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Motor vehicles are composed of a large number of parts, and planning the maintenance activities of different parts is a crucial decision that affects system reliability, operation costs, and capacity requirements of service providers. We propose a systematic method to determine the critical parts that should be handled with extra preventive maintenance (PM) and prepare alternative PM plans with different levels of cost and capacity usage. Our method uses a multicriteria decision-making approach to determine the critical parts and conducts statistical reliability analysis with failure data and expert knowledge to create the maintenance plans. We use the proposed method in a case study to determine optional PM packages that would support regular PM practices in the after-sales service of a large motor vehicle manufacturer. The main aim of the case study is to increase the satisfaction of customers who are more sensitive to failures, such as carriers of food and medical supplies. The results show that the optional PM packages can decrease the cost of failures while obeying the capacity limitation of the company.

This article analyzes the racial framing of the humanitarian encounter between Turkish and African Muslims as a trope of first contact. Intensifying humanitarian relations with Africa south of the Sahara, in tandem with the AKP’s foreign policy, have led to the emergence of a racialized affective regime in Turkey that endows Islamic philanthropy with new racial meanings. This article argues that racial subjects like the White Muslim and the Black Muslim are produced through the affective labor of humanitarian volunteers and others, who narrativize and circulate experiences of first contact in Turkey. Based on a multi-sited ethnography in Turkey, Tanzania, Senegal, Gambia and Benin, this article, explores race-making as affective labor. Taking on Berg and Ramos-Zayas’s (2015) call for an anthropological theorization of race and affect, it develops a critical framework to examine how a particular form of affective labor; humanitarian voluntarism, produces differently racialized subjects, specifically the White Muslim and Black Muslim. In order to do so, this analysis draws on James Baldwin’s insights into the racial and affective politics of the first contact to discuss how Turkish humanitarians build on and alter the racialized affective regime Baldwin is describing.

Purpose: To investigate preoperative and postoperative factors affecting functional success in anatomically successful retinal detachment surgery.Methods: Seventy-five eyes of 75 patients with rhegmatogenous retinal detachment who underwent anatomically successful surgery from 2014 to 2019 with more than 1 year follow-up were included in the study. Demographic characteristics, ocular examination findings, preoperative and postoperative spectral domain optic coherence tomography images were retrospectively evaluated.Results: The mean age was 53.9 ± 17 years (range, 11–85 years). The mean follow-up period was 36.7 ± 16 months (range, 14–72 months). The mean best-corrected visual acuity of the patients before surgery was 1.35 ± 1.24 and at postoperative 12 months was 0.66 ± 0.5 logarithm of the minimum angle of resolution. Patients who were operated in 7 days of visual symptoms onset were found to have better visual acuity at the first and subsequent postoperative exams. Preoperative proliferative vitreoretinopathy, vitreous hemorrhage, and extent of retinal detachment were found to have a negative effect on functional success at 12 months. Regeneration of the outer retinal layers had a positive effect on visual acuity at 12 months but did not significantly increase visual acuity after 12 months. Multivariate analysis showed that preoperative external limiting membrane integrity was significantly associated with better functional outcomes.Conclusions: Early intervention, presence of preoperative external limiting membrane integrity, and restoration of postoperative outer retinal layers positively affected functional success. The presence of preoperative vitreous hemorrhage, preoperative proliferative vitreoretinopathy, and the extent of retinal detachment had a negative effect on prognosis at 12 months.

This study was carried out to determine the physicochemical properties and the fatty acid composition of milk samples collected from different originated Anatolian water buffaloes living in the same farm. The fat amounts in samples were ranged between 5.24 and 8.67%. The fatty acids with the highest ratios in buffalo milk fat belonged to C16:0 (palmitic acid), C18:1 (oleic acid), C18:0 (stearic acid) and C14:0 (myristic acid). Saturated fatty acids (SFA) (62.6 to 67.3 %) were found to be more dominant in buffalo milk fat than monounsaturated fatty acids (MUFA) (28.1 to 32.99 %) and polyunsaturated fatty acids (PUFA) (3.22 to 9.57%). Conjugated linoleic acid contents of the samples were determined between 1.46 % and 2.11 %. The conjugated linoleic acid ratios of the samples were similar. It was concluded that origin difference was effective on the physicochemical properties and the fatty acid composition of buffalo milk. It is thought that the results obtained from this study will contribute to obtaining information about the nutritional properties of Anatolian buffalo milk and to improve the nutritional and technological properties of products.

