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İNCE, ALİ TÜZÜN

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ALİ TÜZÜN
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Author: İNCE, ALİ TÜZÜN × Start date: 2020 × End date: 2023 ×

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    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
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    ID: 3524972 MUCINOUS PANCREATIC CYST SUBGROUPS: THE ROLE OF CYST FLUID VISCOSITY AND CYST MORPHOLOGY IN DIFFERENTIATION
    (2021-05-21T00:00:00Z) KÖKER, İBRAHİM HAKKI; Elagöz, Şahende; MALYA, FATMA ÜMİT; Kiremitçi, Sercan; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN; KÖKER, İBRAHİM HAKKI; MALYA, FATMA ÜMİT; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN
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    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.
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    Pankreas Divisum’un Akut Pankreatit’te Yeri, Takipli Hastalarda Restenoz ve Malignite Gelişenlerin Özellikleri
    (2021-11-21T00:00:00Z) Köker, İbrahim Hakkı; Biberci Keskin, Elmas; Koçhan, Koray; Kiremitçi, Sercan; Değirmencioğlu, Şerife; Seven, Gülseren; İnce, Ali Tüzün; Şentürk, Hakan; KÖKER, İBRAHİM HAKKI; BİBERCİ KESKİN, ELMAS; KOÇHAN, KORAY; KİREMİTÇİ, SERCAN; DEĞİRMENCİOĞLU, ŞERİFE; SEVEN, GÜLSEREN; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN
    GİRİŞ: Pankreas divisum (PD) akut pankreatit’le (AP) başvuran hastalarda tanı konulması zor olabilen bir konjenital patolojidir. Amacımız PD’lu hastaların AP’deki sıklıklarını ve takip sonuçlarını değerlendirmekti.METODLAR: Retrospektif olarak AP ile başvuran 524 hastanın 32 (%6.1)’inde kesitsel ve endosonografik olarak PD tanısı koyduk. Pankreas divisum’lu hastaların yaş ve cinsiyet özellikleriyle takipte restenoz ve malignite gelişen hastaların özelliklerini değerlendirdik.BULGULAR: Akut pankreatitle başvuran 524 hastada etyolojik olarak ilk sırada biliyer patolojiler (n=308(58.7), 191(%62) kadın) bulunurken, PD’lu 32 (%6), 18(%56.3) erkek, yaş ortalaması 44.7±15.1 yıl (min-maks 16-75) hastada biliyer etyolojiden anlamlı olarak yaş (p<0.001) ve cinsiyet (p<0.001) farklı saptadık. Hastaların 29’u (%90.6) komplet tipti (17(58.6) erkek). Inkomplet PD’nin 2’si kadın, 1’i erkekti. Hastaların 20’sine (%62.5) tedavi amaçlı wirsung’a minor papilladan plastik stent yerleştirildi. Takipte 4 (%20) hastada stent sonrası minor papilla’da restenoz gelişti. Bunların 3 (%75)’ü erkekti. Restenoz gelişen 4 hastanın yaş ortalaması 44±12.3, (min-maks 28-57) yıldı. Bu hastalardan 1’ine endosonografik wirsungogastrostomi ile wirsung-gastrik duvar arasında fistül oluşturularak wirsung içindeki taşlar temizlendi. Takip esnasında 1 inkomplet (60 yaş), 1 komplet PD’li (44 yaş) 2 erkekten birisinin pankreas baş ve gövdesinde, diğerinin pankreas başında CA 19-9 eksprese etmeyen agresif seyirli pankreatik duktal adeno karsinom saptadık.SONUÇ: Pankreas divisum AP’de düşük oranda ve erkek cinsiyette daha fazla iken, restenoz ve malignite gelişimini de yine erkeklerde daha sık saptadık. Restenoz tedavisinde ise wirsungo-gastrostomik fistül oluşturma yaklaşımı uygun bir seçenek olabilir. Anahtar Kelimeler: akut pankreatit, malignite, pankreas divisum, restenoz
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    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.
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    MUCINOUS PANCREATIC CYST SUBGROUPS: THE ROLE OF CYST FLUID VISCOSITY AND CYST MORPHOLOGY IN DIFFERENTIATION
    (2021-06-01T00:00:00Z) Koker, Ibrahim H.; Elagoz, Sahende; Malya, Fatma U.; Kiremitci, Sercan; Ince, ALİ TÜZÜN; Senturk, Hakan; İNCE, ALİ TÜZÜN
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    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.
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    PublicationOpen Access
    Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model.
    (2021-01-14T00:00:00Z) Hegyi, Péter J; Soós, Alexandra; Tóth, Emese; Ébert, Attila; Venglovecz, Viktória; Márta, Katalin; Mátrai, Péter; Mikó, Alexandra; Bajor, Judit; Sarlós, Patrícia; Vincze, Áron; Halász, Adrienn; Izbéki, Ferenc; Szepes, Zoltán; Czakó, László; Kovács, György; Papp, Mária; Dubravcsik, Zsolt; Varga, Márta; Hamvas, József; Németh, Balázs C; Macarie, Melania; Ince, ALİ TÜZÜN; Bordin, Dmitry S; Dubtsova, Elena A; Kiryukova, Mariya A; Khatkov, Igor E; Bideeva, Tanya; Mickevicius, Artautas; Ramírez-Maldonado, Elena; Sallinen, Ville; Erőss, Bálint; Pécsi, Dániel; Szentesi, Andrea; Párniczky, Andrea; Tiszlavicz, László; Hegyi, Péter; İNCE, ALİ TÜZÜN
    Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.
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    Comparison of scoring systems used in acute pancreatitis for predicting major adverse events.
    (2020-01-07T00:00:00Z) Taşlıdere, B; Biberci, Keskin; Şentürk, H; İnce, ALİ TÜZÜN; Gülen, B; BİBERCİ KESKİN, ELMAS; TAŞLIDERE, BAHADIR; KOÇHAN, KORAY; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN
    OBJECTIVES:Timely identification of patients with acute pancreatitis who are likely to have a severe disease course is critical. Based on that, many scoring systems have been developed throughout the years. Although many of them are currently in use, none of them has been proven to be ideal. In this study, we aimed to compare the discriminatory power of relatively newer risk scores with the historical ones for predicting in-hospital major adverse events, 30-day mortality and 30-day readmission rate.PATIENTS AND METHODS:Patients who had been admitted due to acute pancreatitis were retrospectively investigated. Five risk scoring systems including HAPS, Ranson, BISAP, Glasgow, and JSS were calculated using the data of the first 24h of admission. Predictive accuracy of each scoring system was calculated using the area under the receiver-operating curve method.RESULTS:Overall 690 patients were included in the study. In-hospital major adverse events were observed in 139 (20.1%) patients of whom, 19 (2.5%) died during hospitalization. 30-day all-cause mortality and 30-day readmission were observed in 22 (3.2%) and 27 (3.9%) patients respectively. Negative predictive value of each score was markedly higher compared to positive predictive values. Among all, JSS scoring system showed the highest AUC values across all end-points (0.80 for in-hospital major adverse events; 0.94 for in-hospital mortality; 0.91 for 30-day mortality). However, all five scoring systems failed to predict 30-day readmission.DISCUSSION:JSS was the best classifier among all five risk scoring systems particularly owing to its high sensitivity and negative predictive value
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