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Water quality parameters such as temperature, dissolved oxygen, pH and total dissolved solids are important environmental factors affecting fish welfare. The deterioration of these parameters beyond the tolerance limits causes environmental stress and suppression of the immune system. Moreover, it allows opportunistic pathogens that are always present in the environment to infect immune-suppressed fish and cause serious disease outbreaks. In this study, water quality parameters and pathogenic bacteria profiles were monitored for 1 year in rainbow trout farms operating in the same river basin. Then, a data set was created considering the pathogenic bacteria in the diseased fish and the water quality parameters in the farm environment. Each of the water quality parameters in the data set was first used as an attribute and their order of importance in terms of disease outbreak was determined. Then, using multinomial logistic regression (MLR) analysis, which is one of the machine learning (ML) techniques, the possibility of water quality parameters revealing a disease outbreak was evaluated. Furthermore, very effective models that can be used to predict the probability of disease occurrence in trout farms with an accuracy of 95.65% have been created.

Ülkemizde kalkınma yatırımları arasında yer alan akarsu havzalarında inşa edilen bazı barajlar sit alanlarını ve Taşınmaz Kültür Varlıklarını etkilediğinden, kültürel mirası koruyan ve gelecek nesillere aktaran önemli bir görevi beraberinde getirmektedir. Bu nedenle kalkınma projeleri gerçekleştirilirken kalkınma-kültürel mirasın korunması dengesinin gözetilmesi önem kazanmaktadır. Kalkınma projeleri nedeniyle tehdit altında giren kültür varlıkların kurtarılması ya da olumsuz etkilerin azaltılması için son seçenek olarak yerinde koruma, kısmı veya bütünüyle yeni bir yere nakil edilmesi gibi çalışmaların gerçekleştirmesini gerektirmektedir. Makalenin konusunun oluşturan ve Güney Anadolu Bölgesinde Siirt, Şırnak, Mardin, Diyarbakır ve Batman illerinin kimi yerleşimlerini kapsayan Ilısu Barajı ve Hidroelektrik Santralı (HES) Projesinin rezervuar alanında kalan Hasankeyf’teki kültür varlıklarının korunma ve kurtarılmasına yönelik çalışmalar bu anlamda en özel örneklerdir. İnterdisipliner uzman ekiplerle hazırlanan yönetim planı çerçevesinde, bütünleşik koruma ilkelerine dayanılarak gerçekleştirilen bu çalışmaların, benzer yok olma tehdidi ile karşılaşan kültür varlıklarının korunması/kurtarılması için yaklaşımlar ve metotlar açısından fikir vermesi hedeflenmiştir.

Bayburt İli, Aydıntepe İlçesi, Prehistorik dönemlerden beri yerleşim izleri taşıyan bir yöre olarak dikkati çekmektedir. İçerisinde bulunduğu bölgenin tarih öncesi çağlardan itibaren süregelen ticari yol ağına sahip olması, verimli toprakları, su kaynaklarına yakınlığı nedeniyle tarihsel süreç içerisinde farklı uygarlıklara ev sahipliği yapmıştır. Bayburt ve çalışma konusu Aydıntepe’de (Hart) yapılan yüzey araştırmalarında eski kalıntıların izlerini taşıyan çok sayıda eser günümüze kadar ulaşmıştır. Bu çalışmada, Aydıntepe İlçe merkezinde yer alan bulunduğu ilçe ismi ile anılan yeraltı şehrinin mimari fonksiyon analizi incelenmiştir. Aydıntepe Yeraltı Şehri, geçmişten günümüze kadar varlığını kısmen sürdürerek gelmiş olan ve bulunduğu bölgede tekil kültür varlığı niteliği taşıyan tarihi açıdan da büyük öneme sahip alanlardan birisidir. Aydıntepe Yeraltı şehrinde kısa süreli kazı çalışmaları yapılmıştır. Çalışmaların sürdürülememesinin en önemli sebebi yeraltı şehrinin bazı kısımlarında meydana gelen göçüklerdir. Bu çalışmada yeraltı şehrinin ortaya çıkarılan bölümünün tamamının planı çıkarılmış, plan doğrultusunda yapıların işlevlerine ve konservasyonuna yönelik öneriler sunulmuştur. Çalışma sonucunda yeraltı şehrinin M.S. 3. yüzyılda yapılmış olabileceği ve uzun süre kullanıldığı düşünülmüştür.

Diseases are quite common in fish farms because of changes in physico-chemical characteristics in the aquatic environment, and operational concerns, i.e., overstocking and feeding issues. In the present study, potential factors (water physico-chemical characteristics and heavy metal load) on the disease-causing state of the pathogenic bacteria Lactococcus garvieae and Vagococcus sp. were examined with machine learning techniques in a trout farm. Recording of physico-chemical characteristics of the water, fish sampling and bacteria identification were carried out at bimonthly intervals. A dataset was generated from the physico-chemical characteristics of the water and the occurrence of bacteria in the trout samples. The eXtreme Gradient Boosting (XGBoost) algorithm was used to determine the most important independent variables within the generated dataset. The most important seven features affecting bacteria occurrence were determined. The model creation process continued with these seven features. Three well-known machine learning techniques (Support Vector Machine, Logistic Regression and Naïve Bayes) were used to model the dataset. Consequently, all the three models have produced comparable results, and Support Vector Machine (93.3% accuracy) had the highest accuracy. Monitoring changes in the aquaculture environment and detecting situations causing significant losses through machine learning techniques have a great potential to support sustainable production.

