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The study aimed to evaluate the impact of the dual trigger with the combination of GnRH agonist and standard dose of recombinant hCG on IVF outcomes in poor ovarian responders with GnRH antagonist protocol. 1283 cycles of 1010 poor responder patients according to Bologna criteria were retrospectively analysed in terms of final oocyte maturation: dual trigger group (250 mu g hCG + 0.2 mg triptorelin) or standard group (250 mu g hCG). Primary outcome measures were the number of retrieved and mature oocytes. The secondary outcome measures were clinical pregnancy rates and live birth rates. The number of retrieved oocytes, mature oocytes, and the top-quality embryos transferred were significantly higher in the dual trigger group (p < .001). Fertilisation rates (73.6% vs 69.6%, p = .009), implantation rates (18.7% vs 14.6, p = .039), clinical pregnancy rate per embryo transfer (27.5% vs. 19.9%, p = .010) and live birth rate per embryo transfer (21.6% vs. 14.9%, p = .011) were also significantly higher in the dual trigger group as compared to the hCG trigger group. The usage of dual trigger with a GnRH agonist and a standard dosage of hCG could improve clinical pregnancy rates and live birth rates in poor ovarian responders undergoing GnRH antagonist IVF/ICSI cycles.IMPACT STATEMENT What is already known on this subject? Dual trigger with standard dose of hCG has been the subject of trials in normal responders to optimise IVF outcomes. The results of these studies showed significant improvements in implantation and pregnancy rates with an increase in the number of mature oocytes retrieved. As a result, dual trigger has become a popular ovulation trigger option in GnRH antagonist cycles. What do the results of this study add? There is limited data about the use of dual trigger in poor ovarian responders (PORs). According to our study, increasing the number of retrieved oocytes, mature oocytes, the number of fertilised oocytes, the number of transferred embryos and top quality embryos transferred by using dual trigger in patients with PORs have a positive impact on pregnancy outcomes. What are the implications of these findings for clinical practice and/or further research? These findings implies potential advantages of dual trigger usage for improving IVF outcomes in PORs. With large sample sized prospective randomised trials, dual trigger with combination of GnRHa and a standard dose of hCG might replace the traditional ovulation trigger with hCG in PORs.

PURPOSE Nasal septal perforation (NSP) consists of defects of mucosa, cartilage, and bone. Nasal septal surgery is by far the most common cause of NSP. Many surgical approaches have been described for NSP repair. In this study, the authors describe a novel technique for repairing all sizes of NSP using an only fascia lata graft. METHODS The authors implemented a retrospective study design. Seventeen patients who underwent NSP repair between January 2016 and January 2019 were included to the study. Entire nasal surgical steps were performed under endoscopic view, harvested fascia lata graft is placed in tympanoplasty fashion after all edges of perforation is elevated and implantation bed is prepared. RESULTS The mean size of the septal peforations were 18.52 ± 4.17 mm horizontally, 11.52 ± 3.42 mm vertically. The mean follow up period was 14.47 ± 9.5 months (range: 2-36). In 15 of the 17 patients, total NSP closure was achieved (88,23%). CONCLUSIONS Endoscopic close technique using fascia lata for nasal septal perforation closure is a safe and reliable technique with high success rate and it should be considered in patients with nasal septal perforation.

Waste biomass, a renewable resource, is a reasonable choice for green clean power generation using advanced thermal treatment technologies such as gasification. In this research, dried-densified olive pomace residues from olive oil production have been applied as biomass feedstock in a new gasification process for synthesis gas (syngas) generation using a 500 kg h−1 throughput capacity autothermal modified updraft gasifier system. The product syngas generation rate is found to be approximately 2.5 Nm3 kg−1 of olive pomace, with a calorific value (CV) between 5.0 MJ Nm−3 and 7.0 MJ Nm−3. More than 85% of carbon in pomace is converted to produced syngas by the gasification system. The gasification reactor generates syngas which passes through a specially designed swirl hot gas burner and is then burned directly in a thermal oil boiler retrofitted to an organic Rankine cycle (ORC) turbine generator. As a result, the produced syngas at around 350°C is directly combusted with tars so that a great deal of chemical energy loss is prevented. The thermal oil heater has a thermal energy capacity of 1.77 MWh. The generated 1.6 MWh thermal energy from the thermal oil heater is transferred to the ORC turbine to generate 240 kW electrical power.

AIM The aim is to identify the chronic endometritis (CE) incidence in recurrent implantation failure (RIF) patients undergoing in vitro fertilization (IVF) treatment and compare the IVF outcomes of RIF patients with CE following antibiotic therapy with RIF patients without CE. Another purpose is to compare the IVF outcomes of described RIF patients with patients undergoing the first cycle of IVF. METHODS In this retrospective cohort study, CE was diagnosed with CD-138 immunohistochemical staining. Among RIF patients, two groups were formed as group 1, including patients diagnosed with CE and treated by antibiotics (n = 129), and group 2, including patients without CE (n = 103). Patients with the first IVF cycle having similar infertility etiologies with RIF patients were reviewed as group 3 (n = 932). RESULTS CE was diagnosed in 55.6% of RIF patients. The number of oocytes retrieved was not different between groups. Implantation rates (IR) were similar after antibiotic treatment in RIF patients with or without CE. However, Group 3 had a higher IR (41.1%) than group 1 and 2 (23.1% and 30.1%, respectively) (p

Objective: Management of ovarian endometrioma before IVF treatment is still challenging. We aimed to assess the effect of the pre-cycle surgical removal of endometriomas on IVF outcomes in a large number of cycles in patients undergoing IVF/ICSI treatment. Besides this, we also proposed to compare the cycle outcomes within both normo and poor responder patients to evaluate the impact of endometrioma and its surgery. Study Design: A retrospective cohort study was conducted in a private IVF clinic between September 2014 and December 2018. A total of 2438 IVF/ICSI cycles of 1936 patients were reviewed. Patients who had previous endometrioma surgery (Group 1), patients with non-operated endometrioma (Group 2), and patients without endometriosis, including tubal factor infertility confirmed by laparoscopy and unexplained infertility without endometrioma (Group 3) were analyzed in this study. Results: Total dose of gonadotropins was significantly higher in group 1 than others (p < 0.05). However, antral follicle counts, estradiol levels on the day of hCG trigger, the number of retrieved and metaphase II oocytes were significantly lower in group 1 than in other groups (p < 0.05). Poor response to gonadotropins was more frequent in group 1 as compared to other groups (47.9%, 34.3%, 35.5%, respectively) (p < 0.05). Cycle cancellation rates were significantly higher in group 1 than in other groups (6.7%, 1.4%, and 2.8%, respectively) (p < 0.05). Clinical pregnancy (CPR) and live birth rates (LBR) per cycle and embryo transfer were not different among groups. However, CPR per cycle and embryo transfer were significantly higher in the operated endometrioma group within unexpected poor responders (p = 0.023, p = 0.010, respectively). CPR and LBR per cycle and per embryo transfer were similar within normoresponder patients. Multiple logistic regression analysis revealed that female age and poor response to gonadotropins were the significant variables in predicting live birth (OR: 0.946, CI: 0.926-0.966, p < 0.001 and OR: 3.294, CI: 2.336-4.645, p < 0.001, respectively). Conclusion: Pre-cyle removal of endometrioma may have an adverse impact on ovarian reserve, and pregnancy outcomes seem to be similar with or without surgery in patients undergoing IVF treatment. However, endometrioma surgery may be considered in the subsequent IVF cycles of patients with lower than expected ovarian response. (c) 2021 Elsevier B.V. All rights reserved.