Purpose: The cingulate gyrus is a potential surgical area to treat tumours, psychiatric diseases, intractable pain and vascular malformations. The aim of the study was to define the topographic anatomy and arterial supply of the cingulate gyrus located on the medial surface of the cerebral hemisphere. Methods: We studied thirty-six hemispheres, each hemisected in the midsagittal plane. The vertical thickness of the cingulate gyrus was measured at the anterior commissure (AC), posterior commissure (PC), and genu levels of the corpus callosum. The branches of the anterior and posterior cerebral arteries supplying each zone were noted separately. The arterial pathways were transformed to digital data in AutoCAD to identify the condensation and reduction areas. Results: The mean AC-PC distance was 27.17±1.63 mm. The thinnest region was the genu level of the corpus callosum (10.29 mm). The superior internal parietal artery (SIPA), inferior internal parietal artery (IIPA) and pericallosal artery (PrCA) supplied all zones of the cingulate gyrus. The anterior zone received the greatest supply. The arterial condensation and reduction areas on both sides of cingulate gyrus and its x, y, and z coordinates specified. Conclusions The target cingulotomy (TC) area was determined for anterior cingulotomy. The properties of the TC area are that the thinnest region of the cingulate gyrus is supplied relatively less than other areas and is close to the anterior cingulotomy areas in the literature. The arterial reduction area (ARA) was found to be suitable for corpus callosotomy in terms of avoiding haemorrhage.

To avoid the potential risks associated with all hazardous wastes, it is important that containment methods are intended to prevent the migration of liquid hazardous wastes or leaks containing hazardous components. Therefore, impermeable barriers were used to prevent contamination. In this study, geotechnical tests were performed on samples by mixing rubber and bentonite with silica fume at certain percentages. The aim of the experimental studies is to evaluate the applicability of certain proportions of silica fume, rubber, and bentonite mixtures as impermeable liner material. Possible cracks in bentonite during drying are reduced by the use of silica fume. Absorption of dynamic effects that may occur on the impermeable barrier layer is achieved by adding waste rubber in a uniform size. Several geotechnical tests were performed to examine the mixed rubber and bentonite with silica fumes. Looking at the results of the whole that mixed rubber and bentonite with silica fume yielded usable results and a blend for construction of a liner.

Priapism is a rare condition in the newborn. The aim of this study was to investigate the demographic, etiologic and clinical features of neonatal priapism. We retrospectively analysed the data of 11 patients diagnosed with neonatal priapism in the neonatal intensive care unit between 2000 and 2019. Priapism was defined as an erection in the neonatal period, lasting more than 4 hours. Etiological examinations revealed polycythemia in one (9.09%) patient, D-dimer elevation in three patients, and heterozygous methyltetrahydrofolate 667 gene mutations in one patient. Other patients were considered idiopathic. Detumescence was achieved in all 11 (100%) patients during the follow-up period. The median hospitalization duration was 6 (IQR [4, 8]; range, 2–9) days. The median follow-up duration was 38 (IQR [30, 42]; range, 13–94) months for patients followed-up in our hospital after discharge. Neonatal priapism is a rare condition. Successful treatment results can be achieved with conservative methods. Data acquired from our study showed that diseases with a tendency to hypercoagulation belong to the etiology by damaging penile microcirculation and make the response to conservative treatment more challenging.

