; Tekin, Çağla; TEZCAN, GÜLÇİN; Aksoy, Seçil Ak; Gürbüz, Melisa; BEKAR, AHMET; KOCAELİ, HASAN; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Eser, Pınar; TUNCA, BERRİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Diş Hekimliği Fakültesi/Temel Bilimler Bölümü.; Bursa Uludağ Üniversitesi/İnegöl Meslek Yüksekokulu.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Deney Hayvanları Yetiştirme ve Araştırma Birimi.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; 0000-0002-1640-6035; 0000-0003-0132-9927; 0000-0002-1619-6680; ABX-9081-2022; AAI-2073-2021; HKM-7750-2023; EUG-3329-2022; GDC-6329-2022; JJL-1176-2023; JJH-2235-2023; CGB-7869-2022; FDK-3229-2022; IRO-2619-2023Glioblastoma (GB) has susceptibility to post-surgical recurrence. Therefore, local treatment methods are required against recurrent GB cells in the post-surgical area. In this study, we developed a nanofiber-based local therapy against GB cells using Oleuropein (OL), and rutin and their combinations with Temozolomide (TMZ). The polylactic acid (PLA) coreshell nanofiber webs were encapsulated with OL (PLA(OL)), rutin (PLA(rutin)), and TMZ (PLA(TMZ)) by an electrospinning process. A SEM visualized the morphology and the total immersion method determined the release characteristics of PLA webs. Real-time cell tracking analysis for cell growth, dual Acridine Orange/Propidium Iodide staining for cell viability, a scratch wound healing assay for migration capacity, and a sphere formation assay for tumor spheroid aggressiveness were used. All polymeric nanofiber webs had core -shell structures with an average diameter between 133 +/- 30.7-139 +/- 20.5 nm. All PLA webs promoted apoptotic cell death, suppressed cell migration, and spheres growth (p < 0.0001). PLA(OL) and PLA(TMZ) suppressed GB cell viability with a controlled release that increased over 120 h, while PLA(rutin) caused rapid cell inhibition (p < 0.0001). Collectively, our findings suggest that core-shell nanowebs could be a novel and effective therapeutic tool for the controlled release of OL and TMZ against recurrent GB cells.Publication Coexistence of TERT C228T mutation and MALAT1 dysregulation in primary glioblastoma: new prognostic and therapeutic targets(Taylor & Francis, 2021-06-21) Ak Aksoy, Seçil; Mutlu, Melis; Tunca, Berrin; Kocaeli, Hasan; Taşkapılıoğlu, Mevlüt Özgür; Bekar, Ahmet; Tekin, Çağla; Arğadal, Ömer Gökay; Civan, Muhammet Nafi; Kaya, İsmail Seçkin; Ocak, Pınar Eser; Tolunay, Şahsine; AKSOY, SEÇİL; Mutlu, Melis; TUNCA, BERRİN; KOCAELİ, HASAN; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; BEKAR, AHMET; Tekin, Çağla; ARGADAL, ÖMER GÖKAY; Civan, Muhammet Nafi; KAYA, İSMAİL SEÇKİN; OCAK, PINAR; TOLUNAY, ŞAHSİNE; Bursa Uludağ Üniversitesi/İnegöl Meslek Yüksekokulu.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0002-1619-6680; 0000-0001-5472-9065; 0000-0003-0132-9927; 0000-0002-5126-1548; ADM-8457-2022; ABX-9081-2022; AAI-2073-2021; FPB-0403-2022; ABI-6078-2020; FDK-3229-2022; AAW-5254-2020; GDC-6329-2022; CCA-2925-2022; HKP-0793-2023; ILC-4543-2023; AAI-1612-2021Objective: This study was designed to conduct molecular classification based on IDH1/2, TERT, ATRX, and DAXX changes in pediatric and adult primary glioblastoma (GB) and to analyze the potential interaction of LncRNA MALAT1 in the determined homogeneous subgroups. Methods: We analyzed the expression profiles of ATRX/DAXX and MALAT1 using the qRT-PCR method and IDH and TERT mutation status using DNA sequencing analysis in 85 primary pediatric and adult GB patients. Results: IDH1 mutation was observed in 5 (5.88%) and TERT mutation in 65 (76.47%) primary pediatric and adult GB patients. ATRX and DAXX were detected in 18 (21.18%) and 7 (8.24%) patients. TERT mutation and loss of ATRX/DAXX were associated with short overall survival (p < 0.001, p < 0.001, respectively). Patients carrying especially TERT C228T mutation had worse prognosis (p < 0.001). Six subgroups were obtained from the genetic analysis. Among the subgroups, MALAT1 was highly expressed in group A that had a single TERT mutation as compared to that in groups D and E (p = 0.001 and p < 0.001, respectively); further, high MALAT1 expression was associated with worse prognosis in patients with C228T