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Aim: To investigate the association between menstrual cycle regularity in healthcare providers and COVID-19 pandemic-related anxiety, depression, stress. Methods: A cross-sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18–40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID-19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS-21). Results: A total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18–40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS-21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score. Conclusion: The current study showed the association between the COVID-19 pandemic-induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.

Introduction: Sclerostin is an anti-anabolic protein synthesized by osteocytes that may cause osteoporosis by inhibiting bone formation. The aim of our study was to investigate the correlation between sclerostin and bone mineral density (BMD) reduction in renal transplant recipients (RTRs) with more than 1 year after transplantation. Material and methods: This cross-sectional study was conducted on 80 patients (38 (47.5%) male/42 (52.5%) female) RTRs with a mean age of 44.68 ± 10.39 years. Patients were compared with an age and sex-matched control group of 40 healthy individuals. BMD was measured by dual-energy X-ray absorptiometry. The levels of sclerostin were determined using enzyme-linked immunosorbent assay. Results: The mean sclerostin was 3.77 ± 0.3 pg/mL in patients and 3.81 ± 0.21 pg/mL in healthy individuals. The mean T score of femoral trochanter (FT) (FT-T), femoral neck (FN) (FN-T), lumbar vertebrae (L1-4) (L1-4-T) were −0.81 ± 0.86, −1.08 ± 1.09 and −0.8 ± 1.2, respectively. The mean Z score of FT (FT-Z), FN (FN-Z), L1-4 (L1-4-Z) were −0.6 ± 0.73, −0.32 ± 0.9 and −0.54 ± 1.13, respectively. FT-Z and L1-4-Z were lower in patients than healthy subjects (p = 0.009, p = 0.021 respectively). Serum creatinine (p 3.84 pg/mL had higher FT-T (p = 0.040), FT-Z, FN-T (p = 0.018), FN-Z (p = 0.006) than those with a log10 sclerostin of ≤3.84 pg/mL. There was a significant correlation between log10 sclerostin and FN-T (r = −0.296, p = 0.009) and FN-Z (r = −0.269, p = 0.019). In linear regression analysis, high sclerostin was found to be correlated with male gender, lower FN-T and lower FN-Z independently of other risk factors. Conclusion: The levels of sclerostin can predict reduction of proximal femur BMD and development of mineral and bone disorder in RTRs. There was no difference in sclerostin levels between RTRs and healthy individuals. Resumen: Introducción: La esclerostina es una proteína con efecto antianabólico sintetizada por los osteocitos que puede causar osteoporosis al inhibir la formación de hueso. El objetivo de nuestro estudio fue investigar la correlación entre la esclerostina y la reducción de la densidad mineral ósea (DMO) en receptores de trasplante renal (RTR) más de un año después del trasplante. Materiales y métodos: Este estudio transversal se realizó en 80 pacientes (38 [47,5%] varones/42 [52,5%] mujeres) RTR con una edad media de 44,68 ± 10,39 años. Se comparó a los pacientes con un grupo de comparación emparejado por edad y sexo de 40 individuos sanos. La DMO se midió mediante absorciometría de rayos X de doble energía. Los niveles de esclerostina se determinaron utilizando un enzimoinmunoanálisis de adsorción. Resultados: El nivel medio de esclerostina fue de 3,77 ± 0,3 pg/ml en pacientes y 3,81 ± 0,21 pg/ml en individuos sanos. La puntuación T media del trocánter femoral (TF) (T-TF), del cuello femoral (CF) (T-CF), las vértebras lumbares (L1-4) (T-L1-4) fue de −0,81 ± 0,86, −1,08 ± 1,09 y −0,8 ± 1,2, respectivamente. La puntuación Z media del TF (Z-TF), CF (Z-CF), L1-4 (Z-L1-4) fue de –0,6 ± 0,73, −0,32 ± 0,9 y −0,54 ± 1,13, respectivamente. Las puntuaciones Z-TF y Z-L1-4 fueron inferiores en los pacientes que en los sujetos sanos (p = 0,009 y p = 0,021, respectivamente). Los niveles de creatinina sérica (p 3,84 pg/ml tuvieron puntuaciones T-TF (p = 0,040), Z-TF, T-CF (p = 0,018), Z-CF (p = 0,006) superiores a las de los pacientes con un log10 esclerostina ≤3,84 pg/ml. Se observó una correlación significativa entre log10 esclerostina y T-CF (r = −0,296, p = 0,009) y Z-CF (r = −0,269, p = 0,019). En el análisis de regresión lineal, se observó que los niveles elevados de esclerostina estaban correlacionados con el sexo masculino, una puntuación T-CF inferior y una puntuación Z-CF inferior independientemente de otros factores de riesgo. Conclusión: Los niveles de esclerostina pueden predecir la reducción de la DMO del fémur proximal y el desarrollo de un trastorno mineral y óseo en RTR. No se observaron diferencias en los niveles de esclerostina entre los RTR y los individuos sanos.

Nearly 50% of patients with metastatic melanoma harbor a BRAFV600-mutation, which can be targeted with the use of BRAF and MEK inhibitors, either in the front-line or treatment-refractory setting. Encorafenib is the newest BRAF-inhibitor to have received FDA-approval in combination with the MEK inhibitor binimetinib.The authors provide an overview of the preclinical development and the clinical trials that led to the use of encorafenib in BRAFV600-mutant melanoma. They also give discussion on its current use in clinical practice, providing their expert perspectives on the subject.Preclinical research has provided strong rationale for upgrading encorafenib investigation into clinical development/testing. However, there is not yet enough data to determine where encorafenib may fit in comparison to other drugs in the same class, and ongoing trials will further define its role in the treatment of melanoma. Of note, there are ongoing studies that further explore the role of encorafenib + binimetinib such as in combination regimens with immunotherapy drugs, and in brain metastases.

Chronic post-thrombotic occlusion of the iliofemoral veins causes significant morbidity, which can be alleviated if venous drainage is restored. We report our technique of surgical endophlebectomy and patchplasty of the common femoral vein (CFV) in conjunction with iliac vein stenting to restore venous flow from the infrainguinal venous system to the vena cava.There were 157 patients who underwent CFV endophlebectomy combined with iliocaval recanalization. Questionnaires were completed both preoperatively and postoperatively to allow comparison. These included the Clinical, Etiology, Anatomy, and Pathophysiology clinical classification; the Venous Clinical Severity Score; the Villalta scale; the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms; and the 36-Item Short Form Health Survey quality of life questionnaire.Mean follow-up duration was 14.4 ± 2.9 months (range, 10-29 months). The mean preoperative Venous Clinical Severity Score was 15.3 ± 2.2, and this fell to 6.1 ± 1.8 after treatment (P .001). The mean preoperative Villalta score dropped from 12.7 ± 2.6 to 6.3 ± 1.4 (P .001). The quality of life and symptom severity scores were improved after 3 months by 17.2 points for quality of life (P .001) and 20.5 points for symptom severity (P .001). Primary patency was 81% (124/153) and secondary patency was 89.5% (137/153) at 12 months. Wound complications related to groin incision and lymphatic fistulas were observed in 22.8% (35/153) and 28.7% (44/153), respectively.The hybrid operation of CFV endophlebectomy in conjunction with iliac vein recanalization should be considered a safe and effective treatment option in patients with severe post-thrombotic syndrome and iliofemoral veno-occlusive disease.

