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Abstract Objective The primary aim of this study is to elucidate the spiritual needs encountered by family members who intricately engage in the progression of illness within the palliative care framework, thus assuming the paramount responsibility of caregiving. Methods This study was approved by the Institutional Review Board and Ethics Committee of the University of Health Sciences İzmir Tepecik Training and Research Hospital (17/01/2022–2022/01–16). The research was designed as a prospective study. It was conducted through face-to-face, interactive interviews with family caregivers of patients admitted to the palliative care unit at Tepecik Training and Research Hospital between April 2022 and December 2022. The interviews were performed using a phenomenological approach and structured in a question-and-answer format. Data from twenty family caregivers were analyzed using thematic analysis. The questions were specifically designed to explore the psychological processes, spirituality, conceptions of God, meaning-making, and coping strategies of the family caregivers. Results Caregivers experienced various psychological and emotional states progressing through stages of denial, anger, and acceptance. Spirituality emerged as a critical coping mechanism providing strength and meaning amidst caregiving challenges. Caregivers’ perceptions of God varied from loving to punitive, influencing their interpretations of suffering and caregiving roles. Conclusion This study underscores the importance of integrating spiritual support into palliative care practices. Recognizing and addressing caregivers’ spiritual needs is crucial for enhancing their well-being and improving the quality of palliative care delivery. Training healthcare professionals in spiritual care and implementing targeted interventions can effectively support family caregivers in their caregiving journey.

Abstract Background Although pulse oximetry technology, which is considered the standard of care to ensure optimum oxygenation, is indispensable in clinical practice, especially in the detection of hypoxemia, it has some limitations in the detection of hyperoxemia. Oxygen Reserve Index can provide clinicians with a crucial pathway in detecting and preventing hyperoxia, noninvasively. Our aim in this study is to determine the hyperoxia detection ability of ORi and to investigate the effectiveness of ORi and SpO2-guided FiO2 titration in preventing hyperoxia. Methods This prospective randomized study was conducted in the operating theater of Health Sciences University İzmir Tepecik Training and Research Hospital from September 1, 2020, to December 1, 2022. Patients undergoing major abdominal surgery were divided into two groups: the control group and the SpO2 + ORi group. FiO2 titration was performed in the SpO2 + ORi group to maintain the ORi between 0.00 and 95%

This study introduces the Passive Earth Reinforcement for Lateral Equilibrium Optimisation (PERLEO) methodology, a novel approach to enhancing stability in deep excavations. Aimed at addressing limitations in existing geotechnical practices, especially in reducing deformations and bending moments in retaining structures, PERLEO utilises soil–cement blocks as passive reinforcement. Employing comprehensive numerical analysis through PLAXIS 2D software, the research advances traditional methods with sophisticated computational modelling. This study thoroughly evaluates the effect of soil–cement blocks’ geometrical configurations on the lateral displacement and bending moments of retaining walls. Key findings indicate that optimal dimensions of these blocks significantly mitigate wall deflection and bending moments, thereby enhancing the stability and the overall integrity of deep excavation projects. Additionally, this research introduces design charts, providing tools for engineers to determine the estimates for maximum lateral displacement and maximum bending moment, based on the specific dimensions of soil–cement block configurations and the depths of excavation and embedment. This methodology not only contributes to improved safety and efficiency in deep excavation works but also offers a more economical approach by reducing potential financial and temporal hazards associated with structural failures in complex geotechnical projects.

Objective: To evaluate the overseas experiences of our intensive care unit doctors and to determine out the reasons for our doctors who couldnot go and what support they wanted. Materials and Methods: The created questionnaire was delivered to the doctors via the internet. The survey consisted of three main parts. They were asked in the first part, sociodemographic characteristics; in the second part, how long they went abroad, how they choose the center, from whom they received support; in the third part, the reasons why our physicians who donot have been abroad experienced could not go, on which subject/center they want to gain professional experience, and how to get support in this regard. Results: 31.4% of the 156 participants had professional abroad experience. 55% of those who went stated that they found the center with their own efforts, and very few (13 people, 26%) stated that they received support from the education/administrative unit of the institution they worked during the admission. In academically titled physicians, the level of foreign language and the importance given to education abroad were quite high. It was determined that the frequency of reading articles was correlated only with the duration of the profession. The most common reasons for physicians who couldnot get a chance to go was not being able to find a clinic/scholarship program to go to/not being informed (63.5%) and high accommodation/living fees (48.4%). Conclusion: Professional overseas experience has a high contribution to our physicians and our health system. The biggest obstacle for our physicians who cannot attend is not being able to find a center/clinic to go to. We think that the institutions/associations to which they are affiliated can support this issue.

