Search

Objective:The diagnosis of hypertension in adolescents aged ≥13 and Methods:This study was designed by retrospectively screening the records of 395 adolescents with both office and 24-hour ambulatory blood pressure measurements. Each blood pressure measurement was classified according to both the ESGH2016 and AAP2017 guidelines. Patients were divided into three subgroups according to body mass index. Cohen’s kappa analysis was used to evaluate the agreement between the two guidelines.Results:The majority of adolescents were normotensive according to both guidelines, 55.9% by ESHG2016 and 43.1% by AAP2017. For the whole group, the frequency of hypertension was 32.4% with ESHG2016 and 34.4% with AAP2017; while, in obese patients, hypertension frequencies were 38.8% and 43.3%, respectively. The diagnosis of hypertension was demonstrated with the two guidelines, and there was significant agreement at a substantial level, both for the obese subgroup and the whole study group (kappa value = 0.738 and 0.785, respectively). The frequency of white-coat hypertension was higher with the AAP2017 guideline (28.1% versus 16.2%, p < 0.001).Conclusion:With our experience in this single-centre study, it seems that both the AAP2017 and the ESHG2016 guidelines can be used in the diagnosis of hypertension in adolescents.

Primary heart tumours are rarely encountered. Myxomas, which are included in this group of tumours, are the most common primary benign neoplasms of the heart and approximately 75-80% of them are found in the left atrium. In our case, a 72-year-old female patient, who had complaints of shortness of breath, pain in the chest and swelling in the legs that increased in the last three months. We present a case with a myxoma in the right atrium with a dimension of 80x60x15 mm attached to the interatrial septum. According to the echocardiographic examination, it clinically shows signs of right heart failure, almost completely obstructs the right atrium and extends to the right ventricle. Ascending aortic aneurysm was also detected on the echocardiography. Despite the fact that the right atrial mass obliterating the cardiac chambers was removed by surgery, the valve pathology caused by the lesion did not regress.

C3 glomerulopathy (C3G) is characterized by heterogeneous clinical presentation, outcome, and predominant C3 accumulation in glomeruli without significant IgG. There is scarce outcome data regarding childhood C3G. We describe clinical and pathological features, treatment and outcomes, and risk factors for progression to chronic kidney disease stage 5 (CKD5) in the largest pediatric series with biopsy-proven C3G. Sixty pediatric patients with C3G from 21 referral centers in Turkey were included in this retrospective study. Patients were categorized according to CKD stage at last visit as CKD5 or non-CKD5. Demographic data, clinicopathologic findings, treatment, and outcome data were compared and possible risk factors for CKD5 progression determined using Cox proportional hazards model. Mean age at diagnosis was 10.6 ± 3.0 years and follow-up time 48.3 ± 36.3 months. Almost half the patients had gross hematuria and hypertension at diagnosis. Nephritic-nephrotic syndrome was the commonest presenting feature (41.6%) and 1/5 of patients presented with nephrotic syndrome. Membranoproliferative glomerulonephritis was the leading injury pattern, while 40 patients had only C3 staining. Patients with DDD had significantly lower baseline serum albumin compared with C3GN. Eighteen patients received eculizumab. Clinical remission was achieved in 68.3%. At last follow-up, 10 patients (16.6%) developed CKD5: they had lower baseline eGFR and albumin and higher frequency of nephrotic syndrome and dialysis requirement than non-CKD5 patients. Lower serum albumin and eGFR at diagnosis were independent predictors for CKD5 development. Children with C3G who have impaired kidney function and hypoalbuminemia at diagnosis should be carefully monitored for risk of progression to CKD5. Graphical abstract

WOS:000565809700014 PubMed: 32994776 Introduction: Eyelid tumours mostly originated from skin and its appendeges. External carcinogens like UV radiation causes cell damages in the eyelid skin and contributes to carcinogenesis. Apoptosis is a very important mechanism to prevent these damage and probable neoplatic change. Aim: To compare caspase-3, p53 and Bcl-2 levels between patients with basal cell carcinoma (BCC) of the eyelid and healthy individuals. Material and methods: Pathology archives from October 2012 to April 2015 were scanned for BCC biopsies of the eyelid and tissue removed during blepharoplasty and entropion procedures. A total of 36 specimens were found. The specimens were divided into two groups: BCC group and controls (consisting of eyelid tissue removed during routine blepharoplasty). The pathology specimens were then stained using p53, Bcl-2 and caspase-3 stains and the intensity of staining was graded on a 0-3 scale. Results: Samples from a total of 36 patients were included in the study. Eighteen (50.0%) patients were female. There were 13 patients in the BCC group and 23 patients in the control group. The mean age was 66.0 +/- 10.8 years in the BCC group, and 65.61 +/- 11.22 years in the control group. The caspase-3 staining was lower in the BCC group than in the control group. No significant differences were found between the BCC group and the control group in terms of p53 levels or Bcl-2 levels (both of them, p = 1.000). Conclusions: The caspase-3 level was lower in the BCC group. This result suggests that these enzymes can play a significant role in carcinogenesis of eyelid BCC.