Item does not contain fulltext BACKGROUND: Rezafungin is a next-generation, once-a-week echinocandin in development for the treatment of candidaemia and invasive candidiasis and for the prevention of invasive fungal disease caused by Candida, Aspergillus, and Pneumocystis spp after blood and marrow transplantation. We aimed to compare the efficacy and safety of intravenous rezafungin versus intravenous caspofungin in patients with candidaemia and invasive candidiasis. METHODS: ReSTORE was a multicentre, double-blind, double-dummy, randomised phase 3 trial done at 66 tertiary care centres in 15 countries. Adults (≥18 years) with systemic signs and mycological confirmation of candidaemia or invasive candidiasis were eligible for inclusion and randomly assigned (1:1) to receive intravenous rezafungin once a week (400 mg in week 1, followed by 200 mg weekly, for a total of two to four doses) or intravenous caspofungin (70 mg loading dose on day 1, followed by 50 mg daily) for no more than 4 weeks. The primary endpoints were global cure (consisting of clinical cure, radiological cure, and mycological eradication) at day 14 for the European Medical Agency (EMA) and 30-day all-cause mortality for the US Food and Drug Administration (FDA), both with a target non-inferiority margin of 20%, assessed in the modified intention-to-treat population (all patients who received one or more doses of study drug and had documented Candida infection based on a culture from blood or another normally sterile site obtained within 96 h before randomisation). Safety was evaluated by the incidence and type of adverse events and deaths in the safety population, defined as all patients who received any amount of study drug. The trial is registered with ClinicalTrials.gov, NCT03667690, and is complete. FINDINGS: Between Oct 12, 2018, and Aug 29, 2021, 222 patients were screened for inclusion, and 199 patients (118 [59%] men; 81 [41%] women; mean age 61 years [SD 15·2]) were randomly assigned (100 [50%] patients to the rezafungin group and 99 [50%] patients to the caspofungin group). 55 (59%) of 93 patients in the rezafungin group and 57 (61%) of 94 patients in the caspofungin group had a global cure at day 14 (weighted treatment difference -1·1% [95% CI -14·9 to 12·7]; EMA primary endpoint). 22 (24%) of 93 patients in the rezafungin group and 20 (21%) of 94 patients in the caspofungin group died or had an unknown survival status at day 30 (treatment difference 2·4% [95% CI -9·7 to 14·4]; FDA primary endpoint). In the safety analysis, 89 (91%) of 98 patients in the rezafungin group and 83 (85%) of 98 patients in the caspofungin group had at least one treatment-emergent adverse event. The most common treatment-emergent adverse events that occurred in at least 5% of patients in either group were pyrexia, hypokalaemia, pneumonia, septic shock, and anaemia. 55 (56%) patients in the rezafungin group and 52 (53%) patients in the caspofungin group had serious adverse events. INTERPRETATION: Our data show that rezafungin was non-inferior to caspofungin for the primary endpoints of day-14 global cure (EMA) and 30-day all-cause mortality (FDA). Efficacy in the initial days of treatment warrants evaluation. There were no concerning trends in treatment-emergent or serious adverse events. These phase 3 results show the efficacy and safety of rezafungin and support its ongoing development. FUNDING: Cidara Therapeutics and Mundipharma.

Bu çalışmada sıcak-Jüpiter türü çok sayıda ötegezegenin barınak yıldızlarının önünden geçiş zamanlarının değişimleri ile büyük çoğunluğu ortak zarf evresini tamamlamış bir grup çift yıldızın tutulma zamanlarının değişimleri üzerine yapılan uzun süreli bir araştırma ve bu araştırma kapsamında Türkiye’deki beş ayrı gözlemevinde yapılan gözlemlerin sonuçları sunulmaktadır. Son olarak, geçiş zamanları değişimi gösterdiğinden şüphelenilen TrES-5 sistemine ilişkin ön analizler bir örnek çalışma olarak sunulmuştur.

This study was aimed to determine the current antibiotic resistance of Lactococcus garvieae, which causes significant economic losses in rainbow trout (Oncorhynchus mykiss) farms. For the study, three farms located around a stream were visited in two consecutive disease outbreaks. Bacteria were isolated from the diseased fish and all bacterial isolates were identified using conventional and molecular methods. Then, they were examined for 5 different antibiotic resistance genes and their antibiotic susceptibility profiles were determined using the disc diffusion technique. The results of the study revealed that all 16 isolates had a different antibiotic resistance profile and each should be considered as a separate strain. Additionally, they showed that there may be different L. garvieae strains within and between farms, using the same water source. Comparison of the results with previous studies from the region and different regions of the country revealed that antibiotic resistance is increasing in L. garvieae, and screenings on a limited number of isolates may not give an accurate picture of the final status of antibiotic resistance. These outcomes of the study are discussed in terms of treatment strategies that trout farms in the region should follow when treating lactococcosis.