Bu araştırma, Isparta koşullarında 11 kırmızı mercimek çeşidinin (Çiftçi, Özbek, Kafkas, Tigris, Fırat-87, Evirgen, Seyran-96, Çağıl, Altıntoprak, Şakar ve Kırmızı-51) verim ve bazı verim öğeleri bakımından değerlendirilmesi amacıyla yürütülmüştür. Çalışma 2018-2021 yılları arasında iki yıl süreyle, tesadüf bloklarında bölünmüş parseller deneme desenine göre 3 tekrarlamalı olarak kurulmuş, varyans analizleri yapılmış, önemlilik olduğu belirlenen faktörlerde elde edilen ortalamalar Tukey testi ile karşılaştırılmıştır. İki yıllık ortalamalara göre bitki boyu 21,75-28,01 cm, ilk bakla yüksekliği 10,21-15,91 cm, bitkide bakla sayısı 31,31-49,48 adet, tane sayısı 36,06-64,76 adet, bitki verimi 2,41-5,17 g, tane verimi 139,61-257,73 kg da-1, bin tane ağırlığı 29,50-38,32 g, hasat indeksi %30,03-49,31, su alma kapasitesi 0,019-0,033 g tane-1 ve protein oranı %26,83-29,75 arasında değişim göstermiştir. Sonuç olarak tane verimi ve verime katkısı yüksek özellikler bakımından Evirgen, Çağıl ve Seyran-96 çeşitlerinin ön plana çıktığı belirlenmiştir.

Quantitative volumetric assessment of filamentous actin (F‐actin) fibers remains challenging due to their interconnected nature, leading researchers to utilize threshold‐based or qualitative measurement methods with poor reproducibility. Herein, a novel machine learning‐based methodology is introduced for accurate quantification and reconstruction of nuclei‐associated F‐actin. Utilizing a convolutional neural network (CNN), actin filaments and nuclei from 3D confocal microscopy images are segmented and then each fiber is reconstructed by connecting intersecting contours on cross‐sectional slices. This allows measurement of the total number of actin filaments and individual actin filament length and volume in a reproducible fashion. Focusing on the role of F‐actin in supporting nucleocytoskeletal connectivity, apical F‐actin, basal F‐actin, and nuclear architecture in mesenchymal stem cells (MSCs) are quantified following the disruption of the linker of nucleoskeleton and cytoskeleton (LINC) complexes. Disabling LINC in MSCs generates F‐actin disorganization at the nuclear envelope characterized by shorter length and volume of actin fibers contributing a less elongated nuclear shape. The findings not only present a new tool for mechanobiology but introduce a novel pipeline for developing realistic computational models based on quantitative measures of F‐actin.

The relationship between hydrogen peroxide and the metabolism of polyamines and the role of NADPH oxidase (NOX) in that relationship under drought conditions remains unclear. To reveal the relationship, expression levels of the genes in polyamine metabolism, such as arginine decarboxylase, agmatine aminohydrolase, spermidine synthase, S-adenosyl methionine decarboxylase, diamine oxidase, and polyamine oxidase were determined by RT PCR under drought stress combined with exogenous hydrogen peroxide (H2O2) and diphenyleneiodonium chloride (DPI) treatments in maize seedlings. In addition, some basic stress parameters (leaf water potential, lipid peroxidation), levels of polyamines (putrescine, spermidine, and spermine), and gene expression of NOX were measured under drought stress. Exogenous H2O2 induced the polyamine content by up-regulating polyamine-synthesizing genes and downregulating polyamine oxidizing genes. When the NOX enzyme was inhibited by DPI, the polyamine pathway tended towards degradation instead of production. Exogenous H2O2 regulated the metabolism of polyamines to promote their synthesis, and NOX played a key role in that regulation.

Son zamanlarda İranlılar Türkiye’ye hatırı sayılır bir biçimde ilgi göstermişler ve bunların bir bölümü de bu ilgiyi konut alımıyla bir göç sürecine dönüştürmüşlerdir. Bu çalışmanın amacı, Türkiye’ye konut alımıyla göç eden İranlı göçmenlerin itme-çekme ve ilişkiler ağı teorileri başta olmak üzere, göç teorileri ışığında göç etme nedenlerini analiz etmektir. Bu nedenle, göç süreçlerinde İran’ın itici faktörleri ve Türkiye’nin çekici faktörlerine odaklanılmış ve ilişkiler ağının önemi anlaşılmaya çalışılmıştır. Çalışmanın konusuna uygun olarak 22 katılımcıyla yarı yapılandırılmış görüşmeler gerçekleştirilmiştir. Katılımcılara kartopu örnekleme yöntemiyle ulaşılmış, COVID-19 salgını nedeniyle görüşme formları kendilerine dijital yollarla iletilmiştir. Yapılan görüşmeler göstermiştir ki İranlı göçmenler için İran’ın yarı açık bir toplum özelliği sergilemesi, dengesiz ekonomik koşullar sunması ve eğitim sisteminde gözlemlenen aksaklıklar birer itici faktör olarak göçü tetikleyen etmenler olmuştur. Buna karşın Türkiye’nin açık toplum olarak nitelendirilmesi, daha dengeli ekonomi, taleplere daha çok cevap veren eğitim sistemi ve medyanın yumuşak güç işlevi gibi faktörler İranlılar için çekici etmenler olmuştur.