mutation (p < 0.001). Conclusions: Our findings highlight that the presence of TERT C228T mutation and expression of MALAT1 can be used as primary targets during the follow-up of primary GB patients and in the development of new treatment strategies.Item Çökme kırığının neden olduğu sagittal sinüs oklüzyonu: olgu sunumu(Uludağ Üniversitesi, 2004-07-16) Sarıgül, Sani; Taşkapılıoğlu, M. Özgür; Bekar, Ahmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.Majör venöz sinüsler üzerindeki kırıkların tedavi şeması tartışmalıdır. Başına taş düşmesi sonrası başvurduğu başka bir merkezde superior sagittal sinüs üzerinde açık çökme kırığı saptanan ve ciltteki kesisi sütüre edilen olgu, dört gün sonra alt ekstremitede güçsüzlük ve artan baş ağrısı şikayetiyle merkezimize başvurdu. Kraniyal bilgisayarlı tomografisinde çökme fraktürü ve manyetik rezonans anjiografide superior sagittal sinüs oklüzyonu tespit edilen olgu opere edildi. Majör venöz sinüsler üzerindeki çökme kırıkları, intrakraniyal hipertansiyon ve nörolojik bulgular varlığında cerrahi olarak dekomprese edilmelidir.Publication Comparison of clinical and molecular wnt and shh subgroups in medulloblastoma tumor cases(Turkish Neurosurgical Soc, 2021-01-01) Kaya, Ismail Seckin; Aksoy, Secil; Mutlu, Melis; Tekin, Cagla; Taskapilioglu, Mevlut Ozgur; Tunca, Berrin; Civan, Muhammet Nafi; Ocak, Pinar Eser; Kocaeli, Hasan; Bekar, Ahmet; Egeli, Unal; Cecener, Gulsah; Tolunay, Sahsine; Kaya, Ismail Seckin; KAYA, İSMAİL SEÇKİN; Aksoy, Secil; AKSOY, SEÇİL; Mutlu, Melis; Tekin, Cagla; Taskapilioglu, Mevlut Ozgur; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Tunca, Berrin; TUNCA, BERRİN; Civan, Muhammet Nafi; Ocak, Pinar Eser; Kocaeli, Hasan; KOCAELİ, HASAN; Bekar, Ahmet; BEKAR, AHMET; Egeli, Unal; EGELİ, ÜNAL; Cecener, Gulsah; ÇEÇENER, GÜLŞAH; Tolunay, Sahsine; TOLUNAY, ŞAHSİNE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Bölümü.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Medikal Biyoloji Bölümü.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pataloji Anabilim Dalı.; 0000-0001-5472-9065; 0000-0002-1619-6680; 0000-0003-0132-9927; 0000-0001-7904-883X; 0000-0002-3820-424X; AAH-1420-2021; AAH-8540-2021; ABX-9081-2022; HKP-0793-2023; AAI-2073-2021AIM: To determine the Wnt and SHH subtypes at the molecular level, and to compare them clinically by examining the changes in CTNNB1, AXIN, PTCH1, SMO, SUFU, and GLI1 mRNA expression in the medulloblastoma of a Turkish population determined according to patient selection criteria. In this context, the clinical distinction between Wnt and SHH groups are realized by considering the age, gender, survival time, location of the lesion, and radiological features of the patients.MATERIAL and METHODS: Molecular separation was performed by RT-PCR analysis of CTNNB1, AXIN, PTCH1, SMO, SUFU, and GLI1 mRNA expression changes.RESULTS: About 17.8% and 22.2% of the cases were included in the Wnt and the SHH group, respectively. When comparing group differences based on clinical and molecular data, 72.7% and 66.6% of matches were observed in the Wnt and the SHH group, respectively.CONCLUSION: It has been revealed that molecular analysis and grouping of patients with medulloblastoma can provide support for clinically determined subgroups.Item A comparison of effects of alfentanil, fentanyl, and remifentanil on hemodynamic and respiratory parameters during stereotactic brain biopsy(Lippincott Williams & Wilkins, 2006) Bilgin, Hülya; Moğol, Başağan Elif; Bekar, Ahmet; İşçimen, Remzi; Korfalı, Gülsen; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-8111-5958; 0000-0001-6639-5533; AAI-8104-2021; A-7338-2016; 6701663354; 23982134100; 6603677218; 16645821200; 6701462594The aim of this study was to compare the effects of 3 different sedative-analgesic regimens in patients with intracranial mass lesions undergoing stereotactic brain biopsy. A 135 outpatients with American Society of Anesthesiologists I to II were divided into 3 groups: group A (n = 45) received a loading dose of IV alfentanil 7.5 mu g/kg followed by infusion rate of 0.25 mu g/kg/min; group F (n = 45) received a bolus dose of 1 mu g/kg IV fentanyl and repeated as needed; and group R (n = 45) received infusion of 0.05 mu g/kg/min