Introduction The aim of this study was to compare clinical results of bilateral decompression and laminotomy and contralateral laminotomy following discectomy from the same side in patients who have far lateral disk herniation and lumbar spinal stenosis at the same level. Materials and Methods Twenty-four patients with far lateral disk herniation have been divided into two groups: group 1 (n = 14), those who have been through bilateral canal decompression with far lateral discectomy and ipsilateral approach, and group 2 (n = 10), those who have been through far lateral discectomy and bilateral decompression with unilateral approach from contralateral side. Early postoperative, 1st month, and 12th month back and leg pain Visual Analogue Scale (VAS) scores of the patients have been retrospectively evaluated. Results There is no significant difference between 1st month back and leg pain VAS scores of the groups. But 12th month back and leg pain VAS scores of group 1 are significantly higher than 1st month VAS scores. Also, 12th month back and leg pain VAS scores of group 1 are significantly higher than group 1. In the scanning carried out when the complaints of eight patients in group 1 continued, pars interarticularis fracture has been observed on the side where the surgery has been performed (57.1%). Six of these eight patients have been through stabilization surgery (42.8%). Conclusion Long-term postoperative results are better in cases who have been performed bilateral decompression with unilateral approach from contralateral side with median incision following paramedian incision discectomy in patients with far lateral disk herniation and spinal stenosis.

Systemic treatment options with proven efficacy for the treatment of metastatic uveal melanoma are limited. In this study, we aimed to evaluate the efficacy of nivolumab in metastatic uveal melanoma patients. In our multi-center study, the files of patients who received nivolumab treatment with a diagnosis of metastatic uveal melanoma were retrospectively reviewed and their information was recorded. Seventeen patients were enrolledand 16 patients were evaluable for efficacy. The objective response rate (ORR) was 18% including one confirmed complete response and two confirmed partial responses. The median progression-free survival (PFS) was 5.8 months (95% CI, 0.03-11.57 months), and the median overall survival (OS) was 10.5 months (95% CI, 3.87-14.14 months). Significant longer OS and PFS were observed in patients with the performance status of the Eastern Cooperative Oncology Group (ECOG-PS) 0. Although significant longer OS was detected in patients with low median lactate dehydrogenase (LDH) levels, no significant difference was found in PFS. Grade 1 and 2 fatigue and decreased appetite were the most common side effects associated with treatment (17%); grade 3 and 4 side effects were not observed. Immunotherapy is also emerging as a treatment option among the limited number of treatment options in metastatic uveal melanoma (mUM), but its efficacy needs to be demonstrated with prospective studies involving a larger number of patients.

Medya sektöründe oligopol piyasa yapısına neden olan mülkiyet yoğunlaşması, sektörde birkaç büyük medya kuruluşunun öne çıkmasını sağlamaktadır. Kamu üzerindeki etkisi göz önüne alındığında kitle iletişim araçlarının birer ideolojik üretim aygıtlarına dönüşebilmelerinden dolayı, medya sektöründe yatay birleşmeler sonucunda çapraz mülkiyet yoğunlaşmasına sahip bir medya kuruluşu düşünüldüğünde, güçlü bir yönlendirme gücünden söz edilebilmektedir. Bu gücün yanı sıra sermaye sahipleri tarafından günümüzde bir sanayi sektöründen farksız yaklaşılan medya alanının temel işlevi olan kamu yararı göz ardı edilmektedir. Bu çalışmada medya sektöründe geçmişten beri var olan ve özellikle neo-liberal politikalardan sonra büyük ilerleme kaydeden medyada mülkiyet yoğunlaşması olgusunun Türk medya sektöründeki oluşturduğu etkiler anlatılmaya çalışılmıştır. Medya sektörünün kendisinden beklenen kamu yararı işlevine karşı olumsuz anlamda etki eden, toplumun doğru ve çeşitli haber alma hakkına zarar veren bu etkiler kavramlar ve örnek olaylarla birlikte açıklanmıştır. Mevcut konunun irdelenmesinde literatür taraması da yapılarak güncel eserlerden yararlanılmıştır, Ownership concentration, which causes oligopoly market structure in the media sector, makes several large media organizations stand out in the sector. Considering its effect on the public, a strong steering power can be mentioned when considering a media establishment that has a cross-ownership concentration as a result of horizontal mergers in the media sector, since mass media can turn into ideological production devices. In addition to this power, public benefit, which is the main function of the media field, which is approached by capital owners as indistinguishable from an industrial sector today, is ignored. In this study, the effects of the phenomenon of ownership concentration in the media sector, which has existed in the media sector from the past and made great progress especially after neo-liberal policies, on the Turkish media sector is tried to be explained. These effects, which have a negative impact on the public benefit function expected of the media sector and harm the society's right to receive accurate and various news, are explained with concepts and case studies. The current works were used by making literature reviews in examinating the current issue