Objective: Granulomatous interstitial nephritis is a rare finding, and etiology differs by geography. We aimed to investigate the distribution of causes of granuloma/granulomata in the kidney and renal survival of these patients in a tertiary care hospital in Western Turkey. Material and Method: Medical records of adults who underwent a kidney biopsy procedure in our institution between January 2000 and June 2019 were reviewed. Pathology reports were searched for biopsies where a granuloma was identified. Results: Nineteen of 1121 (1.7%) kidney biopsies included granuloma, 17 in native kidneys, and 2 in transplants. The majority of indications for native kidney biopsy was a rise in serum creatinine. Etiologies of granuloma included the following: pauci-immune vasculitis (n=11, 64.7%), tuberculosis (n=2, 11.8%), drug-induced (n=2, 11.8%), tubulointerstitial nephritis/uveitis (TINU) syndrome (n=1, 5.9%), and systemic-lupus erythematosus (n=1, 5.9%). Despite treatment, 6 of 11 (54.5%) patients with vasculitis developed end-stage kidney disease (ESKD) during the median follow-up of 16 months. Both of the patients with tuberculosis, and the patient with TINU syndrome developed ESKD months after the kidney biopsy, despite appropriate therapies. The only case with drug-induced granuloma and both cases with allograft kidney granuloma responded well to glucocorticoids, achieving a complete renal recovery. Conclusion: The majority of our series had granuloma in the kidney secondary to vasculitis and renal outcomes appear considerably unfavorable despite treatment, probably related to the primary diagnosis. Multicenter studies are needed to better determine the etiology and outcome of each granuloma etiology at different geographic locations.

Aim:Risk, injury, failure, loss, and end stage (RIFLE); acute kidney injury network (AKIN) and kidney disease: Improving global outcomes (KDIGO) classifications are the most commonly used criteria for the diagnosis of acute kidney injury (AKI). The aim of our study was to determine the relationship between the mortality and the severity of AKI diagnosed by using RIFLE, AKIN, and KDIGO classifications in critically ill patients.Materials and Methods:Data of 1,491 patients hospitalized in tertiary intensive care unit were retrieved from electronic medical records and patients diagnosed with AKI were included in the study. AKI severity was determined according to the RIFLE, AKIN, and KDIGO classifications.Results:One hundred fifty-five patients were included in the study. The percentages of patients in risk, damage, and failure stages according to the RIFLE criteria were 14.8%, 40.0%, and 45.2%, respectively. The percentages in stage 1, 2 and 3 were 45.6%, 30.6%, and 23.8% according to the AKIN criteria and 18.7%, 21.7%, and 54.1% according to the KDIGO criteria, respectively. There was a difference in mortality between the stages of AKI determined according to the AKIN and RIFLE criteria. Mortality was found to be higher in patients in KDIGO stage 3.Conclusion:These three classifications do not consider the etiology of AKI. Therefore, it may be possible that they do not accurately reflect the relationship between mortality and AKI severity. However, the KDIGO classification, which emerged with the need arising from the inadequacy of the classifications used before it, seems to be more valid in this respect.

Summary: Background: Primary hyperparathyroidism (pHPT) caused by a single benign parathyroid adenoma is a common endocrine disorder that is affected by regional differences. Living in different geographical regions reveals differences in the laboratory results and pathological findings, but studies on this subject are not sufficient. The article focuses on biochemical and pathological effects of geographical differences in parathyroid adenoma. In addition, the present study seeks to elaborate on treatment methods and effectiveness of screening in geographical area of Bulgaria and Turkey. Method: In this prospective study, 159 patients were included from 16 centres. Demographic characteristics, symptoms, biochemical markers and pathologic characteristics were analysed and compared between 8 different regions. Results: Patients from Turkish Black Sea had the highest median serum calcium (Ca) level, whereas patients from Eastern Turkey had the lowest median serum phosphorus (P) level. On the other hand, there was no significant difference between Ca, parathormone (PTH) and P levels according to regions. Patients from Eastern Turkey had the highest adenoma weight, while patients from Bulgaria had the lowest adenoma weight. The weight of adenoma showed statistically significant differences between regions (p

Vermicompost fertilizers have started to attract attention in agriculture last years. Various liquid vermicompost fertilizers are produced and used in agriculture and some of them known as vermiliquer, vermi leachate, vermi tea or vermicast with little differences. This study is aimed to determine the effects of foliar application of liquid vermicompost fertilizer on yield and some yield components on some Turkey triticale varieties under Central Anatolian conditions in Kırıkkale province during the growing period 2014-15 and 2015-16. Six different (control, 75, 150, 250, 350 and 450 cc da-1) liquid vermicompost fertilizer doses were applied by the foliar spraying method at the beginning and end of March in both years to the five Turkey triticale varieties (Alperbey, Mikham 2002, Tatlıcak 97, Karma 2000 and Ümranhanım). According to the results, plant height, grain number and grain yield in spike, grain yield per decare, harvest index and protein content results were found to be significant in fertilizer × variety × year interaction. There is also a statistically significant difference between thousand-grain weight and the variety x fertilizer doses interaction, and between varieties and fertilizer doses in terms of spike length. The positive effects of liquid vermicompost fertilizer doses, except 450 cc da-1, were determined in varieties. It was observed that a satisfactory yield can be obtained from 250 cc da-1 in the absence of nitrogen fertilizers as the top fertilizer. It could be deduced that 250-350 cc da-1 doses of vermicompost fertilizer can be applied in triticale based on varying ecological conditions and varieties in Central Anatolian ecological conditions.

