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Abstract Introduction This paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes. Background The ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up. Methods ADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients’ clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach’ for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox. Results User satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated. Conclusions Having finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel.

BackgroundThe increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). ObjectiveThis paper’s objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. MethodsThe DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. ResultsAs of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. ConclusionsIt has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

Abstract. Background:. To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction. Materials and methods:. Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months. Results:. Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p 0.05). Conclusions:. Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.

BackgroundThere is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support. ObjectiveThe Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems. MethodsThis paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 “testing and evaluation” phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening. ResultsThe technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. ConclusionsPatients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic. Trial RegistrationClinicalTrials.gov NCT03834207; https://clinicaltrials.gov/ct2/show/NCT03834207 International Registered Report Identifier (IRRID)RR1-10.2196/21994

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians. Keywords: Integrated care, Chronic disease management, Clinical decision support systems, Evidence based clinical guidelines

Objectives: After radical prostatectomy, surgical margin positivity is an important indicator of biochemical recurrence and progression. In our study we want to compare the surgical margin positivity rates for retropubic radical prostatectomy (RRP) and robotic assisted radical prostatectomy (RALP) and investigate the factors affecting surgical margin positivity in RALP. Materials and methods: Data from 78 RRP and 62 RALP patients operated from 2011 May to 2016 March were retrospectively screened. Patients in both groups were compared in terms of age, postop hematocrit reduction, hospital stay, duration of follow-up, surgical margin positivity, biochemical recurrence and oncologic parameters. In RALP group it was searched the relationship between the surgical margin positivity and prostate specific antigen (PSA), positive biopsy core, biopsy Gleason scoring, pathologic stage and Gleason scoring, lymph node positivity, lymphovascular and perineural invasion, extracapsular extension, seminal vesicle invasion, prostate weight. Results: Patients in the RALP group had lower postop hematocrit reduction and shorter hospital stay (p < 0.001). There was no difference in surgical margin positivity between RALP and RRP groups (37.1% vs. 29.5%, p = 0.341). In RALP group there was a correlation between surgical margin positivity and positive biopsy core number (p = 0.011), pathologic stage (p < 0.001) and Gleason score (p < 0.001), EAU risk classification (p = 0.001), seminal vesicle invasion (p = 0.045), extraprostatic extension (p < 0.001). There was no correlation between prostate weight (p = 0.896), PSA (p = 0.220), biopsy Gleason score (p = 0.266), lymph node positivity (p = 0.140), perineural (p = 0.103) and lymphovascular invasion (p = 0.92) with surgical margin positivity. Conclusions: Positive biopsy core number, pathological stage and Gleason score, EAU risk classification, seminal vesicle invasion and extraprostatic extension are correlated with surgical margin positivity in RALP.

