Person: KOCAKAYA, DERYA
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KOCAKAYA
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DERYA
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Publication Open Access Outcome of solid and cavitary pulmonary nodules in rheumatoid arthritis patients— case series(2022-01-01) AKSOY, AYSUN; BOZKURTLAR, EMİNE; KARAKURT, SAİT; ERYÜKSEL, SEMİHA EMEL; İNANÇ, GÜZİDE NEVSUN; KOCAKAYA, DERYA; AKSOY A., KOCAKAYA D., Yalçinkaya Y., BOZKURTLAR E., KARAKURT S., Eryüksel E., İnanç N.© TÜBİTAK.Background/aim: Rheumatoid pulmonary nodule can be detected in up to 32% of rheumatoid arthritis (RA) patients and approximately one-third of nodules may cavitate. We aimed to evaluate characteristics of patients with RA developing cavitary pulmonary nodular (CPN) lesions under disease-modifying antirheumatic drugs (DMARDs), follow-up of both cavitary and solid nodules, and their outcome with the treatment. Materials and methods: RA patients who presented with CPN lesions during follow-up were recruited retrospectively in this case series analysis. Total numbers and mean diameters of cavitary and solid nodules in each thorax computed tomography (CT) have been determined and followed up by two experienced pulmonary physicians. Moreover, changes in treatment after the development of the CPN lesions and characteristics of cavitary nodules were collected. Results: Eleven patients with CPN lesions were reported. At the time of CPN diagnosis, more patients were taking leflunomide than methotrexate (81% vs 19%). Half of the patients were receiving biologic therapy and only 18% were taking anti-TNF drugs. After a median of 24 (3–65) months of follow-up, the regression of CPN lesions was determined in 45% (5/11) of patients. Four of these 5 (80%) patients were switched to a treatment regimen without leflunomide and three of them to nonanti-TNF biologic treatment or targeted synthetic DMARDs (tocilizumab, tofacitinib, and rituximab). Conclusion: CPN lesions seen in RA patients are often pulmonary manifestations of the underlying disease; however, one must rule out malignancies or infections. If lesions progress under DMARDs, it is advised to discontinue synthetic DMARDs (LEF/MTX) and switch to another biological DMARD with different modes of action.Publication Open Access The role of procalcitonin as a biomarker for acute pulmonary exacerbation in subjects with cystic fibrosis and non-cystic fibrosis bronchiectasis(2022-01-01) KOCAKAYA, DERYA; ARIKAN, HÜSEYİN; ERYÜKSEL, SEMİHA EMEL; CEYHAN, BERRİN; Mammadov F., Olgun Yildizel S., Kocakaya D., ARIKAN H., Cinar C., Eryuksel E., CEYHAN B.Objective: Patients with cystic fibrosis (CF) and non-CF bronchiectasis are prone to exacerbations of pulmonary infections. C-reactive protein (CRP) and procalcitonin (PCT) are inflammatory markers. The aim of this study is to evaluate the role of CRP and PCT on exacerbations of CF and non-CF bronchiectasis. Patients and Methods: The medical records of 18 CF (52 hospitalizations) and 20 non-CF bronchiectasis patients (51 hospitalizations) were reviewed retrospectively. CRP, PCT levels and, white blood cell (WBC) counts on admission and follow-up were evaluated. Results: C-reactive protein levels correlated with PCT levels on admission in all patients. Baseline PCT levels were markedly higher (>0.5µg/L) in 12% of CF and 10% of non-CF bronchiectasis patients, however, baseline CRP values were markedly higher (>5mg/L) in 96% of CF and non-CF bronchiectasis patients (p=0.760 and p=0.100, respectively). Baseline CRP and PCT levels were positively correlated with hospitalization length (r=0.501, p=0.001 and r=0.289, p=0.04, respectively) in CF patients, but not in non-CF bronchiectasis. Conclusion: Our study shows the potential utility of these biomarkers to determine the severity of the exacerbation particularly predicting hospitalization length in CF patients. Both biomarkers could be able to guide antibiotic treatment of infective exacerbations in CF and non-CF bronchiectasis patients.Publication Open Access Radial arterial thrombosis in COVID-19: A case report(2022-01-01) ÇİÇEK, FURKAN CUMA; EYÜPLER, ÇAĞLA; YETGİNOĞLU, ÖZGE; AK, KORAY; KOCAKAYA, DERYA; Durmus N. S. , ÇİÇEK F. C. , EYÜPLER Ç., Omur C., YETGİNOĞLU Ö., AK K., KOCAKAYA D.Thrombosis due to hypercoagulable state is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19). Increased D-dimer levels are an important marker of the presence and risk of thrombosis. In this report, we present that a 59-year-old male patient developed thrombosis in the distal radial arteries despite normal