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Background and Objectives: Robotic bariatric surgery is increasingly adopted by surgeons. We present the surgical results of 527 consecutive patients who underwent robotic Roux-en-Y gastric bypass (RYGB) using the standard technique.

Abundant procaviid fossils from archaeological contexts at Karain Cave, Antalya, Turkey, comprise the first record of this extant family of Hyracoidea outside Afro-Arabia. The relatively large body dimensions of the remains, which are attributed to Procavia capensis (the rock hyrax) indicate that the climate was relatively cool and humid, more so than the region where the nearest extant neighbours survive, the subspecies Procavia capensis syriaca, which is a smaller animal living in Syria, Lebanon, Jordan and Israel., Directorate of Antiquities, Turkey; TUBITAK Research Grant [YDABAG 102Y045], The authors are grateful to the reviewer Luis Alcala and an anonymous reviewer for their constructive revision of the manuscript. The Karain excavations were carried out on behalf of the T.C. Ministry of Culture and Tourism, Directorate of Antiquities, and the University of Ankara, Faculty of Language, History and Geography. Excavations were funded by the Directorate of Antiquities, Turkey. SM was funded by TUBITAK Research Grant YDABAG 102Y045.

Position-related brachial plexus injury may be diagnosed currently because of the rise in the number of laparoscopic colorectal surgeries being performed. The Trendelenburg position, which is necessary for laparoscopic and robotic surgeries, may lead to excessive pressure on the shoulders and thus cause brachial plexus injury. There are some risk factors like prolonged surgery and high BMI. Most patients recover with high-dose corticosteroid treatment and physical therapy. We report a case of brachial plexus injury caused by patient position during surgery.

Dalak infarktı özellikli bulguları olmayan,klinik şüphe olmadığı sürece tanısı çok zor konulan ve nadir görülen sessiz birklinik durumdur. Çoğunlukla sebebi tromboemboli veya hematolojik birhastalıktır. Genelde cerrahi müdahalegerektirmeden medikal tedavi ile tablo geriler. Literatürde sayılı olgubildirimleri mevcuttur ve tanı özellikle acil serviste nadiren akla gelipkonulabilir. Biz acil servise karın ağrısı şikayeti ile başvuran, atriyalfibrilasyonu olan ve dalak infarktı saptanan olgumuzu literatür taramasıeşliğinde tartışmak istedik., Spleen infarction is a rare, uncommonclinical condition that is difficult to diagnose unless clinical suspicion ispresent. It is mostly due to thromboembolism or hematologic disease. It usuallyregresses with medical treatment without surgical intervention. A small numberof case reports are available in the literature, and the diagnosis rarely comesinto mind, especially in the emergency department. We wanted to discuss a casewith atrial fibrillation and splenic infarction presenting to the emergencydepartment with abdominal pain.