Introduction: A growing share of the population in OECD countries is of age 65 and over, expected to reach 22% by 2030 (compared to 15% in 2010). Life expectancy has also significantly increased. People at age of 65 are expected to live for an average of 21 and 17 years for women and men; an almost 40% increase since 1960. The profound success in improving life expectancy has resulted in a new set of challenges. Challenge: Shift of resources was necessary, redirected to address the complex needs of multi-morbidity patients. Furthermore, patients’ needs are not effectively met by current care models, which tend to operate in isolation. This results in static services that patients need to wander. It is common for patients to revisit all levels of care discussing their needs, and reconciling potentially conflicting objectives amongst their conditions (e.g., incompatible lifestyle goals, adverse drug effects and side-effects, undetected conditions). Optimal collaboration and coordination between professionals in the delivery of integrated care have become essential requirements for the provision of high-quality care. Coordinated care aims for the orderly arrangement of individual and group efforts providing unity of action in pursuit of a common goal. Method: C3-Cloud is an e-health based ICT system, offering integrated, patient-centred care, considering all aspects of multi-morbidity and creating a collaborative environment, for all involved stakeholders. The navel of the system consists of the patient care plan, a digital shared picture of the patients’ needs and care regime. The care plan allows all professionals to review and understand the implications of one condition in the presence of others; this by its nature is complex, containing a considerable amount of diverse information. Navigating, understanding, and interpreting all the information can be confounding. The C3-Cloud Clinical Decision Support Service (CDS) offers an automated means of interpreting the available data. CDSS connects to the care plan repository, and continuously searches records for relevant data. The algorithms and integration of recommendations to the service were reviewed and validated by clinicians. Human computer interaction methods were employed to ensure optimal interaction between C3-Cloud and its users. Results: C3-Cloud offers CDSS for diabetes, renal failure, depression and congenital heart failure, with over 300 rules and checks that deliver four best practice guidelines in parallel; whilst reconciling their objectives, and monitoring their outcomes. It creates warnings or recommendations for the patient as well as for formal and informal carers. Discussion and Conclusions: C3-Cloud offers a powerful way to ensure that subtle, as well as critical, information about the patient, is presented to healthcare professionals, along with guideline based recommendations. The rules reconcile potential conflicts amongst conditions. Combined with a single patient and professionals interface, it provides a seamless experience throughout the health and care service. The C3-Cloud CDS service provides support to three pilot sites throughout Europe, currently undergoing evaluation. Acknowledgements: C3-Cloud is funded from the EU Horizon 2020 research and innovation project C3-Cloud, under grant agreement No 6891810. This abstract is based on the work and material of the entire C3-Cloud consortium.

Background: Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients’ family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. Methods: This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution’s ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). Results: The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52±0.51 years and the age at the time of operation was 17.89±0.42 years; for PC patients, the corresponding ages were 15.23±0.55 years and 16.77±0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17±0.15 for PE patients and 8.37±0.26 for PC patients. The postoperative pain duration was 51.93±5.18 days for PE patients and 38.5±6.88 days for PC patients. Conclusion: In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.

Background: Utilization of the available observational healthcare datasets is key to complement and strengthen the postmarketing safety studies. Use of common data models (CDM) is the predominant approach in order to enable large scale systematic analyses on disparate data models and vocabularies. Current CDM transformation practices depend on proprietarily developed Extract—Transform—Load (ETL) procedures, which require knowledge both on the semantics and technical characteristics of the source datasets and target CDM.Purpose: In this study, our aim is to develop a modular but coordinated transformation approach in order to separate semantic and technical steps of transformation processes, which do not have a strict separation in traditional ETL approaches. Such an approach would discretize the operations to extract data from source electronic health record systems, alignment of the source, and target models on the semantic level and the operations to populate target common data repositories.Approach: In order to separate the activities that are required to transform heterogeneous data sources to a target CDM, we introduce a semantic transformation approach composed of three steps: (1) transformation of source datasets to Resource Description Framework (RDF) format, (2) application of semantic conversion rules to get the data as instances of ontological model of the target CDM, and (3) population of repositories, which comply with the specifications of the CDM, by processing the RDF instances from step 2. The proposed approach has been implemented on real healthcare settings where Observational Medical Outcomes Partnership (OMOP) CDM has been chosen as the common data model and a comprehensive comparative analysis between the native and transformed data has been conducted.Results: Health records of ~1 million patients have been successfully transformed to an OMOP CDM based database from the source database. Descriptive statistics obtained from the source and target databases present analogous and consistent results.Discussion and Conclusion: Our method goes beyond the traditional ETL approaches by being more declarative and rigorous. Declarative because the use of RDF based mapping rules makes each mapping more transparent and understandable to humans while retaining logic-based computability. Rigorous because the mappings would be based on computer readable semantics which are amenable to validation through logic-based inference methods.