Although orthostatic proteinuria (OP) is the most common cause of childhood proteinuria, excluding transient proteinuria, data regarding prevalence and long-term prognosis are limited. We aimed to determine prevalence of OP in healthy schoolchildren evaluating relationships with age, gender and body mass index, and determine follow-up. A total of 1701 healthy children aged 6–15 years were selected using a population-based, stratified, cluster-sampling method; and random urine samples were taken. For proteinuria ≥ 1+ in first urine samples, second and third random samples were taken at least 2 weeks apart to exclude transient proteinuria. For continuing proteinuria after third samples, first morning urine samples were collected. Cases where proteinuria was not detected in first morning urine samples were diagnosed as OP. Sixty-four of 1701 children (3.7%) had proteinuria on first random urine samples. After second and third urine samples, proteinuria persisted in only 16 (0.94%). OP was detected in 11 (0.65%). Prevalence of OP tended to decrease with increasing BMI, though not statistically significant. All 7 cases with OP who were re-evaluated later, had no proteinuria 3 years after diagnosis. Prevalence of OP in our study was lower than the literature. At least three random urine samples should be taken to exclude transient proteinuria in an asymptomatic child/adolescent before making a diagnosis of OP using first morning urine samples. OP is a benign condition and resolves spontaneously in most cases. Underweight children had a tendency for OP compared with overweight and obese children; however, further studies with larger number of patients are needed.

OBJECTIVES: Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique. MATERIAL AND METHODS: A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity. RESULTS: No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.

Congenital nephrotic syndrome (CNS) is a genetic disease that is present in the antenatal period or during the first 3 months of life. In this study, we aimed to compare growth parameters of patients with CNS who received kidney transplants and either (1) had a normal glomerular filtration rate (GFR) at the time of transplant or (2) chronic kidney disease (CKD) at the time of transplant. Patients with a diagnosis of CNS who had a minimum follow-up period of 6 months were evaluated retrospectively. Children at stages 4 or 5 CKD or patients receiving dialysis during the pretransplant period were defined as group 1; patients with normal GFR at the time of transplantation were classified as group 2. Short stature and low weight were defined as less than −2 standard deviation scores (SDS) for height and weight according to their age. A total of 17 patients were included in the study. Thirteen of 17 patients had NPHS1 gene mutations. Group 1 and group 2 consisted of 8 and 9 patients, respectively. Mean height SDS and mean weight SDS in group 2 were higher than group 1 in the pretransplant period (−4.34 ± 1.74 vs −2.84 ± 1.56; P = .011 and −3.54 ± 0.93 vs −1.83 ± 1.13; P = .008). In the post-transplant period, the significant difference in height SDS continued in favor of group 2 (−3.16 ± 1.11 vs −1.16 ± 0.87; P = .002). The short stature rate was 83% in group 1 and 72% in group 2 in the pretransplant period (P = .62), and 83% in group 1 and 27% in group 2 in the post-transplant period (P = .02). Early renal transplantation seems to be effective for optimal height gain in children with CNS.

In the present study, computational fluid dynamics techniques are used to investigate numerically the performance of a heat exchanger (shell and helical tube) in order to improve its ability of tra...

Microscopic polyangiitis nodosa (MPA) is a necrotizing vasculitis that affects small vessels, typically associated with myeloperoxidase anti-neutrophil cytoplasmic antibody. Cerebrovascular diseases are rarely reported to be associated with MPA. A 41-year-old male patient presented to the emergency room with complaints of speech difficulty and loss of strength on the left upper extremity, and MPA was detected with cerebral hemorrhage and renal failure. The case report, just as we first defined with this case in the national literature, was presented to emphasize that MPA may be rarely demonstrated with symptoms of cerebrovascular involvement except for commonly seen organ involvement. WOS:000461206800017 2-s2.0-85088097959

The most important determinant of long-term graft survival in renal transplantation is adequate immunosuppression. Inadequate immunosuppression may lead to graft loss due to the presence of anti-HLA antibody. The aim of this study was to investigate the effect of variability in tacrolimus blood concentration on anti-HLA antibody development in pediatric recipients of living-donor renal transplants. Pediatric recipients of living-donor renal transplants were retrospectively evaluated. Patients with a minimum of two years of follow-up who were administered tacrolimus were included in the study. Patients who had pretransplant anti-HLA antibody were excluded. Variability in tacrolimus blood concentration was assessed using the coefficient of variation (“tacrolimus CV”) method. Tacrolimus CV was calculated separately for the first 6 months post-transplant, between 6 and 12 months post-transplant, and from the end of the first year post-transplant to the last follow-up. We constructed receiver operating characteristic (ROC) curves of the tacrolimus CV for each group to find the best cutoff value. A total of 67 patients (including 48 males; 72%) with a mean age of 15.16 ± 4.43 years were included in the study. Anti-HLA antibody positivity was detected in 12 patients (18%). More than three HLA mismatches and the presence of acute cellular rejection correlated with the development of anti-HLA antibody (p = 0.056, 0.009). Tacrolimus CVs for the three periods were 0.37 ± 0.11, 0.31 ± 0.18, and 0.35 ± 0.12, respectively. The cutoff value of tacrolimus CV for anti-HLA antibody development was calculated as 0.32 with a sensitivity of 90.91% and specificity of 50.94% [AUC (area under the curve) 0.713, p = 0.023]. During the second 6-month period and after a year post-transplant, the percentage of patients with tacrolimus CV > 0.32 was significantly higher in the anti-HLA antibody positive group than in the antibody negative group (67% vs 31%, p = 0.027; 83% vs 47%, p = 0.033). The eGFR (estimated glomerular filtration rate) was similar for the anti-HLA antibody negative and positive groups (78.72 ± 2.86 vs 77.45 ± 8.08, p > 0.05). High tacrolimus concentration variability appears to be associated with anti-HLA antibody formation in pediatric recipients of living-donor renal transplants.