The mesenchymal stromal cells (MSCs) residing within the stromal component of visceral adipose tissue appear to be greatly affected by obesity, with impairment of their functions and presence of senescence. To gain further insight into these phenomena, we analyzed the changes in total proteome content and secretome of mouse MSCs after a high-fat diet (HFD) treatment compared to a normal diet (ND). In healthy conditions, MSCs are endowed with functions mainly devoted to vesicle trafficking. These cells have an immunoregulatory role, affecting leukocyte activation and migration, acute inflammation phase response, chemokine signaling, and platelet activities. They also present a robust response to stress. We identified four signaling pathways (TGF-β, VEGFR2, HMGB1, and Leptin) that appear to govern the cells’ functions. In the obese mice, MSCs showed a change in their functions. The immunoregulation shifted toward pro-inflammatory tasks with the activation of interleukin-1 pathway and of Granzyme A signaling. Moreover, the methionine degradation pathway and the processing of capped intronless pre-mRNAs may be related to the inflammation process. The signaling pathways we identified in ND MSCs were replaced by MET, WNT, and FGFR2 signal transduction, which may play a role in promoting inflammation, cancer, and aging © 2020. Acar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. All Rights Reserved. The mesenchymal stromal cells (MSCs) residing within the stromal component of visceral adipose tissue appear to be greatly affected by obesity, with impairment of their functions and presence of senescence. To gain further insight into these phenomena, we analyzed the changes in total proteome content and secretome of mouse MSCs after a high-fat diet (HFD) treatment compared to a normal diet (ND). In healthy conditions, MSCs are endowed with functions mainly devoted to vesicle trafficking. These cells have an immunoregulatory role, affecting leukocyte activation and migration, acute inflammation phase response, chemokine signaling, and platelet activities. They also present a robust response to stress. We identified four signaling pathways (TGF-β, VEGFR2, HMGB1, and Leptin) that appear to govern the cells’ functions. In the obese mice, MSCs showed a change in their functions. The immunoregulation shifted toward pro-inflammatory tasks with the activation of interleukin-1 pathway and of Granzyme A signaling. Moreover, the methionine degradation pathway and the processing of capped intronless pre-mRNAs may be related to the inflammation process. The signaling pathways we identified in ND MSCs were replaced by MET, WNT, and FGFR2 signal transduction, which may play a role in promoting inflammation, cancer, and aging © 2020. Acar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. All Rights Reserved. Erciyes University Research Project Fund BAP-FYL-2017-7399 Università degli Studi della Campania Luigi Vanvitelli CUP B23D18000250007

Objective: To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines. Patients and methods: This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test. Results: In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged

The prognostic value for metastasis of the cell-cycle progression score and phosphatase and tensin homolog haven't been evaluated jointly in contemporary men with exclusively intermediate- or high-risk prostate cancer. We evaluated associations of cell-cycle progression and phosphatase and tensin homolog with metastasis-free survival in contemporary intermediate/high-risk prostate cancer patients overall, and intermediate/high-risk men receiving salvage radiotherapy.In a case-cohort of 209 prostatectomy patients with intermediate/high-risk prostate cancer, and a cohort of 172 such men who received salvage radiotherapy, cell-cycle progression score was calculated from RNA expression, and phosphatase and tensin homolog was analyzed by immunohistochemistry. Proportional hazards regression, weighted for case-cohort design or unweighted for the salvage radiotherapy cohort, was used to evaluate associations of cell-cycle progression, phosphatase and tensin homolog with metastasis-free survival. Improvement in model discrimination was evaluated with the concordance index.In the case-cohort 41 men had metastasis, and 17 developed metastasis in the salvage radiotherapy cohort, at median follow-up of 3 and 4 years, respectively. For both case-cohort and salvage radiotherapy cohort, cell-cycle progression was independently associated with metastasis-free survival after adjustment for Cancer of the Prostate Risk Assessment Post-Surgical: hazard ratio (95% confidence interval) = 3.11 (1.70-5.69) and 1.85 (1.19-2.85), respectively. Adding cell-cycle progression to Cancer of the Prostate Risk Assessment Post-Surgical increased the concordance index from 0.861 to 0.899 (case-cohort), and 0.745 to 0.819 (salvage radiotherapy cohort). Although statistically significant in univariate analyses, phosphatase and tensin homolog was no longer significant after adjustment for Cancer of the Prostate Risk Assessment Post-Surgical. Analysis of interaction with National Comprehensive Cancer Network risk group showed that cell-cycle progression had the strongest effect among unfavorable intermediate-risk men.In the first study to evaluate metastasis risk associated with cell-cycle progression and phosphatase and tensin homolog in exclusively intermediate/high-risk prostate cancer, and in such men with salvage radiotherapy, cell-cycle progression but not phosphatase and tensin homolog was associated with significantly increased 2- to 3-fold risk of metastasis after Cancer of the Prostate Risk Assessment Post-Surgical adjustment.