Introduction: Lung cancer is the most common cause of cancer-related death in the world. Changes in the treatment of metastatic lung cancer in recent years have made targetable mutations gain importance. MET alteration is one of these driver mutations and crizotinib is a tyrosine kinase inhibitor used in therapy. Methods: In our study, data of patients with c-MET amplification who received crizotinib treatment between July 2017 and November 2020 in the Medical Oncology Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital were retrospectively analyzed. c-MET scanning was performed by the fluorescent in situ hybridization method by using Cytotest MET/CCP7 probe kit by evaluating 100 tumor cells and the threshold value for positivity was accepted as above 20%. Results: Eight of 28 patients who received crizotinib treatment had c-MET amplification. Seven of these patients were male and one was female. Progression-free survival and overall survival in these eight patients were 9.4 and 10.9 months, respectively, and objective response rate was 50%. Grade 4 nausea was observed in only one patient; there was no grade 4–5 toxicity and no patient discontinued the drug due to toxicity. Conclusion: Crizotinib is an effective treatment option other than cytotoxic chemotherapy in the limited number of patients with MET amplification in the stage 4 lung adenocarcinoma subgroup. It is important to investigate this amplification, which can be detected especially in smoking patients in the appropriate patient group, and to use appropriate tyrosine kinase inhibitors in treatment.

Background Coronavirus disease 2019 (COVID-19) has quickly turned into a global pandemic with close to 5 million cases and more than 320,000 deaths. Cancer patients constitute a group that is expected to be at risk and poor prognosis in COVID pandemic. We aimed to investigate how cancer patients are affected by COVID-19 infection, its clinical course and the factors affecting mortality. Methods In our single-center retrospective study, we included cancer patients with laboratory confirmed COVID-19 in our hospital. Demographic, clinical, treatment, and laboratory data were obtained from electronic medical records. Logistic regression methods were used to investigate risk factors associated with in-hospital death. Results In the hospital, 4489 patients were hospitalized with COVID infection and 77 were cancer patients. The mean age of cancer patients was 61.9 ± 10.9 and 44 of them were male (62%). While the mortality rate in non-cancer patients was 1.51% (n = 68), this rate was significantly higher in cancer patients, 23.9% (n = 17). The stage of the disease, receiving chemotherapy in the last 30 days also lymphopenia, elevated troponin I, d-dimer, CRP, and CT findings were associated with severe disease and mortality. Severe lung involvement (OR = 22.9, p = 0.01) and lymphopenia (OR = 0.99, p = 0.04) are the most important factors influencing survival in logistic regression. Conclusions The disease is more severe in cancer patients and mortality is significantly higher than non-cancer patients. These data show that it may be beneficial to develop dynamic prevention, early diagnosis and treatment strategies for this vulnerable group of patients who are affected by the infection so much.

Background Vascular complications, which we rarely encounter during lumbosacral stabilization surgeries, can be life-threatening if they are not treated quickly. These arterial injuries occur during screw insertion. Our presentation with the common iliac artery injury during the decortication process in transverse processes with the “pedicle awl” will be the first case in the literature to our knowledge. Case Description Lumbosacral decompression and stabilization surgery was performed in a 57-year-old patient with L1-S1 spinal stenosis and scoliosis. After the stabilization process was completed, while decorticating the transverse processes with the pedicle awl, the tool fell to the paravertebral region, and then active arterial hemorrhage was observed at the surgical site. Hemostasis was achieved in the surgical field, but a rapid progressive drop was observed in the patient's blood pressure. The surgery was quickly terminated, and the patient was turned to the supine position. Vascular surgeons opened the abdomen with a midline laparotomy, and approximately 2600 mL hematoma was evacuated from the retroperitoneum. The 5-mm defect in the left common iliac artery was repaired by primary suturing. The patient had no problem in postoperative follow-up and was discharged on the 10th postoperative day. Conclusions In these complications that we rarely encounter in lumbosacral stabilization surgeries, perioperative findings should be well evaluated, and rapid intervention should be made in cases in which vascular injury is considered. One must remember that every tool used during surgery can be dangerous even in an experienced hand.