Dünyada olduğu gibi Türkiye'de de temel eğitim amaçlarından biri milli kimlik oluşturmaktır. Lise ders programında milli kimliğin oluşturulmasında en etkili derslerden birisi tarih dersleridir. Bu nedenle tarih öğretmenleri milli kimlik ve aidiyet kavramları hakkında yeterli bilgi ve donanıma sahip olmalıdır. Araştırmada lise programında yer alan tarih derslerindeki ünite ve kazanımlar incelenerek kimlik ve aidiyet açısından analiz edilmiştir. Ardından kimlik ve aidiyet üzerine yapılan çalışmalar incelenerek sonuçları analiz edilmiştir. Çalışmada, Trabzon'da görev yapan tarih öğretmenlerinin kimlik ve aidiyet kavramlarına ilişkin görüşleri ortaya konulmuştur. Çalışmada nitel araştırma yöntemlerinden yarı yapılandırılmış görüşme veri toplama aracı olarak kullanılmıştır. Elde edilen veriler içerik analizi ile değerlendirilmiştir. Tarih dersini yürütmekte olan öğretmenlerin kimlik ve aidiyet kavramları hakkındaki görüşleri ayrıntılı bir şekilde incelenmiştir. Çalışma grubu olarak 20 öğretmen çalışmaya dahil edilmiştir. Öğretmenlere yöneltilen sorulardan elde edilen verilerin içerik analizi sonucunda öğretmen görüşleri ortaya çıkarılmıştır. Araştırmamızın sonunda, araştırmaya katılan öğretmenlerin, kimlik ve aidiyet kavramlarının tarih öğretiminde önemini bildikleri sonucuna varılmıştır. Öğretmenler kimlik ve aidiyet kavramlarının daha iyi algılanabilmesi için mevcut programların belirli periyotlarla gözden geçirilmesi gerektiğini vurgulamaktadır. Geliştirilecek programlarla öğrenciler tarihsel analiz becerilerini geliştirmek, tarihsel olaylarla bağlantılı analiz yapabilmek için milli kimlik ve aidiyet kavramlarının önemli olduğunu vurgulamışlardır. Katılımcıların kimlik-aidiyet kavramlarını derslerde öğretirken farklı yöntemlere başvurduğu görülmüştür. Tarih eğitiminin, kimlik ve aidiyet kavramlarını öğretmek için çok önemli bir unsur olarak kabul edildiği ortaya çıkmıştır. One of the essential educational objectives in Turkey as well to create national identity as in the world. One of the most effective courses in the formation of national identity in the high school curriculum is history courses. For this reason, history teachers should have sufficient knowledge and equipment about the concepts of national identity and belonging.In research, by examining units and achievements in history courses taking part in high school program were analyzed in terms of identity and belongingness. Then, by examining the studies on identity and belongingness and their results were analyzed. In research, the opinions of history teachers working in Trabzon about the concepts of identity and belongingness were revealed.In the study, semi-structured interview which is one of the qualitative research methods was used as the implement of collection data. The obtained were evaluated by content analysis. The opinions of the teachers who are conducting the history course about the concepts of identity and belonging were examined in detail. Twenty teachers were included in the study as researching group. In the result of the content analysis of the data obtained from the questions posed to the teachers, the opinions of the teachers were revealed.At the end of the our research, it was concluded that the teachers who participated in the research had known the importance of identity and belongingness concepts in history teaching. The teachers emphasize that the present programs should be reviewed with specific periods in order to better understand the concepts of identity and belongingness. With the programs to be developed, students emphasized that the concepts of national identity and belongingness are important in order to develop historical analysis skills and to make analysis in connection with historical events. It was observed that the participants applied different methods while teaching the concepts of identity-belongingness. It has emerged that history education is regarded as a very important factor in order to teach the concepts of identity and belongingness. 93

Bu çalışmanın amacı, Petty (1991, 1993) tarafından geliştirilen Mesleki İş Etiği Ölçeği’nin [Occupational Work Ethics Inventory, (OWEI)] geçerlilik ve güvenirlik analizinin yapmaktır. Bu amaçla, Akdeniz ve Güneydoğu Anadolu Bölgeleri’nde bulunan devlet ve vakıf üniversitelerinde çalışan 521 öğretim elemanına kolayda örnekleme yöntemiyle anket uygulanılarak veri elde edilmiştir. Verilerin analizinde, keşfedici faktör analizi ve doğrulayıcı faktör analizi ile iç tutarlılık analizleri kullanılmıştır. Bu çalışmada yapılan geçerlilik ve güvenirlik çalışmalarının sonuçları, ölçeğin orijinali için yapılan çalışmaların sonuçları ile oldukça benzerlik göstermiştir. Sonuç olarak bu ölçeğin, Türkiye’deki araştırmalarda kullanılabilecek düzeyde güvenilir ve geçerli bir ölçek olduğu bulgusu elde eldilmiştir.