We sought to elucidate the degree of variation across centers by calculating center-specific standardized mortality ratios (SMRs) for infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal life support (ECLS).The Extracorporeal Life Support Organization (ELSO) registry data (2000-2019) were used to estimate SMRs. Center-specific SMRs and their 95% confidence intervals (CIs) were used to identify centers with mortality as significantly worse (SW), significantly better (SB), or not different (ND) relative to the median standardized mortality rate.We identified 4,223 neonates with CDH from 109 centers. SMRs were risk-adjusted for pre-ECLS case-mix (birthweight, sex, race, 5 min Apgar, blood gases, gestational age, hernia side, prenatal diagnosis, pre-ECLS arrest, and comorbidities). Observed (unadjusted) mortality rates across centers varied substantially (range: 14.3%-90.9%; interquartile range [IQR]: 42.9%-62.1%). Thirteen centers (11.9%) had SB SMRs1 (SMR 0.52 to 0.84), 7 centers (6.4%) had SW SMRs1 (SMR 1.25 to 1.43), and 89 centers (81.7%) had SMRs ND relative to the median SMR rate across all centers (i.e., SMR not different from one). Descriptive analyses demonstrated that SB centers had a lower proportion of cases with renal complications, infectious complications and discontinuation of ECLS owing to complications, as well as differences in pre-ECLS treatments and timing of CDH repair, compared to SW and ND centers.This study specifically identified ECLS centers with higher and lower survival for patients with CDH, which may serve as a benchmark for institutional quality improvement. Future studies are needed to identify those specific processes at those centers that leads to favorable outcomes with the goal of improving care globally.Level III.

AMAÇ: Koronavirüs hastalığı 2019 (COVID-19) salgınının tüm insanlığın, özellikle de sağlık çalışanlarının ruh sağlığını etkilediği düşünülmektedir. En sık görülen psikiyatrik hastalıklardan biri olan depresyon açısından COVID-19 ile ön planda mücadele eden hastane öncesi sağlık çalışanlarının değerlendirilmesi ve etkileyen faktörleri belirlemek önemlidir. Bu çalışmada Hastane öncesi acil tıbbi hizmetlerinde çalışan sağlık uzmanları arasında COVID-19 ile ilişkili depresyon ve ilişkili faktörleri analiz etmeyi amaçladık.GEREÇ VE YÖNTEM: Bu kesitsel çalışma, hastane öncesi acil tıbbi hizmetlerinde çalışan 552 sağlık mesleği mensubu üzerinde bir anket yöntemi kullanılarak gerçekleştirilmiştir. Beck’in Depresyon İndeksi (BDI) ile ölçülen infekte olma riski ve korkusu, bilgi kaynaklarına güven ve depresyon düzeyleri COVID-19 ile ilişkili olarak değerlendirildi.BULGULAR: Kadınların BDI skorları erkeklerden daha yüksekti (p = 0.009). BDI puanları, eşi vefat etmiş veya boşanmışlarda evli veya bekarlara göre daha yüksekti. COVID-19 ile enfekte olma korkusu yüksek olanlar da BDI puanları daha yüksek saptandı Bilgi kaynaklarına güveni daha az olan ve hastalık hakkındaki bilgi düzeyi düşük olanlar katılımcıların BDI puanları daha yüksek tespit edildi.SONUÇ: Boşanmış veya dul kalmış kadınlar, enfekte olma riski ve enfekte olma korkusu daha yüksek olanlar, bilgi kaynaklarına güveni düşük olanlar ve hastalık hakkında düşük düzeyde bilgisi olanlar COVID-19 ile ilişkili depresyona daha yatkındır ve bu nedenle desteklenmelidir., OBJECTIVE: Coronavirus disease 2019 (COVID-19) pandemic is thought to have affected the mental health of all humanity, especially health workers. It is important to evaluate prehospital healthcare workers fighting COVID-19 at the forefront in terms of depression, which is one of the most common psychiatric diseases, and to determine the factors that affect it. In this study, we aimed to analyze the COVID-19-related depression and associated factors among healthcare professionals working in pre-hospital emergency medical services (PEMS).MATERIAL AND METHODS: This cross-sectional study was conducted using a survey method on 552 healthcare professionals working in PEMS. The perceived risk and fear of being infected, trust in information sources, and depression levels as measured by Beck's Depression Inventory (BDI) were evaluated in relation to COVID-19.RESULTS: Women had higher BDI scores than men (p = 0.009). BDI scores were higher in widowed or divorced compared to married or single individuals. Those with greater perceived risk and fear of being infected with COVID-19 had also increased BDI scores. BDI scores were higher in those with low trust in information sources and a low level of knowledge about the disease.CONCLUSIONS: Women, divorced or widowed, those with greater perceived risk and fear of being infected, those with low trust in information sources, and those with a low level of knowledge about the disease are more prone to depression associated with COVID-19 and hence should be supported.