Background: Pectus excavatum (PE) is the most common chest wall deformity. The Nuss Questionnaire modified for Adults (NQmA) is a disease-specific health-related quality of life assessment tool for patients with pectus deformities. The aim of this study is to adapt the NQmA into Turkish. Methods: Two hundred and sixty-five patients with PE were participated, with an age range of 14 to 29 years. All patients underwent a physical examination and had not undergone corrective surgery. The Turkish version of the NQmA was completed by patients and their parents. Results: The content validity index based on expert opinions was 91% for the patient questionnaire and 96% for the parent questionnaire. The Cronbach’s alpha value for the NQmA was found to be 0.805 for the patient questionnaire and 0.800 for the parent questionnaire. Exploratory factor analysis was used to assess construct validity. Two factors explained 51.1% of the total variance in the patient questionnaire (psychosocial: 31.145%, Cronbach’s alpha=0.818; physical: 19.955%, Cronbach’s alpha=0.862). In the parent questionnaire, two factors explained 51.422% of the total variance (psychosocial: 26.097%, Cronbach’s alpha=0.743; physical: 25.325%, Cronbach’s alpha=0.827). Construct validity was confirmed by confirmatory factor analysis. Conclusion: The Turkish version of the NQmA was found to be valid and reliable for the assessment of quality of life in patients with PE.

Abstract A 36-year-old woman, unresponsive to pneumonia antibiotherapy followed by antituberculosis treatment, was referred to our clinic. Thorax computed tomography (CT) and positron emission tomography CT showed cystic mass and mediastinal lymph node with suspicion of malignancy. Fine needle aspiration biopsy and mediastinoscopy showed no malignancy, so the patient underwent an exploratory thoracotomy. A frozen section of wedge-resected mass was reported as adenocarcinoma, leading to right lower lobectomy with mediastinal lymph node dissection. Besides cutting-edge diagnostic techniques, exploratory thoracotomy for cavitary lung lesions can still be necessary, as the last-line choice. The probability of malignancy must always be considered, despite a patient's age or symptoms.

Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.

Anlık gönüllüler, afet ve acil durumlar sonrası müdahale ve iyileştirme çalışmalarında sıklıkla görülen fenomenlerden biridir. Literatürde, anlık gönüllüler bir yönüyle önemli bir iş gücü ve ekonomik kaynak olarak nitelendirilebilirken, diğer yandan organize olunamaması, afet ve acil durumlar konusunda yeterli bilgi ve beceriden yoksun kişileri de barındırabilmesi, güvenlik açısından risk oluşturulması ve idarenin söz konusu kişilere yönelik yasal sorumluluklarındaki belirsizlik gibi başlıklar yönüyle çeşitli sorunların da birer parçası olabilmektedirler. Bu çalışmada, afet ve acil durumlarda anlık gönüllülerin potansiyel rollerine ilişkin literatür taraması yapılarak, “anlık gönüllü” kavramının Türkçe literatüre kazandırılması ve gelecekte bu konuda yapılacak çalışmalara temel oluşturacak ve ivme kazandıracak bir farkındalığın yaratılması amaçlanmıştır. Bu amaç doğrultusunda, Türkiye’de afet ve acil durumlara ilişkin yasal ve idari düzenlemeler incelenmiştir. Bunun sonucunda, ilgili düzenlemelerde anlık gönüllülere ilişkin düzenleyici hükümlere yer verilmediği ve gelecek planlarında bu gönüllülerin, afet ve acil durum yönetimine ilişkin politika ve stratejilerde dikkate alınmadığı görülmüştür. Bu nedenle, afet ve acil durumlar sonrası yürütülen faaliyetlerde yer alan anlık gönüllüler ile ilgili yasal zeminin oluşturulması, afet yönetim sistemine entegre edilmesi ve afetlere dirençli bir toplum oluşturmak için anlık gönüllü faaliyetleri konusunda toplumun bilinçlendirilmesi gerekmektedir.