Fuzzy Logic (Fuzzy Logic) is a branch of science based on thinking like human beings and solving them with mathematical functions. Fuzzy logic theory is a mathematical theory. Based on fuzzy set theory, it also uses intermediate values. The fuzzy logic that emerged in 1965 is used in many fields. In the production of pacemakers, in the production of artificial organs, in many electronic devices, company efficiency estimation, etc. situations are used. Fuzzy logic, which is frequently used in the solution of problems that occur in uncertain situations such as quality assessment in recent years, is one of the artificial intelligence methods. With the help of machines, people-specific data and experiences are studied using the fuzzy logic approach. In this study, by using Matlab Fuzzy Toolbox, it was aimed to design a system that gives information about the breeding performances of cows. The expert system was designed based on the optimal values under the ideal conditions specified in the literature. The architecture of the system presented in this paper is designed as three input parameters and one output. The designed system was tested with 100 sample values. Afterwards, expert results were evaluated and system decisions were compared. The success of the decision support system was 94%. As a result, the reproductive efficiency of cows can be determined with this designed system. With this determination, the handling or disposal of cows can be determined.

Idiopathic pulmonary hypertension(IPAH) is a rare disease that causes severe morbidity and mortality despite advances in treatment management. Evaluating the prognosis of the disease is critical in determining therapeutic approaches. We aimed to evaluate the prognostic significance of C-reactive protein/albumin ratio (CAR) and uric acid, which is an easily applicable and inexpensive parameter in patients with IPAH.Seventy-two IPAH patients and 99 consecutive non-IPAH patients as a control group were enrolled in the study retrospectively. Right heart catheterization(RHC), echocardiography, and laboratory parameters of the two groups and those who died and survived among the IPAH patients were compared.IPAH and control group were compared at the first stage and CAR (1.98(0.28-10.74), 0.75(0.22-4.7),respectively;p 0.01) and uric acid (0.33(0.19-0.87), 0.3(0.11-0.48) mmol/L, respectively; p = 0.03) values were significantly higher in the pulmonary hypertension group compared to the control group. Compared with the surviving IPAH patients, CAR (4.60(1.39-10.74),1.54(0.28-6.74),respectively;p 0.001) and uric acid levels (0.458(0.26-0.87), 0.315(0.19-0.56) mmol/L, respectively; p 0.001) were significantly higher in the group of patients who died. In the multivariate Cox regression models uric acid(p 0.001) and CAR(p 0.001) were found to be associated with survival time. Receiver operating characteristic curves (ROC) analyses showed that 1.54 CAR value (AUC = 0.81,Sens:85.7%,Spec:56.9%,p 0.001) and 5.85 mg/dL (0.348 mmol/L) uric acid value (AUC = 0.864, Sens:85.7%, Spec:78.4%, p 0.001) are strong predictors for mortality.In this study, we showed that simple markers such as CAR, which augment the inflammation marker feature of CRP, and uric acid can give prognostic information in PAH patients.

[No Abstract Available]

Objective: Pericardiocentesis is a percutaneous drainage procedure performed in cardiac tamponade or a moderate-large pericardial effusion that does not respond to medical treatment. The prognosis varies according to the etiology of pericardial effusion, and the parameters that can determine the prognosis are unknown. In this study, we aimed to find predictors that can determine inpatient mortality in patients who underwent pericardiocentesis and to determine cancer etiology. Method: Ninety-one patients who underwent pericardiocentesis due to moderate-large pericardial effusion or pericardial tamponade were evaluated retrospectively. Baseline characteristics of the patients, their cancer diagnosis before and after pericardiocentesis, pericardial effusion cytology, echocardiographic parameters and laboratory parameters in the baseline evaluation were evaluated. The group with inpatient death (n = 14) and the surviving group (n = 77) were compared with each other. Results: There was no significant difference between baseline demographic characteristics and echocardiographic parameters when the patients with inpatient mortality and survivors were compared; only patients diagnosed with cancer (p