D-dimer level. The patient was treated with enoxaparin, iloprost infusion, and cilostazol. This case should lead us to be very careful that people diagnosed with COVID-19 with normal D-dimer levels may also have thrombosis.Publication Open Access The impact of cystic fibrosis- and noncystic fibrosis-bronchiectasis on pulmonary artery wall thickness and right heart functions assessed by speckle-tracking echocardiography(2023-06-01) GÜREL, YUSUF EMRE; VEZİR, DUYGU; KOCAKAYA, DERYA; SÜNBÜL, MURAT; ÇİNÇİN, AHMET ALTUĞ; ÖZBEN SADIÇ, BESTE; SAYAR, NURTEN; CEYHAN, BERRİN; Gürel E., VEZİR D., Güçtekin T., Doğan Z., KOCAKAYA D., Olgun S., SÜNBÜL M., Çinçin A., Özben B., SAYAR N., et al.BACKGROUND: Right heart functions are affected in patients with bronchiectasis as a result of pulmonary hypertension induced by chronic hypoxemia. Pulmonary artery wall thickness has recently been introduced as a sign of intensive and prolonged inflammation. The aim of this study was to analyze right ventricular and right atrial functions and to mea-sure pulmonary artery wall thickness in patients with cystic fibrosis-bronch iecta sis in comparison to those with noncystic fibrosis-bronchiectasis and healthy individuals. METHODS: We studied 36 patients with cystic fibrosis-bronchiectasis, 34 patients with noncystic fibrosis-bronchiectasis, and 32 age- and sex-matched control subjects. Lung function tests were performed. All subjects underwent comprehensive echocardiographic evaluation including conventional, tissue Doppler, speckle-tracking, and pulmonary artery wall thickness measurements. RESULTS: Right ventricular global longitudinal strain and global longitudinal right atrial strain during ventricular systole decreased in cystic fibrosis-bronchiectasis group compared with noncystic fibrosis-bronchiectasis and control groups (P <.001, both). Conversely, pulmonary artery wall thickness was increased in cystic fibrosis-bronchiectasis group in comparison to other groups (P <.001). Moreover, right ventricular global longitudinal strain was lower and pulmonary artery wall thickness was higher in patients with airflow obstruction (P <.001 and P =.025, respectively) than in those without. Only right ventricular global longitudinal strain was significantly correlated with pulmonary function test parameters. The negative effect of cystic fibrosis on right ventricular and right atrial functions was independent of age, gender, and disease duration. CONCLUSION: Our study showed that right ventricular and right atrial functions were deteriorated and pulmonary artery wall was thickened in cystic fibrosis-bronchiectasis patients more than noncystic fibrosis-bronchiectasis patients. Right ventricular global longitudinal strain detected subclinical right ventricular dysfunction and was associated with the severity of pulmonary disease.Publication Open Access The angiogenic gene profile of pulmonary endarterectomy specimens: Initial study(2023-01-01) ERMERAK, NEZİH ONUR; YILMAZ, BETÜL; BATIREL, SAİME; OLGUN YILDIZELİ, ŞEHNAZ; KOCAKAYA, DERYA; MUTLU, BÜLENT; YILDIZELİ, BEDRETTİN; ERMERAK N. O., YILMAZ B., BATIREL S., OLGUN YILDIZELİ Ş., KOCAKAYA D., MUTLU B., Tas S., YILDIZELİ B.© 2023 The Author(s)Objectives: The underlying mechanisms for the development of chronic thromboembolic pulmonary hypertension and prognostic biomarkers are not clear yet. Thus, our aim is to assess and identify new biomarkers for the expression of 84 key genes linked to angiogenesis. Methods: Patients who had levels more than 1000 dynes·sec·cm−5 were included in the test group, and the other patients were included in the control group. Twelve specimens were taken from the patients. RT2 Profiler PCR Array (Qiagen) was used to quantify the expression of the 84 key genes. Results: Eight patients (6 male, 2 female, median age 54.4 ± 13.1 years) who underwent pulmonary endarterectomy were included. Pulmonary vascular resistance improved significantly from 811 ± 390 dyn/s/cm−5 to 413.3 ± 144.9 dyn/s/cm−5 (P .005) after surgery. Median length of hospital stay was 11.62 ± 2.97 days. The test group had a distinct pattern of impaired angiogenic and antiangiogenic genes. The expression levels of TGFA, TGFB1, THBS2, THBS1, TGFBR1, SERPINE1, SERPINF1, TGFB2, TIMP2, VEGFC, IFNA1, TNF, CXCL10, NOS3, IGF1, and MMP14 were downregulated in the specimens from the patients who had higher pulmonary vascular resistance values, whereas some genes, including PDGFA, showed upregulation that was statistically nonsignificant in the same group. Conclusions: These results can lead to the development of new markers that could predict adverse outcomes of patients with CTEPH. Identification of new markers that are related to worse outcomes would enable screening patients for early diagnosis and treatment.Publication Open Access Pulmonary arterial wall thickness is increased in Behçet's disease patients with major organ ınvolvement: Is it a sign of severity?