Ilısu Barajı ve Hidroelektrik Santralı (HEPP) Projesi’nin tamamlanmasıyla büyük bir bölümü su altında kalacak olan Hasankeyf’teki kültürel mirasın belgelenmesi, korunması ve kurtarılmasına yönelik bir kurtarma projesi oluşturulmuştur. Bu proje kapsamında yeralan Er Rızk Camii Minaresi de yeni Hasankeyf yerleşiminde oluşturulan arkeopark alanındaki yeni yerine bütünüyle taşınanarak baraj gölü suları altında kalma tehdidinden kurtarılmıştır. Er Rızk Camii Minaresi taşıma çalışmaları kapsamında farklı seviyelerinden elde edilen taş ve derz/moloz dolgu harç örnekleri, çeşitli analitik metotlar kullanılarak arkeometrik yönden incelenmiştir. Er Rızk Camii Minaresi’ne ait taş ve harç örnekler öncelikle görsel olarak değerlendirildikten sonra fotoğraflanarak belgelenmiş ve kodlanmıştır. Arkeometrik çalışmalar kapsamında taş ve harç örneklerin fiziksel özellikleri temel fiziksel testlerle (birim hacim ağırlığı, su tutma kapasitesi ve gözeneklilikleri), suda çözünen tuz miktarı ile pH değerleri de kondaktometrik analiz ile belirlenmiştir. Harç örneklere, agrega/bağlayıcı ve agregada tane boyutu dağılımı (granülometrik) analizi uygulanmıştır. Örneklerin petrografik özellikleri, ince kesitleri hazırlanıp optik mikroskop analizi ile, kimyasal özelikleri de PED-XRF analizi ile belirlenmiştir.

Sharing clinical and radiological results in patients with degenerative lumbar scoliosis (DLS) treated surgically with dynamic system and describing an alternative technique for scoliosis correction. Between 2013 and 2018, 48 patients with flexible degenerative lumbar scoliosis (DLS) were operated with dynamic stabilization with Polyetheretherketone Rod (PEEK rod) after rigid rod application. Preoperative and postoperative scoliosis angles (standing and supine ) were statistically compared. Preoperative and postoperative low back pain (LBP) Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared. In addition, preoperative C7 Sagittal Vertical Axis (SVA) values and lumbar lordosis angles were compared with postoperative values. The mean follow-up period of the patients was 48.3 months (range 30–76), the mean age was 67.08 (range 49–84). While the average Cobb angle of all patients was 9.65 in preoperative supine position, the average Cobb angle with standing position was 19.73. The mean standing Cobb angle of the patients after surgery was 3.52. The mean Cobb angle in the supine position after surgery was 3.02. The difference between the preoperative and postoperative patients' Cobb angles in standing and supine position were statistically significant (p:0,000, p:0,000, respectively). The differences of VAS and ODI scores between preoperative and postoperative period were statistically significantly (p:0,000, p:0,000; respectively). Especially in patients with flexible LDS, the technique we have defined and dynamic stabilization with PEEK rod provides significant correction. There was no loss of correction in our patients during postoperative follow-up period. PEEK rod is insufficient for lordosis increase and correction of SVA values.

The aim of this study is to investigate the combination of cefepime and sulbactam. Sulbactam, when administered , will effectively inhibit all Extended-spectrum beta lactamases (ESBLs) of the microorganism, while cefepime will inhibit the growth of the resistant microorganisms since it will not be hydrolyzed by OXA-48. Forty OXA-48-producingK. pneumoniaestrains were investigated for their Minimum inhibitory concentrations (MICs) for carbapenems, cefepime, and cefepime + sulbactam by broth microdilution method. Also, the mutant prevention concentration (MPC)s of cefepime alone or in combination with sulbactam was determined. Additionally, the bactericidal activities of cefepime and cefepime + sulbactam were evaluated by the time-kill curve (TKC) assay against selected strains. Also, the in vitro synergistic activity of cefepime + sulbactam combination was determined by TKC. Based on MIC results, up to 35/40 and 34/40 of the strains were resistant to carbapenems and cefepime, respectively. Cefepime + sulbactam MIC range was lower than those for cefepime alone against all the studied isolates. Moreover, cefepime + sulbactam combination presented lower MPC values than cefepime alone. The synergistic interactions of cefepime + sulbactam were also achieved against studied strains at 24 h. No antagonism was observed against studiedK. pneumoniaestrains. The findings of this study displayed that cefepime + sulbactam combination had synergistic or additive effect against OXA-48-producingK. pneumoniaestrains. Additionally, it was first observed that this combination could display a lower MPC than cefepime alone. Further investigations may be helpful for understanding the effectiveness of cefepime + sulbactam combinations for OXA-48-positive carbapenem-resistantK. pneumoniaeisolates. Istanbul University

Metal pressure under farm conditions was examined on the gill and muscle tissues of farmed Sparus aurata and compared with their wild counterparts (Sparus aurata, Trachurus trachurus, Mullus barbatus). Al, Mn, Cd, Co, Cr, Cu, Ni, Pb and Zn accumulation amounts in gill tissue of farmed fish were 28.821, 37.620, 0.136, 0.300, 3.730, 2.441, 3.222, 2.474 and 127.494 mg/kg respectively. Among them, Cd, Cr, Cu and Pb concentrations in gill tissue of farmed fish were higher than that in wild fishes. Metal depositions in muscle tissue of farmed fish were far below that in the gill tissue. The accumulated Al (6.700 mg/kg) in the muscle tissue of farmed fish was higher than in wild ones. The results showed that metal accumulation levels (especially Cd, Cr, Cu and Pb) in the gill tissue of farmed fish indicate metal pressure under captive conditions. Furthermore, the calculated hazard index (HI) and total hazard index (THI) of the considered elements in the edible part of farmed fish were below the level considered safe, which elucidates that farmed fish do not pose any threat to the human consumer in terms of metal toxicity.