Standart bir En Önemsiz Bit (EÖB) algoritması, bir görüntünün en az önemli bitlerinin ortalama %50' sini değiştirir. Bu durum gri tonlamalı bir görüntüde yaklaşık olarak %0,2 bozulmaya neden olur. Bu nedenle, keskin olmayan gri tonlamalı görüntülerde EÖB uygulaması, insan görsel sistemi tarafından kolayca tespit edilebilecek çok fazla gürültüye neden olur. Ek olarak; görüntü piksel piksel tarandığında, gizli mesaj yetkisiz kişilerce kolayca okunabilir. Bu çalışmada sağlam ve algılanamayan blok tabanlı EÖB steganografi yöntemi geliştirilmiştir. İlk önce kapak resmi bloklara bölünür, sonra görüntünün daha az ayrıntılarını içeren blokları tespit etmek için her bir bloğun medyan geometrik ortalaması ve aritmetik ortalaması hesaplanır. Yöntemin, veri gizleme işleminden önce görüntünün veri yükü kapasitesini hesaplayabilme avantajı vardır. Geliştirilen yöntem ayrıca yetkisiz kişilerin gizli mesajları tespit etmelerini zorlaştırır. Yöntemin performansı MSE, PSNR ve SSIM gibi matematiksel yöntemlerle ölçülmüştür. Yöntem, dört test görüntüsünde %0,9999' un üzerinde yapısal benzerlik skoru elde etmiştir ve standart EÖB algoritmasından 20 kat daha iyi sonuç alındığı gösterilmiştir., A standard Least Significant Bit (LSB) algorithm changes average 50% of the least significant bits of an image. This causes approximately a 0.2% distortion on a grayscale image. Therefore, the application of LSB on non-sharp grayscale images causes too much noise that can be easily detected by the human visual system. In addition; when the image is scanned pixel by pixel, hidden message can be easily read by unauthorized persons. A robust and imperceptible block-based LSB steganography method is developed in this study. First, cover image is divided into blocks, then median geometric mean and arithmetic mean of each block is calculated to select blocks those contain less detail of the image. Method has an advantage of calculating data load capacity of image before embedding process. Proposed method also makes it difficult for unauthorized people to detect hidden messages. Performance of the method is measured by mathematical methods such as MSE, PSNR and SSIM. The method achieved structured similarity score over 0.9999% on four test images, indicating a 20-fold better result than the standard LSB algorithm.

Background and Aims Nephrotic syndrome in childhood is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Although most children respond to glucocorticoid therapy, approximately 10% of patients turn out to be steroid resistant (steroid-resistant nephrotic syndrome [SRNS]). Although several studies in children with SRNS have shown that mutations in genes encoding proteins in the podocyte skeleton may be responsible for the etiology in only one-third of cases, the genetic features related with renal prognosis and response to immunosuppressive agents are not fully recognized. The aim of this study was to investigate the genomic alterations associated with renal prognosis and resistance to immunosuppression in children with SRNS. Method The children with SRNS were enrolled in this study. Custom gene panel was designed for next-generation sequencing analysis of more than 20 target genes (ABCB1, ABCC2, CTLA4, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, FOXP3, GSTP1, IMPDH1, IMPDH2, NOS3, NR3C1, SLCO1B1, SLCO1B3, TPMT, UGT1A9, UGT2B7) and 200 single nucleotide variants (SNVs) which were reported as implicated in renal prognosis of nephrotic syndrome. The target gene panel was enriched for drug metabolism regulating transporters and enzymes. Results A total of 25 children, 16 boys (64%), median age at last visit 17.5 years (13-18 years), median age at diagnosis 7.5 years (2-15), median follow-up 9.58±4.54 years, were included in the study. All patients were diagnosed focal segmental glomerulosclerosis on renal biopsy.

OBJECTIVE In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. MATERIAL AND METHODS The medical records of patients who underwent ultrasonography (US), non- acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed. RESULTS A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was

AIM: To investigate 3-year results in our neovascular age related macular degeneration (NV-AMD) patients treated with ranibizumab. METHODS: Retrospective study. Visual acuity (VA), a full biomicroscopic examination (anterior segment and fundus), and optical coherence tomography (OCT) findings were noted at every visit. All patients were followed monthly. The VA values for the visits closest to 12, 24, and 36mo were analysed. 101 eyes of 73 patients were enrolled. According to the initial VA, the patients were divided three groups: initial VA ≤35 (Group 1), 36-54 (Group 2), and ≥55 letters (Group 3). After three loading doses of 0.5 mg ranibizumab if retreatment was needed, again, 0.5 mg ranibizumab was administered RESULTS: Totally 57 of the 101 eyes were from males and 44 were from females. The average age was 75.1 years. The difference on the changes of VA among three groups at 24 and 36mo were statistically significant (P=0.02 and 0.001 respectively). At the end of the 36-month follow-up the VA increase in Group 2 was significant (P=0.001). At the 12, 24, and 36mo visits most of the eyes showed no VA loss and most of these eyes were in Group 1. The average number of injections administered was 7.3 and the average number of visits was 23.9 during the follow-up. CONCLUSION: VA improvement was significant in those with mild initial VA (36-54 letters). Most eyes showed no VA loss regardless of the initial VA. No correlation between the final VA and the average number of injections.