Objective: Prolonged coagulation test is a common finding before surgery. This study determined the prolonged prothrombin time (PT) and/or activated partial thromboplastin time (aPTT) during the surgical preparation of pediatric patients. Material and Methods: As a cross-sectional study, 74 children aged 0.25-17 years, who had prolonged preoperative coagulation tests, were included in the Eskişehir State Hospital Pediatric Hematology and Oncology Clinic between September 3, 2013, and September 16, 2014. Results: The mean age of the children was 5.6+-3.4 years, wherein 60 (81%) cases were male. Adenoid-tonsillar operations were planned in 46%, circumcision in 43%, abdominal operations in 5%, and other operations in 6%. A history of bleeding was found in 7 (10%) of the families and 3 (4%) of the cases. Previous surgery or injury was found in 24 (32%) of the children and did not develop more bleeding than expected. The coagulation tests revealed 22 (30%) patients with prolonged PT (value range: 14-35.1 s), 47 (63%) with prolonged aPTT (value range: 37.1-129.6 s), and 5 (7%) with both prolonged PT and aPTT. A necessary operation was performed in 47 patients who did not have a history of bleeding diathesis in the patient or family, with a normal mixed test and factor levels, and PT of

Objective:Coronavirus disease 2019 (COVID-19) has placed an unprecedented burden on healthcare systems and restricted resources for non-COVID patients worldwide. Treatment approaches and follow-up plans have been modified to prevent the risk of infection for patients and healthcare workers. Patients prefer to delay or cancel their treatments during the peak period of infection.Materials and Methods:We retrospectively reviewed the characteristics of patients with breast cancer who were consulted at our outpatient clinic right after early COVID-19 peak in May and June 2020 and compared them with the same period in 2017 to 2019.Results:The number of patients who consulted at our outpatient medical oncology clinic declined in May and June 2020. This decline was regardless of stage and was larger in May than in June 2020. In general, the distribution of tumor subtypes [luminal, human epidermal growth factor receptor 2 (HER-2) positive, and triple negative] was not different from 2017 to 2020. Less than half of the patients received adjuvant chemotherapy following early COVID-19 peak in May and June 2020. Few patients received chemotherapy for metastatic disease, whereas many metastatic patients received endocrine therapy. None of the consulted new patients had a non-invasive disease. More patients received endocrine therapy than chemotherapy.Conclusion:The presentation patterns of patients with breast cancer after early COVID-19 peak differed from those during the same period in the last 3 years. The pandemic affected the number of new patients consulted and the way medical oncologists treat their patients.

Bir turistik destinasyonun sahip olduğu olumlu imaj, o bölgenin aldığı turistik varış ve turizm gelirleri açısından büyük önem arz etmektedir. Olumlu bir imaj yaratabilmek stratejik bir karar olması dolayısıyla uzun vadeli bir süreci ifade etse de çıktıları buna değdiğini çarpıcı bir şekilde gözler önüne sermektedir. Özellikle sahip olunan pozitif imaj, deneyim kalitesi ve algılanan değer gibi turistik talebi önemli ölçüde etkileyebilecek birçok değişkenin de kontrol altında tutulmasını sağlamakta, hatta etkilenmesine sebebiyet vermektedir. Bu gerçeklerden hareketle araştırmada destinasyon imajının algılanan değer ve deneyim kalitesi üzerindeki etkisini tespit etmek amaçlanmıştır. Bu kapsamda Kastamonu şehir merkezinde üç ay süreyle anket yapılmıştır. Değerlendirmeye tabi tutulan 397 anketle birlikte oluşturulacak modele ilişkin ölçeklere faktör analizi yapılmış ve yapısal model oluşturulmuştur. İnceleme neticesinde destinasyon imajının algılanan değer ve deneyim kalitesi üzerinde anlamlı ve pozitif etkisinin olduğu tespit edilmiştir.

Background and Aims: Post-dural puncture headache is seen more frequently in pregnant women due to stress, dehydration, intra-abdominal pressure, and insufficient fluid replacement after delivery. Obesity protects against post-dural puncture headache in pregnant women; increased intra-abdominal fat tissue reduced cerebrospinal fluid leakage by increasing the pressure in the epidural space. Therefore, this study investigated the influence of body mass index on post-dural puncture headache in elective cesarean section patients in whom 27G spinal needles were used. Material and Methods: The study included 464 women who underwent elective cesarean section under spinal anesthesia. Dural puncture performed with a 27G Quincke spinal needle at the L3-4 or L4-5 intervertebral space and given 12.5 mg hyperbaric bupivacaine intrathecally. The patients were questioned regarding headache and low back pain 6, 12, 24, and 48 h after the procedure, and by phone calls on days 3 and 7. Results: Post-dural puncture headache developed in 38 (8.2%) patients. Of the patients who developed post-dural puncture headache, 23 (60.5%) had a body mass index

PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.