We present a case report of an unusual giant lesion of anterior cruciate ligament (ACL) causing destruction and requiring reconstruction of ACL. A case report of a 32-year-old male patient presented to orthopedics outpatient clinic with 2 years history of right knee instability and clicking symptoms with no history of an obvious injury. Magneric resonance imaging showed a giant lesion occupying all ACL structure in the knee with 30×15×15 mm dimensions. The patient had an arthroscopy and it showed destruction of ACL, which required ACL reconstruction in the same sitting. Biopsy results showed a chronic non-specific inflammatory synovial epithelial tissue with increased vascularity and thickened wall vessels.

OBJECTIVE: The aim of this study was to assess the clinical and radiological results of our high tibial osteotomy technique combining fixator-assisted nailing and subtubercle tibial osteotomy in varus malalignment. METHODS: This was a retrospective study of a consecutive series of 32 knees in 32 patients (‘2 follow-up loss’ 12 males and 18 females; mean age at the time of operation: 50.6±7.8 (36–62) years) operated on between 2014 and 2016. Radiographic and clinical measurements were assessed pre- and postoperatively. Kolmogorov-Smirnov, paired t and Wilcoxon rank tests were used in the statistical analyses. RESULTS: The mean follow-up period was 36.1±8.15 (31–53) months, the mean duration of the hospital stay was 3.6±0.1 (2–6) days, and the mean Kellgren-Lawrence score was 2.4±0.6 (2–4). Time to bony union was an average of 16.17 (12–29) weeks. Compared to the preoperative mechanical medial proximal tibial angle, femorotibial angle and mechanical axis deviation measurements, all the postoperative values showed significant changes (p0.05), and the postoperative Caton-Deschamps index did not show a meaningful change (p>0.05). The postoperative visual analog scale, Knee Society Score, and Modified Hospital for Special Surgery Knee Scoring System measures showed significant improvement compared to the preoperative values (p

Background: Hashimoto thyroiditis diagnosis is primarily established on clinical and laboratory findings; however, some hashimoto thyroiditis cases are euthyroid and seronegative. Moreover, these patients might also have normal conventional ultrasound findings. Aims: In our study, we aimed to distinguish the typical background characteristics of hashimoto thyroiditis using virtual touch tissue imaging quantification maps obtained with acoustic radiation force impulse imaging. Methods: Our study consisted of 28 hashimoto thyroiditis patients without characteristics of ultrasound findings and 28 healthy subjects. The thyroid parenchymal tissue mechanical properties were analyzed with the virtual touch tissue imaging quantification after ultrasound examination, and then related colored maps were obtained. Shear wave velocities were recorded (m/s) from the homogenous area where hardest and softest points were closest to each other on virtual touch tissue imaging quantification maps. The difference between the minimum and maximum shear wave velocities for each case (Δv) was calculated and recorded. Results: Assessment of virtual touch tissue imaging quantification maps revealed a significant difference between hashimoto thyroiditis and control groups in terms of maximum SWV’s, but no significant difference was observed between the minimum shear wave velocities (p Δv values were taken into account. In summary, the effects of chronic autoimmune thyroiditis can be distinguished by simply using Δv on virtual touch tissue imaging quantification maps. When the cut-off value of Δv was accepted 0.42, the diagnosis of hashimoto thyroiditis could be made with 88% accuracy. Conclusion: We suggest that shear wave velocities measurement on virtual touch tissue imaging quantification maps is a promising method in equivocal hashimoto thyroiditis cases, in which the diagnosis of hashimoto thyroiditis is unachievable with clinical, laboratory and conventional ultrasound findings.

Objective: Intrauterine insemination (IUI) is frequently used to treat patients with ovulation disorders, cervical factor, mild male infertility and unexplained infertility. The aim of this study was to investigate the impact of modified speculum application on the success of IUI in patients with unexplained infertility. Materials and methods: This prospective randomized study reviewed 219 women who had undergone controlled ovarian hyperstimulation (COH)-IUI treatment. In the modified speculum application group (109 patients with 124 cycles), the screw of the vaginal speculum was loosened after passing the internal os with catheter and the vaginal speculum remained in this position to ensure closure of the cervix during the procedure. In the conventional speculum application group (110 patients with 132 cycles), the screw of the vaginal speculum was not loosened to close the lips of cervix after passing the internal os with the catheter and the vaginal speculum was removed after withdrawal of the insemination catheter. The primary outcome was live birth rate. Results: The modified and conventional speculum application groups had statistically similar demographic and clinical characteristics. There were no significant differences between the study and the control groups in terms of the clinical pregnancy rate per cycle and per patient (24.1% vs 18.9% and 26.6% vs 22.7%, respectively), as well as the live birth rate per cycle and per patient (19.3% vs 15.1% and 22% vs 18.1% respectively). Conclusion: Applying gentle mechanical pressure on the portio vaginalis of the cervix using a vaginal speculum during IUI does not improve pregnancy and live birth rates in patients with unexplained infertility. Keywords: Intrauterine insemination, Controlled ovarian hyperstimulation, Speculum, Technique

OBJECTIVE To compare the IVF outcome of patients assumed to be poor responders before their first cycle treated by microdose flare-up or GnRH antagonist protocols with patients who had a poor ovarian response after their first cycle stimulated with long GnRH protocol. STUDY DESIGN Observational cohort study. PLACE AND DURATION OF STUDY Department of Obstetrics and Gynecology, IVF Unit of Gazi University Faculty of Medicine, from September 2014 to February 2019. METHODOLOGY Patients treated with the first cycle of IVF and diagnosed as poor responders after ovarian stimulation were evaluated according to the treatment protocol, including microdose flare-up (Group 1: 136 patients), GnRH antagonist (Group 2: 105 patients), and long GnRH agonist (Group 3: 77 patients). RESULTS Basal FSH level was significantly lower in group 3 compared to other groups (p

The acceleration of Convolutional Neural Networks (CNNs) on FPGAs is becoming increasingly popular for computer vision tasks. However, the limited memory and bandwidth of these devices pose some challenges to the design of conventional CNN accelerators, which use external DRAM to store the intermediate results of each layer. To mitigate these criticalities, researchers have proposed the fused-layer methodology, which diminishes the accesses to the external DRAM by accelerating simultaneously multiple subsequent layers on the same chip. In this work, we propose a configurable fused-layer accelerator that exploits output tiling and the half-precision float datatype to reduce resource utilization. We assessed its effectiveness with experiments on VGG-16 and Yolo-Lite CNNs, targeting a Xilinx Zynq ZU6EG FPGA. Our design achieved up to 42% speedup and up to 95% fewer transfers from external memory compared to a single-layer baseline solution. Moreover, to ease and quicken the design space exploration, we developed a Machine Learning model that predicts the performance and the resource utilization of our accelerator with an accuracy > 90% on the reported dataset.