Introduction: A vast majority of multiple myeloma (MM) patients requires subsequent lines of therapy following relapses. The choice of regimen following relapse is influenced by response, tolerance to prior therapies, as well as by disease and patient features. Treatment options are limited for those who develop triple-class refractory disease. In this setting, the role of a salvage autologous stem cell transplantation (sAHCT) is controversial. This unmet need has driven the development of new therapies with novel mechanisms of action. Selinexor, an oral selective inhibitor of nuclear export (SINE) compound, was recently approved by the FDA and EMA for use in heavily pretreated relapse refractory (RRMM) patients, including triple-class refractory RRMM and FDA has also approved the agent in patients with first relapse. In the absence of head-to-head studies, comparison of treatment options among triple-class treated patients is based on real world experience. Here we performed a retrospective comparison between outcomes following sAHCT versus Selinexor combinations administered among RRMMs. Patients & Methods: Between January 2015 and April 2021, 22 patients at our center underwent sAHCT for treatment of refractory relapse. A transplant was defined as salvage if the patient had already received one prior AHCT and underwent a further AHCT after evidence of disease progression not responding to second generation proteasome inhibitors (PI), İmmunomodulating agents (IMID) or antiCD38 monoclonal antibody. We compared the outcomes of these patients with 10 RRMM patients who had exhausted their treatment options and were progressing on their last line of therapy to receive Selinexor, dexamethasone in combination with either bortezomib (n=7) (XVd) or carfilzomib (n=3) (XCd) as a part of a Karyopharm Expanded Access Program (KEAP). Selinexor was administered 80-100 mg po weekly in combination. Response and disease progression were assessed according to the IMWG criteria. Results: Patients' characteristics and the outcome of treatments are shown in Table. The median age of patients was similar in both groups. Patients were heavily treated with a median of 6 prior lines of therapy (4-9) and 2 out of 10 carried high-risk cytogenetics in SVd group. Seven (31.8%) patients with high-risk cytogenetics underwent sAHCT. All patients were treated with or refractory to immunomodulators and proteasome inhibitors. Five patients responded to DCEP bridging therapy prior to sAHCT. Five patients received Selinexor after sAHCT. One patient underwent sAHCT due to progression under Selinexor treatment. In sAHCT group, 68.2% of patients relapsed within a median of 6.3 months (Figure-1). Figure-2 shows the impact of the prior lines of therapy and selinoxor on PFS.Adverse events on selinexor regimens included fatigue, nausea, thrombocytopenia which were managed with Selinexor dose adjustment and supportive care. Two patients eventually transitioned to new therapies, while 4 still remain on SVd due to continued response. Conclusion: Our results based on a small number of patients, compared with outcomes post sAHCT reflects comparable duration of response and disease control rates with Selinexor-PI regimens among selected patients. Hospitalization and prolonged infusions are not required with the selinexor regimens, and prolonged treatment is possible with advance in lines of therapy duration of response lessens with any treatment modality. Despite of a DCEP bridging therapy prior to sAHCT, Selinexor combos have achieved similar PFS even among triple class refractory MM patients. For countries where CAR-T therapies are not accessible, sAHCT and Selinexor combinations may be considered as a valid clinical option after failing CD38 monoclonal antibodies, PI and IMIDs. These data support the use of selinexor-based regimens in the treatment of relapsed MM, and given the potency of the combinations, in earlier lines of therapy including in patients who have received anti-CD38 mAbs. Figure 1 Figure 1. Disclosures Kashyap: Karyopharm: Current Employment. Niblock: Karyopharm: Current Employment. Beksac: Amgen,Celgene,Janssen,Takeda,Oncopeptides,Sanofi: Consultancy, Speakers Bureau. OffLabel Disclosure: Selinexor has not been approved for myeloma patients in Turkey. It could be used as a part of Karyopharm Expanded Access program (KEAP).

Agbas, Ayse/0000-0002-3658-8622; Ozcakar, Zeynep/0000-0002-6376-9189; Cakar, Nilgun/0000-0002-1853-0101 WOS: 000437355600002 PubMed: 29533929 Background: There are limited data on infants with atypical hemolytic uremic syndrome (aHUS). The aim of this study was to determine the clinical and laboratory features, and to evaluate treatment modalities and outcomes in infants with aHUS. Materials and Methods: Relevant data on patients with onset of aHUS at age

Summary Background Circumcision is one of the oldest and most frequently performed surgical interventions in many societies across the world. Boys undergoing this procedure experience anxiety and fear during the preoperative period. In addition, postoperative pain in children is reported to be associated with anxiety and fear. Aim This study aimed to examine the effects of using virtual reality (VR) intervention before circumcision on the pre-and postoperative anxiety and fear levels and postoperative pain symptoms in children. Material and methods This randomized controlled experimental study included 5–10-year-old boys referred to a pediatric hospital for circumcision between June and September 2019. Randomization was performed using the randomized block design, and the subjects were divided into control (n = 38) and experimental (n = 40) groups. The data were collected using a participant information form, the children's fear scale (CFS), the children's anxiety meter scale (CAM-S), and the Wong-Baker Faces Pain Rating Scale (WBS); data were analyzed using SPSS 22.0 package program. Results Of the children included in the study, 59% were between the ages of five and six years and 78.2% had no previous hospital experience. Children in the experimental group had significantly lower mean scores of CAM-S and CFS in the pre-and postoperative periods than those in the control group. Also, the mean postoperative WBS score was significantly lower in the experimental group than in the control group. Discussion Results of this study were similar to those reported previously that VR interventions were effective in reducing fear and anxiety in the preoperative period (Dehghan et al., 2019, Ryu et al., 2018; Olbrechta et al., 2020). Previous studies have shown that patient immersion in interactive VR provides a distraction from painful stimuli and can decrease an individual's perception of the pain (Pouarmand et al., 2018; Chad et al., 2018). Conclusion Distracting children using a VR intervention before circumcision decreased their anxiety and fear both before and after the surgery, and it was found that the pain symptoms were lower in the postoperative period. Summary Table . Comparison of CAM-S, CFS, and WBS scores between the groups. VR Group X ± SD Control Group X ± SD p CAM-S Pre-op 1.27 ± 0.647 3.76 ± 3.07 p Post-op 3.73 ± 2.47 7.76 ± 2.83 p P p p Observer reported Pre-op 1.60 ± 1.00 3.32 ± 2.45 p Post-op 3.28 ± 3.01 7.03 ± 3.00 p P p p CFS Self-reported Pre-op 0.46 ± 0.55 0.97 ± 1.19 p = 0.104∗ Post-op 1.33 ± 1.03 2.45 ± 1.50 p = 0.001∗ P p p Observer reported Pre-op 0.56 ± 0.55 0.84 ± 0.97 p = .341∗ Post-op 1.18 ± 0.97 2.26 ± 1.24 p P p p = .002∗∗ Pain scores Nurse reported Post-op 1.18 ± 0.747 (0–3) 3.16 ± 1.38 (1–5) p Observer reported Post-op 1.35 ± 1.09 (0–4) 3.00 ± 1.52 (0–5) p