Bu araştırma, Türkiye’de tescilli bazı kırmızı mercimek çeşitlerinin Isparta ekolojisinde verim ve verim unsurlarının belirlenmesi için 2016 - 2017 yıllarında yürütülmüştür. Bu amaçla, 11 adet tescilli kırmızı mercimek çeşidinde bitki boyu, ilk bakla bağlama yüksekliği, bitkide bakla ve tane sayısı, bitki verimi, biyolojik verimi, birim alan tane verimi, yüz tane ağırlığı, su alma kapasitesi ve tane protein oranı özellikleri incelenmiştir. Varyans analiz sonuçlarına göre, incelenen tüm özelliklerde çeşitler arasında istatistiki yönden önemli farklılıklar bulunmuştur. Araştırma sonuçlarına göre, çeşitlerin ortalaması olarak bitki boyu 27,50-32,80 cm, ilk bakla yüksekliği 9,23-20,20 cm, bitkide bakla sayısı 30,13-50,73 adet, bitkide tane sayısı 40,96-64,70 adet, bitki tane verimi 0,49-2,07 g, biyolojik verimi 223,8-506,9 kg/da, birim alan tane verimi 66,0-195,8 kg/da, yüz tane ağırlığı 2,91-3,64 g, su alma kapasitesi 0,027-0,033 g/tane ve protein oranı %27,68-32,27 arasında değişim göstermiştir. Kırmızı mercimek çeşitleri arasında en yüksek birim alan tane verimine Çiftçi çeşidi sahip olmuştur. Kafkas çeşidi ikinci sırada yer almakla birlikte; bu çeşidin ilk bakla bağlama yüksekliği makineli hasat için önerilen 12 cm sınırında olması, önemli bir dezavantaj olarak görülmüştür. Sonuç olarak, Isparta ili ve benzer ekolojik koşullara sahip yörelerde kırmızı mercimek tarımının yapılabileceği, kırmızı mercimek tarımında tane ve protein verimini arttırmak için Çiftçi kırmızı mercimek çeşidinin önerilebileceği sonucuna varılmıştır.

Objectives: In this study, we present our early and late results of different anastomosis techniques for the creation of brachiocephalic fistulas for hemodialysis. Patients and methods: Between January 2012 and December 2016, a total of 61 patients (37 males, 24 females; median age 59 years; range 44 to 72 years) who underwent arteriovenous fistula (AVF) operation for hemodialysis were retrospectively reviewed. Side-to-side (STS) and end-to-side (ETS) anastomosis techniques in the brachial region were compared in terms of patency and complication rates in the early- and late-term. Results: There were 29 patients in the STS group and 32 patients in the ETS group. Although there was a proportional difference in the patency rates and complications between the groups, it was not statistically significant, particularly in the long-term period. The patency rates of STS and ETS at two years were 69% and 59.4%, respectively, indicating that none of the techniques was superior to the other. The presence of peripheral arterial disease and diabetes mellitus was the most significant factors affecting the patency rates. Conclusion: Both ETS and STS anastomosis techniques should be planned individually. Although both techniques yield a similar patency rate, fistulas are superior to grafts and catheters. Fistulas, which may be the last chance of a patient, can be safely created using both techniques. [Turk J Vasc Surg 2020; 29(1.000): 38-40]

Background : P-glycoprotein (P-gp) transports many chemicals that vary greatly in their structure and function. It is normally expressed in renal proximal tubular cells. We hypothesized that P-gp expression influences light chain excretion. Therefore, we investigated whether renal tubular P-gp expression is altered in patients with plasma cell disorders. Methods : We evaluated renal biopsy specimens from patients with plasma cell disorders (n = 16) and primary focal segmental glomerulosclerosis (the control group, n = 17). Biopsies were stained with an anti-P-gp antibody. Loss of P-gp expression was determined semi-quantitatively. Groups were compared for loss of P-gp expression, and clinical variables. Results : P-gp expression loss was more severe in patients with plasma cell disorders than it was in those with glomerulonephritis (P = 0.021). In contrast, clinical and histological parameters including serum creatinine, level of urinary protein excretion, and interstitial fibrosis/tubular atrophy grade were not significantly different between the groups. P-gp expression loss increased with age in patients with plasma cell disorders (P = 0.071). This expression loss was not associated with serum creatinine, the level of urinary protein excretion or the interstitial fibrosis/tubular atrophy grade. There was no significant association between the severity of P-gp expression loss with the types and serum levels of light chains, isotypes and serum immunoglobulin levels. Conclusion : Renal tubular P-gp expression is significantly down-regulated in patients with plasma cell disorders characterized by nephrotic range proteinuria. Additional studies are needed to determine whether reintroduction of renal tubular P-gp expression would mitigate the proximal tubular injury that is caused by free-light chains.

Amaç: Koroner arter hastalığı tüm dünyada ve ülkemizde ölümün en önemli sebebidir. Koroner arter by-pass cerrahisi uygulanan hastaların risk düzeyi arttıkça postoperatif komplikasyonlarda artmaktadır. Bu çalışmanın amacı; koroner arter by-pass cerrahisi uygulanan hastalarda postoperatif erken dönemde oluşan kardiyak komplikasyonların tanı ve tedavisinde ekokardiyografinin rolünü araştırmaktır. Gereç ve Yöntem: Bu amaçla Haziran 2016 – Haziran 2017 tarihleri arasında kliniğimizde koroner arter by-pass cerrahisi uygulanan 53 hasta postoperatif dönemde 1 (bir) hafta boyunca günlük ekokardiyografik değerlendirme ile takip edildi.Bulgular: Hastalarda en az drenaj 300 cc iken en fazla 1200 cc (ortalama 460 cc) oldu. Perikardiyal efüzyon 1.günde 28 hastada, 2.günde 6 hastada, 3. günde ise sadece 1 hastada tespit edildi. İki hastada postop 0. gün kalbin ön yüzünde ciddi bası oluşturan ve hemodinamiyi etkileyen perikardiyal tamponat vardı. Bu hastalar yeniden operasyona alınarak hemodinamisi stabil hale getirildi.Sonuç: Koroner bypass yapılan hastaların Yoğun Bakım ünitelerindeki takibinde Ekokardiografinin rutin olarak kullanılmasının hastanede kalış süresini, morbiditeyi ve mortaliteyi önemli ölçüde azaltabileceği kanaatindeyiz.