Lung cancer is the leading cause of cancer-related deaths, worldwide. Despite immune checkpoint inhibitors and targeted therapy have revolutionized the treatment of metastatic nonsmall cell lung cancer (NSCLC), a significant proportion of patients are still treated with platinum-based chemotherapy. It is widely noticed that systemic inflammation plays an important role in the development and progression of many solid tumors. In this study, we aimed to analyze the predictive role of the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI) in patients with advanced NSCLC treated with first-line platinum-doublet chemotherapy.We retrospectively collected data of patients treated with first-line therapy for metastatic NSCLC. All patients were treated with first-line platinum-doublet chemotherapy. The patients were grouped based on the median values of SII, PNI, and NLR. The Mann-Whitney U test was used for comparisons between groups.The chemotherapy response rate (RR) was 75% in all patients. RR is statistically significantly lower in high SII, low PNI, and high NLR groups.High inflammatory indexes in metastatic NSCLC patients who were treated with platinum-doublet chemotherapy are related to low chemotherapy RR.

Introduction Immune checkpoint inhibitors (ICIs) are being commonly used to treat solid tumours such as renal cell carcinoma. Hypophysitis is an acute or chronic inflammation of the pituitary gland and nivolumab or pembrolizumab induced hypophysitis is markedly lower compared to ipilimumab. Case report We present a novel case of a patient with mRCC who was diagnosed with nivolumab induced hypophysitis based on clinical suspicion due to his hormonal profile and a range of symptoms that he developed during nivolumab immunotherapy. Management and outcome He was treated with high dose of hydrocortisone administered intravenously, subsequently changed to the oral route and physiologic dose. Discussion Nivolumab induced hypophysitis is a rare condition that usually presents with fewer symptoms. High degree of clinical suspicion and a multidisciplinary team required to diagnose and treat such cases.

In our study, we aimed to evaluate the pathological response rates and side effect profile of adding pertuzumab to the treatment of HER2+ locally advanced, inflammatory, or early-stage breast cancer. This study was conducted by the Turkish Oncology Group (TOG) with data collected from 32 centers. Our study was multicentric, and a total of 364 patients were included. The median age of the patients was 49 years (18-85 years). Two hundred fifteen (60%) of the cases were hormone receptor/HER2+ positive(ER+ or PR+, or both), and 149 (40%) of them were HER2-rich (ER and PR negative). The number of complete responses was 124 (54%) in the docetaxel+trastuzumab+pertuzumab arm and 102 (45%) in the paclitaxel+trastuzumab+pertuzumab arm, and there was no difference between the groups in terms of complete response. In 226 (62%) patients with complete response, a significant correlation was found with DCIS, tumor focality, removed lymph node, and ER status P < 0.05. Anemia, nausea, vomiting, myalgia, alopecia, and mucosal inflammation were significantly higher in the docetaxel arm, P < 0.05. In our study, no statistical difference was found between the before-after echocardiography values. DCIS positivity in biopsy before neoadjuvant chemotherapy, tumor focality; the number of lymph nodes removed and ER status were found to be associated with pCR. In conclusion, we think that studies evaluating pCR-related clinicopathological variables and radiological imaging features will play a critical role in the development of nonsurgical treatment approaches.

A 36-year-old male patient, who was an agricultural farmer and had a diagnosis of bicuspid aortic valve and coarctation, was admitted with symptoms of fever, fatigue, and shortness of breath that lasted for a month, in March 2017. Examination revealed dyspnea and bilateral rales and rhonchi in lung auscultation. A 3/6 systolic murmur was heard in the mesocardiac focus. The laboratory tests showed a white blood cell count of 15.14x10(3)/mu l, erythrocyte sedimentation rate of 36 mm/h, and C-reactive protein of 26 mg/l. An echocardiogram showed mobile vegetation (30x10 mm) on the aortic valve and severe aortic and tricuspid valve insufficiency. All blood cultures that are taken from the patient with the diagnosis of infective endocarditis were negative and C. burnetii phase I IgG antibody was positive at 1/32768 titer. As far as we know, herein, we present a case of endocarditis due to C. burnetii, which is the third case that is reported in Turkey. Q ateşi, Coxiella burnetii ’nin neden olduğu zoonotik bir hastalıktır. Çiftlik hayvanları insan enfeksiyonları için birincil rezervuarlardır. Akut Q ateşi genellikle grip benzeri bir hastalık olarak ortaya çıkar. Kronik formda ana klinik tablo endokardittir. Otuz altı yaşında erkek hasta, biküspit aort kapağı ve koarktasyon tanısı alan bir tarım çiftçisi, Mart 2017’de bir aydır devam eden ateş, yorgunluk ve nefes darlığı şikayetleri ile başvurdu. Fizik muayenede hasta dispneik olup, akciğer seslerinde bilateral ral ve ronküs mevcuttu. Mezokardiyak odakta 3/6 sistolik üfürüm duyuldu. Laboratuvar testlerinde lökosit 15,14x103 /µl, eritrosit sedimentasyon hızı 36 mm/saat, C-reaktif protein 26 mg/l idi. Ekokardiyogramda aort kapağında hareketli bir vejetasyon (30x10 mm), şiddetli aort ve triküspit kapak yetmezliği saptandı. Enfektif endokardit tanısıyla hastadan alınan tüm kan kültürleri negatif sonuçlandı. C. burnetii faz I IgG antikoru 1/32768 titrede pozitif geldi. Bu makalede bildiğimiz kadarıyla Türkiye’de bildirilen üçüncü olgu olan C. burnetii’ye bağlı endokardit vakasını sunduk.