remifentanil. Target level of sedation was 3 to 4 of the Ramsay Sedation Scale. Systolic and diastolic blood pressure, heart rate, respiratory rate, peripheric oxygen saturation (SpO(2)), and end-tidal carbon dioxide were recorded at different stages of the procedures. The patients in group F had significantly lower mean heart rate than those in groups A and R, but this was not in the limits of the bradycardia. The patients in group A had significantly lower mean SpO(2) than those in the other groups, but mean SpO(2) values did not drop below 94%. There were no significant differences in end-tidal carbon dioxide and respiratory rate values among the groups. Our results suggest that all 3 regimens have relatively similar hemodynamic and respiratory responses. The use of bolus fentanyl technique caused less hemodynamic stability. The continuous infusion technique of remifentanil or alfentanil provided better control on hemodynamic parameters.Item Complications of brain tissue pressure monitoring with a fiberoptic device(Springer, 1998) Bekar, Ahmet; Gören, Suna; Korfalı, Ender; Aksoy, Kaya; Boyacı, Suat; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirurji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-1190-6831; AAI-3551-2021Seventy-five patients with intracranial hypertension whose Glasgow Coma Score (GCS) was 8 or below and in whom intracranial pressure (ICP) was monitored were examined for complications of this procedure. In 20 of the 75 patients we used only an intraparenchymal fiberoptic ICP monitoring transducer, while, in the remaining 55 patients, who required CSF drainage, a ventricular drainage set (VDS) was used in addition to ICP monitoring. The duration of monitoring with the ICP transducer alone was approximately 5.1 +/- 2.6 das (min. 1, max. 13) and that of ICP monitoring with VDS was 6.2 +/- 3.1 days (min. 1, max. 13). In 8 cases a total of 9 complications were experienced (12 %). These complications were infection in 3 cases (4 %), epidural hematoma in 2 cases (2.7 %): disconnection in 2 cases (2.7 %) and contusion in 2 cases (2.7 %). Although none of the 44 patients who were monitored for less than 5 days experienced infection, 3 of the 31 patients monitored for longer than 5 days did experience infection (9.7 %) (p < 0.05). None of the 20 patients who underwent ICP monitoring only experienced infection. However, 3 of the 55 patients in whom the ventricular drainage set was implanted in addition to the transducer for ICP monitoring experienced infection (p < 0.05). Owing to its minimally invasive nature, low complication rate, and accuracy in monitoring the parenchyma pressure, the Camino fiberoptic intraparenchymal monitor has become the system of choice in our clinic.Item Correlation of chromosomal imbalances by comparative genomic hybridization and expression of EGFR, PTEN, p53, and MIB-1 in diffuse gliomas(Spandidos Publication, 2007-05-01) Gutenberg, Angelina; Gunawan, Bastian; Schulten, Hans Jurgen; Yakut, Tahsin; Bekar, Ahmet; Egeli, Ünal; Doygun, Muammer; Tolunay, Şahsene; Ercan, İlker; Uludağ Üniversitesi/Tıp Fakültesi/Genetik ve Moleküler Biyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirurji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Bioistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0001-7904-883X; 0000-0002-2382-290X; AAH-1420-2021; 6602802424; 6603677218; 55665145000; 6603789069; 6602604390; 6507050239The histological subclassification of gliomas is increasingly assisted by the underlying molecular genetics which has major importance in guiding clinical management of the disease. However, the assessment of several molecular events for improving clinical care remains a challenge. Herein, we report on comparative genomic hybridization (CGH) and immunohistochemical (IHC) assessment of EGFR, PTEN, p53, and MIB-1 expression in 13 oligodendrogliomas (10 WHO grade II, 3 WHO grade III), one oligoastrocytoma (WHO grade III) and 23 high-grade astrocytomas Q WHO grade III, 20 glioblastoma multiforme). The most frequent imbalances in oligodendroglial tumors including the oligoastrocytic case were, in decreasing order of frequency, +7q, -1p, and -4q and in astrocytomas +7q, -10q, +7p, -9p, -10p, +20q, and +20p. Some