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Öğe Forecasting Stone-Free Status Following Percutaneous Nephrolithotomy Utilizing Explainable Machine Learning(Mdpi, 2026) Cicek, Resul; Topcu, Ibrahim; Dural, Bulut; Balikci Cicek, Ipek; Yilmaz, Murat; Colak, CemilBackground: This study aimed to create and evaluate explainable machine learning models for forecasting postoperative stone-free status following percutaneous nephrolithotomy (PNL) utilizing a substantial clinical cohort. Methods: This retrospective single-center analysis encompassed 2144 adult patients who received PNL from 2010 to 2024. We employed clinical, radiographic, stone-related, and surgical data to train four supervised machine learning models: Extreme Gradient Boosting (XGBoost), Random Forest, Light Gradient Boosting Machine (LightGBM), and Adaptive Boosting (AdaBoost). We used the Synthetic Minority Oversampling Technique exclusively on the training set to fix the class imbalance. We assessed the model's accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (ROC-AUC) to see how well it worked. SHapley Additive exPlanations (SHAP) were used to measure explainability. Results: The total stone-free rate was 84.8%. XGBoost had the best predictive performance of the models tested, with an accuracy of 0.916 and a ROC-AUC of 0.975. LightGBM was close behind. Random Forest and AdaBoost had relatively inferior performance. SHAP analysis identified anatomical anomalies as demonstrated the strongest association with stone-free outcomes. The size of the access sheath and the number of stones were next. Other parameters that were identified by SHAP as important contributors to model predictions were the placement of the stone, Guy's Stone Score, the length of the operation, and the density of the stone. These feature associations demonstrated clinical coherence with established knowledge in surgical practice. Conclusions: Explainable machine learning algorithms, especially XGBoost, can accurately predict stone-free outcomes following PNL in a way that makes sense to doctors. The incorporation of SHAP improves transparency and facilitates the prospective application of these models as decision-support instruments in personalized surgical planning.Öğe Investigation of genetic causes in non-obstructive azoospermic patients(Mre Press, 2025) Dural, Bulut; Gecit, Ilhan; Aykanli, Emre; Ekici, Cemal; Oguz, Fatih; Koc, AhmetBackground: Male factor infertility is a health problem that affects millions of couples around the world. Male factor infertility is responsible for approximately more than half of all cases of infertility. About 15% of men and 10% of women with infertility may have genetic abnormalities, including chromosomal abnormalities and single gene mutations. In this study, results of genetic analys is of the infertile male patients who underwent testicular sperm extraction (TESE) with the diagnosis of nonobstructive azoospermia were evaluated in order to reveal genetic defects that impair or prevent spermatogenesis in male infertility. Methods: We compared the results of peripheral blood chromosome analysis, molecular karyotyping, male infertility genetic panel, and also testosterone, prolactin, follicular stimulating hormone and luteinizing hormone levels in non-obstructive azoospermic infertile patients aged 26-44 years, and investigated the relationship between these parameters and genetic mutations. Results: As a result of this research, among 26 patients, INSL3 (insulin-like peptide 3) gene mutation, which is considered pathogenic according to the criteria published by the American College of Medical Genetics and Genomics (ACMG) was detected in 1, FSHR (follicle stimulating hormone receptor) gene polymorphism in 17, CFTR (cystic fibrosis transmembrane conductance regulator) mutations in 5, CATSPER1 (cation channel sperm associated 1) and TEX101 (testis expressed 101) in 1, LHCGR (luteinizing hormone/choriogonadotropin receptor) in 1, ZMYND15 (zinc finger myndtype containing 15) in 1, DNAH5 (dynein axonemal heavy chain 5) in 2, and DNAH11 (dynein axonemal heavy chain 11) changes in 1 patient. In the chromosome analysis, 47XXY Klinefelter syndrome was observed in 6 patients. Conclusions: The results have shown that non-obstructivea zoospermic patients with complaints of infertility may have other genetic abnormalities leading to infertility, despite the results of chromosomal analysis of the peripheral blood samples were within normal reference limits. Investigating these underlying genetic disorders helped us find the cause of infertility in ourpatient population.Öğe Non obstruktif azospermik hastalarda genetik nedenlerin araştırılması(İnönü Üniversitesi, 2021) Dural, Bulut; Geçit, İlhanAmaç: İnfertilite dünya genelinde milyonlarca çifti etkileyen bir sağlık sorunudur. Başvuruların yaklaşık yarısından erkek infertilitesi sorumludur. Erkeklerin yaklaşık % 15'inde ve infertilitesi olan kadınların % 10'unda, kromozom anormallikleri ve tek gen mutasyonları dahil olmak üzere genetik anormallikler mevcut olabilir. Sonuç olarak gelecekte kısırlığın genetik nedenlerinin artmaması için genetik faktörlerin belirlenmesi, infertil çiftin uygun yönetimi için iyi bir uygulama haline gelmiştir. Biz, yapılan bu çalışmada infertilite nedeniyle başvuran ve Non-obstrüktif azoospermi tanısıyla testiküler sperm ekstraksiyonu (TESE) operasyonu yapılan hastaların genetik analiz sonuçları değerlendirildi. Bu çalışmada, erkek infertilitesinde spermatogenezi zayıflatan ya da engelleyen genetik defektlerin ortaya çıkması amaçlanmıştır. Gereç ve Yöntem: Çalışmamızda 26-44 yaş arası non-obstrüktif azospermik infertil hastalarda; periferik kanda kromozom analizi, moleküler karyotipleme, erkek infertilite paneli, testosteron, prolaktin, folliküler stimülan hormon ve lüteinizan hormon düzeylerinin karşılaştırılması ve bu parametrelerle genetik mutasyonların ilişkisinin incelenmesini amaçladık. Bulgular: Çalışmamızda 26 hastanın 1 tanesinde American College of Medical Genetics and Genomics (ACMG) 'in yayınladığı kriterlere göre patojenik olduğu kabul edilen INSL3 gen mutasyonu, ayrıca klinik önemi belirsiz varyant olarak 17 hastada FSHR gen polimorfizmi, 5 hastada CFTR mutasyonu, 1 hastada CATSPER1 ve TEX101, 1 hastada LHCGR, 1 hastada ZMYND15, 2 hastada DNAH5, 1 hastada DNAH11 değişikliği tespit edilmiştir. Yapılan kromozom analizinde 6 hastada 47XXY kleinefelter sendromu izlendi. Sonuçlar: Çıkan sonuçlar göstermiştir ki infertilite şikayeti ile başvuran non-obstrüktif azoospermik hastaların periferik kandan çalışılan kromozom analizi normal olsa dahi infertiliteye neden olan başka genetik değişiklikler olabilir. Altta yatan bu genetik bozuklukların araştırılması infertilitenin nedenini bulmamızda yardımcı olabilir.Öğe Paratesticular sarcoma of the spermatic cord: A rare case of dedifferentiated leiomyosarcoma(Elsevier Science Inc, 2026) Cicek, Resul; Topcu, Brahim Brahim; Dural, Bulut; Toprak, Serhat; Yildirim, Omer Faruk; Karacor, YasinParatesticular sarcomas are extremely rare tumors characterized by aggressive biological behavior and a significant risk of recurrence and metastasis. We present a rare case of paratesticular sarcoma ultimately diagnosed as dedifferentiated liposarcoma following comprehensive histopathological and immunohistochemical evaluation. The patient presented with complaints of scrotal edema and discomfort, and radical inguinal orchiectomy was performed. The definitive diagnosis was established through comprehensive histological and immunohistochemical evaluation and was defined as dedifferentiated liposarcoma. This report emphasizes the critical importance of comprehensive pathological evaluation and highlights total surgical excision as the primary approach in the treatment of paratesticular sarcomas due to their rarity and complex diagnosis