Aim:Three-dimensional (3D) printing has gained popularity among all fields of science in recent years. New research studies about the utilization of 3D printing in the medical field, in terms of medical devices and implants, have been published recently. We tried to adapt this technology into thoracic surgery by implanting 3D produced ribs following chest wall resection with a novel material called Nylon 680 Co-Polymer. We, hereby, present the preliminary results of this experimental study.Materials and Methods:We ordered multi detector computerized tomography of the chest for 2 pigs. We measured the area that we planned to resect on chest wall and used the data for printing custom-made rib for the reconstruction of the resected area. Then, we produced ribs with a USA Food and Drug Administration approved material called Nylon 680 Co-polymer (Taulman 3D, Saint Peters, MO, USA) by using 3D printer (Afinia H480, Chanhassen, MO, USA). Pigs were operated under general anesthesia. and the resected areas were reconstructed with custom-made 3D printed ribs.Results:One of the pigs passed away due to myocardial infarction while waking up from anesthesia. We followed up the other pig for 45 days. Then, we sacrificed the animal and resected the operated part for histopathological evaluation. Histopathologic evaluation revealed moderate chronic inflammation with a few giant cells containing pigmented foreign bodies.Conclusion:Although we need more studies, it is an important step for adapting 3D-printing into thoracic surgery. Additionally, it is important to identify a potential new material (Nylon 680 Co-polymer) for the future studies. We can use this new material for 3D-printed implant and mesh production, which enables us to produce custom-made products with lower cost in shorter time.

Objective:This study aimed to evaluate clinical musical perception, analyze the relationship between speech recognition and music perception, and investigate the effects of a three-month musical perception activities on these parameters in adult cochlear implant (CI) users with post-lingual hearing loss.Methods:Free-field hearing and speech tests in a quiet environment, the Turkish matrix test, and the Turkish version of the clinical assessment of musical perception test were performed on 18 adult unilateral CI users before and after the three-month music training. Results were compared with those of 18 healthy controls.Results:Prior to the musical perception activities, word recognition scores, Turkish matrix test results, and 500, 1000, and 6000 Hz free-field hearing thresholds were significantly correlated with the clinical assessment of musical perception test scores in the CI group (p

Supported by the European Commission under Horizon 2020, mHealth4Afrika is co-designing and validating a modular, multilingual, state-of-the-art health information system addressing primary healthcare requirements in resource constrained environments. mHealth4Afrika has co-designed a comprehensive range of functionality and medical programs in partnership with Ministries of Health, district health officers, clinic managers and primary healthcare workers from urban, rural and deep rural health facilities in Ethiopia, Kenya, Malawi and South Africa. This paper provides insights into how mHealth4Afrika is leveraging HL7 FHIR to support standards-based data exchange and interoperability between Electronic Medical Records and DHIS2. This work is currently being validated in the field. [ABSTRACT FROM AUTHOR]

Objective:To investigate the validity and reliability of the Fournier’s gangrene severity index (FSGI) and Uludag Fournier’s gangrene severity index (UFGSI) scoring systems and their components in outcome prediction for patients with Fournier’s gangrene.Materials and Methods:Recods of 87 patients, who were diagnosed with Fournier’s gangrene in our clinic between March 2005 and May 2016, were retrospectively analyzed. The patients were divided into 2 groups as survivors and non-survivors. Parameters belonging to the groups were compared.Results:The overall mortality rate was 13.7%. There was no correlation between mortality and dissemination of disease to the rectum, lower abdomen or lower extremity (p>0.05). There was a significant difference in renal failure, heart rate, blood urea nitrogen, creatinine, calcium and serum bicarbonate (HCO₃) values, and FSGI and UFGSI scores between the survivor and non-survivor groups (p