Introduction: Breast cancer is one of the most common malignancy that metastases to brain with the risk of 10-16%. Brain metastasis has been reported to be more common among younger women with tumors larger diameter and higher grade, hormone negative and HER2 positive ones. We reviewed inhere treatment of patients with brain metastasis without extracranial metastasis of HER-2 positive breast cancer. Patients and Method: Totally 470 HER2 positive breast cancer patients were evacuated and treatment and clinicopathological factors of 20 patients with brain progression without extracranial metastasis were revised retrospectively. Overall survival (OS) and progression free survival (PFS)and related factors were analysed with univariate analysis. Results: Median survival could not to be reached but, 3 years survival rate was 77% and median PFS was 16.1 months. Brain metastasis were treated with surgery followed with radiotherapy among 9 patients (45%) and only with radiotherapy other 11 (55%) patients. While nearly half of the patients received trastuzumab based therapy after local treatment, lapatinib-capecitabine were given to 7 (35%) and TDM-1 to 4 (20%) patients. There is no significant relation with anti-HER2 therapy in respect to OS or PFS. Conclusion: Although anti-HER2 therapy has known to be improve prognosis of HER-2 positive breast cancer with brain metastasis, there is no consensus which therapy is better. Treatment option can be based adverse effect, patient performance or cost-effectiveness until in the future prospectively designed study related the anti-HER2 therapy after local brain therapy will be come up.

The direct effect of fungi on human health makes the fungal diversity in the air an important and necessary subject for examination. Studies that determine fungal diversity generally depends on culture methods. Developed culture-independent methods eliminate many disadvantages of existing culture-dependent methods. In our study, duplicate air samples were collected on 5 different days at a Microbiology Research Laboratory to compare these methods. Samples were collected in 3 different groups: (A) culture method and ITS-targeted Sanger DNA sequencing with 100 L samples, (B) culture method and ITS-targeted Sanger DNA sequencing with 1000 L samples, (C) filter method and next generation sequencing with 1000 L air sample. The Groups A, B and C defines culture, isolation and SANGER DNA-based methods, culture and next generation sequencing methods and directly next generation sequencing methods, respectively. Method-A failed to represent real fungal diversity. Method-B did represent the diversity but did not truly represent relative abundance of the species. Method-C can be completed in 2 days whereas Method-A and B can be completed in 2 weeks and 1 week, respectively. In conclusion, we recommend direct DNA isolation which is followed by ITS-targeted NGS in order to study fungal diversity in indoor air environments.

Background: Breast cancer is the most common type of cancer among women in the world. Neoadjuvant chemotherapy is the standard treatment modality in locally advanced disease. Pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance to predict complete response in locally advanced breast cancer patient who underwent neoadjuvant treatment. Method: Data from 55 non-diabetic, locally advanced breast cancer patients, treated with neoadjuvant chemotherapy between 2015-2017, were retrospectively evaluated. Demographic and clinicopathologic findings were analyzed. HOMA-IR was calculated by using obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (Fasting insulin x Fasting glucose / 405). We considered cut-off of 2.5 for insulin resistance. All patients received taxane and anthracycline-based neoadjuvant chemotherapy and then were operated within an average of 4-10 weeks. Findings were analyzed using SPSS. BMI, menopausal status, clinical stage, pathological receptor subtype, Ki-67 index, grade, and insulin resistance have been assessed the effects on pathological complete response status by the Logistic Regression. Results: At the time of diagnosis, the median age was 48.5 (min 27-max 80) years. Twenty-five patients had no insulin resistance. Most common pathologic subtype was hormone receptor positive, Her-2 negative invasive ductal carcinoma. Baseline demographics and disease characteristics are outlined in Table 1. Sixteen (29%) patients had pCR. Of these 16 patients with pCR, 5 (16%) had insulin resistance and 11 (44%) did not. There was a statistically significant difference between the two groups. Insulin resistance was significantly associated with lower pCR rate. We found that patients with insulin resistance had a 3.9 times lower probability of pCR than patients without insulin resistance [OR: 3.9, 95%CI:(1.1 - 13.6); p=0.02]. Conclusion: Our results reveal that insulin resistance might be a predictive biomarker for pCR in breast cancer who underwent neoadjuvant treatment. Molecular mechanisms for these associations are not well known, therefore more comprehensive and prospective studies are needed. Table 1: Baseline demographic and clinical findingsAll patients (n=55)Insulin ResistancepYes (n=30)No (n=25)Age (median) (min-max)48.5 (27-80)52 (29-80)45 (27-66)0.06BMI (median) (min-max)29.6 (18.92-43.4)33.25 (18.92-43.4)27.01 (21-35.2)0.015Waist circumference100 (56-116)100 (56-116)89 (56-106)0.7Hip circumference108 (58-134)110 (58-134)106 (95-120)0.5Fasting Glucose Level99 (72-126)103 (82-126)91 (72-115)0.003HDL57 (24-96)55 (24-83)59 (40-96)0.07LDL124 (51-219)120 (51-198)139 (61-219)0.6Total Cholesterol215 (117-314)205 (117-298)218 (127-314)0.5Trigliseride98 (56-467)121 (58-467)89 (56-164)0.007White Blood Cell6700 (3100-11100)7550 (4100-11100)6100 (3100-8900)0.004Sedimentation Rate31 (8-78)33 (9-58)27 (8-78)0.2CRP3.4 (1.59-43)4.3 (2-43)3.3 (1.5-12.5)0.01Menopause Status (n) (%)Premenopause32 (58%)16 (53%)16 (69%)0.4Postmenopause23 (42%)14 (47%)9 (31%)Clinical Stage2A9 (16%)7 (23%)2 (8%)0.22B18 (32%)10 (33%)8 (32%)3A20 (36%)8 (27%)12 (48%)3B7 (14%)5 (17%)2 (8%)3C1 (2%)01 (4%)Pathologic subtypeInvaziv ductal44 (80%)26 (87%)18 (72%)0.8Invaziv lobular5 (9%)1 (3%)4 (16%)Others6 (11%)3 (10%)3 (12%)Receptor StatusHR+, HER2-31 (56%)17 (56%)14 (56%)0.7HR-, HER 2 +7 (13%)5 (16%)2 (8%)HR+, HER2+9 (16%)4 (14%)5 (20%)HR-, HER2-8 (15%)4 (14%)4 (16%)Ki-67 index≤ 1513 (23%)11 (37%)2 (8%)0.01> 1537 (67%)19 (63%)23(92%)GradeGrade 111 (20%)11 (37%)0 Citation Format: Ozkan Alan, Tugba Akin Telli, Bilge Aktas, Sinan Koca, Ilker N Ökten, Tugba Basoglu Tuylu, Nazim C Demircan, Rukiye Arikan, Ozlem Ercelep, Mustafa U Ugurlu, Handan Kaya, Serap Kaya, Nalan Akgul Babacan, Faysal Dane, Perran F Yumuk. Does insulin resistance predict complete response in breast cancer patients who underwent neoadjuvant treatment? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-18.