individual imbalances were associated with increasing numbers of chromosomal changes, that were +7q in both oligodendrogliomas and astrocytomas, and -9p, -10q, +20p, and +20q in astrocytomas. The markers p53 and MIB-1 were significantly higher expressed in astrocytomas than in oligodendrogliomas and expression levels of p53 and EGFR were inversely associated within the astrocytic group. In addition, p53 overexpression correlated positively with +7q and negatively with -1p in the oligodendroglial group whereas EGFR overexpression correlated positively with -1p in the oligodendroglial and positively with +7p and -10p in the astrocytic group. Short overall survival was significantly associated with +7p and -10q in astrocytomas. Collectively, these results contribute to the increasing clinical relevance of assessing tumor biological markers in gliomas.Item CT-guided high-level percutaneous cervical cordotomy for intractable cancer pain(Türk Nöroşirürji Derneği, 2017) Bekar, Ahmet; Taşkapılıoğlu, M. Özgün; Eser, Pınar; Bilgin, Hülya; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; 0000-0001-6639-5533; 0000-0001-5472-9065; 0000-0003-0132-9927; A-7338-2016; AAW-5254-2020; ABB-8161-2020; AAI-2073-2021; 6603677218; 25936798300; 55211742300; 6701663354AIM: To evaluate the safety and effectiveness of computed tomography-guided high-level percutaneous selective cervical cordotomy (CT-guided HPSCC). MATERIAL and METHODS: CT-guided percutaneous procedures were performed in fifty-nine patients between the years 20042013 for cancer pain. Forty-eight patients with cancer-related body pain were treated with CT-guided HPSCC was evaluated retrospectively. RESULTS: CT-guided HPSCC was performed in 33 male and 15 female patients. The mean age was 49.93 years. The distance between skin-dura, anteroposterior diameter and mediolateral diameter was measured as 40 to 71.1 mm, 8 to 88 mm and 8 to 99 mm respectively. The mean postoperative Karnofsky Performance Score (KPS) was 95. Mean preoperative Visual Analog Scale (VAS) score was 9.6, and 3.6 on postoperative day 1. The 6th month follow-up VAS score was 6.8. Preoperative total sleeping hours in a 24-hour period were 5.5 hours, which increased in the immediate postoperative period to 8.5 hours. The most common pathology treated was bronchogenic carcinoma. Six of the procedures were bilateral and there were no permanent complication due to the procedure. CONCLUSION: CT-guided HPSCC is still very effective, cheap and repetitive procedure for cancer pain. The procedure should be performed by experienced surgeons and although there is a hegemony of opioids, the number of surgeons that perform the procedure must be increased.Publication Ct-guided percutaneous trigeminal tractotomy-nucleotomy for intractable craniofacial pain(Karger, 2020-09-01) Türkkan, Alper; Bekar, Ahmet; BEKAR, AHMET; Eser Ocak, Pınar; Taşkapılıoğlu, M. Özgür; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; OCAK, PINAR; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 0000-0003-0132-9927; 0000-0001-5472-9065; ABX-9081-2022; ABB-8161-2020; AAI-2073-2021Object:In this report, we aimed to analyze the outcome results of our patients who underwent percutaneous trigeminal tractotomy (TR) and nucleotomy (NC) procedures, which are defined as destructive procedures targeting the descending trigeminal tractus and nucleus caudalis of the spinal trigeminal nucleus, respectively, for intractable craniofacial pain.Methods:The medical records of a total of 12 patients who underwent a total of 14 computed tomography (CT)-guided TR-NC procedures at our clinics between 2005 and 2017 were retrospectively reviewed.Results:A significant increase in patients' performance status (p= 0.015) as well as a significant decrease in the VAS score (p< 0.001) were achieved. Grade I pain relief (VAS = 0, no pain) was established in 66.7% of the patients, whereas grade II pain relief was observed in the remaining patients. Two of the patients suffered from recurrent pain after the initial procedure. Both patients underwent a second trigeminal TR-NC procedure, and grade I pain relief was re-established. The mean VAS score at 3-month follow-up was 1.4 +/- 1.1, whereas this score at 6-month follow-up was 2 +/- 