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Abstract Background Thiol-disulfide homeostasis (TDH) plays a pivotal role in various physiological mechanisms, including antioxidant defence, detoxification, apoptosis, regulation of enzyme activities and cellular signal transduction. TDH can be used as a biomarker to detect oxidative stress (OS) levels and ischemia status in the tissues. Coronary artery bypass grafting (CABG) surgery is a procedure associated with high oxidative stress. Dexmedetomidine, an alpha-2 agonist anaesthetic agent, has antioxidant effects. In this study, the effects of dexmedetomidine on oxidative stress in CABG surgery were investigated. Methods Patients who underwent on-pump CABG surgery were divided into two groups: those receiving dexmedetomidine (Group D) and those not receiving dexmedetomidine (Group C). From anesthesia induction to the end of surgery, patients in Group D received intravenous infusions of 0.05–0.2 mcg/kg/min remifentanil and 0.2–0.7 mcg/kg/h dexmedetomidine. Patients in Group C received intravenous infusion of 0.05–0.2 mcg/kg/min remifentanil. Blood samples were collected from the patients 30 min before induction of anesthesia (T1), 30 min after removal of the aortic cross-clamp (T2), and at the end of the surgery (T3). Thiol-disulfide homeostasis (TDH) was assessed using a novel method. A novel automated method enables the determination of native thiols, total thiols and disulfides levels in plasma, allowing the calculation of their respective ratios. Results In patients receiving dexmedetomidine, lower postoperative levels of disulfide, disulfide/native thiol, and disulfide/total thiol, along with higher native thiol/total thiol, were observed compared to the control group. (p 0.05) Conclusions In our study, through dynamic thiol-disulfide measurements, we found that levels of oxidative stress (OS) were lower in patients who received dexmedetomidine. We believe that the positive effects of dexmedetomidine on OS could be beneficial in CABG surgery. Furthermore, we anticipate that with further studies conducted in larger patient cohorts, the clinical utilization of dexmedetomidine will become more widespread. Trial registration number NCT05895331 / 06.07.2023.

OBJECTIVE: In this study, we evaluated vitamin B12 and iron parameters in Turkish children with ADHD in order to examine the relationship between ADHD symptoms and these parameters. METHODS: Drug-naive 100 ADHD patients, aged between 6 and 12 years old, were included in the study. None of them had acute or chronic diseases. All patients were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children – Present and Lifetime Version (K-SADS-PL). Conners Parent Rating Scale (CPRS) was used for screening ADHD symptoms and symptom severity. Blood samples were evaluated for ferritin, haemoglobin, MCV, RDW, and vitamin B12 parameters. RESULTS: We indicated an inverse relationship between haemoglobin levels and learning, anxiety subscale scores of CPRS. Also, vitamin B12 and psychosomatic subscale scores were found negatively related whereas the relationship was in the opposite direction for ferritin. Vitamin B12 level was negatively correlated with learning problems and psychosomatic subscales of CTRS in the combined subtype of ADHD. CONCLUSION: Vitamin B12 and iron support may be useful in treatment of childhood ADHD, especially for learning problems, besides medication.

The effects of high nitrate concentrations on alterations in maximal photochemical efficiency of PSII ratio (Fv/Fm), chlorophyll content, chlorophyll degradation, growth rate and proline accumulation in Chlorella vulgaris Beyerinck [Beijerinck] were investigated in this study. The Fv/Fm ratio was observed in response to the increased nitrate concentration. The Fv/Fm ratio decreased in C. vulgaris following 44 h in 12.99 mM NaNO3-enriched media. Experimental results showed that, growth rates and chlorophyll content declined by increasing nitrate concentration. The decrease in the ratio of chlorophyll a/b with enrichment of high nitrate concentration (6.5 mM and 12.99 mM NaNO3) was also caused by a decrease in chlorophyll a and an increase in chlorophyll b concentration in C. vulgaris cultures. The results showed that 6.5 and 12.99 mM nitrate concentration increased proline content in treated cells, which suggests that nitrate stress lead to proline accumulation in C. vulgaris.

Plant polyamines (PAs) have been assigned a large number of physiological functions with unknown molecular mechanisms in many cases. Among the most abundant and studied polyamines, two of them, namely spermidine (Spd) and thermospermine (Tspm), share some molecular functions related to quality control pathways for tightly regulated mRNAs at the level of translation. In this review, we focus on the roles of Tspm and Spd to facilitate the translation of mRNAs containing upstream ORFs (uORFs), premature stop codons, and ribosome stalling sequences that may block translation, thus preventing their degradation by quality control mechanisms such as the nonsense-mediated decay pathway and possible interactions with other mRNA quality surveillance pathways.