Background and objectives: Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. Methods: 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4 h in the first 24 h. Adverse effects were questioned every 4 h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. Results: There was no difference in acute pain scores and analgesic consumption through the 24 h period, Visual Analog Scale at 24 h was 1.5 ± 1.5 cm for follicular group 1.4 ± 1.7 cm for luteal group (p = 0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6 ± 0.7 cm and 1.8 ± 0.8 cm for follicular group and 2.7 ± 1.3 cm and 2.9 ± 1.7 cm in the luteal group (p = 0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group (p = 0.01) and oral feeding time was shorter in follicular phase (5.9 ± 0.9 h) than in luteal phase (6.8 ± 1.9 h, p = 0.02). Conclusions: Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle. Resumo: Justificativa e objetivos: As flutuações dos hormônios sexuais femininos durante o ciclo menstrual influenciam a percepção da dor. A inibição endógena da dor é prejudicada na fase folicular do ciclo menstrual. Testamos a hipótese primária de que cirurgias em mulheres durante a fase folicular têm mais dor aguda e precisam de mais opioide que aquelas na fase lútea e a hipótese secundária testada foi que as cirurgias em mulheres durante a fase folicular têm mais dor incisional aos três meses de pós-operatório. Métodos: No total, 127 mulheres adultas submetidas à colecistectomia laparoscópica foram randomizadas para serem operadas durante a fase lútea ou folicular de seus ciclos menstruais. Um regime padronizado para anestesia e tratamento da dor foi administrado a todas as pacientes. A dor e o consumo de analgésico foram avaliados na sala de recuperação pós-anestésica e a cada quatro horas nas primeiras 24 horas. Efeitos adversos foram avaliados a cada quatro horas. Os tempo para ingestão oral e deambulação foram registrados. Dor pós-cirúrgica, ansiedade hospitalar, escala de depressão e questionário SF-12 foram avaliados em visitas feitas no primeiro e terceiro meses. Resultados: Não houve diferença nos escores de dor aguda e no consumo de analgésicos durante o período de 24 horas, Escala Visual Analógica em 24 horas foi de 1,5 ± 1,5 cm para o grupo folicular e 1,4 ± 1,7 cm para o grupo lúteo (p = 0,57). A dor persistente no pós-operatório foi significativamente mais prevalente no primeiro e terceiro mês, com incidência de 33% e 32% nas pacientes em fase folicular versus 16% e 12% na fase lútea, respectivamente. A Escala Visual Analógica no primeiro e terceiro mês foram 1,6 ± 0,7 cm e 1,8 ± 0,8 cm no grupo folicular e 2,7 ± 1,3 cm e 2,9 ± 1,7 cm no grupo lúteo (p = 0,02), respectivamente. Não houve diferença significativa entre os grupos em relação à ansiedade e à depressão, escore SF-12 em ambos os tempos. Náusea foi mais comum no grupo na fase folicular (p = 0,01) e o tempo para alimentação oral foi menor na fase folicular (5,9 ± 0,9 horas) que na fase lútea (6,8 ± 1,9 horas, p = 0,02). Conclusões: Embora a dor persistente no pós-operatório tenha sido significativamente mais prevalente no primeiro e no terceiro mês após a cirurgia, a magnitude da dor foi baixa. Nossos resultados não apoiam o agendamento de cirurgias tendo como alvo fases específicas do ciclo menstrual. Keywords: Menstrual cycle, Acute pain, Chronic pain, Cholecystectomy, Laparoscopy, Postoperative pain, Palavras-chave: Ciclo menstrual, Dor aguda, Dor crônica, Colecistectomia, Laparoscopia, Dor pós-operatória

BACKGROUND: Freiberg's infraction is an osteochondrosis of a lesser metatarsal head resulting in joint degeneration. There is no consensus regarding the management of these lesions. Here, we describe an interpositional arthroplasty using extensor digitorum brevis tendon as a solution for Freiberg's disease. MATERIALS AND METHODS: Between 2003 and 2006, 6 women and 4 men with Freiberg's disease unresponsive to conservative treatment were operated with interpositional arthroplasty with extensor digitorum brevis tendon. Mean age was 34 (range, 20 to 48) years and followup time 24.6 (range, 12 to 36) months. The transferred tendon was passed through a tunnel, centered, stabilized and rolled into a ball following the debridement of joint. According to the Smillie classification, there were 3 grade II, 5 grade III, and 2 grade IV. The AOFAS scoring system was used for clinical assesment. RESULTS: The mean preoperative and postoperative AOFAS scores were 58.3 (range, 44 to 77) and 80.4 (range, 67 to 100), respectively. The complaint of pain with joint motion was decreased in all patients except one. The postoperative passive range of motion of joints did not differ significantly. We found 4 excellent (40%), 5 good (50%) and 1 poor (10%) result. CONCLUSION: We recommend our technique of interpositional arthroplasty with the extensor digitorum brevis tendon because it is free of additional donor site morbidity. It can be performed easily without specialized instruments. Also, the use of natural tissue eliminates potential foreign body reactions and risk of infection. [ABSTRACT FROM AUTHOR]