Aim: Children with disabilities are more vulnerable than non-disabled children. The family is the key point in preventing and starting violence against children. However, data on the violence sensitivity and violent discipline used by parents with disabled children are quite insufficient. This study aimed to determine violence sensitivity and violent discipline used by parents with disabled and non-disabled children. Methods: One hundred and fifty-five parents (with 60 disabled and 95 non-disabled children) completed the Violence Sensitivity Towards Children Scale with sociodemographic and disciplinary practices information form. Results: In this study, it was determined that the Violence Sensitivity Towards Children Scale’s mean score of the parents with disabled children (41.66±5.30) was lower than that of the parents with non-disabled children (44.18±4.94), and the difference between them was statistically significant. It was also found that the percentages of discipline used by the parents with disabled children and of the parents with non-disabled children were 96.7% and 84.2%, respectively, and using verbal violence most frequently. A statistically significant difference was found between the two groups only in terms of verbal and physical violence. Conclusion: The study concludes that parents with disabled children are less sensitive to violence against their children and they resort to violent discipline more than parents with non-disabled children. Keywords: disabled children, parents, violence

Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acıbadem Mehmet Ali Aydınlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.

Laser-based Direct Energy Deposition (L-DED) is one of the most commonly employed metal additive manufacturing technologies. In L-DED, a laser beam is employed as a heat source to melt the metal powder that is deposited on a substrate layer by layer for the generation of a desired component. The powder is commonly fed through a nozzle into the molten pool by means of a carrier gas and therefore, a nozzle design that ensures optimal deposition of the material is of critical importance. Additionally, its design also affects the powder and gas flows that arise in the nozzle and during the deposition. This, in turn will affect the characteristics of the generated clad and the performance of the whole deposition. Therefore, an optimization of deposition nozzle geometry can be as important as the controlling of deposition process parameters in order to obtain best component qualities. In this context, the present review work is aimed at analysing the different nozzle designs employed in powder-based L-DED processes and the influence of different geometrical features and configurations on the resulting powder and gas flows. Concretely, the main characteristics of each design, their advantages and their possible shortcomings are analysed in detail. Additionally, a review of most relevant numerical models employed during the development of new and optimised nozzle designs are also addressed.

Background: We aimed to assess the factors associated with the transition time to full enteral feeding (FEF) in newborns with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. Methods: We obtained data retrospectively from medical records of the neonates diagnosed with HIE and treated by therapeutic hypothermia to evaluate the factors associated with transition time to FEF. Results: Sixty-one neonates were included in the study. The median gestational age (GA) and birth weight were 39 (37–40) weeks and 3245 (2715–3575) grams, respectively. APGAR scores at the first and fifth minutes were 3 (1–5) and 6 (4–7), respectively. Fifty-seven (93.4%) of the newborns were diagnosed as having moderate HIE, and 4 (6.6%) of them had severe HIE. Transition time to FEF was found to be negatively correlated with gestational week (r, P: -0.280, 0.029) and birth weight (r, P: -0.315, 0.013); and positively correlated with lactate (r, P: 0.295, 0.044), BUN (r, P: 0.285, 0.026) and creatinine levels (r, P: 0.345, 0.007); duration of invasive (r, P: 0.565, 0.0001) and non-invasive mechanical ventilation (r, P: 0.261, 0.042), use of antibiotics (r, P: 0.556, 0.0001) and inotropic agents (r, P: 0.524, 0.0001) and hospitalization (r, P: 0.654, 0.0001). Conclusion: Clinicians should be more careful while starting to feed babies undergoing therapeutic hypothermia with higher lactate levels and impaired renal functions, and should be encouraged to feed clinically stable neonates with HIE as soon as possible, as the transition time to FEF could be related with better clinical outcomes.

