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İNCE, ALİ TÜZÜN

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ALİ TÜZÜN
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  • PublicationMetadata only
    Early prediction of acute necrotizing pancreatitis by artificial intelligence: a prospective cohort-analysis of 2387 cases.
    (2022-05-12T00:00:00Z) Kiss, Szabolcs; Kiss, Szabolcs; Pintér, József; Molontay, Roland; Nagy, Marcell; Farkas, Nelli; Farkas, Nelli; Sipos, Zoltán; Sipos, Zoltán; Pecze, László; Pecze, László; Földi, Mária; Földi, Mária; Vincze, Áron; Vincze, Áron; Takács, Tamás; Takács, Tamás; Halász, Adrienn; Halász, Adrienn; Faluhelyi, Nándor; Faluhelyi, Nándor; Farkas, Orsolya; Farkas, Orsolya; Váncsa, Szilárd; Váncsa, Szilárd; Erőss, Bálint; Erőss, Bálint; Párniczky, Andrea; Párniczky, Andrea; Hegyi, Péter; Hegyi, Péter; Fehérvári, Péter; Fehérvári, Péter; Czakó, László; Czakó, László; Izbéki, Ferenc; Izbéki, Ferenc; Boros, Eszter; Boros, Eszter; Hamvas, József; Hamvas, József; Varga, Márta; Varga, Márta; Mickevicius, Artautas; Mickevicius, Artautas; Nagy, Rita; Nagy, Rita; Bunduc, Stefania; Bunduc, Stefania; Hegyi, Péter Jenő; Hegyi, Péter Jenő; Márta, Katalin; Márta, Katalin; Borka, Katalin; Borka, Katalin; Doros, Attila; Doros, Attila; Hosszúfalusi, Nóra; Hosszúfalusi, Nóra; Zubek, László; Zubek, László; Molnár, Zsolt; Molnár, Zsolt; Szentesi, Andrea; Szentesi, Andrea; Bajor, Judit; Gódi, Szilárd; Sarlós, Patrícia; Czimmer, József; Szabó, Imre; Pár, Gabriella; Illés, Anita; Hágendorn, Roland; Németh, Balázs Csaba; Kui, Balázs; Illés, Dóra; Gajdán, László; Dunás-Varga, Veronika; Fejes, Roland; Papp, Mária; Vitális, Zsuzsanna; Novák, János; Török, Imola; Macarie, Melania; Ramírez-Maldonado, Elena; Sallinen, Ville; Galeev, Shamil; Bod, Barnabás; Ince, ALİ TÜZÜN; Pécsi, Dániel; Varjú, Péter; Juhász, Márk Félix; Ocskay, Klementina; Mikó, Alexandra; Szakács, Zsolt; İNCE, ALİ TÜZÜN
  • PublicationOpen Access
    The relationship between serum histon levels and the severity of acute pancreatitis.
    (2019-09-01) Biberci, Keskin; Şentürk, H; Köker, İH; Sümbül, Gültepe; İnce, AT; İNCE, ALİ TÜZÜN; SÜMBÜL, BİLGE; ŞENTÜRK, HAKAN
    Background/Aims: Despite various scoring systems and imaging methods, it is hard to predict the severity and the course of acute pancreatitis (AP), thereby necessitating better and more reliable markers. Since inflammation plays a key role in the pathogenesis of AP, we sought to determine whether histone, which is a novel inflammatory marker, may play a role in the prediction of severity and prognosis. Materials and Methods: A total of 88 consecutive adult patients (>18 years) with a first AP episode were prospectively enrolled in the study. Severe AP was defined as having a revised Atlanta score >3 in the first 48 h after admission. Circulating histone 3 and 4 levels were measured using the enzyme-linked immunosorbent assay method. Results: Eighty-eight consecutive adult patients with a first episode of AP were divided into two groups according to severity, in which 56 (63.6%) were assigned to the mild AP group and 32 (36.4%) to the severe AP group. White blood cell, hemoglobin, creatinine, and aspartate aminotransferase levels were significantly higher in the severe AP group. However, there was no difference in serum histone levels between the groups, and there was no correlation between revised Atlanta score and serum histone levels either. Conclusion: Serum histone levels did not significantly differ between the severe and mild AP groups. Therefore, these markers may not provide additional benefit for determining the severity of AP.