Purpose:We aimed to assess the effectiveness of magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VABB), evaluate and compare the characteristics and histopathologic findings of lesions, and overview the follow-up results of benign lesions.Methods:MRI findings and histopathologic results of breast lesions biopsied by MRI-guided VABB between 2013 and 2016 were retrospectively analyzed. MRI findings closely related with malignancy were investigated in particular. Follow-up results of benign lesions were evaluated.Results:MRI-guided VABB was applied to 116 lesions of 112 women. Of the lesions, 75 (65%) were benign, while 41 (35%) were malignant. Segmental (94%), clustered (89%), and clustered ring (67%) non-mass-like enhancement patterns were found to be more related with malignancy. False-negative rate of MRI-guided VABB was 12%, underestimation rate was 21%. One of the 54 followed-up benign lesions had a malignant result.Conclusion:MRI-guided VABB is a reliable method for the diagnosis of breast lesions that are positive only on MRI. Follow-up results show that cancer detection rate is low for radio-pathologically concordant lesions. Further multicenter studies with larger patient population are needed to elucidate these results.

Güdük apandisit, nadir bir komplikasyon olup apandektomi sonrası 1/50.000 oranında görülmektedir.Apendektomi öyküsü olan hastalarda güdük apandisit tanısı gözden kaçabilmektedir.Klinik olarak akut apandisite çok benzemektedir.Biz de bu makalemizde nadir görülen, acil serviste güdük apandisit tanısı konmuş bir vakayı sunacağız. ( Sakarya Tıp Dergisi 2016, 6(1):34-37 ) Anahtar Kelimeler: Nadir; Güdük; Apandisit

Objective. Presenting early and midterm results of aortic and iliac artery aneurysms treated with Multilayer Flow Modulators (MFM). Methods. We retrospectively reviewed the medical records of 23 patients (19 males and 4 females) who are admitted to our clinic between April of 2014 and February of 2016, diagnosed with thoracoabdominal aortic aneurysm and/or iliac aneurysm, and treated using MFM. The patients were followed up for the development of potential clinical presentations for 12 months. Results. MFM implantation was successfully completed in all the patients. During the process, two patients developed endoleak and so they were treated with postdilatation that was performed through balloon intervention, whereby the patients fully recovered. Although a short-term ischemic cerebrovascular event occurred in one of the patients 36 hours after the MFM, the patient recuperated without any noticeable neurological sequelae. Overall, three patients died after the procedure, one of whom died in hospital three days following the intervention due to acute renal failure, while the second one lost his life at the end of the first month due to the occlusion of superior mesenteric and celiac arteries. The third patient died at the end of the third month due to acute myocardial infarction. The rest of the patients developed no complications or had no mortality at their 12-month follow-ups. Conclusion. MFM can be preferred as an alternative approach in the treatment of aorta and iliac artery aneurysms including major lateral branches. The present results should be confirmed with additional future studies conducted with larger patient groups for longer periods.

1980 sonrası süreçte küreselleşmenin giderek artan etkisi ile birlikte teknolojik gelişmeler ve yeni üretim biçimleri ortaya çıkmıştır. Bu dönemde; kamu kesimi harcamalarının bütçe içerisindeki payı artarken, harcama türleri de değişmektedir. Bu çerçevede çalışmanın amacı; kamu harcamalarının kalkınmaya olan etkisinin araştırılmasıdır. Bu kapsamda; kamu harcamalarının kalkınmaya olan etkisi Türkiye örneği ile araştırılmaktadır. Araştırmanın odağını; 81 il oluşturmaktadır. Bu illerde 2008-2012 yılları aralığındaki veriler ele alınmaktadır. Oluşturulan araştırma modeli ekseninde; 81 il için sosyo-ekonomik yenilik endeksi, (HDI) İnsani Gelişme Endeksi metodolojisine göre oluşturulmuştur. Daha sonra; fonksiyonel sınıflandırmaya göre kamu harcamaları ve siyasi değişkenler ile sosyo-ekonomik gelişmişlik endeksi arasındaki ilişki panel veri analizi yöntemi kullanılarak ele alınmıştır. Yapılan analiz neticesinde kamu harcamalarının büyük kısmının sosyo-ekonomik yenilik endeksi üzerinde pozitif ve anlamlı bir etkisi olduğu sonucuna ulaşılmıştır.