Fuel pipes popularly used in automotive industry applications carry fuel from the fuel tank to the engine and work under variable vibrations having different magnitude and frequency parameters due to the engine’s rotation frequency and road profile’s spontaneous change. Considering that the transfer of the fuel to the engine in the desired way has a crucial importance on the driving performance, any problem that may exist because of the vibrations cannot be acceptable in the pipe assembly. Because of this reason, all manufactured fuel pipes have to be well tested in terms of some industrial standards. The fluid excitement test is a very useful and commonly accepted method in the industry. However, this method produces enormous amount of noise that does not allow to obtain healthy pressure values from the sensors. In this study, Kalman filtering method has been used to interpret the data that have been obtained from the sensors. The usefulness and effectiveness of the proposed Kalman filtering method have been shown and discussed based on the test results.

Aim Viral infections commonly affect kidney transplant recipients and may lead to graft failure and death. The aim of this study was to evaluate the antibody seroprevalence against viral agents in kidney transplant recipients. Material and Methods The records of children who underwent kidney transplantation between 2008 and 2018 in Akdeniz University Faculty of Medicine were retrospectively reviewed. Epstein-Barr virus, cytomegalovirus, hepatitis A virus, hepatitis B virus, varicella, measles, rubella and mumps serologies evaluated before transplantation, were recorded. The clinical characteristics of seronegative and seropositive patients were compared, and factors that affected seropositivity were investigated. Results The study included 253 children with a mean age of 16.7±6.23 years. The mean age at transplantation was 11.4±5.01 years. The seropositivity rates for vaccine-preventable viral infections varied: hepatitis B 89.7%, hepatitis A 60.5%, measles 78.7%, rubella 88.1%, mumps 61.2%, and varicella 71.9%. Cytomegalovirus seropositivity was 92.1% and Epstein-Barr virus seropositivity was 82.2%. Hepatitis B antibody positivity was 91.8% in patients undergoing hemodialysis, 94.5% in patients undergoing peritoneal dialysis, and 84.9% in pre-emptive transplantation patients (p=0.037). The mean age at transplantation was higher in patients with seropositivity for both cytomegalovirus and Epstein-Barr virus compared with seronegative patients (p

To ensure the safety of the analog data, it is enough to store it physically. With the transfer of data to the digital environment, the concept of data security has been moved to a different dimension. The emergence of the Internet brought data security among the most discussed issues. Higher data transfer speed and higher storage capacity of data make more difficult the protection and authentication of digital data including personal and commercial audio, video and image. Concepts such as cryptology, steganography, digital signature and watermarking have been used for data security. In this study, the concept of watermarking which is used for data security is explained. History of watermarking, watermarking methods, watermarking types and watermarking media are mentioned. Watermarking methods are introduced in the spatial and frequency domain. Comparison of methods and performance metrics are described.

This study presents a new approach to determine the likelihood of asymptomatic carriers of the SARS-CoV-2 virus by using interaction-based continuous learning and inference of individual probability (CLIIP) for contagious ranking. This approach is developed based on an individual directed graph (IDG), using multi-layer bidirectional path tracking and inference searching. The IDG is determined by the appearance timeline and spatial data that can adapt over time. Additionally, the approach takes into consideration the incubation period and several features that can represent real-world circumstances, such as the number of asymptomatic carriers present. After each update of confirmed cases, the model collects the interaction features and infers the individual person's probability of getting infected using the status of the surrounding people. The CLIIP approach is validated using the individualized bidirectional SEIR model to simulate the contagion process. Compared to traditional contact tracing methods, our approach significantly reduces the screening and quarantine required to search for the potential asymptomatic virus carriers by as much as 94%., Comment: 15 pages,6 figures,2 tables

Special devices are required to perform tampering on an analogue image. This requires a serious cost and skill. But it is easy to tamper on a digital image. Digital images can be tampered even with easy accessible free digital image editing software. Moreover, this tampering can occur even with a mobile phone. In particular, tampering on important images such as images containing financial data, images of official documents, etc., can lead to money and time losses. In this study, a method of tamper detection in order to protect the RGB images and performing a recovery of the tampered region has been proposed. The proposed method can recover a tampered image even without any information of the original. Method backups the value of each pixel of the image to the farthest pixel possible. The image is first separated into layers R, G and B. Each layer is then divided into blocks of equal size 2 × 2. The pixel of each layer is embedded in different layers of the corresponding blocks by the LSB method before sending it to receiver side. The image obtained on the receiver side is scanned by the inverse algorithm. The value of the detected pixels is withdrawn from the corresponding block pixels and the image is repaired. Method seems to work quickly and effectively and it is tested on RGB credit card images. The results are shown in the study.