The main goal of this research is to investigate the physical structure of space plasma around the Moon. The moon, which is an obstacle in front of the solar wind, surrounds by solar wind plasma and this plasma displays different physical characteristics on the day and night sides of the Moon. The properties of this plasma surrounding the Moon, the behavior of the lunar wake, and how it depends on the solar wind parameters have not been revealed yet. For this purpose, ARTEMIS spacecraft have been placed in orbits to provide a more precise understanding of the physical structure of the plasma around the moon. In this study, we examined the similarities and differences of the lunar wake behavior when the Moon is inside and outside of the magnetosphere via ARTEMIS spacecraft, when one of the spacecraft takes measurements in the lunar wake while the other directly takes solar wind data.

Introduction: Ado-trastuzumab emtansine (T-DM1) is an antibody–drug conjugate and its survival advantage has been shown in advanced human epidermal growth factor receptor 2 (HER2)–positive breast cancer. However, clinical trials underrepresent patients ⩾65 years of age, leading to a lack of information in this population. We analyzed the real-world outcomes of older women who were treated with T-DM1 therapy. Methods: We performed a multicenter, observational, retrospective analysis of patients aged ⩾65 years treated with T-DM1. A total of 93 patients from 10 cancer centers were involved in the study. Our goal was to determine the survival, response rates, and toxicity profile in T-DM1–treated patients, as well as the factors that influence survival. Results: Median follow-up was 12.2 months. Objective response rate was 29%. Median progression-free survival (PFS) and overall survival (OS) were 8.47 and 15.0 months, respectively. In multivariate analysis, Eastern Cooperative Oncology Group Performance Score 2 was found to be an independent prognostic factor for worse PFS (hazard ratio [HR] 1.81, p = 0.032) and OS (HR 2.33, p = 0.006). Any adverse event (AE) was seen in 92.5% of patients; grade 3 or 4 AEs were seen in 30.1%. Dose reduction or treatment discontinuation rates were 11.8% and 6.5%, respectively. Conclusion: The efficacy of T-DM1 was acceptable and it was generally well-tolerated among older patients with advanced HER2-positive breast cancer.

Purpose Neoadjuvant chemotherapy is the standard front-line treatment modality in locally advanced breast cancer. Achieving pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as the skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance, body mass index (BMI), metabolic syndrome, and inflammation markers to predict complete response in breast cancer patients who underwent neoadjuvant treatment. Methods Data from 55 locally advanced non-diabetic breast cancer patients, treated with neoadjuvant chemotherapy between 2015 and 2017, were retrospectively evaluated. Homeostatic model assessment, IR = insulin resistance (HOMA-IR) was calculated by using the obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (fasting insulin × fasting glucose/405). We considered a cut-off of 2.5 for insulin resistance. The systemic inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Results Twenty-five patients had no insulin resistance. The most common pathologic subtype (56%) was hormone receptor (HR) positive and human epidermal growth factor receptor-2 (Her-2)-negative invasive ductal carcinoma. Sixteen (29%) patients had a pathological complete response (pCR). We found that the probability of pCR in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [OR: 4.7 (95%CI 1.7–17.2), p = 0.01]. Conclusion Our results revealed that insulin resistance may have a negative effect on pathological complete response (pCR) following neoadjuvant therapy particularly with hormone-positive and Her-2-negative cases of non-diabetic breast cancer.

Oral glucose tolerance testing (OGTT) is the recommended approach for the diagnosis of gestational diabetes mellitus (GDM). Leptin and chemerin are two examples of hormones from adipokine family, which mostly takes part in glucose metabolism and inflammatory processes. We aim to find a possible new and tolerable screening technique for GDM using salivary levels of leptin and chemerin.Saliva samples of pregnant patients, on their 24-28th weeks of gestation, are collectedELISA study for leptin showed an insignificant difference between patients with GDM and patients without where the values were 0.44 ± 0.33 and 0.34 ± 0.24 respectively (Leptin and chemerin can be detected in saliva. Chemerin levels are significantly higher in patients with GDM, thus this knowledge can be used to develop a new screening method for OGTT.

Preeclampsia (PE), which occurs in approximately 5% of pregnancies worldwide and constitutes clinically serious complications in 2–3%, is one of the leading causes of maternal and prenatal morbidit...

The connection between education and technology offers an exciting opportunity for universities to utilize social media marketing activities not only to recruit new students or to create brand image and reputation, but also to enhance student satisfaction. Despite having a large number of studies indicating the importance of social media as a tool for student recruitment, the studies on the importance of social media marketing activities (SMMA) for students who are already enrolled are rare. This study aims at examining the relationship between SMMA and student satisfaction, considering perceived quality as a mediator in the higher education sector in North Cyprus. Utilizing a cross-sectional online survey, the data for this study was collected during October- November 2020 from 424 international students enrolled in North Cyprus universities. The model was assessed and the data was analyzed using Structural Equation Model (SEM) in AMOS statistical software. The findings suggest that SMMA has a positive relationship with the perceived quality of education, and perceived quality mediates the relationship between SMMA and student satisfaction positively.