Since pseudoarthrosis or screw loosening is frequently seen in lumbosacral stabilizations ending in S1, S2 screws are used more frequently to support S1 screws. This study aims to describe a new screw placement technique and location from S2. Revision surgery was applied to the patient who had previously undergone surgery with the rigid instrumentation system and encountered pseudoarthrosis during the follow-up period. Instrumentation was performed from S2 to the promontorium. The patient’s chronic low back pain arising due to pseudoarthrosis was reduced and a strong lumbosacral dynamic instrumentation was performed to the patient. Dual screw placement from S2 and/or screw placement in the S2-promontorium direction is a new alternative to provide a powerful instrumentation.

Background and aim: baricitinib is an inhibitor of Janus-associated kinase (JAK) subtypes 1 and 2 with various effects on intracellular signaling pathways. Approved for rheumatoid arthritis (RA), and recently used for severe COVID-19, the prevalence of infections associated with baricitinib treatment has not been widely reported. We aimed to analyze the prevalence of infectious side effects in patients treated with baricitinib. Methods: using the WHO global pharmacovigilance database (VigiBase), we carried out an extensive data analysis of approximately 300 patients treated with baricitinib. The prevalence of infectious side effects was our main focus. Patients treated with baricitinib for the indication of severe COVID-19 were excluded.Results: the most prevalent infectious side effect of baricitinib was oral herpes (IC025 of 4.36) and herpes zoster infection (IC025 of 4.159). On the contrary, gastrointestinal viral infections, infectious pleural effusions and various viral pneumonias had low prevalence rates (IC025 values of 0.173; 0.093; and 0.188, respectively). Conclusion: based on a big data analysis, baricitinib was associated with infectious complications where oral herpes and herpes zoster infections shown to be more prevalent than previously reported. The immunomodulatory effect of baricitinib including cytokine effects on immune cells and the inhibition of numerous growth factors and cytokines such as IL-2, suppressing both innate and adaptive immune responses, are the most comprehensive mechanisms behind such side effects. Given the clinical indications for baricitinib (RA) and the current use in severe COVID-19, cautious approach should be taken before introducing baricitinib particularly in immunosuppressed patients.

Nivolumab is a monoclonal antibody that binds to the programmed death-1 (PD-1) receptor and blocks its interaction with PD-L1 and PD-L2. High response rates have been achieved with its use in the treatment of metastatic renal cell carcinoma (mRCC). We aimed to determine a relationship between 18-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) performed before nivolumab treatment and treatment-related survival.Between 2014 and 2021, 32 patients who received nivolumab and had pretreatment 18F-FDG-PET/CT evaluation were included in this retrospective study. The total SUVmax (sum of SUVmax) of all tumoral foci and the lesion with the highest SUVmax value were recorded. The relationship of these values with progression-free survival (PFS) and overall survival (OS) was evaluated.The median highest SUVmax and sum of SUVmax values were found as 14.4 and 41.4, respectively. PFS and OS were longer in the group with a sum of SUVmax value below 41.4 compared to the group with a higher group (OS, median 9.52 vs. 4.2 months (p=0.018); PFS, median 9.6 vs. 3 months(p=0.003), respectively). In the group with the highest suv-max value below 14.4, PFS was evaluated as statistically significant compared to the higher group (PFS, median 16.74 vs. 3.3 months(p=0.004)), while OS was not found to be statistically significant (OS, median 25.45 vs. 16.74 months (p=0.110)).Our study showed that there might be a relationship between SUVmax values and PFS and OS. The SUVmax values before nivolumab treatment can be used to predict prognosis and survival in mRCC patients.