Objective: Publications of congress presentations (oral/poster) contribute to the literature by creating new information. In this study, we examined the publication rate of poster and oral presentations at the 1st Congress of the Society of Urological Surgery in Turkiye held in 2012. Materials and Methods: We investigated the congress booklet belonging to the 1st Congress of the Society of Urological Surgery in Turkiye held in 3-7 October 2012. We investigated the publication rates of 176 poster and 103 oral presentations under the headings of uro-oncology, andrology, pediatric urology, endourology, transplantation, continence and other by searching the PubMed and Science Citation Index Expanded (SCI-E) databases. Results: Of the 176 poster and 103 oral presentations, 79 (28.3%) were subsequently published. The publication rate in journals included in the SCI-E was 24.3%. While 33% of oral presentations were published, 25.5% of poster presentations became publications and this difference was not found to be statistically significant (p=0.48). The mean duration from presentation to publication was 21.1 months. Conclusion: The publication rate of presentations at the 1st Congress of the Society of Urological Surgery in Turkiye was higher than in most national congresses in different disciplines, but lower than many international congresses in the field of urology. Future studies investigating congress data from several consecutive years will provide clearer results.

Background: Video-assisted thoracoscopic surgery (VATS) anatomic lung resections are gradually becoming the standard surgical approach in early-stage non-small cell lung cancer (NSCLC). The technique is being applied in cases of larger tumors depending on the experience of the surgical team. The objective of this study was to compare early surgical and survival outcomes in patients undergoing anatomic pulmonary resections using VATS and thoracotomy techniques for clinical T2 NSCLC during the adaptation period of the surgical team to the VATS approach. Methods: The data of all patients who underwent anatomic pulmonary resection for NSCLC using VATS and open techniques since April 2012 were recorded to create a prospective lung cancer database. Clinical T2 NSCLC patients who underwent VATS anatomic lung resection were identified and compared with cT2 patients who underwent open resection. Results: Between April 2012 and August 2014, 269 anatomical resections for NSCLC were performed (80 VATS and 189 thoracotomy). Thirty-four VATS patients who had clinical T2 disease were identified and stage-matched to thoracotomy patients. The average tumor diameter was comparable (34.2±11.1×29.8±10.1 mm vs. 32.3±9.8×32.5±12.2 mm, p=0.4). Major complications were higher in the thoracotomy group (n=0 vs. n=5, p=0.053). There was no 30-day mortality, and the 2-year survival rate was 91% for VATS and 82% for thoracotomy patients (p=0.4). Conclusion: VATS anatomic resections in clinical T2 NSCLC tumors are safe and have perioperative and pathologic outcomes similar to those of thoracotomy, while remaining within the learning curve.

Studies have demonstrated the benefits of low frequency residual hearing in music perception and for psychoacoustic abilities of adult cochlear implant (CI) users, but less is known about these effects in the pediatric group. Understanding the contribution of combined electric and acoustic stimulation in this group can help to gain a better perspective on decisions regarding bilateral implantation. We evaluated the performance of six unilaterally implanted children between 9 and 13 years of age with contralateral residual hearing using the Clinical Assessment of Music Perception (CAMP), spectral ripple discrimination (SRD), and temporal modulation transfer function (TMTF) tests and compared findings with previous research. Our study sample performed similarly to normal hearing subjects in pitch direction discrimination (0.81 semitones) and performed well above typical CI users in melody recognition (43.37%). The performance difference was less in timbre recognition (48.61%), SRD (1.47 ripple/octave), and TMTF for four modulation frequencies. These findings suggest that the combination of low frequency acoustic hearing with the broader frequency range of electric hearing can help to increase clinical CI benefit in pediatric users and decisions regarding second-side implantation should consider these factors.

Varicocele, the most important identifiable pathological cause of male infertility, is rarely observed on the right side. In isolated cases of right-sided varicocele, the presence of retroperitoneal masses compressing the inferior vena cava should be considered by further investigation. The retroperitoneal masses that are detected tend to grow rapidly due to their location and may be very large at the time of diagnosis. Soft tissue sarcomas are the most common cause of retroperitoneal masses, while paragangliomas are rare causes. Retroperitoneal paragangliomas should be diagnosed via detection of symptoms caused by hormonal activity, observation of the compression effect of the mass, or incidentally during imaging studies. SIMILAR CASES PUBLISHED: This study presents the first case of retroperitoneal paraganglioma in a 41-year old man as isolated right-sided varicocele that has been described in the published reports.