(2023-03-01) KOCAKAYA, DERYA; DİRESKENELİ, RAFİ HANER; ALİBAZ ÖNER, FATMA; Ağaçkıran S. K., Sünbül M., Doğan Z., Kocakaya D., Kayacı S., Direskeneli H., Alibaz-Oner F.Objectives Behcet\"s disease (BD) is a unique systemic vasculitis mainly involving veins, in contrast to other vasculitides. Prior studies have shown that pulmonary arteries (PAs) have a similar structure to systemic veins. In this study we aimed to assess PA wall thickness by transthoracic echocardiography (TTE) in BD patients compared with healthy controls (HCs) and patients with non-inflammatory pulmonary embolism (NIPE). Methods Patients with BD (n = 77) and NIPE (n = 33) and HCs (n = 57) were studied. PA wall thickness was measured from the mid-portion of the main PA with TTE by two cardiologists blinded to cases. Results PA wall thickness was significantly lower in HCs [3.6 mm (s.d. 0.3)] compared with NIPE [4.4 mm (s.d. 0.5)] and BD [4.4 mm (s.d. 0.6)] (P < 0.001 for both). PA wall thickness was similar between BD and NIPE (P = 0.6). Among patients with BD, PA wall thickness was significantly higher in patients with major organ involvement compared with mucocutaneous limited disease [4.7 mm (s.d. 0.4) vs 3.7 (0.4), P < 0.001], HCs and NIPE (P < 0.001 and P = 0.006, respectively). PA wall thickness was comparable between patients with vascular and non-vascular major organ involvement [4.6 mm (s.d. 0.5) vs 4.7 (0.3), P = 0.3]. Conclusion We observed that PA wall thickness was significantly higher in BD with major organ involvement compared with patients with only mucocutaneous limited disease, HCs and NIPE. These results suggest that increased PA wall thickness may be a sign of severe disease with major organ involvement in BD.Publication Open Access Clinical validation of an activity-based enzyme assay for early stage lung cancer(2023-06-01) KOCAKAYA, DERYA; Dempsey P. W., Aparicio C. S., Gonzalezirias R., Hantula S., Kagawa M., Bossmann S. H., Covarrubias-Zambrano O., Nagji A. S., Veeramachaneni N. K., Ermerak N. O., et al.8533 Background: The USPSTF guidelines recommend annual LDCT scans for 15.5 million adults with a heavy smoking history. While LDCT can reduce deaths by 20%, screening compliance remains low. A blood test with clinically useful, cost effective performance could improve compliance and access when integrated with the standard of care. We describe here a lyophilized nanosensor system for detecting protease enzyme activity in sera with clinically useful diagnostic activity in early stage lung cancer. We evaluated the performance of the assay by examination of prospectively collected sera for detection of cancer in high risk patients. Methods: Sera were obtained in multiple independent studies to include pathologically confirmed, treatment naive lung cancer patients and LDCT confirmed negative individuals. Protease activity was measured on 18 different nanosensors built with protease targets mainly selective for members of the Matrix Metalloproteinase and Cathepsin families. Lyophilized plates were incubated with serum and enzyme activity was measured indirectly as a continuous variable by a fluorescent plate reader. A machine learning modeling tool (Emerge) was used to detect signal associated with a cancer \"fingerprint\" of protease activity. The analysis stratified allocation into training and testing sets of 250 samples each and reserved a third out of sample validation set (250 samples) for reporting. Results: 750 clinical samples included 30% lung cancers, 63% males, 91% smokers, and an average age of 63 years (SD=9). Cancer cases were distributed across stages I (41%), II (17%), III (20%) and IV (20%) with 5% unknown. Histological classification included 59% adenocarcinoma, 31% squamous cell and 11% other subtypes. Using an Emerge model with only nanosensor activity and gender as inputs, we evolved a balanced algorithm. The algorithm can be further modified to favor sensitivity or specificity depending on the application by applying model weighting factors. We report the performance observed in the 250 out of sample validation set at three points on this spectrum (Table). Among Stage I cancer samples, the balanced algorithm had an accuracy of 90% (26/29). Conclusions: Current LDCT tools show low compliance. We demonstrate