Aim To evaluate whether the duration of sexual abstinence has impact on oxidative stress in semen samples. Methods Oxidative reaction was tested for different levels of reactive oxygen species (ROS) by nitro blue tetrazolium assay in 90 patients with the diagnosis of unexplained or male factor infertility that were grouped into 3 groups as 0-2 (group 1), 3-4 (group 2) and >4 days (group 3) of duration of sexual abstinence. Subsequently, the remaining semen was prepared by gradient method for ovarian stimulation and intrauterine insemination (IUI) cycles to compare pregnancy rates in terms of different levels of ROS and different abstinence periods. Results Increased staining pigment intensity was related to higher level of ROS in >4 days' group as compared to groups 0-2 and 3-4 days (70% vs 43.3% and 50%, P = 0.013 and P = 0.014, respectively). Pregnancy rates significantly decrease with prolonged abstinence period (26.7%, 16.7% and 6.7% in groups 1, 2 and 3, respectively, P = 0.039). Progressive motile sperm count after gradient method of sperm preparation for IUI was highest in 3-4 days of abstinence period than shorter and longer abstinence groups. Conclusion Longer duration of sexual abstinence causes higher oxidative stress and decreases pregnancy rates in IUI cycles.

On a global scale, the quantity of biomass waste is steadily increasing, particularly in densely populated urban areas. The electricity and heat energy generation from biomass gasification is a via...

Objective The aim of the present study was to investigate effects of resveratrol (RSV) over ovarian hyperstimulation syndrome (OHSS) in rat model. Materials and Methods 24 female Wistar rats (22 days old) were divided into four groups. Group 1 (control group; n = 6) received 0.1 ml intraperitoneal (IP) saline from days 22–26; group 2 (mild-stimulated group; n = 6) received 10 IU pregnant mare serum gonadotropin (PMSG) on day 24 and 10 IU of hCG 48 h later (day 26); group 3 (OHSS group; n = 6) was given 10 IU of PMSG for 4 consecutive days from day 22 and 30 IU hCG on the fifth day to induce OHSS; group 4 (OHSS + RSV group; n = 6) was treated the same as group 3, but received 60 mg/kg RSV 2 h before PMSG injection for 4 consecutive days and 2 h before the hCG injection on the fifth day. Results Weight gain was highest in the OHSS group. Ovarian weights were lower in the treatment group than OHSS group. Peritoneal fluid VEGF levels were lower for RSV group compared to group 2 and 3. Total VEGF immunoreactivity was higher in OHSS group than group 1, 2 and 4. Conclusion These results indicate that RSV is beneficial for prevention of OHSS by reducing the increases in body and ovarian weight and VEGF activity. These effects may be mediated by anti-inflammatory, anti-oxidant and anti-angiogenic capacity of RSV.

Objectives: This study aimed to evaluate the serum concentrations of PAPP-A (pregnancy associated placental protein-A), a biomarker which is associated with cardiovascular disease, in patients with polycystic ovary syndrome (PCOS). Materials and Methods: A total of 62 women with PCOS, and 68 age and body mass index (BMI) matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as PAPP-A levels were assessed in each subject. Results: Women with PCOS and controls yielded similar median serum levels of PAPP-A (1.7 ng/ml versus 1.8 ng/ml, respectively, p = 0.328). However, when patients were compared based on BMI; subgroup analyses found that among women with BMI

Open technique septorhinoplasty (SRP) provides better surgical control and stronger anatomical assessment; however, one of its biggest disadvantages is postoperative columellar scar. In this study, the authos aimed to compare the absorbable polyglactin 910 (PG) (Vicryl Rapide 6/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 6/0; Ethicon Inc.) suture materials and their effects on the postoperative columellar scar. In this study, 89 patients (61 females and 28 males) who underwent primary open technique SRP were included; 42 patients were included in the PP group and 47 were included in the PG group. Sutures were removed in PP group on 7th postoperative day. Sutures were left to be absorbed in the PG group. Columellar scar was assessed with visual analog scale (VAS) subjectively and with the modified Stony Brook Scar Evaluation Scale (SBSES) objectively in 6th postoperative month. SBSES results in PG and PP groups were 3.88 ± 0.80 and 3.67 ± 0.80, respectively. There was no statistical significance between the two groups (p = 0.352). VAS results in PG and PP groups were 8.04 ± 0.91 and 7.71 ± 0.85, respectively. There was no statistical significance between the two groups (p = 0.200). No postoperative wound infection was seen in either of the groups. PG delivers good postoperative results in columellar scar. We recommend using PG for columellar incision closure since it provides less discomfort and anxiety for the patient, and less office time for the surgeon during the suture removal.

Amac : Kinezyofobi’nin gundelik ve sportif aktivitelerin uzerindeki rolunu, Tempa Kinezyofobi skorunu (TSK) Tagner aktivite skoru (TAS) uzerindeki etkilerini arastirmaya ama c ladik. Hipotez: Yuksek Tempa Kinezyofobi skoru Tagner aktivite skorunu dusurur. Materyal Metod: Ocak 2010-Aralik 2016 yillari arasinda o n c apraz bag rekonstruksiyonu yapi lan 50 hasta c alismaya alindi. Tum hastalara Lysholm diz skorlamasi, Tagner aktivite skorlamasi ve Tempa Kinezyofobi skorlamasi yapildi. Hastalarin her iki dizine 30 derecede KT-1000 artrometre uygulandi. Tempa Kinezyofobi skoru, Tagner aktivite skoru ve Lysholm knee skoru ile karsilastirildi . Sonuclar: Hastalarin ortalama yasi 29.6 (18-50) ve minimum takip sureleri 12 ay idi. Hastalarin 20’sinde (%40) ayni zamanda meniskus yirtigi mevcuttu. Tagner aktivite skoru, Tempa Kinezyofobi skoru ile anlamli olarak negatif bir korelasyon oldugu goruldu. Yuksek Tempa kinezyofobi skoru olan hastalarda Tegner aktivite skoru dusuk, dusuk Tempa kinezyofobi skoru olan hastalarda Tegner aktivite skoru anlamli olarak yukek oldugu goruldu. Istatistiksel olarak TKS ve TAS Lysholm skorlari arasinda, meniskus yirtigi olan ve olmayan hastalar arasinda anlamli bir fark bulunmadi. Cikarim: Calismamiz diz fonksiyonlarinin, istenilen duzeyde olmasi, yaralanma oncesi gundelik aktivite ve sportif aktiviteye geri donus icin yeterli olmadigini gosterdi. Lysholm skoru yuksek olsa bile Kinezyofobini sportif aktiviteye geri donuste onemli rol oynamaktadir. Calismamiz sonuclarina gore, tum on capraz bag yirtigi icin opere edilecek hastalarin kinezyofobi hakkinda bilgilendirilmesini ve testin yapilmasini, ayrica, yuksek kinezyofobi skoru olan hastalara fizik tedavinin yaninda psikolojik terapi almalari oneririz.