Objective: To determine average acoustic reflex thresholds in geriatric groups by assessing ipsilateral and contralateral acoustic reflex and reflex decay tests.Methods: A total of 25 elders between ages 65-84 years (74.3±5.4) and 25 individuals between ages 18-45 years (30.4±4.2) were recruited for the study. After ear, nose, and throat examination, ipsilateral and contralateral acoustic reflex thresholds at 500, 1000, 2000, and 4000 Hertz (Hz) were determined and a reflex decay test at contralateral 500 Hz was conducted. Ipsilateral acoustic reflex thresholds were obtained with high-frequency band, low-frequency band, and wide band noise, and the results were compared with ipsilateral acoustic reflexes at 500, 1000, 2000, and 4000 Hz.Results: There was no statistically significant difference between the two groups in ipsilateral and contralateral acoustic reflex measurements at 500, 1000, 2000, and 4000 Hz (p>0.05). Negative reflex decay was obtained in all participants and no statistically significant difference between the two groups was observed in terms of reflex decay thresholds (p>0.05). Acoustic reflex with high-frequency band noise was observed in five of nine elders whose acoustic reflexes were not obtained at 2000 and 4000 Hz, whereas acoustic reflex with low-frequency band noise was observed in one of six elders who did not show reflexes at 500 and 1000 Hz.Conclusion: It was concluded that although some changes were observed due to age, middle ear and stapes muscles work normally in geriatric group. In the reflex decay test, reliable results were obtained at contralateral 500 Hz. Acoustic reflex measurements with low- and high-frequency band noise may also be used to assess middle ear functions.

Primary squamous cell carcinoma of the renal parenchyma is a rare entity and only 4 cases have been reported in the literature. A 73-year-old female patient presented to our clinic with the complaint of right flank pain. On radiologic evaluation, a 6x5x4 cm hypodense mass showing heterogeneous contrast enhancement was observed in the upper pole of the right kidney. An uneventful laparoscopic radical nephrectomy was performed. Final pathologic diagnosis was squamous cell carcinoma. No pathological involvement was observed on postoperative positron emission tomography/computed tomography. Our patient is still alive and she has not received any adjuvant treatment.

Bu araştırmanın temel amacı; sokakta çalışan çocukların depresif belirti düzeylerini ortaya koymak ve bu belirtileri sokakta çalışmayan çocukların depresif belirti düzeyleri ile karşılaştırmaktır. Bununla birlikte bu araştırma da örnekleme alınan çocukların sosyo-demografik özellikleri ile depresif belirti düzeyleri arasındaki ilişkileri ortaya koymak amaçlanmıştır. Araştırmanın evreni Diyarbakır Büyükşehir Belediyesi sınırlarıiçinde yaşayan 12-17 yaşlarındaki tüm çocuklardır. Araştırmada 12-17 yaşlarında sokakta çalışan 82, aynıyaşgrubundan sokakta çalışmayan 82 kontrol grubu olmak üzere toplam 164 çocuk örneklem olarak alınmıştır. Araştırmada çocukların depresyon düzeyleri “Kovacs Çocukluk Depresyon Ölçeği” ile ortaya konulmuştur. Ayrıca örnekleme alınan çocukların demografik özelliklerini ortaya koymak amacıyla anket uygulamasıyapılmıştır. Sokakta çalışan çocukların depresif belirti düzeyleri, sokakta çalışmayan çocuklarınkine göre daha yüksektir. Bununla birlikte göç etmişailelerin çocuklarının, fazla kardeşe sahip olan çocukların, anne-babalarının eğitim ve gelir düzeyleri düşük olan çocukların depresif belirti düzeyleri de yüksek bulunmuştur. Sağlıklıbir toplumun oluşması, sağlıklıbireylerin yetişmesi ile mümkün olacaktır. Bu sebeple çocukların ruh sağlığınıtehlikeye düşürecek çevresel faktörlerin tespit edilmesi ve gereken önlemlerin alınmasıönem arz etmektedir.