  • PublicationOpen Access
    Comparison of tomographic and colonoscopic diagnoses in the presence of colonic wall thickening
    (2014-01-01) Ince, ALİ TÜZÜN; BAYSAL, Birol; KAYAR, Yusuf; Arabaci, ELİF; Bilgin, MEHMET; HAMDARD, Jamshid; YAY, Adnan; Senturk, HAKAN; İNCE, ALİ TÜZÜN; ARABACI, ELİF; BİLGİN, MEHMET; ŞENTÜRK, HAKAN
    Introduction and objective: Colonic wall thickening is a common condition in a number of benignant and malignant diseases. This study investigated the accuracy of radiological diagnoses in patients diagnosed with colonic wall thickening using multislice CT (MDCT). Materials and method: Files of patients with colonic wall thickening diagnosed with 64-slice MDCT were reviewed retrospectively. The colonoscopy results of these patients were grouped under neoplastic process (cancer and adenomatous polyp), inflammatory bowel disease (IBD), diverticulitis and other etiology (nonspecific events, ischemic colitis, solitary rectal ulcer, external compression, secondary to volvulus and radiotherapy), and the results were statistically evaluated. p values < 0.05 were considered statistically significant. Results: The study was performed on 505 files (290 males [57.4%], 215 females [42.6%], mean age: 49.15 ± 18.4 years). CT and colonoscopic diagnoses were reviewed and the following CT to colonoscopy ratios was observed: neoplastic process: 44.4% vs. 40.2%; IBD: 42.4% vs. 42.4%; diverticulitis: 4% vs. 4.2%; other etiology: 9.3% vs. 3.2%. Colonoscopy failed to identify pathology in 9.9% of the patients. The sensitivity, specificity, PPV, NPV and accuracy of CT were 95.6%, 90.4%, 87.1%, 96.8% and 92.4%, respectively, in detecting neoplastic processes; 97.2%, 97.9%, 97.2%, 97.9% and 97.6%, respectively, in detecting IBD; 90.5%, 99.8%, 95%, 99.6% and 99.4%, respectively, in detecting diverticulitis, and 50%, 96,7%, 62.5%, 94.6% and 92%, respectively, in detecting other etiology. Conclusion: While, accuracy of 64 slice-CT in diagnosing colonic wall thickenings secondary especially to neoplastic processes, IBD and diverticulitis was significantly higher, but differential diagnosis is challenging in pathologies due to other etiologies.
  • PublicationMetadata only
    Early prediction of the severe course, survival, and ICU requirements in acute pancreatitis by artificial intelligence
    (2023-01-01) İnce A. T.; Silahtaroğlu G.; Seven G.; Koçhan K.; Yıldız K.; Şentürk H.; İNCE, ALİ TÜZÜN; SEVEN, GÜLSEREN; KOÇHAN, KORAY; ŞENTÜRK, HAKAN
    AbstractObjectiveTo evaluate the success of artificial intelligence for early prediction of severe course, survival, and intensive care unit(ICU) requirement in patients with acute pancreatitis(AP).MethodsRetrospectively, 1334 patients were included the study. Severity is determined according to the Revised Atlanta Classification(RAC). The success of machine learning(ML) method was evaluated by 13 simple demographic, clinical, etiologic, and laboratory features obtained on ER admission. Additionally, it was evaluated whether Balthazar-computerized tomography severity index(CTSI) at 48-h contributed to success. The dataset was split into two parts, 90% for ML(of which 70% for learning and 30% for testing) and 10% for validation and 5-fold stratified sampling has been utilized. Variable Importance was used in the selection of features during training phase of machine. The Gradient Boost Algorithm trained the machine by KNIME analytics platform. SMOTE has been applied to increase the minority classes for training. The combined effects of the measured features were examined by multivariate logistic regression analysis and reciever operating curve curves of the prediction and confidence of the target variables were obtained.ResultsAccuracy values for the early estimation of Atlanta severity score, ICU requirement, and survival were found as 88.20%, 98.25%, and 92.77% respectively. When Balthazar-CTSI score is used, results were found as 91.02%, 92.25%, and 98% respectively.ConclusionsThe ML method we used successfully predicted the severe course, ICU requirement and survival, with promising accuracy values of over 88%. If 48-h Balthazar-CTSI is included in the calculation, the severity score and survival rates increase even more.