LTE systems provide high data rates. For excellent customer pleasure, it is important to provide high data rates fairly. Scheduling algorithms have a key role to allocate radio resources among users efficiently. Best CQI algorithm is one of the well-known schedulers which aims to maximize cell throughput but compromises fairness. On the other hand, Round Robin endeavor to enhance fairness but not sufficient for cell throughput performance. PF algorithm offers a balance between throughput and fairness. In this paper, a new scheduling algorithm that balances the performance between fairness and cell throughput is proposed. The proposed algorithm is better than the Best CQI algorithm in terms of fairness. At the same time, peak and average throughput remain higher than PF, it has been achieved to allocate resources to users who have never reached the resources, unlike Best CQI. The criteria of throughput fairness increased together with distribution fairness.

The goal of content-based recommendation system is to retrieve and rank the list of items that are closest to the query item. Today, almost every e-commerce platform has a recommendation system strategy for products that customers can decide to buy. In this paper we describe our work on creating a Generative Adversarial Network based image retrieval system for e-commerce platforms to retrieve best similar images for a given product image specifically for shoes. We compare state-of-the-art solutions and provide results for the proposed deep learning network on a standard data set.

OBJECTIVES We aimed to the determine urinary tract infection and graft survival rates in pediatric renal transplant recipients with lower urinary tract dysfunction with particular focus on neurogenic bladder, posterior urethral valve, and vesicoureteral reflux nephropathy. MATERIALS AND METHODS Patients were grouped according to primary diseases as those with and without lower urinary tract dysfunction. Urinary tract infections during year 1 posttransplant were investigated. Estimated glomerular filtration rate was calculated using Schwartz formula. RESULTS Our study investigated 133 kidney transplant recipients. Lower urinary tract dysfunction was found in 58 patients (43.6%): 25 with posterior urethral valve, 24 with vesicoureteral reflux nephropathy, and 9 with neurogenic bladder. Rates of posttransplant urinary tract infection were higher in patients with lower urinary tract dysfunction than in those without during both the first 6 months posttransplant (24.6% vs 10.8%; P = .037) and between posttransplant months 6 and 12 (24.6% vs 8.2%; P = .01). Patients with neurogenic bladder had the highest rate of urinary tract infections, and their estimated glomerular filtrations rates were lower compared with patients with posterior urethral valve and vesicoureteral reflux nephropathy at month 6 and years 1, 2, and 5 posttransplant (P < .001). The 5-year graft survival rates of patients without lower urinary tract dysfunction and those with vesicoureteral reflux nephropathy were similar (51.3% vs 51.6%; P = .891). CONCLUSIONS Graft survival rates of patients with posterior urethral valve and vesicoureteral reflux nephropathy were similar to those shown in patients without lower urinary system dysfunction; however, patients with neurogenic bladder had worse graft survival and urinary tract infection rates.

Creative Construction Conference, CCC 2017 -- 19 June 2017 through 22 June 2017 -- -- 137308, In construction projects architectural drawings are the main documents which show how a structure has to be built. In this sense, most of the data necessary for project management are prepared based on these drawings. Therefore, architectural drawing errors will adversely affect the constructability and hence, the time and cost of a construction project. On the other hand, although the structures are built 3D, architectural drawings are prepared 2D. This circumstance complicates the detection of drawing errors during the design phase. In other words, drawing errors are mostly encountered during the construction phase. In fact, drawing errors are risks which can be detected during the planning phase in nature. In this study, it was argued that to detect drawing errors in planning phase architectural and engineering drawings should be prepared 3D instead of 2D. In this context, drawings of an official approved hotel project were redrawn by means of BIM to determine whether there exists drawing errors. The results of the study revealed that drawings involved many errors and 3D drawings enable early detection of them. © 2017 The Authors.

Objective: It was aimed to determine the viral agents in hospitalized infants with acute bronchiolitis and to evaluate the association between clinical course and these agents.

The leakage problem, which occurs due to the high hydrostatic pressure values of the fluid inside the pipes, is a serious issue in most of the pipeline systems. Therefore, the leak tightness test is required in different standards for verification of almost every kind of pipes used in both academic researches and industrial applications. The behavior of the hydrostatic pressure parameter in the test pipe has to be as smooth as possible during the leak tightness test. The conventional control loops of the servo mechanisms used for pumping the test fluid into the test pipe are weak to provide the minimum overshoot, the rise time and the steady-state error. In this situation, hydrostatic pressure tests are not capable of giving meaningful results. In this study, a leak tightness test machine working with a servo control loop to provide the optimum hydrostatic pressure pattern is designed. The efficacy of the designed leak tightness test machine and proposed optimized servo control loop have been shown with both simulation and experimental results.