Introduction: The aim of this study was to compare computed tomography (CT)- and positron emission tomography (PET)/CT-based gross tumor volume (GTV) delineation and its subsequent expansion to the planning target volume (PTV), and to analyze the resultant doses of 3-dimensional conformal radiotherapy (3D-CRT) to critical organs. Methods: 15 patients with unresectable extrahepatic cholangiocarcinoma (EHCC) were enrolled into this study. PTVCT-based plans were initially made, and then PTVPET-CT-based plans were created using the same beam angles and isocenter. The dosimetric parameters analyzed included GTVCT, PTVCT, GTVPET-CT and PTVPET-CT. Prescribed and delivered radiation doses to target volumes and delineated organs at risk were also compared. Results: Mean GTV and PTV were significantly reduced in the PET/CT-based plan compared to the CT-based plan; the mean reductions of GTV and PTV were 28.7% and 15.2%, respectively. The mean value for GTVPET/GTVCT mismatch was 49.5 ± 28.9%, and that for GTVCT/GTVPET was 95.9 ± 19.5%. The mean value for PTVPET-CT/PTVCT mismatch was 21.9 ± 7.0% and that for PTVCT/PTVPET-CT was 39.1 ± 9.2%. Liver doses were significantly reduced (17.1%) in the PET/CT-based plan compared to the CT-based plan; the doses received by at least 30% and 50% of the liver were 30.0%, and 27.3%, respectively. Conclusion: The potential benefit of PET/CT is the reduction in geographic misses and regional treatment failures associated with CT-based planning.

DergiPark: 284294 klujfeas Bu çalışmada, firma değerlemesi felsefi temelleriyle birlikte incelenerek en yaygın olarak kullanılan firma değerleme yöntemleri: firma değerinin indirgenmiş nakit akım yöntemine göre tespiti, firma değerinin göreceli değerlemeyöntemine göre tespiti ve firma değerinin ekonomik değer yöntemine göre tespiti teorik olarak incelenmiştir.

In this study, we investigated the shrinking effect of concurrent three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation (AD) on prostate volume, and its possible impact on the dose received by the rectum and bladder during the course of 3D-CRT. The difference between the prostatic volumes determined on pre-treatment planning CT (PL-CT) and post-treatment CT (PT-CT) following a 3D-CRT course was assessed in 52 patients with localised prostate carcinoma. The changes in mean prostate volume when compared with PL-CT and PT-CT-based measurements were assessed. The pre- and post-treatment mean prostate volumes for the whole study population were 49.7 cm(3) and 41.0 cm(3) (p _ 0.02), respectively. The study cohort was divided into two groups depending on the duration of neoadjuvant androgen deprivation (NAD): 23 patients (44.7%) were designated as "short NAD" (or =3 months; SNAD) and the remaining 29 (55.3%) as "long NAD" (3 months; LNAD). Patients on SNAD experienced a significantly greater reduction in prostate volume compared with those on LNAD (14.1% vs 5.1%; p _ 0.03). A significant increase in rectum V(40-60) values in PT-CT compared with PL-CT was demonstrated. LNAD patients had significantly higher rectal V(50-70) values at PT-CT compared with the SNAD group. There was a significant decline in V(30)-V(75) bladder values in PT-CT compared with PL-CT in the SNAD group. In conclusion, a higher prostate volume reduction during 3D-CRT was demonstrated when RT planning was performed within 3 months of NAD. However, this reduction and daily organ motion may lead to an unpredictable increase in rectal doses.

The purpose of this study was to evaluate the efficacy of oral glutamine in the prevention of acute radiation-induced esophagitis (ARIE) and weight loss in lung carcinoma patients, and to determine the clinical/dosimetric predictors of ARIE.Data from 41 patients with stage III lung carcinoma treated with thoracic irradiation were retrospectively analyzed. Twenty-two patients (53.6%) received prophylactic powdered glutamine in doses of 10g/8h. Prescribed radiation dose to planning target volume was 60Gy, in 30 fractions, 5 days/week. The primary endpoint included the ARIE incidence and its correlation with clinical/dosimetric factors relative to treatment with glutamine.Glutamine was well tolerated. Grade 2 or 3 ARIE occurred in 20 (48.8%) of 41 patients: seven in the glutamine-supplemented group, and 13 in the glutamine-free group (p=0.002). All seven patients with grade 3 esophagitis were in the glutamine-free group (36.8% vs. 0%). Glutamine supplementation appeared to significantly delay ARIE onset for six days (22 days vs. 16 days; p=0.002). Glutamine-supplemented patients demonstrated a lower incidence of grade 2 or 3 ARIE (27.2%), and gained weight during radiotherapy (p=0.04). V55 was the only dosimetric parameter that correlated with the severity of ARIE in glutamine-free patients: a V55 of35% had a 31% risk of ARIE grade 2 or 3, and the risk increased to 76% with a V55 ofor=35% (p=0.01).This schedule and dosage of glutamine may be beneficial in the prevention of ARIE and weight loss in lung cancer patients undergoing thoracic irradiation.