  • PublicationOpen Access
    Role of gut microbiota: Obesity and NAFLD
    (2014-04-01) GANGARAPU, Venkatanarayana; YILDIZ, Kemal; Ince, ALİ TÜZÜN; BAYSAL, Birol; İNCE, ALİ TÜZÜN
    Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease in developed countries. Obesity is the most important risk factor for metabolic syndrome and NAFLD. Accumulated evidence has revealed that gut microbial compositional changes may be associated with more energy harvesting from the diet, which promotes increased fatty acid uptake from adipose tissue and shifts lipid metabolism from oxidation to de novo production. Furthermore, changes in intestinal barrier function contribute to metabolic endotoxemia in the form of low-grade microbial inflammation. Persistent inflammation exacerbates NAFLD progression. In this review, we discuss the role of gut microbiota in obesity and NAFLD.
  • PublicationMetadata only
    An unusual simultaneous occurence of gastric adenocarcinoma, leiomyoma and B-cell small lymphocytic lymphoma involving the perigastric lymph nodes and spleen
    (2013-04-01) Kocaman O.; Şentürk H.; Danalıolu A.; Türkdoan K.; Arabacı E.; Yıldız K.; İnce A. T.; İNCE, ALİ TÜZÜN
  • PublicationOpen Access
    Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit
    (2018-11-01) kayar, yusuf; Baysal, Birol; Tozlu, Mukaddes; ŞENTÜRK, hakan; Atay, Musa; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN; İNCE, ALİ TÜZÜN
    Background: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. Materials and Methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17–92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease.
  • PublicationOpen Access
    Initial Renal Function (eGFR) Is a Prognostic Marker of Severe Acute Pancreatitis: A Cohort-Analysis of 1,224 Prospectively Collected Cases
    (2021-08-01T00:00:00Z) İnce, Ali Tüzün; Farkas, Nelli; Németh, Dávid; Hamar, Peter; Hegyi, Peter; Hágendorn, Roland; Czakó, László; Izbéki, Ferenc; Galeev , Shamil I; Papp, Mária; Faluhelyi, Nandor; Gombos, Katalin; Nagy, Tamás; Szénási , Gábor; Vincze, Aron; Illés , Dóra; Hegyi, Péter Jenő; Szentesi, Andrea; Párniczky, Andrea; Hamvas , József; Varga, Marta; İNCE, ALİ TÜZÜN
    Background:Acute pancreatitis (AP) is a life-threatening disease. We aimed to explore the prognostic relevance of renal function based on estimated glomerular filtration rate (eGFR).Methods:A prospective registry of AP patients was established by the Hungarian Pancreatic Study Group. Data of 1,224 consecutive patients were collected between 2012 and 2017. Patients were divided into 3 groups according to their eGFR measured within 24 h of hospitalization:normalrenal function: >90 mL/min,mildto moderate renal functionalimpairment: 30–90 mL/min andsevererenaldysfunction: <30 mL/min. Associations of eGFR with outcome (survival, length of hospitalization, AP severity, blood glucose), inflammatory markers (erythrocyte sedimentation rate, white blood cell count), anemia and organ failure (heart, kidney, liver) were analyzed.Results:Death, longer hospitalization and severe AP, but not the cause of AP, were significantly associated with lower eGFR. The inflammatory markers (CRP, WBC count) but not anemia (Hb, Htk) were closely associated with severe renal dysfunction. Renal function was associated with heart and renal failure but not with other complications of AP such as respiratory failure, local pancreatic complications, diabetes or peptic ulcer. eGFR was not associated with liver damage (ALAT, γ-GT) or liver function (serum bilirubin) although biliary complications, alcohol and metabolic syndrome were the most common etiologies of AP.Conclusions:Our study suggests a useful prognostic value ofinitialeGFR in AP patients. Even mild eGFR reduction predicted mortality, severity of AP and the length of hospitalization. Thus, precise evaluation of renal function should be considered for assessing AP severity and outcome.