Platin-based chemotherapies are first-line treatment methods after surgery in bladder cancer. Recently, novel immunotherapies emerged after platin-based regimens. The purpose of this study was to evaluate the prognostic significance of microsatellite instability (MSI), tumor infiltrating lymphocytes (TILs) and programmed cell death ligand-1 (PD-L1) expression which are used as predictive biomarkers in immunotherapy.Clinical and pathological features of bladder cancer patients who underwent radical cystectomy were retrospectively analyzed from their records in this single-center study. PD-L1, PD-L1 on TIL, PMS2, MSH2, MSH6 and MLH1 immunohistochemistry staining were carried out to archieve resected tumor specimens of the eligible patients. MSI was evaluated according to existing of PMS2, MSH2, MSH6 and MLH1.MSI was high in 24.6% of 61 patients. PD-L1 expression on tumor cells and PD-L1 expression on TIL were positive in 14.8% and 16.4% of the patients, respectively. Intratumoral TIL rate was10% in 12 patients (19.7%). There was no statistically significant relationship between PD-L1, PD-L1 on TIL, MSI and TIL rate and patients' characteristics including sex, stage, pathologic grade and lymph node status. There was a positive trend between MSI-high patients and overall survival (OS) (p=0.089). Univariate analysis did not reveal any significant difference at 3-years OS with PD-L1 tumor expression and PD-L1 expression on TIL and TIL rate10% (p=0.822, p=0.638, p=0.318, respectively) Conclusion: This study revealed that there is a positive trend between OS and MSI but no prognostic significance of PD-L1 and TIL which are proven predictive biomarkers of immunotherapy in patients with bladder cancer.

Background Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case report A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient’s pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics. Conclusion Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.

Introduction Patients with distant metastatic melanoma has a poor prognosis, with a reported median survival time of six to eight months. In modern era, survival has prolonged with the immunotherapy and targeted therapy options. Potent and selective BRAF inhibitors have been developed that specifically inhibit mutated BRAF over other RAF kinases. Vemurafenib was the first selective tyrosine kinase inhibitor developed to target the V600E allele of BRAF-mutant melanoma. Case Report In this report, we present a case of BRAFV600E-mutant metastatic melanoma, which is being treated with vemurafenib monotherapy with complete response for about seven years. Management and Outcome The patient is still being treated with vemurafenib and radiologic complete response is ongoing for about seven years. Discussion Patients treated with BRAF inhibitors monotherapy had promising response rates and improvement in the progression-free survival and overall survival, but melanoma cells became resistant very quickly, affecting the progression. In this case, we present a case that has permanent response to vemurafenib monotherapy.

Televizyon, icat edildiği tarihten bu yana toplumsal etkisi açısından önemini koruyan bir kitle iletişim aracı olmuştur. Topluma yönelik farklı fonksiyonları olan televizyonun en önemli işlevi haber ve bilgi vermedir. Haber verme işlevi, televizyon için sonraları diğer işlevlerden biri olan eğlendirme işlevi ile karışmaya başlamış ve haber sunumları sunucu temelinde şekillenmeye başlamıştır. Bu bağlamda ilk olarak ABD’de ortaya çıkan “anchor” kavramı ana haber bültenlerine yeni bir soluk getirmiştir. Gün sonunda olup bitenleri öğrenmek için bireyler tarafından sıklıkla tercih edilen ana haber bültenleri aynı zamanda televizyon kanalları için de bir prestij göstergesidir. Bu nedenle televizyon kanalına karşı bireylerin birtakım yargılara varacağı ana haber bültenleri oldukça önemli görülmektedir. Ana haber bülteninde işlenen haber konuları, haber sıralaması, sunucunun haberi sunuş tarzı gibi unsurlar televizyon kanalının izlenmesi açısından belirleyici olabilmektedir. Bu çalışmanın amacı da ana haber bültenlerinde işlenen haber konuları ve haberin sunum tarzının reyting ile bir ilişkisi olup olmadığını belirtmektir. Çalışma, Türkiye’deki ana haber bültenlerinin toplum tarafından tercih edilme sebeplerini ortaya koyma açısından önem taşımaktadır. Bu bağlamda, Türkiye’de en çok izlenen ana haber bültenleri (haber konusu, haber sayısı, sunum şekli açısından ele alınarak) nitelik ve nicelik olarak içerik çözümlemesi yöntemiyle incelenmiş, ana haber bültenlerinde yayınlanan haberlerin konusu ve sunum şekli ile reyting oranları arasında bağlantı olduğu tespit edilmiştir.

In this study, natural radioactivity concentrations of fish feed and feed raw materials were assessed. Several feeds and raw materials were provided from the suppliers who dominate the aquaculture sector. ²²⁶Ra, ²³²Th and ⁴⁰K concentrations were determined by using a high‐purity germanium detector. The measured activity concentrations of samples ranged from 3.28 ± 0.27 to 15.90 ± 1.36, from 1.27 ± 0.10 to 12.07 ± 1.21 and from 52.01 ± 2.60 to 1,158.96 ± 54.42 Bq/kg for ²²⁶Ra, ²³²Th and ⁴⁰K respectively. The gamma dose rate and annual effective dose rate of samples were calculated to be in the range of 1.99–50.47 nGy/h and 2.44–61.89 µSv/yr respectively. Since the calculated radiological risk parameters of the samples were lower than the world wide average values, the radiation hazard is insignificant for human handlers.