Objective: Drug induced sleep endoscopy (DISE) is a valuable tool which is used in the diagnosis of obstructive sleep apnea (OUA). The aim of this study is to evaluate inter-rater and intra-rater consistency of DISE. Methods: 36 OSA patients with Apnea-hypopne index>5 included in this study. DISE was performed and recorded digitally for all patients, by the first author (OA1). VOTE scores were noted to procedure report in patients’ charts. Video records of DISE were blindly evaluated six months after the last procedure, by observer 1 for the second time (OA2) and by observer 2 (OB) for the first time. DISE was evaluated by using VOTE classification. OA1 and OA2 scores were compared to determine intra-rater reliability and OA2 and OB scores were compared to determine inter- rater reliability. Results: Inter-rater consistency of DISE was poor to good. Highest consistency rate was found in velum at anteroposterior configuration, while the lowest was found in the same level at lateral configuration. Intra-rater consistency of DISE was moderate to excellent. Highest consistency rate was found in epiglottis at lateral configuration, while the lowest was found in oropharynx level. Conclusion: OSA is condition with possible serious complications. DISE is a tool that could change the course of treatment in OSA. The validity of DISE is quite acceptable although a golden standard classification tool could enable us to “speak the exact same language” and will surely increase the diagnostic success of DISE.

ObjectiveThis study assessed the preferences of surgeons regarding surgical modalities used for adenotonsillectomy, and determined anxiety levels related to the adenotonsillectomy procedure.MethodsA 10-question survey created by the authors was administered to 413 ENT specialists attending the 4th Congress of Otorhinolaryngology Head and Neck Surgery, held in October 2017 in Barcelona, Spain.ResultsCold knife dissection was the preferred surgical modality for both adenoidectomy and tonsillectomy. Most participants reported encountering one to five patients with post-tonsillectomy bleeding throughout their entire career. The mean anxiety levels during surgery and the 10-day post-operative period were 3.39 ± 2.14 and 4.18 ± 2.63, respectively (p < 0.05). There was a significant negative correlation between anxiety level and surgeon's experience (p < 0.05).ConclusionCold dissection is still the preferred surgical modality for adenotonsillectomy, while both suture ligation and electrocautery are used for haemostasis. Paediatric adenotonsillectomy is likely to generate anxiety in ENT surgeons, and the possibility of secondary post-tonsillectomy bleeding increases the anxiety levels of surgeons in the post-operative period.

BACKGROUND/AIM The aim of the study was to compare the luteal estradiol patch/GnRH antagonists priming protocol (LPP) with the standard GnRH antagonist protocol in poor ovarian responders (PORs) in terms of the outcomes of in vitro fertilization (IVF) treatment. MATERIALS AND METHODS IVF outcomes of 265 cycles in 265 patients (106 in the LPP group, 159 in the standard GnRH antagonist group) were evaluated retrospectively. RESULTS Mean length of stimulation (11.4 ± 2.7 vs. 10.0 ± 2.7 days; P < 0.05) and the total gonadotropin dose (3403 ± 1060 vs. 2984 ± 1112) used were significantly greater in the LPP group than in the standard GnRH antagonist protocol group. The mean number of oocytes retrieved (3.5 ± 2.6 vs. 3.7 ± 2.8), the number of mature oocytes (2.8 ± 2.2 vs. 2.6 ± 2.2), fertilization rates (65% vs. 62%), the number of embryos transferred (1.6 ± 0.6 vs. 1.7 ± 0.6), and implantation rates (16% vs. 13%) were similar. The cancellation rate did not significantly differ between the groups (9.4% vs. 13.2%). There were no significant differences in the clinical pregnancy (11.3% vs. 13.2%) or live birth rates per patient (3.8% vs. 9.4%) and clinical pregnancy (18.8% vs. 22.6%) or live birth rates per embryo transfer (6.3% vs. 12.9%) between the groups. CONCLUSION LPP does not improve IVF outcomes when compared with the standard GnRH antagonist protocol in PORs.

In this study, it is aimed at measuring the university students’ behaviors of receiving online counseling services and determining the causes which have a causal relationship with these behaviors. University students’ behaviors of receiving online counseling services and the causes of those behaviors are investigated through structural equation model based on Theory of Planned Behavior. In this study, four different data collection tools were developed to measure subjective norm about the online counseling, perceived behavioral control, intention and behavior. The attitude towards online counseling was measured using Online Counseling Attitude Scale, which was developed by Rochlen et al. (Measurement and Evaluation in Counseling and Development 37(2):95, 2004) and adapted into Turkish by Demirci et al. (International Journal of Psychology and Educational Studies 1(1):15–22, 2014). Internet anxiety was measured using Internet Anxiety Scale, which was developed by Joiner et al. (Computers in Human Behavior 23(3):1408–1420, 2007) and adapted into Turkish by Akin (2012). The data of this study were collected from participants in two steps. In the first step which is the development of the scale, the data were collected from 150 students studying at faculty of education of a university in Central Black Sea Region during 2014–2015 academic year. In the second step which is the testing of the proposed model, the data were collected from a total of 480 students [319 (66.46%) female, 161 (33.54%) male] studying at faculty of education of the same university, but they are different from the participants in the first step. According the results, the proposed model estimated the variance on the intention and behavior of receiving online counseling. The variance on the intention of receiving online counseling was affected by the internet anxiety most. In contrast with the argument of TPB, perceived behavioral control has no impact on intention, but has a direct and significant impact on behavior.

Objectives: The aim of the study was to measure advanced oxidation protein products (AOPPs) as markers for oxidative stress to evaluate cardiovascular risk in pre- and postmenopausal women and to compare the results with malondialde­hyde (MDA) levels. Material and methods: Twenty premenopausal women and 84 naturally postmenopausal patients were enrolled in the study. AOPP and MDA plasma levels were measured. The postmenopausal group was further subdivided into two groups: postmenopausal age of 40–49 and of 50–59 years. AOPP and MDA levels were compared between premenopausal, 40–49 and 50–59 year old menopausal women. Results: Plasma AOPP and MDA levels in postmenopausal women were increased when compared with their premeno­pausal peers (123.83 ± 55.51 μmol/L vs. 61.59 ± 16.42 μmol/L and 6.50 ± 1.05 μmol/L vs. 5.98 ± 0.77 μmol/L; respectively). Mean plasma AOPP levels in the two menopausal age groups were both significantly higher from the premenopausal group (118.64 ± 59.1 μmol/L vs. 61.59 ± 16.42 μmol/L and 132.31 ± 48.97 μmol/L vs. 61.59 ± 16.42 μmol/L; respectively). No significant difference was found in mean AOPP levels between postmenopausal subjects of 40–49 and 50–59 years age (118.64 ± 59.12 μmol/L vs. 132.31 ± 48.97 μmol/L). Mean plasma MDA levels of each of two postmenopausal age groups were both significantly higher from the premenopausal group (6.50 ± 1.04 μmol/L vs. 5.98 ± 0.77 μmol/L and 6.50 ± 1.10 μmol/L vs. 5.98 ± 0.77 μmol/L; respectively). However, no statistically significant difference between the two postmenopausal age groups (6.50 ± 1.04 μmol/L vs . 6.50 ± 1.10 μmol/L) was found. Conclusions: AOPP and MDA levels are elevated in postmenopausal women as compared to their premenopausal peers, suggesting they can be used as markers for cardiovascular risk in postmenopausal women.