Objectives: To evaluate treatment results and toxicities in patients who received concomitant chemoradiotherapy (CRT) followed by consolidation with docetaxel and cisplatin in locally advanced unresectable non-small cell lung cancer (NSCLC). Methods: Ninety three patients were included in this retrospective study. The patients received 66 Gy radiotherapy and weekly 20 mg/m 2 docetaxel and 20 mg/m 2 cisplatin chemotherapy concomitantly. One month later than the end of CRT, consolidation chemotherapy with four cycles of docetaxel 75 mg/m 2 and cisplatin 75 mg/m 2 were administered at each 21 days. Results: Median age of the patients was 57 (range, 30-74). Following concomitant CRT, 14 patients (15%) showed complete and 50 patients (54%) showed partial response (total response rate was 69%). The median follow-up was 13 months (range: 2-51 months). The median overall survival was 18 months (95% confidential interval [CI]: 13.8-22.1 months); local control was 15 months (95% CI: 9.3-20.6 months); progression-free survival was 9 months (95% CI: 6.5-11.4 months). Esophagitis in eight (9%) patients, neutropenia in seven (8%) patients and pneumonitis in eight (9%) patients developed as grade III-IV toxicity due to concomitant CRT. Conclusion: Concomitant CRT with docetaxel and cisplatin followed by docetaxel and cisplatin consolidation chemotherapy might be considered as a feasible, and well tolerated treatment modality with high response rates despite the fact that it has not a survival advantage in patients with locally advanced unresectable NSCLC.

Azot protoksitsiz düşük akımlı desfluran anestezisinde remifentanil ve fentanil infüzyonlarının hemodinamik değişiklikler ve derlenme koşulları açısından karşılaştırılması Cihan Şahin1, Dilek Yazıcıoğlu2 1TOBB ETÜ Hastanesi, Anestezi Ve Reanimasyon Ana Bilim Dalı, Ankara 2Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Anestezi Ve Reanimasyon Ana Bilim Dalı, Ankara AMAÇ: Azot protoksitsiz düşük akımlı desfluran anestezisinde remifentanil ve fentanil infüzyonlarının hemodinamik değişiklikler ve derlenme koşulları açısından karşılaştırılmasıdır. YÖNTEM: Elektif kulak cerrahisi geçirecek ve Amerikan Anestezistler Derneği I-II fizyolojik sınıfta 40 yetişkin hasta rastgele Remifentanil (Grup R; n=20) ve Fentanil (Grup F; n=20) gruplarına ayrıldı. Kalp hızı, sistolik, diastolik ve ortalama arter basınçları, periferik oksijen saturasyonu, Bispektral indeks değeri, soluk sonu karbondioksit ve desfluran konsantrasyonları, inspiratuvar oksijen ve karbondioksit monitorize edildi, değerler 5 dk arayla kaydedildi. Grup R’de 1 µg kg-1 yükleme ardından 0,25-1µg kg-1 dk-1 remifentanil infüzyonu başlandı; Grup F’de, fentanil 2 μg kg -1 bolus ardından, 3 μg kg-1 saat -1 infüzyon başlandı, infüzyon her 30 dakika sonunda 0,5 μg kg-1saat-1 azaltıldı ve operasyonun son 10-15 dakikasında sonlandırıldı. Operasyon sonunda ekstübasyon, spontan göz açma zamanı, Aldrete derlenme skoru ≥9 olma süreleri ile istenmeyen olaylar ve tedavileri kaydedildi. BULGULAR: Gruplar hasta özellikleri bakımından benzerdi. Gruplar arasında diastolik arter basınçları 70 ve 80. dakika ölçümlerinde (Grup R’de daha düşük p=0,0174 ve p=0,0346); ortalama arter basınçları 80 ve 85. dakika ölçümlerinde (Grup R’de daha düşük p=0,04 ve p= 0,03) ve kalp hızında birden fazla ölçüm zamanında fark bulundu. Fentanil uygulanan grupta derlenmenin daha erken olduğu belirlendi; derlenme süresi Grup R: 9,9 ± 2,9 dk, Grup F: 8,4 ±0,9 dk (p= 0,0411). SONUÇ: Azot protoksitsiz düşük akımlı desfluran anestezisinde remifentanil veya fentanil infüzyonu hemodinamik değişkenler bakımından benzer etkilere sahiptir; her iki ajan bu amaçla güvenle kullanılabilir; azaltılan dozlarda infüzyon şeklinde uygulanan fentanil daha kısa derlenme süresi sağlamakla remifentanilden üstün bulunmuştur. Anahtar Kelimeler: desflurane, düşük akım anestezi, fentanyl, nitröz oksitsiz, remifentanil