OBJECTIVE As aneurysm-related events and rupture is not eliminated, postoperative lifelong surveillance is mandatory after endovascular aneurysm repair (EVAR). For surveillance colored Doppler ultrasound (CDUS) is a standard method of noninvasive evaluation having the advantages of availability, cost-effectiveness, and lack of nephrotoxicity and radiation. We evaluated CDUS for primary surveillance tool after elective EVAR by comparing with computerized tomography. METHODS Between January 2018 and March 2020, 84 consecutive post-EVAR patients were evaluated. First, CDUS was performed by two Doppler operators from the Radiology Department and then computed tomographic angiography (CTA) was performed. The operators were blind to CTA reports. A reporting protocol was organized for endoleak detection and largest aneurysm diameter. RESULTS Among 84 patients, there were 11 detected endoleaks (13.1%) with CTA and seven of them was detected with CDUS (r = .884, p

Background The new coronavirus disease (SARS-CoV-2) has caused more than 350,000 deaths worldwide. Thrombotic complications due to considerable inflammation, cytokine-mediated microvascular damage and pulmonary immunothrombosis formation seem to have emerged as an important issue in people infected with COVID-19. Methods This study reviewed consecutive symptomatic patients with proven COVID-19 infection admitted to Acibadem University Hospital in Istanbul, Turkey (15 March–25 May 2020). The primary outcome was any venous thromboembolic (VTE) complication. The secondary outcome was the incidence of subsegmental pulmonary embolism with or without deep vein thrombosis (DVT), which represented immunothrombosis development. Results The mean age was 55.7±17.4 years (range, 29–84); 224 (63.6%) were men. Of those patients, 12 (3.4%) died, 273 (77.5%) were discharged alive and 67 (19.1%) were still hospitalised as of 25 May 2020. Venous thromboembolic events occurred in 58 patients with a cumulative rate of 16.4% during the study period. The surprising discovery was that DVT was not identified in 20 (86.9%) of the 23 patients with subsegmental pulmonary embolism, which corroborated the pulmonary immunothrombosis theory. Conclusions The high incidence of VTE events suggests an important role of COVID-19-induced coagulopathy. Thus, repeated assessment and optimised treatment are necessary to reduce the occurrence of VTE and prevent fatal pulmonary embolism events. Further studies are needed to investigate the molecular mechanism of this immunothrombosis development.

Aim: To investigate etiology and prognostic significance of pontine tegmentum lesions accompanying a cluster of acute flaccid myelitis. Method: We retrospectively examined patients from 6 centers in Turkey who manifested encephalitis or myelitis associated with dorsal pontine lesions on magnetic resonance imaging (MRI) between July 2018 and February 2019. Results: Twenty-two patients were evaluated. Ten of 22 (45%) presented with acute paralysis and 12 of 22 (55%) with brainstem symptoms only. Reverse transcription polymerase chain reaction for enterovirus was positive in 2 patients’ respiratory tract. Other etiologic factors were detected in 10 cases. On follow-up, patients presenting with symptoms of myelitis developed motor sequalae although spinal cord lesions on MRI resolved in 5 of 9 (55%). Encephalitic symptoms, present in 17 cases, recovered in 13 (76%), and brain MRI showed complete or near-complete resolution in 11 of 14 (78%). Conclusion: Various etiologic agents can be detected in patients with pontine involvement, even in a series collected during an outbreak of EV-D68. Encephalitis has a fair outcome but clinical recovery is slow and motor sequalae are frequent in spinal involvement, irrespective of follow-up spinal MRI findings.

Aims: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. Methods: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients’ visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non‑respondents. Subgroups were compared statistically at the end of 12 months. Results: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non‑respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). Conclusion: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor originating from endothelial cells. Clinical aspect of the disease covers a wide spectrum from a low-grade tumor to a fatal cancer. Most common sites of EHE are reported as lung, liver and bone. Hepatic EHE (HEHE) is a clinical form with an incidence of less than 1 person in a million. Due to rarity of the disease, there is no standard therapy established. Surgery and liver transplantation still seem to be the best approach if possible. However, most of the patients present with unresectable or metastatic disease. Many conventional chemotherapeutic agents and antiangiogenic drugs have been reported previously in the literature with inconsistent outcomes. Here we report 4 cases of HEHE, who benefit distinctly from anti-VEGF treatments in different settings. While combination of paclitaxel and bevacizumab resulted in partial response in 3 patients, one of them also achieved long-term disease stabilization with bevacizumab maintenance with no adverse event. Two of the patients had clear benefit from pazopanib during the course of disease. One patient was treated with thalidomide for 18 months with stable disease, and is still being followed without any treatment. Although targeting VEGF-VEGFR pathway seems to be the best approach in HEHE, randomized studies are urgently needed to support these findings.

Objectives Determining boost volume (BV) during breast radiotherapy can be challenging at times. Therefore, surgical clips are now being widely used. At times, when surgical clips are inadequate in determining the BV, other additional imaging methods are required. In the present study, we aimed to demonstrate that pre-operative positron emission tomography/computed tomography (PET-CT) can be used to determine the BV after a breast-conversing surgery. Methods We selected thirty patients who underwent breast-conserving surgery with surgical clips and had preoperative Fluorine-18-Fluorodeoxyglucose PET (18 FDG PET/CT). The BV in planning tomography (CT) and primary tumor volume (TV) in pre-operative F-18 FDG PET/CT was contoured by a radiation oncologist. These two volumes were superposed using rigid image fusion. In every patient, two BVs were measured. The mean shift between the two volumes by the calculation of the center of mass and percentage of the PET-CT TV (PET-CT TV) in planning the BV (planning target volume [PTV]-BV) was calculated. Results The median age was 52 years (range 25-72 years). The pre-operative PET-CT TV median was 8.89 cm3 (range 1.00-64.30 cm3). The median PTV-BV was 62.92 cm3 (12.57-123.07 cm3). The median shifts between the center of volumes were 1.76 cm (range 0.90-3.50) in X(coronal), 1.73 cm (range 0.60-3.60) in the Y(axial), and 1.20 cm (0.40-2.80) in the Z(sagittal) directions, respectively. The shifts in these three planes were determined to be statistically significant (p

Background: Popliteal artery entrapment syndrome (PAES) is a very rare pathology that can cause lower extremity ischemia in healthy young people. Anomalous anatomic relationships between the popliteal artery (PA) and the surrounding musculo-tendinous structures cause PAES. We present 31 patients with PAES in 35 limbs that were treated surgically in our clinic within a 12-year period. Patients and Methods: From 2001 to 2015, 31 patients (mean age: 32 ± 7.4 years) underwent surgery for PAES. ; 4 patients presented had bilateral PAES. Doppler ultrasonography (US), magnetic resonance angiography (MRA), and conventional angiography were performed as diagnostic procedures. We detected Type I PAES in 4 limbs and Type II PAES in 12 limbs. In the remaining 19 limbs, we diagnosed Type III or Type IV PAES. Simple release of the PA, PA embolectomy and simple release, and the radial artery (RA) patch angioplasty, with or without thromboendarterectomy (TEA), were performed. In 12 limbs, PA continuity was provided by RA interposition. Results: With the exception of 5 patients, no complications were seen after surgery. Haematoma was detected in 2 patients and local infection in 2 patients. One patient required a revision for recurrent PA thromboembolic event 12 h after surgery. At a median follow- up of 23 months (range: 11-29 months), there were no postoperative complications. Conclusions: PAES can result in lower limb ischemia due to chronic vascular trauma in young healthy patients. The use of diagnostic tools such as US, a non-invasive method, and MRA are effective diagnostic tools for early diagnosis. With their combined approach, exact and early diagnosis can be achieved. PA release, alone or with arterial bypass using RA, is a viable treatment option when intervention is necessary to prevent limb loss in the early stages of the disease.