The most common treatment modalities of ectopic pregnancy may influence long-term subsequent fertility outcomes in women who previously treated for ectopic pregnancy. Our objective was to compare long-term subsequent fertility outcomes after treatment with expectant management, systemic methotrexate (MTX) and surgery in tubal ectopic pregnancy. We searched our database for all women diagnosed with tubal ectopic pregnancy between January 2007 and January 2011 who were managed expectantly, with systemic MTX and with surgery. Treatment success and spontaneous pregnancy rates were compared in patients who desire to conceive following a tubal pregnancy. One hundred twelve of 151 women desired to conceive following tubal ectopic pregnancy. Twenty-seven of 112 (24.1 %) patients were managed expectantly. Fifty-three (47.3 %) and 32 (28.5 %) patients were managed with systemic MTX or surgery, respectively. All patients in expectant and surgery groups were managed successfully. Two (3.7 %) patients had surgery after failed treatment with systemic MTX. Spontaneous intrauterine pregnancy rates were 62.9 % in expectantly managed women, 58.4 % in women with systemic MTX and 68.7 % in women with surgery (p > 0.05). Treatment of ectopic pregnancy with either expectant management or systemic MTX is equally effective as compared to surgery. Spontaneous intrauterine pregnancy rates were comparable in expectant management, systemic methotrexate and surgery.

Blockchain (BC) is a framework that saves data records in adjacent blocks that are linked together using cryptography. It is in the form of a distributed database that maintains a continuously growing list of data records that are validated by the nodes participating in the chain. BC presents a decentralized solution, which does not require a third-party organization in the middle for achieving the intra-blocks trust. The information about every transaction ever completed in a blockchain is shared and always available to all nodes. This attribute makes the system more transparent than centralized transactions. The goal of blockchain technology is to provide anonymity, security, privacy, and transparency to all its users. This chapter aims to provide the state-of-the-art information on the use of blockchain technology for securing IoT environments. The advantages and limitations of BC technology for IoT architectures are analyzed. Conceptual blockchain-based IoT architectures for seven different cases are also presented. These being: supply chain management and manufacturing, smart cities, smart homes, healthcare IoT systems, identity management and access control systems, electricity market systems, and insurance systems. The most relevant future challenges for the application of blockchain to IoT environments are also discussed.

The EU is expected to become one of the world’s strongest markets for gasification. This is driven by both the impact of the EU landfill directive and government recognition of the need to generate energy from domestic and industrial waste, particularly from advanced new technologies. The cost of landfill is increasing globally, in particular special industrial waste which has a higher disposal cost. The introduction of the climate change levy has also hastened the need to generate renewable sources of tax-exempt energy. During the recent decade, Beltran Technologies Inc (New York, US) in conjunction with Gasification Consultancy Ltd (Newcastle, UK) and Gebze Technical University (Istanbul, TR) has devoted considerable research and development into biomass and RDF updraft fixed-bed gasification systems. These systems are suitable for CHP technology. Beltran can competitively offer gasification plants for a fuel input up to 2000 kg/h (8 MWt) with power efficiencies in excess of 30% and simultaneous delivery of steam for industrial use or hot water for district heating. Beltran has designed, fabricated, installed, and commissioned a single stream 1 MWh power plus 1.25 MWh thermal energy output from refuse-derived fuel (RDF) derived from municipal solid waste (MSW) gasification plant close-coupled with the internal combustion gas engines. This plant has been commissioned recently and in operation since May 2015. A significant part of the work has been related to testing a new gasifier design to handle high plastic content RDF fuel and the conditioning of the gasifier syngas for use in gas engines. For the fine filtration of the gas and produced water, a reliable solution based on wet electrostatic precipitation and a novel cleanup technology has been demonstrated. Furthermore, the complete gasification system has been fully automated for operating remotely. Beltran’s small-scale single or large-scale modular gasification technology is now considered as state of the art, highly competitive, and an alternative to other existing technologies.

Deep Convolutional Neural Networks (DCNNs) achieve state of the art results compared to classic machine learning in many applications that need recognition, identification and classification. An ever-increasing embedded deployment of DCNNs inference engines thus supporting the intelligence close to the sensor paradigm has been observed, overcoming limitations of cloud-based computing as bandwidth requirements, security, privacy, scalability, and responsiveness. However, increasing the robustness and accuracy of DCNNs comes at the price of increased computational cost. As result, implementing CNNs on embedded devices with real-time constraints is a challenge if the lowest power consumption shall be achieved. A solution to the challenge is to take advantage of the intra-device massive fine grain parallelism offered by these systems and benefit from the extensive concurrency exhibited by DCNN processing pipelines. The trick is to divide intensive tasks into smaller, weakly interacting batches subject to parallel processing. Referred to that, this paper has mainly two goals: 1) describe the implementation of a state-of-art technique to map DCNN most intensive tasks (dominated by multiply-and-accumulate ops) onto Orlando SoC, an ultra-low power heterogeneous multi cores developed by STMicroelectronics; 2) integrate the proposed implementation on a toolchain that allows deep learning developers to deploy DCNNs on low-power applications.

The identification of critical nodes in a graph is a fundamental task in network analysis. Centrality measures are commonly used for this purpose. These methods rely on two assumptions that restrict their applicability. First, they only depend on the topology of the network and do not consider the activity over the network. Second, they assume the entire network is available. However, in many applications, it is the underlying activity of the network such as interactions and communications that makes a node critical, and it is hard to collect the entire network topology, when the network is vast and autonomous. We propose a new measure, Active Betweenness Cardinality, where the importance of the nodes are based not on the static structure, but the active utilization of the network. We show how this metric can be computed efficiently by only local information for a given node and how we can locate the critical nodes by using only a few nodes. We also show how this metric can be used to monitor a network and identify node failures. We evaluate our metric and algorithms on real-world networks and show the effectiveness of the proposed methods.

In this study, our objective was to evaluate the impact of testicular histopathology on the outcome of intracytoplasmic sperm injection (ICSI) cycles of patients with nonobstructive azoospermia and correlate with clinical and hormonal parameters. For this purpose, 271 patients with nonobstructive azospermia (NOA) who underwent testicular sperm extraction (TESE) for ICSI cycles were retrospectively evaluated for sperm retrieval, fertilisation, embryo cleavage, clinical pregnancy and live birth rates among different testicular histology groups. We also correlated hormonal and clinical factors with histological findings. Sperm retrieval and fertilisation rates (FR) were found to be significantly different among all testicular histological groups of NOA except for embryo cleavage, clinical pregnancy and live birth rates. Furthermore, serum follicle stimulating hormone (FSH) level was the most significant variable to predict sperm recovery on TESE. Separate analyses within each testicular histological group revealed that higher FSH was also associated with lower pregnancy rates in only maturation arrest group. In conclusion, testicular histology significantly influences sperm retrieval and FRs but not pregnancy and live birth rates in nonobstructive azoospermia. However, FSH is the best predictor of a successful TESE.