Objective Multisystem inflammatory syndrome (MIS-C) in children is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can be mortal with the involvement of multiple organ systems. However, long-term effects on all organs and organ systems involvement are still unclear or even whether this condition may still occur in which organs. This report aims to identify ocular findings in children with MIS-C on the follow-up. Methods This is a prospective cross-sectional study. Cases diagnosed with MIS-C between May 2020 and February 2021 in our hospital (e.g., cases aged 1 month–18 years old) were included in the study. The same ophthalmologist followed up with the patients after discharge. Patients underwent detailed ophthalmic examinations, including slit lamp biomicroscopy and fundoscopy, best-corrected visual acuity, and Schirmer's 2 test. Results Our study included 22 patients treated with the MIS-C. Twelve (54.5%) were girls, and 10 (45.5%) were boys. Their mean age was 8.7 ± 4.9 years. Pathological ocular findings were found in six (27.2%) patients in the follow-up. The most common finding was punctate epitheliopathy in four (18.2%) patients. The cause of punctate epitheliopathy was dry eye. All patients recovered with treatment. Conclusion Our study is the first to evaluate ocular findings in MIS-C in the long term. Regardless of the severity of the disease, the most common ocular finding in our study was punctate epitheliopathy, that is, dry eye. According to our results, we think patients should be followed up on pathological ocular findings after discharge.

Purpose: Autosomal recessive dedicator of cytokinesis 8 (DOCK8-/-) and autosomal dominant signal transducer and activator of transcription 3 (STAT3+/-) deficiencies are inborn errors of immunity (IEI) disorders present with the classic features of eczema and create a dilemma during differentiation from atopic dermatitis (AD). Therefore, an appropriate approach is required for eczema to diagnose DOCK8-/- and STAT3+/- early. Here, we described a set of clinical and immunological variables, including atypical AD localizations and lymphocyte subsets, to differentiate DOCK8-/- or STAT3+/- from AD. Methods: This multicenter study involved 100 patients with DOCK8-/- and STAT3+/- and moderate/severe AD. We recruited disease manifestations, including detailed localizations of eczema, infections, and allergy. Principle Component analysis (PCA) was used to discriminate DOCK8-/- or STAT3+/- from AD. Results: There were 43 patients with DOCK8-/-, 23 with STAT3+/-, and 34 with AD. Pneumonia, severe infections, mucocutaneous candidiasis, and skin abscesses were commonly observed in DOCK8 and STAT3 deficiencies. Atypical skin involvement with neonatal rash, retro auricular, axillary, sacral, and genital eczema discriminate DOCK8-/- and STAT3+/- from AD with high specificity ranges between 73.5 and 94.1% and positive predictive index ranges between 55 and 93.1%. Together with using absolute numbers of CD3+, CD4+, and CD8+ T cells, the combined clinical and laboratory features showed perfect differentiation between DOCK8-/- or STAT3+/- and AD via PCA. Conclusions: The described features can be easily implemented by physicians providing early diagnosis of DOCK8 and STAT3 deficiencies.

To investigate the correlation between widefield fundus fluorescein angiography (WF-FA) and anterior chamber laser flare photometry (LFP-flare) in Behçet uveitis (BU).Patients with BU who underwent Heidelberg WF-FA between March 2016 and March 2018 were included. Demographics, ocular findings, LFP-flare, central macular thickness were retrospectively analyzed.Eighty-six patients (162 eyes) were included. There was a high correlation between WF-FA leakage score and LFP-flare (rho: 0.691, p .001). For a flare value of 5.75 ph/ms or higher, the sensitivity for predicting angiographic leakage was 70% and the specificity was 94% (AUC: 0.897, p .001). Flare values that were equal or above 7.6 ph/ms were found to be 100% specific for leakage in the WF-FA.A strong correlation was found between WF-FA leakage and LFP-flare in patients with BU. High LFP-flare levels indicate subclinical posterior segment inflammation in clinically inactive BU.