Backgrounds: Although the psychological effects of the COVID-19 pandemic have been investigated, there is no study comparing the effects between the peaks. This study aims to compare the levels of anxiety, depression, and stress of healthcare workers struggling with pandemic between the first and second peaks. Methods: A total of 2460 healthcare workers, 1051 from the first peak period and 1409 from the second peak period, were included in the study. The first peak measurements of the participants were made between 07.04.2020 and 05.05.2020 and the second peak measurements were made between 22.11.2020 and 20.12.2020 according to the peak period in Turkey. Depression-Anxiety-Stress-21(DASS-21) scale was applied to the participants online by the purpose of the study. Results: The mean age of the participants was 32.63 ± 7.70, and 66.5% of them were female. A statistically significant difference was found between the income status (p < 0.001), lifestyle (p < 0.001) and COVID-19 test result (p < 0.001), DASS-21 Depression (p < 0.001, t = -5.311), Anxiety (p < 0.001, t = -8.244), Stress (p < 0.001, -10.056) and total(p < 0.001, t = -8.719) scores of the two groups. Conclusion: The present study results showed that healthcare workers meticulously struggling with the pandemic had increased anxiety, depression, and stress levels at the second peak of the pandemic compared to the first peak.

This study evaluated whether subclinical myocardial dysfunction occurs in first-degree relatives of patients with idiopathic dilated cardiomyopathy (IDCM), using strain echocardiographic imaging, before apparent left ventricular (LV) failure is observed. The study comprised 77 subjects aged 16–63 years who had first-degree relatives with a previous or new diagnosis of IDCM. LV myocardial deformation parameters of the first-degree relatives with normal LVEF (≥55%) values, as assessed using 2D echocardiography, were evaluated. The findings of the first-degree relatives were compared with an age- and sex-matched control group (n = 86). No difference in terms of age, gender, and body surface area was detected between first-degree relatives and controls. First-degree relatives of IDCM patients had significantly lower LVEF (62.04 ± 5.8% vs. 65.65 ± 6.3%, p

Leiomyomasare benign mesenchymal tumors mostly seen in uterus. Uterin leiomyomas are oneof the most common reasons of pelvic masses seen in women whereas ovarianleiomyomas are so rare that among allbenign ovarian tumours it accounts only 0,5-1 %. It’s mostly seen between agesof 20-65 which premenopausal women consist %85 of them. In this case we wanted to present a 14 years old girl who was admitted to ourclinic with a 6 months history of lower quadrant abdominal pain. In theultrasonographic evaluation, there was a solid mass with uterin echogenityextending from posterior of uterus towards left adnexia with diameters of 6 cmx 5,5 cm. The origin of the tumor was unknown and could not be revealed withultrasonography nor MRI until diagnostic laparoscopy was performed. Ovariantumor was removed and the final pathology was compatible with leiomyoma.When we checked the literature there were only 5 cases of ovarian leiomyomareported under age of 20 and mostly they had bilateral character. The youngestage reported was 13. Our case is the second youngest of all reported cases andit shows a unilateral character. The other important aspect of our case is thatsometimes the imaging techniques can’t be adequate for detecting the origin oftumor., Leiomyomlarsıklıkla uterusta rastlanan benin mezenkimal tümörlerdir. Uterin leiomyomlarkadınlarda görülen pelvik kitlelerin en sık nedenlerinden olsa da over kaynaklıleiomyomlar oldukça nadir görülmektedir. Ovaryan leiomyomlar o kadar nadirgörülmektedir ki bütün over kaynaklı benin tümörlerin yalnızca %0,5 ila %1’inioluşturmaktadır. Genellikle 20-65 yaş grubunda görülmekte olup %85’inipremenopozal dönemdeki kadınlar oluşturmaktadır.Bu olgudakliniğimize 6 aydır devam eden alt kadran karın ağrısı nedeniyle başvuran 14yaşındaki bir kız çocuğunu sunduk. Ultrasonografik görüntülemede uterus arkaduvar komşuluğundan sol adneksiyal bölgeye uzanım gösteren, uterin ekojenitesiolan solid görünümde 6x5.5 cm çaplarında kitle izlendi. Kitlenin kaynağınınayrımı ultrason ve mr ile net belirlenememesi üzerine diagnostik laparoskopiuygulandı. Over kaynaklı olduğu görülen kitle çıkarılıp patolojiyegönderildiğinde nihai patoloji sonucu leiomyom ile uyumlu çıktı.Bildirilen vakalariçinde 14 yaşında olarak en genç ikinci vaka olma özelliği, genelderastlanandan farklı olarak unilateral karakter taşıması ile özellikli bir olguolduğunu düşünüyoruz. Ayrıca bazen görüntüleme tekniklerinin kitlenin kaynağınıbelirleme açısından yetersiz kalabildiği de bu olguda karşımıza çıkmıştır.

e16075 Background: Although the distribution in the world varies widely, renal cell carcinoma (RCC) is the ninth most common cancer, especially in males. It’s the seventh most common cancer in Turkey. In this study, the progression-free survival (PFS) and overall survival (OS) of patients with metastatic RCC (mRCC) who were treated at 13 centers in our country were evaluated and the efficacy of first-line treatment approaches was compared. Methods: Data of mRCC patients admitted to 13 outpatient clinics in Turkey between 2008 and 2018 were reviewed retrospectively. Demographic characteristics, pre-treatment clinical evaluations, information about treatment approaches and survival outcomes of the patients were collected. All medical records were collected by a detailed review of the patients’ charts. The median and percentage values were frequently signified for defining of central trends. Kaplan-Meier method was applied for OS analyzes and log-rank test with Cox-regression models were applied for the evaluation of prognostic factors. Results: Data from files of 262 patients were reviewed. Twelve of these patients were excluded from the study because they could not receive treatment due to comorbidities and other reasons at metastatic stage of the disease. Of the patients, 100 (40%) were female and 150 (60%) were male. Median age was 60 (range 21-83). For the entire group, the median PFS (mPFS) was 27.6 months and the median overall survival (mOS) was 46.1 months. In terms of first-line treatment of metastatic disease, 41.3% of the patients received sunitinib, 48.8% of the patients received pazopanib, 15.8% of the patients received other treatments. PFS of the patients receiving sunitinib, pazopanib and the other treatments were 26.3 months, 34.2 months and 14.2 months, respectively. There was no statistically significant difference between PFS of the patients receiving sunitinib and pazopanib (p = 0.05). mOS was 54 months in sunitinib arm, 54.9 months in pazopanib arm and 23.3 months in the other treatment arm. There was no statistically significant difference between two treatment agents in terms of mOS (p = 0.43). Conclusions: Pazopanib was more commonly prescribed in Turkey. There were no statistically significant differences between mPFS and mOS of the patients who received sunitinib and pazopanib for the first-line treatment of mRCC. With increased use of immunotherapeutic agents for the first-line treatment of mRCC in our country, improvement in mOS could be expected.