We aimed to compare the measurements of central corneal thickness (CCT) and endothelial parameters with three different non-contact specular microscopy (SM) devices. Fifteen eyes of 15 healthy individuals (6 males; 9 females) were enrolled in the study. Mean age was 37.93 ± 15.13 years. Endothelial parameters and CCT were measured with Nidek CEM-530, Topcon SP-3000P, and Tomey EM-3000 SM devices by the same physician. Endothelial parameters included endothelial cell count (ECC), maximum, minimum, and average endothelial cell size. and hexagonality ratio. There were no statistically significant differences in ECC, CTT, and average endothelial size (AES) between the devices (p > 0.05). The measurement of maximum endothelial size (MES) was different between Nidek SM and Topcon SM devices (p = 0.001), but there was no difference in MES between Nidek SM and Tomey SM (p = 0.058), and between Topcon SM and Tomey SM (p = 0.081). There was no difference in minimum endothelial size (MinES) between Nidek SM and Topcon SM (p = 0.794); however, there was a significant difference in MinES between Tomey SM and Nidek SM (p

AIM: The aim of this cross-sectional study was to determine the prevalence of the self reported health behaviors and differences in these behaviors by gender and grades in high school adolescents in Izmir, Turkey. MATERIAL AND METHODS: A stratified cluster sampling procedure was used for this cross-sectional study. The study sample included 2 296 students attending 22 high schools in Izmir. As a data collection instrument, some questions from the Health Behavior in School-aged Children Study 2009/2010 questionnnaire and questions which were developed by the researchers to understand behaviors of internet use in adolescents were used. Chi-square tests and Cramer's V statistics were used for statistical analyses. RESULTS: Among the high school students, 33.8% experimented smoking, 26.3% smoked cigarette during the 30 days before the survey, 14.9% smoked cigarette regularly during the 30 days before the survey, 54.1% experimented drinking alcohol, 38.4% drunk alcohol during the 30 days before the survey, 31.6% got drunk, 10.9% were adequately physically active, 59.9% watched TV for a long period of time, 72.8% used internet for a long period of time, 48.1% ate breakfast regularly, 36.2% ate adequate amount of fruit, 14.1% ate adequate amount of vegetable, 31.3% ate candies and chocolate very often, 18% drunk soft drink very often, 30.3% were bullied, 29.9% bullied others and 41% involved in a physical fight. CONCLUSIONS: These results showed that "Adolescent friendly health services" should be generalized all over Turkey, physicians should evaluate each adolescent for his/her health behaviors in each visit and implementation of prevention programs which adopt a health promotion perspective is necessary begining from the elementary school. Language: en

e19536 Background: Pegylated forms of interferon (PEG-IFN) have a better pharmacologic profile than short-acting interferons, resulting in a more convenient less-frequent schedule of injections, less immunogenicity and possibly less toxicity. Several clinical studies of PEG-IFN-α-2a have reported promising results in patients with essential thrombocythemia (ET) and polycythemia vera (PV). Herein, we present the outcomes of MPN patients treated with PEG-IFN-α-2a seen outside of a clinical trial setting at a single center. Methods: Thirty-five MPN Patients treated with PEG-IFN-α-2a between January 2014 and October 2019 were included this retrospective analyses. Therapeutic responses for ET and PV were calculated by the revised ELN/IWG-MRT criteria. Responses in myelofibrosis (MF) were calculated by both EUMNET and ELN/IWG-MRT criteria. Best responses over all cycles of treatment were assessed. Molecular data was limited to JAK V617F. Results: Twenty patients with ET, 13 with PV and two with MF were enrolled in this study. The median age at diagnosis was 47 years (range; 21-83 years). JAK2 V617F mutation was detected in 16 patients (45.7%). Overall, the majority of patients (62.9%) had received at least one prior cytoreductive therapy for underlying disease. Median starting dose of PEG-IFN-α-2a was 90 mcg/week via self injection (range: 45-135 mcg/w). Treatment duration was pursued for a median duration of 21.4 months (range: 1.2-109.8). In the PV/ET group 33 patients were evaluated and overall best response rate was 87.8% (CR in 15 pts and PR in 14 pts). In the MF group (n = 2); a PR was seen in one patient and CR in one patient. No vascular events occurred within the cohort while on therapy. Of the eight patients receiving at least phelebotomy per month, all patients became phelobotomy independent with therapy. Of the 20 ET patients, 12 patients (60%) had platelet normalization (< 450 x 109/L). Among all patients, fatigue (31.4%), muscle pain (20%) and depression (8.6%) were the most common adverse events (AEs). Any grade of hematological AEs was not seen with PEG-IFN-α-2a. Eleven patients discontinued therapy secondary to: treatment associated severe AEs in 8 patients, lack of response in two patients and pregnancy in one patient. No death was reported during the analyses period. Conclusions: Our results suggest that PEG-IFN-α-2a remains a viable treatment option especially for younger patients who want to avoid prolonged cytotoxic therapy.

PURPOSE To obtain simultaneous 24-hour contact lens voltage and systemic arterial blood pressure values with the Sensimed Triggerfish system and Holter monitoring device. METHODS Ten primary open-angle glaucoma (POAG) and 8 pseudoexfoliation glaucoma (PXG) patients were included in the study. The Sensimed Triggerfish contact lens device was used to calculate the 24-hour IOP, and a Holter sphygmomanometer device was used for simultaneous 24-hour blood pressure measurements. We define the 8:00 am-11:00 pm period measurements as diurnal values and the other measurements as nocturnal values. RESULTS The mean nocturnal systolic values (nocturnal SBP 120.5±3.4 for POAG and 122.8±5.3mmHg for PXG) and diastolic BP (nocturnal DBP 70.2±1.9 for POAG and 68.1±1.2mmHg for PXG) were lower than the diurnal (diurnal SBP 134.6±5.3 for POAG, 145.9±41.7mmHg for PXG, diurnal DBP 79.4±5.8 for POAG and 78.6±5.1mmHg for PXG) values, and these differences were statistically significant in both groups (P=0.001 in DBP in PXG and P