Objective: This study aimed to evaluate the incidence rates, reporting rates, and the best imaging plane and sequence for incidental findings in patients undergoing spinal and brain magnetic resonance (MR) imaging. Methods: Three experienced radiologists retrospectively re-evaluated the MR images of 1056 consecutive patients. Results: The incidence rates for extraspinal incidental findings for the images of the lumbar, thoracic, and cervical spine, and extra-neuronal incidental findings on MR images of the brain were 35.47%, 32.25%, 29.16%, and 54.35%; respectively, with reporting rates of incidental findings for these examinations of 31.47%, 8.33%, 29.50%, and 59.62%; respectively. For all examination types, the T2-weighted sequence and the axial plain were the best to reveal the incidental findings of MR examinations, other than that of the cervical spine. Conclusions: Incidental findings, which are commonly detected during routine spinal and brain MR evaluations, are occasionally omitted from formal radiological reports in daily practice. We strongly recommend checking the T2-weighted axial plane for MR imaging of the lumbar, thoracic spine and brain and taking a second look at the T2-weighted sagittal plane MR images of the cervical spine during radiological evaluations.

The concept of k-cores is important for understanding the global structure of networks, as well as for identifying central or important nodes within a network. It is often valuable to understand the resilience of the k-cores of a network to attacks and dropped edges (i.e., damaged communications links). We provide a formal definition of a network»s core resilience, and examine the problem of characterizing core resilience in terms of the network»s structural features: in particular, which structural properties cause a network to have high or low core resilience? To measure this, we introduce two novel node properties,Core Strength andCore Influence, which measure the resilience of individual nodes» core numbers and their influence on other nodes» core numbers. Using these properties, we propose theMaximize Resilience of k-Core algorithm to add edges to improve the core resilience of a network. We consider two attack scenarios - randomly deleted edges and randomly deleted nodes. Through experiments on a variety of technological and infrastructure network datasets, we verify the efficacy of our node-based resilience measures at predicting the resilience of a network, and evaluate MRKC at the task of improving a network»s core resilience. We find that on average, for edge deletion attacks, MRKC improves the resilience of a network by 11.1% over the original network, as compared to the best baseline method, which improves the resilience of a network by only 2%. For node deletion attacks, MRKC improves the core resilience of the original network by 19.7% on average, while the best baseline improves it by only 3%.

With the recent advances in machine learning, Deep Convolutional Neural Networks (DCNNs) represent state-of-the-art solutions especially in image and speech recognition and classification. The most important enabler factor of deep learning consists of the massive computing power offered by programmable GPUs for training DCNNs on large amounts of data. Even the complexity of DCNN deployment scenarios, where trained models are used for inference, have started to require powerful computing systems. Especially in the embedded systems domain, the computational requirements along with ultra low-power and memory constraints exacerbate the situation even further. The STM Orlando ultra low-power processor architecture with convolutional neural network acceleration targets exactly this class of problems. Orlando SoC integrates HW-accelerated blocks together with DSPs and on-chip memory resources to enable energy-efficient convolutions for future generations of DCNNs. Although Orlando platform provides flexibility with programmable DSPs, the large variety of DCNN applications make it challenging the design space exploration of the next generations of Orlando architecture. Many hardware design parameters affect the performance and energy-efficiency of the Orlando SoC. Given the huge size of the design space, design space exploration (DSE) and cost-performance tradeoff analysis is needed to select the best set of parameters for the target DCNN application. In this work, we present the exploration results and the tradeoff analysis carried out for the Orlando architecture on the vee − 16 case study.

Aim We aimed to measure the accuracy of the results of FNAB fine needle aspiration biopsy and preoperative ultrasonography US in patients whose pathologic diagnosis was thyroid cancer and who underwent total thyroidectomy in this study Material and method A total of patients who had undergone thyroidectomy between January and September were included in the study The data of the patients who underwent FNAB following US investigation at our clinic and were diagnosed with thyroid cancer after surgery were evaluated retrospectively Multinodular tissue formation was present on thyroid ultrasonography in all patients The findings that were accepted as ultrasonographically suspicious for malignancy during nodule evaluation were as follows a solid and hypoechogenic nodule a nodule with microcalcifications a nodule with irregular borders a nodule without a halo the length of the nodule being longer than the width increased nodule vascularity on Doppler ultrasonographic evaluation The number of nodules that underwent FNAB the diameter echogenicity hyperechogenic isoechogenic hypoechogenic heterogeneous content solid solid cystic cystic microcalcification presence the presence or absence of a peripheral halo whether the border was regular or irregular and whether the nodule was vascular were noted in the US reports Fine needle aspiration biopsy results and postoperative pathologic diagnoses and ultrasonographic findings of the patients diagnosed with papillary thyroid carcinoma were compared Results Of the patients who underwent thyroidectomy were female and were male The mean age was plusmn years A family history of thyroid or other cancers was present in patients The pathology results of the patients whose previous fine needle aspiration biopsy result was papillary thyroid cancer were also consistent with papillary thyroid cancer Of the patients found to have thyroid cancer papillary carcinoma was present in patients and papillary microcarcinoma in patients Although the incidence of malignancy was high in solid hypoechogenic nodules nodules with vascularization nodules with an anterior posterior diameter transverse diameter ratio gt and nodules without a halo in our study the incidence of malignancy was seen to be less in patients who had a nodule with microcalcification and an irregular border The incidence of cancer was high in nodules cm in size Conclusion FNAB should be performed in patients with a nodule and suspicious US findings to decide whether they should undergo surgery US is a guiding and non invasive examination that can reduce the unnecessary FNAB and surgery rate in US patients

The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP).This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χThe sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group.Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.

Our objective was to assess the role of laparoscopic removal of ovarian endometriomas and ablation of peritoneal endometriosis on the outcome of intracytoplasmic sperm injection (ICSI) - Embryo Transfer cycles by comparing with the results of patients with untreated endometriomas and tubal factor without underlying endometriosis confirmed by laparoscopy. For this purpose, between 2002 and 2015, outcomes of 257 ICSI cycles of 150 patients, including 91 cycles of 48 patients in minimal endometriosis, 57 cycles of 25 patients in endometrioma removal, 65 cycles of 53 patients in non-operated endometrioma, and 44 cycles of 24 patients in tubal factor groups were retrospectively analyzed. Basal ovarian reserve was significantly lower, mean starting and total gonadotropin consumption was significantly higher, and mean serum E2 on the day of hCG injection, number of dominant follicles, number of retrieved total, and MII oocytes were all significantly lower in the endometrioma cystectomy group. Fertilization and embryo cleavage rates were also significantly the lowest in the endometrioma cystectomy group, whereas clinical pregnancy and live birth rates were comparable among all groups. The number of transferred embryos and duration of infertility were the most significant predictors of clinical pregnancy and live birth. Basal antral follicle count was also significant in predicting live birth.