Amaç: Antitrombotik ilaçlar ağır COVID-19 hastalarının tedavisinde kendine rutin bir yer edinmiş olmasına rağmen, enfeksiyona maruz kalmadan önce herhangi bir sebeple antitrombotik ilaç kullanımının hastalığın prognozuna ve klinik seyrine bir etkisi olup olmadığı henüz bilinmemektedir. Bu çalışmanın amacı SARS COV-2’ye maruz kalmadan önce antitrombotik ilaç kullanımının hastalığın klinik seyri ve mortalitesi üzerine etkisi olup olmadığını belirlemektir. Gereç ve Yöntemler: Hastanemiz COVID-19 polikliniğine başvuran COVID-19 tanısı yapılan RT-qPCR test sonucu ile doğrulanan ve bir akciğer görüntülemesi ile COVID-19 pnömonisi tanısı alan tüm hastalar çalışmaya dahil edilmiştir. Covid-19 pnömonisi olan hastaların anamnez bilgileri, hastanede ve yoğun bakımda yatış süreleri hastane kayıt sisteminden elde edildi ve kayıt altına alındı. Tüm hastaların klinik sonlanımları; sağkalım veya exitus olarak sınıflandırılarak kayıt altına alındı. Bulgular: PCR testi pozitif olup aynı zamanda viral pnömonisi olan hasta sayısı toplam 415 idi. Hastaların yaş ortalaması 53±19 ve 234’ü (56%) erkek idi. 415 hastanın 168’i (40%) en az bir çeşit antitrombotik ilaç kullanmakta iken 247’si (60%) herhangi bir antitrombotik ilaç kullanmıyordu. COVID-19 öncesi antitrombotik ilaç kullanan 168 hastada mortalite oranı %4,5 iken, antitrombotik kullanmayan 247 hastada mortalite oranı %12,5 olarak bulundu (p=0.008). Antitrombotik ilaç kullanan 168 hastada yoğun bakıma yatış oranı %10,1 iken, antitrombotik kullanmayan 247 hastada yoğun bakıma yatış oranı %13,7 olarak (p=0.31). Sonuç: Erken hastalıkta, özellikle ayaktan hastalarda antitrombotik tedavi, koagülopatiyi ve endotelyal ilişkili hastalığı önleyebilir, ancak trombo-inflamatuar faz sırasında çok geç bir antitrombotik tedavi uygulaması gerekli koruyucu etkiyi sağlamayabilir. Bu hipotezin uygun prospektif randomize çalışmalarda test edilmesi gerekmektedir.

Objective: COVID-19 increases risk of malnutrition. With proper nutritional management, clinical outcomes are more positive but nutritional management is often overlooked. Aim of our study is to determine competences and attitudes of internal medicine research assistants working in COVID-19 services in terms of nutritional management and the factors that may affect this. Materials and Methods: A 12-question survey was applied to internal medicine research assistants worked/still working in the inpatient service and intensive care units where COVID-19 patients were followed up. Their competences and attitudes about nutrition were learned. Results: A hundred research assistants participated in the study. Ratio of those who considered their knowledge sufficient about nutrition management was 48% (n=48), enteral nutrition was 62% (n=62) and parenteral nutrition was 55% (n=55). There were 92 (92%) research assistants who thought that nutrition was a problem in COVID-19 patients, however there are only 6 (6%) research assistants who have read publications on nutritional management in COVID-19 patients. Research assistants who have performed intensive care or geriatrics rotation stated themselves more competent in nutrition (p = 0.001 & p

We aimed to find out whether the Mini Nutritional Assessment-Short Form (MNA-SF) can predict mortality up to 7 years when compared with the Mini Nutritional Assessment-Long Form (MNA-LF) in geriatric outpatients.This retrospective study was conducted in patients (≥65 years) who were admitted to the geriatric outpatient clinic of a university hospital. MNA-SF and MNA-LF results were available for all patients. Patients were grouped as normal nutrition status (score 12-14), at risk of malnutrition (score between 8 and 11), or malnourished (score ≤7) according to MNA-SF. Based on MNA-LF, patients had normal nutrition status (score ≥24), were at risk of malnutrition (score 17-23.5), or were malnourished (score17). Survival of the patients was assessed retrospectively.The study included 209 patients (62.2% female). During the 7-year follow-up, 77 (36.8%) patients died. After adjusting for age, sex, and Charlson comorbidity index, MNA-SF was significantly associated with all-cause mortality during 6-month, 1-year, 3-year, 5-year, and 7-year follow-up time. MNA-LF was superior to MNA-SF to estimate 6-month (P = 0.004) and 1-year mortality (P = 0.031). There was no difference between MNA-SF and MNA-LF regarding 3-year, 5-year, and 7-year mortality.MNA-SF can predict short-term and long-term mortality in geriatric outpatients as well as MNA-LF. A cut-off value of 11, indicating risk of malnutrition according to MNA-SF, may be used for the risk estimation of 1-year, 3-year, and 5-year mortality. Therefore, this study highlights the importance of screening all geriatric outpatients for malnutrition and especially the risk of malnutrition for early intervention and treatment.