Purpose To determine the patterns of care for lung cancer in Turkish radiation oncology centers. Methods and Materials Questionnaire forms from 21 of 24 (87.5%) centers that responded were evaluated. Results The most frequent histology was non–small cell lung cancer (NSCLC) (81%). The most common postoperative radiotherapy (RT) indications were close/(+) surgical margins (95%) and presence of pN2 disease (91%). The most common indications for postoperative chemotherapy (CHT) were “≥ IB” disease (19%) and the presence of pN2 disease (19%). In Stage IIIA potentially resectable NSCLC, the most frequent treatment approach was neoadjuvant concomitant chemoradiotherapy (CHRT) (57%). In Stage IIIA unresectable and Stage IIIB disease, the most frequent approach was definitive concomitant CHRT (91%). In limited SCLC, the most common treatment approach was concomitant CHRT with cisplatin+etoposide for cycles 1–3, completion of CHT to cycles 4–6, and finally prophylactic cranial irradiation in patients with complete response (71%). Six cycles of cisplatin + etoposide CHT and palliative thoracic RT, when required, was the most commonly used treatment (81%) in extensive SCLC. Sixty-two percent of centers did not have endobronchial brachytherapy (EBB) facilities. Conclusion There is great variation in diagnostic testing, treatment strategies, indications for postoperative RT and CHT, RT features, and EBB availability for LC cases. To establish standards, national guidelines should be prepared using a multidisciplinary approach.

We compared the effects of amifostine and melatonin in preventing radiation-induced epiphyseal growth plate injury in rats.Four-week-old (65-85 g), growing male Sprague-Dawley rats were randomly assigned to receive radiation alone, at 25 Gy in three fractions (group R), or this dose of fractionated radiation proceeded by prophylactic amifostine 200 mg/kg i.p. (group A), melatonin 15 mg/kg i.p. (group M), or amifostine + melatonin (group AM). The right rear extremity of each animal was irradiated while the contralateral leg was shielded from radiation, as a control. Bone growth based on the length of the tibia, femur, and overall limb was calculated 6 weeks after the treatment.In groups R, A, M, and AM, the mean growth loss (GL) for the overall limb was 56.9 +/- 8.1%, 46.8 +/- 7.7%, 36.6 +/- 4.3%, and 38.5 +/- 5.1%, respectively. The limb length discrepancies (LLD) in groups R, A, M, and AM were 13.8 +/- 1.4%, 10.5 +/- 0.3%, 7.4 +/- 0.7%, and 8.8 +/- 1.1%, respectively. Differences in LLD were significant between each treatment group and group R (range: p = 0.0001-0.001). Differences in either of mean GL and LLD were not significant between groups M and AM; however both of these groups had significantly less GL and LLD than group A.We observed a superior radioprotective function of melatonin over amifostine in preventing radiation-induced epiphyseal growth plate injury, without any increase in radioprotective effect by adding amifostine to melatonin.