This study aimed to evaluate the effect of luteal phase support on clinical pregnancy and live birth rates after ovulation induction and intrauterine insemination (IUI).579 cycles from 2010 to 2013 were retrospectively evaluated. Ovarian stimulation was performed with gonadotropins, and rHCG was used for ovulation triggering. All patients received IUI. 451 cycles were supported by receiving vaginal micronized progesterone capsules (142 cycles) or vaginal progesterone gel (309 cycles) whereas 128 cycles were not supported.Clinical pregnancy (20.6 versus 9.4%; p = 0.004) and live birth rates (14 versus 7%; p = 0.036) were higher for supported group than for unsupported group. Progesterone gel and micronized progesterone subgroups achieved similar clinical pregnancy and live birth rates (21.4 versus 19%, p = 0.567 and 14.2 versus 13.4%, p = 0.807; respectively).Luteal phase support improved the success of IUI cycles affecting both clinical pregnancy and live birth rates when gonadotropins were used for ovulation induction. The use of vaginal progesterone gel or micronized progesterone significantly improves clinical pregnancy rates. The live birth rates were higher in the progesterone gel group, but were similar in the micronized progesterone group compared to the unsupported group.

Objective: In the present study, thresholds of airway tone-burst auditory brainstem response (ABR), and pure-tone audiometry were compared, and correlations between threshold values obtained with classical audiometric methods, and pure-tone airway hearing in individuals with advanced, and very advanced sensorineural (S/N) hearing loss were investigated. Methods: Eighty patients with advanced and very advanced S/N hearing loss were included in the study. Pure-tone air conduction thresholds of advanced, and very advanced S/N hearing loss patients detected at 500, 2000 and 4000 Hz frequencies were compared with tone-burst ABR threshold values. Results: Our study population consisted of males with a mean age of 21.8±3.45. Mean differences between thresholds of tone-burst, and pure-tone audiometry were detected to be 4.75 dB, 6.25 dB, and 4.87 dB at stimulus frequencies of 500 Hz, 2000 Hz, and 4000 Hz, respectively. Conclusion: In conclusion, in patients with S/N hearing loss, a strong correlation is found between pure-tone audiometry thresholds, and electrophysiological thresholds obtained at 500, 2000, and 4000 Hz with tone-evoked ABR wave-V. Tone-ABR can be used as a reliable test in the diagnosis of patients with hearing loss in conditions where pure-audiometry cannot be performed.

For the last four decades Unmanned Air Vehicles (UAVs) have been extensively used for military operations that include tracking, surveillance, active engagement with weapons and airborne data acquisition. UAVs are also in demand commercially due to their advantages in comparison to manned vehicles. These advantages include lower manufacturing and operating costs, flexibility in configuration depending on customer request and not risking the pilot on demanding missions. Even though civilian UAVs currently constitute 3 % of the UAV market, it is estimated that their numbers will reach up to 10 % of the UAV market within the next 5 years. Most of the civilian UAV applications require UAVs that are capable of doing a wide range of different and complementary operations within a composite mission. These operations include taking off and landing from limited runway space, while traversing the operation region in considerable cruise speed for mobile tracking applications. This is in addition to being able traverse in low cruise speeds or being able to hover for stationary measurement and tracking. All of these complementary and but different operational capabilities point to a hybrid unmanned vehicle concept, namely the Vertical Take-Off and Landing (VTOL) UAVs. In addition, the desired UAV system needs to be cost-efficient while providing easy payload conversion for different civilian applications. In this paper, we review the preliminary design process of such a capable civilian UAV system, namely the TURAC VTOL UAV. TURAC UAV is aimed to have both vertical take-off and landing and Conventional Take-off and Landing (CTOL) capability. TURAC interchangeable payload pod and detachable wing (with potential different size variants) provides capability to perform different mission types, including long endurance and high cruise speed operations. In addition, the TURAC concept is to have two different variants. The TURAC A variant is an eco-friendly and low-noise fully electrical platform which includes 2 tilt electric motors in the front, and a fixed electric motor and ducted fan in the rear, where as the TURAC B variant is envisioned to use high energy density fuel cells for extended hovering time. In this paper, we provide the TURAC UAV's iterative design and trade-off studies which also include detailed aerodynamic and structural configuration analysis. For the aerodynamic analysis, an in-house software including graphical user interface has been developed to calculate the aerodynamic forces and moments by using the Vortex Lattice Method (VLM). Computational Fluid Dynamics (CFD) studies are performed to determine the aerodynamic effects for various configurations For structural analysis, a Finite Element Model (FEM) of the TURAC has been prepared and its modal analysis is carried out. Maximum displacements and maximal principal stresses are calculated and used for streamlining a weight efficient fuselage design. Prototypes have been built to show success of the design at both hover and forward flight regime. In this paper, we also provide the flight management and autopilot architecture of the TURAC. The testing of the controller performance has been initiated with the prototype of TURAC. Current work focuses on the building of the full fight test prototype of the TURAC UAV and aerodynamic modeling of the transition flight.

Purpose: The aim of this study was to find the most effective ovarian hyperstimulation protocol for patients over 35 years old. Materials and Methods: This is a retrospective study of 390 first IVF cycles of patients older than 35 years, that had serum follicle stimulating hormone < 10 IU/L, and that had no co-existing endocrine disorders. Long (n=181), antagonist (n=71), and micro-dose flare-up (n=138) protocols were evaluated. Results: Clinical pregnancy and live birth rates were highest in long protocol group and lowest in micro-dose protocol group. The difference between long and micro-dose protocol groups was statistically significant (p < 0.05). In multivariate logistic regression analysis, picked-up oocyte count (p = 0.005), endometrium thickness at hCG day (p = 0.006), age (p = 0.006), and antral follicle numbers (p = 0.013) were found to be predictive for obtaining clinical pregnancy. Treatment protocols were not found to be predictive for obtaining clinical pregnancy (p > 0.05). Conclusion: Treatment protocols were not found to be predictive for obtaining clinical pregnancy. Patient's age, antral follicle number, endometrial thickness at hCG day, and picked-up oocyte counts directly effect the pregnancy rates. Long protocol affects these factors positively can be preferred in younger patients with higher antral follicle numbers.

Intrahepatic cholestasis of pregnancy (ICP) is an uncommon disorder, which generally occurs in the second and third trimester of pregnancy with symptoms of pruritus. The cause of ICP is unknown but genetic, hormonal and environmental factors contribute to its pathogenesis. The aetiology of ICP is unclear but elevation in oestrogen levels thought to cause ICP is typically seen in the third trimester of pregnancy, and for this reason it is not usually considered in the differential diagnosis of pruritus and liver function disorders in the first trimester of the pregnancy. We present two cases of pregnancy after IVF treatment diagnosed with ICP following the development of OHSS, deteriorating liver function tests and severe pruritus.