Objective Ultrasound (US) guided pulsed radiofrequency (PRF) therapy can be used on the greater occipital nerve (GON) in patients with chronic migraine (CM) who are unresponsive to conservative treatments. We aimed to demonstrate the change in pain intensity, duration of migraine episodes, frequency of attacks, migraine disability, depression, and sleep disturbance scores before and after treatment in patients with CM who underwent US-guided GON PRF and the effectiveness of treatment. Patients and methods According to the International Classification of Headache Disorders III beta version diagnostic criteria, 25 of 43 patients with CM whom treated with GON PRF were included in the study. The Migraine Disability Assessment Scale (MIDAS), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and a visual analog scale (VAS) were used on patients before GON PRF treatment and at post treatment months 1 and 3. Results The median duration and number of migraine episodes in the post-interventional 1st month and 3rd month were significantly shorter and fewer compared with the pre-intervention period (p < 0.001). In the comparison with the pre-intervention values, all of the scoring concepts, namely the MIDAS, VAS, BDI, and PSQI, revealed a significant drop in the postintervention 1st and 3rd month (p < 0.001). Conclusion In this study, we observed that US-guided GON PRF therapy applied at the proximal (C2) level was a safe and effective treatment option. With GON PRF, we observed a decrease in pain intensity, pain frequency, and duration of episodes, and an improvement in depression symptoms, migraine disability, and sleep disorder scores accompanying chronic migraine.

The relationship between sarcopenia and postoperative outcomes in patients with gastric cancer remains controversial. This study aimed to investigate the impact of sarcopenia on short-term outcomes after surgery for gastric cancer.Patients who underwent surgical treatment for gastric cancer were evaluated in this prospective observational study. Muscle strength, muscle mass, and physical performance were measured before surgery. Diagnosis of sarcopenia was based on the revised European Working Group on Sarcopenia criteria. Postoperative 30-day outcomes, including complications, reoperation, readmission, and operative mortality, were recorded.Sarcopenia was observed in 31 out of 146 patients (21.2%). The overall complication incidence was 31.5%. The postoperative complication rate was higher in the sarcopenic patients compared to the nonsarcopenic patients (54.8% versus 25.2%, P = 0.003). There was no statistically significant difference in terms of surgical complication rates (25.8% versus 14.8%, P = 0.239), although the sarcopenic group had a significantly higher systemic complication rate (38.7% versus 13%, P = 0.003). No statistically significant difference was observed in terms of major complications (3.2% versus 5.2%, P = 1.000). Muscle strength, muscle mass, and physical performance were not identified as independent factors when tested alone at adjusted multivariable analysis. Sarcopenia (Odds ratio: 2.73, 95% CI 1.02-7.52, P = 0.047) and severe sarcopenia (Odds ratio: 4.44, 95% CI 1.57-13.34, P = 0.006) were identified as independent prognostic factors for postoperative complications.Sarcopenia was associated with postoperative complications after gastrectomy for gastric cancer. Severe sarcopenia may serve as a more robust prognostic indicator. The variation in the complication rates between sarcopenic and nonsarcopenic patients was mainly due to difference in systemic complications rather than surgical complications.

This study presents comparable sets of churning and windage power loss measurements of a gear. Measurements are performed under windage (air only) and churning (immersion in oil up to a certain level) to quantify load-independent power losses of a family of spur and helical gears along with representative discs. Aiming at quantifying the impact of gear geometry on churning or windage losses to establish a baseline for the case of no enclosures around the gear, the test matrix is designed to investigate three key items: (a) contribution of losses along the periphery and faces, (b) the influences of gear teeth versus a toothless replacement disc as well as key design parameters (gear module and helix angle), and (c) a comparison of churning and windage power losses measured from the same exact set-up. The churning power losses are shown to increase with the static oil levels due to increased solid-fluid interactions. The impact of oil bath temperature (oil viscosity) on churning loss is observed to be more pronounced for higher oil levels. The presence of gear teeth on the rotating specimen (spur or helical) cause churning loss to increase modestly in comparison to the disc specimens. Furthermore, a larger tooth size results in higher churning power losses. The influence of gear teeth (gear vs. disc) on windage loss is shown to be significant, indicating that modeling a gear in a high-speed windage condition as a cylindrical disc might not be an acceptable practice.