Aims: The present study aimed to evaluate the clinical usefulness of endoscopic treatment of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus and discuss the clinical features and outcomes of thirteen children treated at our institution. Method: We treated thirteen pediatric cases of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus between January 2012 and September 2018. Five female and eight male patients were enrolled in the study. The patients had increased intracranial pressure symptoms due to hydrocephaly. Endoscopic treatment was performed in all cases. Results: The patients were followed-up for an average of 36.8 months. The postoperative intracranial pressure findings improved. There was a reduction in the size of the cyst and ventricles and enlargement of the cortical sulci. One patient suffered transient oculomotor nerve deficit. No further surgical interventions, such as shunt placement, were required during the follow-up period. The head circumference of two of the patients with macrocephaly were stable during the follow-up. There were no postoperative recurrences detected. Conclusions: Endoscopic cyst fenestration and third ventriculostomy are less invasive, safer, and more effective ways to treat suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus in children with hydrocephaly.

Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery. Methods: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (T1), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level. Results: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p

dogan, ozan/0000-0002-0016-8749 WOS: 000438931800005 PubMed: 30084477 Objectives: Our aim is to evaluate the laboratory results arid proteinuria levels of preeclamptic women arid their relationships to maternal and fetal outcomes. Material and methods: One hundred preeclamptic pregnant women who gave birth in our clinic between 2013 and 2015 were included in our study retrospectively. The data collected from the patients included gestational week, age, gravidity, parity, abortus history, blood pressure, biochemical parameters, delivery method, maternal hospitalization time, cesarean indication, complications, blood products required, plasmapheresis use and dialysis need. The details about the newborns were recorded retrospectively. The relationships between preeclampsia signs and maternal and neonatal outcomes were analyzed. The protein amounts were analyzed via 24-hour collected urine analyses and spot urine analyses. Results: A statistically significant positive correlation was observed between neonatal intensive care unit needs and proteinuria levels. Fetal growth restriction, respiratory distress syndrome and sepsis were observed as the level of proteinuria increased, but the result was not statistically significant. Eclampsia was observed only in patients with massive proteinuria, and it was statistically significant. An increase in cesarean sections, placental abruptions, antihypertensive drug needs and blood product replacement rates was observed as the amount of proteinuria increased in preeclamptic women, but the results were not statistically significant. Conclusions: The severity of preeclampsia cannot be determined by the level of proteinuria. However, when massive proteinuria is detected, the clinician should be more cautious about maternal and fetal complications.

Methods: A total of 96 obese patients (mild-moderate and severe) who were being monitored in an obesity outpatient clinic, who had no concomitant disease and no history of smoking and drug use and 20 patients of normal weight with the same characteristics, as the control group, were included in the study. Anthropometric measurements were recorded, and BMI was calculated. Biochemical tests and total blood counts were performed. N/L ratio was obtained by dividing the neutrophil count by lymphocyte count. The results were evaluated using the SPSS statistical analysis program. Results: A significant increase was present in the neutrophil and lymphocyte counts of the morbid obese group compared to the control groups. Due to the increased neutrophil and lymphocyte counts, even though the L/N ratio increased, it was not statistically significant. The increase in total leukocyte count of morbid obese cases was statistically significant compared to mild obese cases. While N/L ratio demonstrated a strongly positive correlation with total leukocyte count and neutrophil count, it demonstrated a weakly positive correlation with waist circumference and with hip circumference. Conclusion: N/L ratio increases by obesity grade and reveals that the concomitant inflammatory response increases. A high count of circulating neutrophils in obese patients might be considered an acute inflammatory response to a chronic inflammatory state. Therefore, N/L ratio might be used as an inflammatory marker in obese patients and might be helpful in the prediction of cardiovascular and metabolic risks for the patient.

The restoration of historic buildings requires a comprehensive approach through a collaborative effort, as well as multi-disciplinary professionals. According to the general conservative guidelines of the Venice Charter of 1964 and the ICOMOS/ISCARSAH Recommendations for the Analysis and Restoration of Structures of Architectural Heritage of 2003, structural engineers are responsible for repair and strengthening of these structures on the basis of principles of authenticity, reliability, compatibility, durability, reversibility, and monitorability. In restoration projects, engineers often face significant issues due to the intrinsic challenges of the projects themselves, as well as the complex level of interaction with other professionals involved. The main goal of this research project is the identification and evaluation of the most significant challenges encountered by structural engineers in restoration applications in Turkey. Data were obtained from semi-structured interviews with six professionals involved in restoration projects in Turkey. The sample group was chosen based on specific competences and involvement in different phases of restoration projects in order to gain different professional perspectives. The results revealed several issues from the early stages of the projects, such as a lack of records about previous interventions, a lack of standards and guidelines with respect to historic structures. The identification and evaluation of these issues is intended to raise awareness by the community as well as by the legislative authorities. In the future, dedicated legislative tools could facilitate the execution as well as the efficiency of these interventions, thus limiting subjective approaches.