The aim of this prospective study is to define markers that can be used in the diagnosis and follow-up of patients with endometriosis by determining serum CA 125, transforming growth factor beta 1 (TGF-beta 1), interleukin 6 (IL-6), and IL-12 levels. The study group consisted of 14 patients diagnosed to have mild to moderate peritoneal endometriosis, 47 patients with ovarian endometrioma during laparoscopy and 12 healthy patients as a control group. Serum CA 125, TGF-beta 1, IL-6, and IL-12 levels were evaluated using ELISA kits. Serum CA 125 levels were significantly higher in the endometrioma group when compared to the control group (p < 0.001) and mild to moderate peritoneal endometriosis group (p

Objective: To predict our pregnancy rates after compulsatory one and conditional two embriyo transfer (ET) number. Design: Retrospective Analysis Materiyal and Methods: One or two embryo transferred 362 patient were analyzed between March 2010 and September 2011. Results: Our clinical pregnancy rate was 31% and implantation rate was 25%. Our pregnancy rates after one or two ET were 30 and 32 % respectively ( P>0.05). We transferred embryos at second, third day or blastocyst stage. Pregnancy rates were 19, 30 and 48 % respectively (p< 0.001), implantation rates were 14.5, 23.5 and 42.4 % respectively ( P< 0.001). Our freezing rate was 39.5 %. Not to have freezing quality embrios or to have increased the the pregnancy rate from 21% to %45 significantly. When one embriyo transfered 95 % single and 5 % twins observed. When two embryos were transfered 81% single,17% twin and 2 % triplets observed. Conclusion: Pregnancy rates for one or two ET were statistically similar. If embryo quality allows us to culture up to blastocyt stage pregnancy rates were statistically increased. New Turkish ET policy resulted 95 % to 81 % single gestational sacs according to 1 or 2 ET at Gazi University IVF center.

Introduction: For tracheal stenosis, tracheal resection and anastomosis is widely considered the treatment of choice. However, this surgical approach is not feasible when the glottis and subglottis are involved or in patients with a poor general condition and tracheal stents are a plausible means of providing a permanent or temporary airway opening. Objectives: Evaluate the features and the results of patients with Montgomery T-tube in tracheal stenosis. Methods: Fifteen patients with Myer-Cotton grades 2-3 circular cicatricial tracheal stenosis who received a Montgomery T-tube between 2002-2011 were analyzed in terms of age, gender, etiology, duration of intubation, location and size of the stenotic segment on computed tomography(CT), follow-up time with the T-tube, the complications that occurred after T-tube removed and additional tracheal surgery. Conclusion: A T-tube can be applied in tracheal stenosis at the first treatment before attempting surgery. The patients should be closely followed-up due to the possibility of re-stenosis and other complications.

Background The accuracy of fine-needle aspiration biopsy (FNAB) is controversial in parotid tumors. We aimed to compare FNAB results with the final histopathological diagnosis and to apply the "Sal classification" to our data and discuss its results and its place in parotid gland cytology. Methods The FNAB cytological findings and final histological diagnosis were assessed retrospectively in 2 different scenarios based on the distribution of nondefinitive cytology, and we applied the Sal classification and determined malignancy rate, sensitivity, and specificity for each category. Results In 2 different scenarios FNAB sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 81%, 87%, 54.7%, and 96.1%; and 65.3%, 100%, 100%, and 96.1%, respectively. The malignancy rates and sensitivity and specificity were also calculated and discussed for each Sal category. Conclusion We believe that the Sal classification has a great potential to be a useful tool in classification of parotid gland cytology.

In this study, we aimed to determine whether anti-Müllerian hormone (AMH) levels vary between fertile and infertile populations and compare them with basal follicle-stimulating hormone (FSH) levels and antral follicle count (AFC). This was a prospective study that included 177 primarily infertile patients who underwent IVF treatment and 162 healthy fertile patients admitted to our clinic for benign diseases. FSH and AMH levels and the AFC of the infertile and fertile populations were compared between the age categories30, 30-39 and ≥40. Correlations between AMH, basal FSH, and AFC with age were evaluated. AFC and AMH levels did not differ between the fertile and infertile groups in all age categories. AMH was inversely correlated with age in both the fertile and infertile populations. However, AFC revealed a stronger correlation with age in both the fertile and infertile populations compared with basal FSH and AMH. Age was positively correlated with basal FSH and inversely correlated with AMH and AFC. In conclusion, there was no significant difference between the fertile and infertile populations in terms of AMH or AFC. The decrease in ovarian reserve in infertile patients is directly related to age, not infertility.

Objective To ascertain the incidence of premature progesterone P rise and its impact on outcomes in controlled ovarian hyperstimulation and intrauterine insemination (COH–IUI) cycles, and also to identify variables related with premature P rise. Study design Four hundred sixty cycles of 460 couples with unexplained infertility having COH–IUI treatment with a starting dose of 75 IU recombinant FSH enrolled in this prospective study. Serum P levels were determined on the day of hCG trigger. Premature P rise was defined as progesterone ≥1 ng/mL. The primary outcome measure was live birth per cycle with regard to P levels of ≥1 ng/mL and ≥1.5 ng/mL. Secondary outcome measures were cycle characteristics associated with P rise. Results The incidence of premature P rise was 22.0%. P levels on hCG day were significantly lower in cycles with live birth as compared to cycles without live birth 0.49 ± 0.51 vs. 0.73 ± 0.82 ng/mL. Live birth rates were significantly lower in cycles with hCG day P levels ≥1.0 ng/mL (%7.9 vs. %22.6) and ≥1.5 ng/mL (%6.4 vs. %20.8). Among age, number of dominant follicles, estradiol, LH and P levels on the day of hCG trigger, it was found that P levels was the only significant variable to predict live birth on multivariate analysis. The number of dominant follicles on hCG day and premature LH surge were the only significant variables related with premature P rise. Conclusion Premature P is a frequent feature of COH–IUI cycles and associated with decreased live birth rates.

Structural deficiencies of the nasal dorsum are most commonly of congenital, traumatic, or iatrogenic etiology. Various grafts, including autografts, homografts, and synthetic materials, have been used to this end and are described in the literature.Autologous septal cartilage is the most commonly used graft material when limited augmentation rhinoplasty is planned. However, it is difficult to retain sufficient cartilage to allow of such augmentation in instances where most of the septal cartilage has been used. The authors place moderately crushed cartilage beneath a monolayer of surgicel when performing limited nasal dorsum augmentation. The aim of the present study is to describe authors' approach and its utility by reviewing other methods reported in the literature.

The soft triangle is a basic, yet delicate and vulnerable, subunit of the nose that is under-rated both academically and surgically. The soft triangle is located at the apex of the nostril, at the point where the dermis is in direct contact with dermis that contains no intervening subcutaneous tissue and it may be unintentionally harmed during rhinoplasty.The authors suggest using a modified incision and closure and filling with significantly or severely crushed cartilage to prevent notching and to provide support for the soft triangle. The more the authors understand the nature of the soft triangle, the more they will be able to obtain superior surgical results in the nasal tip area.