clinical validity of a cost effective tool to detect lung cancer in support of LDCT screening. Based on a simple blood sample, the current test may predict early stage lung cancer with an accuracy of 90%. The performance suggests applications in LDCT compliance, post LDCT management, and eventually screening. A clinically validated version of this technology is being evaluated as a triage tool for LDCT screening. [Table: see text]Publication Open Access Malign melanom, endobronşial metastaz(2009-04-09) KOCAKAYA, DERYA; OLGUN YILDIZELİ, ŞEHNAZ; ERYÜKSEL, SEMİHA EMEL; ÇELİKEL, ÇİĞDEM; KARAKURT, SAİT; Kocakaya D., Abul Y., Olgun Yıldızeli Ş., Eryüksel S. E., Tosuner Z., Yazıcı Z., Çelikel Ç., Karakurt S.Amaç: Malign melanoma melanositlerin malign transfomayonu sonucu gelişir.Pulmoner metastazını pulmoner arterlere ulaşan tümör embolileri yoluyla yapar.Endobronşial yayılımlı malign melonom vakaları sınırlı sayıdadır. Gereç ve Yöntem: Nadir görülen endobronşial yayılım yapmış bronkoskopi ile tanı koyduğumuz vakamızı sunduk. Bulgular: 42 yaşında bayan hasta nefes darlığı şikaye ile başvurdu. 2006 da tanı konan sır a konjenital dev nevüs tanısı mevcu u.5 paket/yıl sigara hikayesi mevcu u. Fizik muayenede bel bölgesinde 25x15 cm boyularında yaklaşık tüm lumbar bölgeyi kaplayan gluteal bölgeye de yayılan dev nevüsü mevcu u. Vücu a özellikle sır a ve saçlı deride birden fazla çok sayıda nevüsler izlendi. Nevüslerde renk değişikliği tariflemiyordu. Sır aki dev nevüste kalınlaşma belir yordu. Solunum sistemi muayenesi doğaldı.Aksiller ele gelen 1x2 cm lik lenfadenopa si mevcu u. PA akciğer grafisinde sol hilar bölgede düzensizlik ve dansite ar şı mevcu u. Toraks BT’de sol üst lobda 40x30 mm kitlesel lezyon mevcu u. Bronkoskopide sol akciğer üst lob girişinde nevüs tarzında siyahımsı mukozadan kabarık endobronşial lezyon izlendi. Alınan bronkoskopik biyopsi, rça ve bronkoalveolar lavaj materyalleri malign melonom ile uyumlu geldi. Sonuç: Malign melanoma bağlı endobronşial metastaz nadirdir. Literatürde 1966-2002 yılları arası yapılmış geniş taramada 204 akciğer dışı kaynaklı endobronşial metastaz vakası saptanmış olup bunları sırasıyla meme(%35), böbrek(%17), kolon ve rektum(%15) oluşturmaktadır.. Deri kanseri vakaları sadece 9 vaka olup , 7’si malign melanom kökenli saptanmış r. Tanıda primer akciğer kanserinden ayırtetmek için bronkoskopi şar r. Malign melannomaya bağlı endobronşial metastazı olgumuzu literatürde nadir görülmEsi nedeniyle sunduk.Publication Open Access FDG PET/CT features of polysaccharide-based hemostatic agent chronic inflammatory changes can mimic metastatic lesions(2022-07-01) KOCAKAYA, DERYA; ASLAN, SEZER; BOZKURTLAR, EMİNE; Bozkurtlar E., Oksuzoglu K., Bostanci K., Aslan S., Kissa T. N., Kocakaya D., Ones T.Purpose To prevent hemorrhagic complications, hemostatic agents (HAs) have been widely used in recent years. The use of HAs can lead to false-positive results on postoperative imaging. There exists only 1 study in the literature evaluating these applications during surgical procedures. Therefore, we aimed to evaluate the postoperative imaging features of polysaccharide-based HAs in thoracic surgery patients who have had F-18-FDG PET/CT scans. Patients and Methods Two hundred nine consecutive patients who underwent thoracic surgery were enrolled in this study. A topical polysaccharide-based HA was applied to the surgical bed for all of the patients. The patients diagnosed with cancer were followed up with subsequent thoracic CT scans, and 42 of these patients were also imaged with F-18-FDG PET/CT, which then comprised the main study group. Due to suspicion of metastasis, 19/42 patients were reoperated or rebiopsied. The latest histopathological findings were accepted as criterion standard, and previous FDG PET/CT images were retrospectively reevaluated. Results Polysaccharide-based HAs that appear as amorphous basophilic material were identified in histopathological samples of 11/19 patients. Lymphocytes, plasma cells, and histiocytes, which formed foreign body reaction and/or foreign body granuloma, indicating the presence of chronic inflammation, were seen in all of the samples. F-18-FDG PET/CT showed increased FDG uptake in all of these lesions. Conclusions Despite the inconsistency of the literature, polysaccharide-based HAs can be demonstrated in human surgical specimens as amorphous basophilic materials even after a long time from the initial surgical procedure. These agents almost always cause chronic inflammatory changes. In addition, these agents may mimic \"false-positive\" findings on postoperative FDG PET/CT scans.