  • PublicationMetadata only
    EFFECT OF CHOLECYSTECTOMY ON PREVENTING RECURRENCE OF ACUTE PANCREATITIS
    (2022-10-11) Seven G.; Musayeva G.; İnce A. T.; Biberci Keskin E.; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; BİBERCİ KESKİN, ELMAS
    Background and AimsCurrent guidelines recommend cholecystectomy in patients with acute biliary pancreatitis (ABP) to prevent recurrence. Some studies suggest that a significant portion of patients with idiopathic acute pancreatitis (IAP) results from occult biliary disease and cholecystectomy, after an episode of IAP, reduces the risk of recurrent pancreatitis. However, in these studies, the work-up for potential biliary cause is not extensive and do not include endoscopic ultrasound (EUS), which can detect a biliary disease up to one-third of patients with IAP. In this study, we aimed to ascertain whether cholecystectomy can prevent pancreatitis recurrence in patients with ABP and IAP.MethodsAdult patients (over 18 years) with first episode of acute pancreatitis (AP) who admitted to inpatient clinic between January 1, 2015 and December 31, 2021 at a tertiary referral center were retrospectively reviewed. Medical records were scrutinized and relevant data extracted. In addition, a questionnaire either by mail or telephone was used. Patients with biliary and idiopathic AP were included in the analysis. Patients with chronic pancreatitis, previous pancreatic surgery, pancreatic cancer, and other etiologies were excluded. Primary outcome was recurrence rate. The diagnosis of IAP was confirmed by exclusion of all known etiological factors for AP using extensive work-up, including EUS and/or magnetic resonance cholangiopancreatography (MRCP).ResultsA total of 500 patients with first episode of AP (300 patients with ABP and 200 patients with IAP) were identified. The mean age was 58 years and 267 women, 233 men. The patients were divided into three different groups: Group 1; patients who had their first pancreatitis attack after cholecystectomy, Group 2; patients who had their gallbladder in situ during the first attack and followed by cholecystectomy and Group 3; patients who had their gallbladder in situ during the first attack but did not have cholecystectomy. The number of patients with recurrence after the first episode of AP were not statistically different in whole study group (25%, 19% and 15%, respectively, P = 0.176). In the subgroup of patients with ABP, the recurrence was higher in group 1 as compared with group 2 and 3 (39%, 19% and 14%, respectively, P = 0.018). On the other hand, in the subgroup of patients with IAP, there was no significant difference among the groups in terms of recurrence (15%, 18%, and 17%, respectively, P = 0.999). When patients with in situ gallbladder during their first attack were compared according to their cholecystectomy history (group 2 vs. group 3), no significant difference was found in neither the ABP nor the IAP subgroups (19% vs 14% and 18% vs. 17%, respectively, P > 0.05). In addition, the effect of endoscopic retrograde cholangiopancreatography (ERCP) on recurrence of pancreatitis was evaluated. In subgroup of ABP, ERCP was effective for reducing the recurrence in group 2 (P = 0.008), while it was not found statistically significant in group 1 and 3. In subgroup of IAP, it ERCP did not reduce the recurrence in any of the groups.ConclusionsIn ABP, the recurrence is high in patients who have their first pancreatitis attack after cholecystectomy. Cholecystectomy alone is not effective preventing recurrence in patients with gallbladder in situ during the first episode; however, the risk can be decreased with adding ERCP to cholecystectomy. On the other hand, cholecystectomy is not effective in reducing the recurrence in patients with IAP.Key Words: Acute biliary pancreatitis; Idiopathic acute pancreatitis; Cholecystectomy.References:1. Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. American Gastroenterological Association Institute Clinical Guidelines Committee. Gastroenterology. 2018 Mar;154(4):1096-1101.2. Räty S, Pulkkinen J, Nordback I, et al. Can Laparoscopic Cholecystectomy Prevent Recurrent Idiopathic Acute Pancreatitis?: A Prospective Randomized Multicenter Trial. Ann Surg. 2015 Nov;262(5):736-41.3. D S Umans, N D Hallensleben , R C Verdonk, et al. Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis. Br J Surg 2020 Feb;107(3):191-199.