1.3. The trigeminal TR-NC procedure resulted in a significant decrease in patients' VAS scores at 3- and 6-month follow-up visits compared with preoperative VAS scores (p< 0.001). Transient ataxia was noted in only one patient (8.3%) early after the procedure.Conclusions:The results presented in the current study support the efficacy of the percutaneous CT-guided trigeminal TR-NC procedure in the management of intractable facial pain in selected patients. The use of CT guidance allows direct visualization of the target area, thereby enhancing the safety and success of the procedure.Item Decompressive craniectomy at the treatment of cerebral infarct in rats(Monduzzi Editore, 1997) Kahveci, Nevzat; Bekar, Ahmet; Korfalı, Ender; Özlük, Kasım; Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirurji Anabilim Dalı.; AAG-7070-2021Effects of decompressive craniectomy after permanent middle cerebral artery occlusion (MCAO) were investigated in rats. In control group (n:13) MCA was couterized via a 3mm subtemporal craniectomy. In decompression group (n:11) after MCAO through 3mm craniectomy additional bone (9x5 mm) was removed dawn to the floor of the middle and temporal fossa and dura left open. 24 h after occlusion the rats were neurologically examined. After decapitation brains were stained with TTC and infarct areas were evaluated with computerized analysing method. Although the mortality in the control group was %15.3 none of the rats in decompressive craniectomy group died. Neurological scoring and infarction size were significantly better in the latter group. The results suggest that decompressive craniectomy reduces mortality, significantly improves neurological outcome and reduces infarction size.Item Deneysel siyatik sinir hasarı modelinde üridin tedavisinin sinir rejenerasyonu ve skar dokusu oluşumu üzerine etkinliğinin araştırılması(Bursa Uludağ Üniversitesi, 2020) Khezri, Marzieh Karimi; Bekar, Ahmet; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.Periferik sinir rejenerasyonu, günümüzde hala çözülemeyen bir sorun olarak karşımıza çıkmaktadır. Üridin majör pirimidin nükleozididir ve Kennedy yolağı aracılığıyla membran fosfolipid sentezinin bir prekürsörüdür. Çalışmamızın amacı; tek taraflı siyatik sinir hasarı sonrasında sistemik verilen üridin’in rejenerasyon ve skar dokusu oluşumu üzerine etkisinin araştırılmasıdır. Çalışmada 96 adet Sprague Dawley erişkin erkek sıçan kullanıldı. Denekler erken (4 grup) ve geç dönem (4 grup) olarak ayrıldı. Birinci grup hariç tüm gruplarda sağ siyatik sinir transeksiyon ve sütürasyon uygulandı. Birinci ve ikinci grupta salin (Sham ve Kontrol), üçüncüde Üridin 100mg/kg (U100), dördüncüde ise Üridin 500mg/kg (U500) intraperitoneal yolla 1 hafta boyunca günde bir kez enjeksiyonu yapıldı. Erken gruplar 1., geç ise 12. haftada sakrifiye edildi. Erken gruplarda apoptotik belirteç, oksidasyon hasarı ve antioksidatif savunma mekanizmaları incelendi. Geç dönemde ise siyatik fonksiyonel (SFI) ve elektrofizyolojik (EMG) testlerinden sonra siyatik sinirleri çıkarılarak akson iyileşmesi incelendi. U500 sıçanlarda anti-apoptoz etkisi kontrole göre anlamlı görüldü (p<0,05). U100 ve U500 gruplarında oksidasyon parametreleri kontrol gruba göre anlamlı düzeyde azalmış (p<0,001) ve anti-oksidasyon parametreleri yükselmiştir (p<0,001). U500 grubunda, kontrol gruba göre sinir ayrılabilirliği açısından anlamlı olarak daha iyi sonuçlar saptandı (p=0,002). 6. ve 12. haftadaki SFI U100 ve U500 gruplarında kontrole göre belirgin iyileşme saptandı (p<0,001). 12.haftada EMG analizlerinde U500 ile tedavi edilen grupta kontrol ve U100 gruplarına göre yüksek amplitüd değerleri saptandı (p<0,001). Akson sayısı açısından; U100 ve U500 gruplarında kontrole göre anlamlı istatistiksel artış görüldü (p<0,05). Sonuçlarımız, sistemik uygulanan üridinin doza bağımlı olarak anti-apoptotik ve anti-oksidatif etkinliğe sahip olduğunu göstermektedir. Ayrıca SFI iyileşme, sinir dokusu rejenerasyonunda artış, perinöral skar dokusunda iii azalma, EMG latansında kısalma, sinir adhezyon ve seperabilite skorlarında iyileşme ve miyelinli akson sayısında anlamlı artışlar tespit edilmiştir. Bulgularımıza göre üridin periferik sinir hasarında iyileşmeyi artırıcı etkinlik göstermektedir.