Objective: Our aim was to investigate the effect of tamoxifen on cervical smear of patients with breast cancer at our clinic.Methods: The data of patients with breast cancer who had received tamoxifen were analyzed between 2006 and 2014, retrospectively. Pap smear results, age, gravidity, parity, smoking status, age of first birth, and detailed gynecologic and obstetric history of patients were noted. Patients who had not received at least one-year tamoxifen therapy and patients without cervicovaginal smear controls or those who left or had received interrupted tamoxifen treatment were excluded. The pap smear results of the tamoxifen and control groups were analyzed.Results: A total of 246 patients (123 in the tamoxifen group and 123 in the control group) were included in this study. None of the patients had cervical squamous intraepithelial lesions and atypical glandular lesions. Atypical squamous cells were significantly higher in the tamoxifen group than in the control group (p=0.03).Conclusion:The use of tamoxifen may be associated with benign squamous atypia in cervical smears. Therefore, pelvic examination and pap smear test are recommended for breast cancer patients annually.

Stewart-Treves syndrome is an angiosarcoma that occurs because of chronic lymphedema, which in most cases is a complication after mastectomy with axillary node dissection and postoperative radiation. Prognosis for this rare tumor is poor. The best therapy is early and radical excision. Chronic lymphedema seems to be an important pathogenic factor. We report a 59-year-old patient with chronic lymphedema and lymphangiosarcoma of the left upper limb who had a left modified radical mastectomy with axillary node dissection and postoperative radiation nine years ago. Additionally, the patient underwent a right modified radical mastectomy with axillary node dissection and postoperative radiation one year ago. In this report, we present a case of Stewart-Treves syndrome after the patient was operated for bilateral breast carcinoma, a review of literature, and principles of treatment.

As destinations are striving to become more competitive and attract visitors and tourists, the performance of its enterprises, including hotels is essential. Despite the significance of research in this area, to date, there are no studies that analyze the accommodation industry of a given destination from a broad perspective, since most of the investigations focus on a specific area of the organization and its relationship with the hotel’s performance. Therefore, the research aims to provide a comprehensive view of the accommodation industry in Istanbul. Moreover, the study will also attempt to establish a standard data collection instrument that can be used in the future as a benchmarking tool. The research will be carried out on a number of complementary perspectives that include management practices, financial performance measures, operational indicators, employee profile and attitudes, customer profile and satisfaction, environmental practices and use and investment in technology. Furthermore, the study attempts to determine the most important factors that affect the performance of the hotels and to explore the relationship between the different variables included.

El rendimiento de las empresas en los destinos turísticos gana importancia con el esfuerzo que realizan estos lugares por volverse más competitivos y atraer visitantes y turistas. A pesarde la necesidad de investigaciones en esta área, hasta la fecha no se ha llevado a cabo ningún trabajo que analice la industria hotelera en un destino desde una perspectiva amplia, ya que la mayoría de los estudios se centran en un área específi ca de la organización y su relación con el rendimiento del hotel. Por lo tanto, este estudio tiene como objetivo ofrecer una visión completa de la industria hotelera en Estambul. Por otra parte, la investigación también tratará de establecer un instrumento de recogida de datos estándar que se pueda utilizar en el futuro como herramienta de evaluación comparativa. La investigación se llevará a cabo desde diferentes perspectivas que incluyen prácticas de gestión, medidas de rendimiento fi nanciero, indicadores operacionales, perfi l y actitudes de los empleados, perfi l y satisfacción de los clientes, prácticas medio-ambientales y uso e inversión en tecnología.Además el estudio trata de deter-minar los factores más importantes que afectan al rendimiento de los hoteles y explorar la relación entre las diferentes variables incluidas.

This book forms part of a series pro- duced on the ‘environment and society’ which particularly emphasizes interactions between the environment and tourism. This second edition includes two new chap- ters: one on climate change and natural disasters; and the other on the relationship between tourism and poverty. Also, it re- flects the changes in the relationship be- tween tourism, society and poverty. The complexity in the relationships between environment and tourism is investigated through a holistic approach and multidis- ciplinary perspective. Cultural, political, economic and social aspects are considered as environmental components, as well as pure physical environmental aspects, whe- reas sustainability is regarded as an integral component of tourism policy. The book consists of nine chapters explaining complex interactions between tourism and the environment.