Önemli bir besin kaynağı olan süt, bebek beslenmesinde kullanılmakta ve tüm dünyada tüketilmektedir. Devam sütlerine geçtiği bilinen kimyasal kontaminantlardan biri mikotoksinlerdir. Küfler tarafından üretilen ve devam sütlerine geçebilen mikotoksinler bebekte sağlık riski oluşturabilir. Mikotoksinlerin toksik etkilerinin önlenmesi için bebeğin normal büyüme ve gelişimi için en önemli besinlerden biri olan devam sütündeki aflatoksin M1 düzeylerinin belirlenmesi önemlidir. Süt kontaminantı olarak aflatoksinlerin kontrolü ile ilgili sosyal koruma projelerinin ve devam sütleri ile ilgili farkındalığın arttırılması halk sağlığı korunması açısından önem arz eder. Çalışmamızda, yeni doğanların diyetlerinde aldığı ürün olan devam sütlerinde, aflatoksin M1’in varlığı ve halk sağlığı bakımından önemi araştırılmıştır. Bu amaçla, 7 farklı firmadan, farklı seri numaralarına sahip süt örneklerini içeren 60 adet devam sütü toplanmıştır. Çalışmamızda Enzyme-linked immunosorbent assay (ELISA) yöntemi kullanılarak devam sütlerinde aflatoksin M1miktarları araştırılmıştır. Avrupa Birliğine uyum çerçevesinde hazırlanmış olan 2008/26 sayılı gıda maddelerindeki kontaminasyonların maksimum limitleri hakkındaki Türk Gıda Kodeksi (TGK) Tebliğinde; çiğ süt, UHT süt ve süt içeren ürünlerin yapımında kullanılan sütlerde maksimum AFM1 miktarının 0.05µg/kg (parts per billion) olması gerektiği belirtilmiştir. Aflatoksin M1 konsantrasyonları hesaplandığında; 0.05 ppb konsantrasyon aralığında Aflatoksin M1 içeren 23 örnek tespit edilmiştir. Sonuç olarak Türk Gıda Kodeksi limit değerini aşan 23 örnek halk sağlığı açısından önem arz etmektedir. Beslenmede devam sütünün sıklıkta tüketildiği ve önemli bir rol oynadığı bebek yaş grubunda, bu ürünler piyasaya çıkmadan önce Aflatoksin M1 varlığının saptandığı daha kapsamlı araştırmaların yapılmasının uygun olduğu düşünülmektedir. Milk, which is an important source of nutrition is used for infant feeding and consumed widely all over the world. Mycotoxins are one of the chemical contaminants that are known to pass through milk. They are produced by molds and pass through milk, and may cause health problems in infants. Determination of aflatoxin M1 levels in follow-on milks which is one of the most important nutrients for healthy grown babies is important in prevention of toxic effects of mycotoxins. Promoting social protection studies concerning aflatoxins as milk contaminants and raising awareness on follow-on milks is important in protection of public health. In our study, investigation of aflatoxin M1 in follow-on milks; a product that newborns take in their diet, and to evaluate the results in terms of public health. For this purpose, 60 follow-on milk samples with different serial numbers were collected from 7 companies. In Turkish Food Codex Communique related to the contaminations in food products with in accordance with the law no 2008/6 for preparation compliance as part of European Onion, indicated that the raw milk, UHT milk and other milks used for production of some products containing milk, maximum aflatoxin M1 should be 0.05 µg/kg (parts per billion). Aflatoxin M1 concentrations were determined by Enzyme-Linked Immunosorbent Assay (ELISA). Our results showed that 37 samples contained aflatoxin M1 with 0.05 parts per billion concentrations. In conclusion, the latter 23 samples including aflatoxin M1 values above Turkish Food Codex limits are important in terms of public health.

Introduction: The incidence of myomas during pregnancy is reported as 1.6-10.7% depending on gestational age. Increased rates of Caesarean Section (CS) together with advanced maternal age bring the decision for caesarean myomectomy (myomectomy during caesarean section) into question. Aim: To compare the obstetric features and clinical outcomes of pregnant women with uterine leiomyoma who had myomectomy together with caesarean section to those who had caesarean section only. Materials and Methods: A retrospective study was performed on a total of 50 pregnant women with myoma that underwent caesarean section in the Obstetrics and Gynaecology Department of Trakya University Medical Faculty between 2007 and 2014. Obstetric history, operative details and type, size and location of leiomyoma were noted and compared. Data were analysed using the IBM Statistical Package for Social Sciences version 17.0 (SPSS Inc., Chicago, IL, USA). Parametric tests were applied to data with normal distribution and non-parametric tests were applied to data without normal distribution. Results: Two groups displayed similar features in terms of age, parity, gestational weeks, type and location of leiomyomas. Notably, average size of leiomyomas was larger (p=0.03) and duration of operation was significantly longer in patients that underwent caesarean myomectomy (72.69±26.73 minutes vs. 56.25±6.64 minutes) (p=0.003). Duration of hospitalisation and preoperative/postoperative values for haemoglobin and hematocrit levels did not show any clinically significant difference (p >0.05). Conclusion: Our results demonstrate that caesarean myomectomy is a safe and effective procedure in especially cases with large uterine leiomyomas.

Landfill site selection is a multi-attribute decision problem, through which factors like available land area, soil conditions, climatological conditions, and economic considerations are investigated in detail. Frequently, it is a challenge to come up with “the one” solution while tackling such complex systems. Therefore, use of tools such as fuzzy analytic hierarchy process (fuzzy AHP) and fuzzy technique for order preference by similarity to ideal solution (fuzzy TOPSIS) should be preferred in order to emphasize pros and cons for each of the studied options. In this study, three possible landfill sites for the city of Istanbul are evaluated through expert opinion and by facilitating fuzzy AHP and fuzzy TOPSIS. Initially, the landfill site selection problem is presented in the framework of a model and then the model is mathematically solved by calculating the individual criterion weights. In conclusion, considering the rapid rate of urbanization for the city of Istanbul, the possible landfill sites convey similar overall results, but differ in specific criteria.

Objective This prospective study was designed to compare ultrasound and autopsy findings on fetal urinary system malformations in second trimester terminations of pregnancy to evaluate the degree of agreement of such findings. Methods From January 2003 to October 2012, a total of 308 second trimester terminations of pregnancy were performed because of fetal malformation diagnosed through second trimester ultrasound examination at a tertiary referral center. Result Among 308 second trimester fetuses with congenital anomalies, 62 (20.1%) had urinary anomalies. Ultrasound and fetal autopsy findings were in full agreement for urinary system malformations in 45 (72.6%) of 62 cases. In six (9.7%), autopsy confirmed the malformations detected by ultrasound but showed additional lesser urinary anomalies. In 10 (16.1%) cases, autopsy revealed major urinary anomalies not determined by ultrasound. In one case (1.6%), ultrasound reported bilateral renal agenesis; however, autopsy revealed a horseshoe kidney. The ultrasound screening sensitivity was 83.8%, and specificity was 99.5%. Conclusion The results showed that prenatal ultrasound achieved a high accuracy in diagnosing fetal urinary malformations. However, fetal autopsy occasionally adds valuable information to prenatal ultrasound findings. © 2014 John Wiley & Sons, Ltd.