Tekno-tipolojik analizleri yapılmış olan Alt Paleolitik yontmataş buluntutopluluğu, düzeltisiz parçalar (%42,88), aletler (%45,28), çekirdek ve çekirdekparçalarından (%11,84) oluşmaktadır. Bunlar dışında 4184 adet yontma artığı tespitedilmiştir.Düzeltisiz parçalar büyük bir oranda (%94,80) basit yongalardanoluşmaktadır. Endüstri içerisinde Levallois tekniği tespit edilmemiştir. Düzeltisizparçaların büyük çoğunluğu düz topuklu, 90°'den büyük kopma açısına sahip vebelirgin vurma yumrulu parçalar içermektedir. Çekirdekler içerisinde ise baskıntipler hazırlanmamış ve şekilsiz çekirdeklerdir. Yongalama yönleri genelde çokyönlüdür.Yontmataş aletler içerisinde baskın grubu kenar kazıyıcılar ve dişlemelialetler oluşturmaktadır. Bunlar dışındaki temel tipler ise düzeltili yongalar, çontuklualetler ve bileşik aletlerdir. Ayrıca üç adet Acheulean tip iki yüzeyli alet tespitedilmiştir.G.Ö. 370 – 400 bin ve daha öncesindeki bir sürece ait olan yontmataşendüstrinin genel özelliklerine bakıldığında Acheulean ve Tayacian kültür öğelerinibir arada barındırdığı görülmektedir. The Lower Paleolithic chipped stone assemblage which analizied technotypologicallyconsist of unretouched pieces (%42,88), tools (%45,28), cores and corefragments (%11,84). Except these pieces, 4184 end-products were identified.Non-retouched pieces are mostly consist of simple flakes (%94,80). There isno evidence of Levallois Technology. Most of the non-retouched pieces have plainbutts, wider than 90° flaking angels and the pronounced bulbs. Among the cores, thedominant types are unprepared and amorphous cores. Flaking directions are usuallymulti-directional.Side scrapers and denticulates are the dominant types among the stone tools.Besides these, main types are retouched flakes, notches and combined tools. Alsothree Acheulean bifaces have detemined.It appears that Acheulean and Tayacian Culture elements are exist togetherwhen exemined the general characteristics of the chipped stone industry in 370 – 400Ka and previous years before present. 292

Background: Ras oncogenes are found in 25% of human tumors and they significantly affect prognosis. One of the major fields studied to improve anticancer drugs is blockade of the oncogenic ras protein function. One of the mechanisms to block the function of these proteins is to block farnesylation using a farnesyl transferase inhibitor (FTI) and thus to prevent the ras from anchoring to the cell membrane. Methods: In this study, we investigated the effects of FTI L-744,832 either alone or in combination with 5-fluorouracil (5-FU; 1 µM/l) and radiotherapy (2, 6, and 10 Gy) on the colon cancer cell line DLD-1 with mutations in K-, N- and H-ras, c-myb, c-myc, p53, fos, sis and DNA repair genes. Drugs were added 3 h after cultivation. Radiotherapy was performed on the 3rd day of the study. On the 3rd day, medium and drugs were changed. Evaluations were performed on the 6th day. Results: Administration of L-744,832, neither alone nor its combination with 5-FU and radiation, affected the number of DLD-1 cells and apoptosis rates. Regarding its effects on the cell cycle, L-744,832 was shown to lead to G₀/G1 and G2/M accumulation in a dose-dependent manner when administered alone. However, in combination with 5-FU, only a G₀/G1 accumulation was observed. Conclusion: Our study showed that FTI L-744,832 does not effect the cell number and apoptosis rate of DLD-1 cells and it cannot overcome 5-FU and radiation resistance, although it is able to modify some phases of the cell cycle.

An unusual case of a lytic, expanding lesion of the manubrium with histological diagnosis of aneurysmal bone cyst in a 13-year-old girl is presented. After a recurrence following primary surgery, the patient was treated successfully by external beam radiotherapy. A total dose of 25.2 Gy was delivered using conventional fractionation (1.8 Gy day(-1)) to the whole sternum. She remains recurrence- and symptom-free 46 months after the end of the treatment. This is the sixth patient with primary aneurysmal bone cyst in the sternal region, the first paediatric patient for this location, and the first case of its kind treated exclusively by radiotherapy ever reported in the literature. The histopathological, radiological and clinical findings of the patient are presented, relevant literature is reviewed, and radiotherapeutic management of such lesions is discussed.

Primary spinal primitive neuroectodermal tumor (PNET) is a rare condition, 18 cases of which have been reported in the literature. In general, this tumor is treated with surgery followed by radiotherapy and chemotherapy, but prognosis is still poor. An 18-year-old female patient with an intradural, extramedullary mass at L3-L5 levels is presented in this report. This is the first female patient with primary spinal PNET at lumbar region, second patient with spinal nerve root origin, and third one with intradural, extramedullary localization ever reported in the literature. After surgery, she was treated with craniospinal radiotherapy and four cycles of combination chemotherapy regimen consisting of vincristine, cyclophosphamide, doxorubicin alternated with ifosfamide, and VP-16. Currently, she is asymptomatic and alive at 25 months. The histopathologic, radiologic, and clinical findings of the patient are presented and relevant literature is reviewed.

Purpose: To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of twice-weekly gemcitabine (TW-G) when administered in conjunction with fixed dose amifostine (A) during external radiotherapy (RT) in patients with advanced pancreatic cancer. Methods and Materials: Ten patients with previously untreated, locally advanced, or asymptomatic-metastatic pancreatic adenocarcinoma were enrolled in this study. RT was delivered by using the standard four-field technique (1.8 Gy daily fractions, 45 Gy followed by a boost of 5.4 Gy, in 5-1/2 weeks). The starting dose of TW-G was 60 mg/m 2 (i.v., 30-min infusion), which is equal to the upper limit of previously reported MTD of TW-G when given without A during RT. A was given just before the TW-G, at a fixed dose of 340 mg/m 2 (i.v., rapid infusion). TW-G doses were escalated by 30-mg/m 2 increments in successive cohorts of 3 to 6 additional patients until DLT was observed. Toxicities were graded using the Radiation Therapy Oncology Group and National Cancer Institute Common Toxicity Criteria, version 2.0. Results: In general, therapy was well tolerated in patients treated at the first two dose levels of 60 mg/m 2 and 90 mg/m 2 . The DLT of TW-G given in conjunction with A during RT were neutropenia, thrombocytopenia, and nausea/vomiting at the dose level of 120 mg/m 2 . Of the 10 patients eligible for a median follow-up of 10 months, 5 remain alive; 1 complete responder, 3 partial responders, and 1 with stable disease. Conclusion: A dose of TW-G at a level of 90 mg/m 2 produced tolerable toxicity and it may possess significant activity when delivered in conjunction with 340 mg/m 2 dose of A during RT of the upper abdomen. Due to the higher MTD of TW-G seen in our study, we consider that the A supplementation may optimize the therapeutic index of TW-G-based chemoradiotherapy protocols in patients with pancreatic carcinoma.

Background: Leptin is a peptide hormone that has a role in the regulation of body weight and has effects on metabolic, neuroendocrine, reproductive and hematopoietic systems. Breast cancer has also been associated with obesity and reproductive hormones, especially estradiol. Only a few studies have investigated the relation between plasma leptin and risk of breast cancer and only one study evaluated the effect of tamoxifen on leptin levels in patients with breast cancer. Methods: We investigated serum leptin levels in gender-, body mass index (BMI)- and agematched breast cancer patients and healthy individuals (58 of each). Results: Serum leptin levels were measured by radioimmunoassay (Human Leptin RIA Kit). Serum leptin levels in the breast cancer patients were significantly higher than those in the control group (27.00 versus 17.65 ng/ml, p = 0.019). There were no differences with respect to BMI and age between control and breast cancer patients. There were no significant differences in BMI and leptin levels between pre- and postmenopausal patients (27.00 ± 1.39 and 27.19 ± 0.81 kg/m 2 , 26.81 ± 6.25 and 27.06 ± 2.98 ng/ml) (p > 0.05). We found no difference in serum leptin level between early and late stages of patients (22.38 versus 31.30 ng/ml, p = 0.086). However, the serum leptin level in patients using tamoxifen was significantly higher than that of patients not using tamoxifen (32.71 and 19.39 ng/ml, respectively p = 0.009). There was no correlation between CA 15-3 and leptin level (r = 0.069, p = 0.610). Conclusion: High serum leptin levels seen in breast cancer patients are not related to stage of the disease or to cancer itself but may be associated with the use of tamoxifen.