Aim: To investigate the relation between use of bone wax and postoperative sternal dehiscence after cardiac surgery. Material and methods: Five thousnad three hundred and eighteen consecutive patients who underwent cardiac surgery between 1999 and 2009 were evaluated prospectively. Perioperative use of bone wax, perioperative data and outcome parameters were recorded. Multivariate logistic regression analysis was performed to define independent risk factors for postoperative sternal dehiscence. Results: Bone wax was used in a total of 1151 (21%) patients. Postoperative sternal dehiscence was detected in 88 (1.6%) patients. The postoperative sternal dehiscence rate was 1.4% in patients without bone wax and 2.5% in patients with bone wax (p = 0.001). The rate of bone wax use was 36.4% in patients with sternal dehiscence and 21.4% in patients without sternal dehiscence (p 70 (OR = 1.9, 95% CI: 1.2-3.1, p = 0.005), chronic obstructive lung disease (OR = 2.4, 95% CI: 1.5-3.9, p 30 (OR = 2.2, 95% CI: 1.4-3.5, p < 0.001). Conclusions: Our findings suggest that use of bone wax may be associated with increased postoperative sternal dehiscence after cardiac surgery. Thus liberal use of bone wax should be

127 Background: Although neoadjuvant treatment has been standart approach in gastric cancer with the positive results of randomized controlled studies in recent years, neoadjuvant treatment approach rates are far below the expectations in our country. We aimed to evaluate neoadjuvant treatment approaches and results of gastric cancer patients in this retrospective study. Methods: We evaluated characteristics and survival outcomes of 54 patients that were operated after neoadjuvant systemic treatment out of 1,143 gastric cancer patients recorded in our database. Results: The median follow-up was 12 months in this study. 38% of the patients was female and the median age was 61 (24-78). While 46 % of the tumors were located in gastro-esophagial junction and cardia, others were located distally. All of the patients treated with neoadjuvant treatment had positive lymph nodes. While lymphatic and perineural invasion were detected in 67% of the patients, vascular invasion was detected in 39 % of the patients after the operation. While 43 % of the patients had grade 3 tumors, others had grade 1-2 tumors. R0 resection was achieved in 91% of the patients and D2 dissection was done in 82% of the patients. FOLFOX/XELOX, DCF/DCX, EOX/ECF and FLOT were applied as neoadjuvant treatment regimes in 19%, 50%, 21% and 11% of the patients respectively. The median chemotherapy cycle number was 3 applied pre and postoperatively. The disease control rate (response or stable disease) was achieved in 75,9 % of the patients after the neoadjuvant chemotherapy. In 13 patients progressive disease was detected and these patients were not operated. We found the median disease free survival was 25 months and overall survival was 41 months in survival analysis. Three year DFS was 29 % and 3 year OS was 52 %. Conclusions: Neoadjuvant treatment approach is important both to facilitate operation procedure and to evaluate efficacy of systemic treatment. As the survival advantage was shown in a study last year, FLOT regime is expected to be used more commonly. The patients have to be evaluated and the treatment decisions should be made in a multidisiplinary tumor board including surgeon, radiologist, medical oncologist to provide optimal treatment benefit.

Amac: Hedef kontrollu infuzyon (HKI) sistemleri, ilaclarin farmakokinetik ozelliklerine gore gelistirilen bilgisayar yazilimlarini iceren cihazlar kullanilarak hastalarin yas, cinsiyet, boy ve agirlik gibi parametrelerinin dikkate alinarak hedef ilac plazma konsantrasyonunun belirlendigi infuzyon seklidir. Calismamizda fentanil ve midazolamin geleneksel intravenoz (IV) infuzyon teknigi ve HKI teknigi ile uygulanmasini, hemodinami, anestezi derinligi ve ilac tuketimi acisindan karsilastirmayi amacladik.Gerec ve Yontem: Etik kurul onayi ve hasta onamlari alinan elektif koroner arter baypas cerrahisi (KABG) gecirecek 80 hasta prospektif olarak calismaya alindi. Hastalarin kalp hizi, pulse oksimetre (SpO2), elektrokardiyografi (EKG), invaziv arteryel monitorizasyonu, Bispektral indeks (BIS) ve serebrel rejiyonel oksijen saturasyonu (rSO2) monitorizasyonlari yapildi. Anestezi induksiyonu sonrasi hastalar sirayla randomize edilerek 2 gruba ayrildi. Grup 1: HKI teknigi ile fentanil ve midazolam infuzyonu uygulanan 40 hasta, Grup 2: geleneksel IV infuzyon teknigi ile fentanil ve midazolam infuzyonu uygulanan 40 hasta tarafindan olusturuldu. Hastalarin BIS degerleri ve hemodinamik parametrelerine gore fentanil ve midazolamin infuzyon hizlarinda ya da hedef plazma konsantrasyonunda gerekli ayarlamalar yapildi.Bulgular: Hastalarin demografik, hemodinamik ve sonuc parametrelerinde gruplar arasi anlamli fark gozlenmemistir (Tablo 1). Ancak, ameliyat boyunca tuketilen fentanil ve midazolam miktarlari Grup 1’de, Grup 2’ye gore istatistiksel olarak anlamli olarak daha dusuk bulunmustur. Ayrica BIS degerleri de daha az ilac tuketimi olmasina ragmen Grup 1’de istatistiksel olarak anlamli olcude daha dusuk bulunmustur.Sonuc: Hemodilusyon, hipotermi ve nonpulsatil akimin kullanildigi baypas cerrahisi uygulamalarinda kan ilac konsantrasyonu bircok faktore bagli olarak degisebilmektedir. Acik kalp cerrahisi kullanilan anestezik ilaclarin kan konsantrasyonlarinin, cerrahinin her safhasinda istenen araliklarda tutulmasi; anestezi yeterliligi acisindan onem tasimaktadir. HKI uygulamasinin anestezi derinligi, farkindalik ve sonuc parametreleri acisindan anlamli olacagi dusuncesindeyiz

Background: Facial rejuvenation by autologous fat transfer is common in aesthetic plastic surgery. The main drawback is progressive resorption, requiring repeated harvesting and microfat grafting. Objective: The authors present a method for cryopreservation of excess harvested fat and tissue to enable subsequent use of previously harvested excess material. Methods: Fat grafts were harvested using a 50-mL syringe and a 3- or 4-mm cannula. A tissue “cocktail” composed of dermis, fascia, and fat was prepared from excised scar tissue, tissue from abdominoplasty, or tissue from reduction mammaplasty. Cocktail specimens were placed in sterile tubes, immersed in a liquid nitrogen tank (−196°C), and stored at −80°C. At 3- to 6-month intervals, repeated cryopreserved fat graft injections were performed. Patients were evaluated by comparing preoperative and postoperative photographs. Results: Between 2000 and 2010, a total of 5199 cryopreserved fat or tissue injections were performed in 2439 consecutive patients (age range, 19–80 years). Nasolabial folds and lips were the most common injection sites. Clinical outcomes were satisfactory, and improved contour was achieved in most patients after repeated injections. Conclusions: Cryopreservation of excess tissue for future injection is promising since repetitive injections are often required after resorption of microfat grafts. In our study, the survival of cryopreserved tissue cocktail or fat was comparable to that of fresh fat grafts and is therefore an effective adjuvant method for facial rejuvenation. Level of Evidence: 4 ![Graphic][1] [1]: /embed/inline-graphic-1.gif