1980 sonrası süreçte küreselleşmenin giderek artan etkisi ile birlikte teknolojik gelişmeler ve yeni üretim biçimleri ortaya çıkmıştır. Bu dönemde; kamu kesimi harcamalarının bütçe içerisindeki payı artarken, harcama türleri de değişmektedir. Bu çerçevede çalışmanın amacı; kamu harcamalarının kalkınmaya olan etkisinin araştırılmasıdır. Bu kapsamda; kamu harcamalarının kalkınmaya olan etkisi Türkiye örneği ile araştırılmaktadır. Araştırmanın odağını; 81 il oluşturmaktadır. Bu illerde 2008-2012 yılları aralığındaki veriler ele alınmaktadır. Oluşturulan araştırma modeli ekseninde; 81 il için sosyo-ekonomik yenilik endeksi, (HDI) İnsani Gelişme Endeksi metodolojisine göre oluşturulmuştur. Daha sonra; fonksiyonel sınıflandırmaya göre kamu harcamaları ve siyasi değişkenler ile sosyo-ekonomik gelişmişlik endeksi arasındaki ilişki panel veri analizi yöntemi kullanılarak ele alınmıştır. Yapılan analiz neticesinde kamu harcamalarının büyük kısmının sosyo-ekonomik yenilik endeksi üzerinde pozitif ve anlamlı bir etkisi olduğu sonucuna ulaşılmıştır.

Objective:Lymphedema is a chronic major complication that is seen frequently post-operatively and has negative effects on quality of life. In our study, determining the early-stage postoperative lymphedema frequency and specifying the risk factors in its development has been aimed.Materials and Methods:One hundred one cases that were operated on for breast cancer were evaluated regarding the 12-month control of their clinical specifications, histopathological specifications, and specifications related with the surgical intervention retrospectively. The data related to the parameters envisioned as risk factors were evaluated.Results:Lymphedema development was found in 7 (6.9%) out of 101 cases constituting the study group. No significant difference (p>0.05) in terms of lymphedema development was determined among age, body mass index (BMI), chemotherapy (CT), postoperative seroma or infection, mastectomy with the dominant arm, and breast-conserving surgery (BCS), which were evaluated as risk factors. There was a significance (p

Apocrine carcinoma of the breast is a relatively rare subgroup of breast tumors and comprises 1-4% of all breast carcinomas. The case is a 49 year-old postmenopausal woman. Two different lumps located near to each other at the left upper quadrant were both reported as invasive ductal carcinoma after core needle biopsy. The patient had undergone breast conserving surgery and sentinel lymph node biopsy of axilla with blue dye after wire localization of the masses. Since the lymph node biopsy was found to be metastatic, level I-II axillary dissection was performed on the patient. Pathology revealed apocrine carcinoma with 1 of 16 dissected lymph nodes and was evaluated as metastasis and the oncology department planned chemotherapy with 4 cycles Epirubicin-Cyclophosphamide protocol followed by radiotherapy.

Adrenal incidentaloma was detected in an 81-year-old male patient and a 37-year-old female patient who had been diagnosed with essential thrombocytosis. Each patient′s Janus Kinase 2 (JAK2) V617F mutation was positive, and they were evaluated as having non-functional adrenal incidentaloma. The JAK2 activates the signal transducers and activators of transcription (STAT) proteins which then activate the phosphoinositol-3 kinases, Ras, mitogen-activated protein (MAP) kinases, and transcription. Constitutive activation causes cell proliferation and dysregulation of apoptosis. It is thought that STAT3 activation-mediated JAK family kinases have a central role in the solid tumor cell series. Permanent activation of STAT3 and STAT5 causes tumor cell proliferation, survival, metastasis, and an increase in tumor-mediated inflammation in solid and hematologic tumors. According to our literature screening, irregular JAK signaling, seen at the pathogenesis of many solid and hematologic tumors, has not been previously evaluated with regard to adrenal tumors. As a result, our cases are the first coexistence of JAK V617F mutation with adrenal incidentaloma in the literature. Because of this, we think that JAK2 mutation must be evaluated to clarify the etiology of adrenal incidentalomas.

Purpose:Patients with unilateral breast cancer are at a higher risk according to the normal population for the presence of cancer in the contralateral breast. Determining the factors that increase the risk of developing bilateral breast cancer provides detection the contralateral breast cancer at an early stage, the possibility of breast conservation surgery, a high disease-free survival rate and prolongation of life.Patients and Methods:Between July 2006 and September 2011, 311 women were treated for primary operable breast cancer, and data was analyzed retrospectively. 10 (3.2%) revealed synchronous bilateral breast cancer, the clinical and histopathologic features of these tumors were evaluated.Results:The median age of the patients with bilateral breast cancer was 42 (28-55) years. Two (20%) of synchronous patients revealed positive family history. Six (60%) patients were in premenopausal status. 15 (75%) of them progesterone receptor positivity, and 3 (30%) of them multicentricity were recorded. 3 (15%) tumors was developed in fibrocystic area. The most common histopathologic type was invasive ductal carcinoma [16 (% 80)].Conclusion:Patients with risk factors such as young age, multicentric disease, developed in fibrocystic area, positivity for progesterone receptor and family history should be evaluated carefully because of the risk of developing bilateral breast cancer.

Objective:The aim of this study was to investigate the stage of breast cancer at presentation, and the factors that cause delayed admission in patients operated for breast cancer.Methods:Data were collected retrospectively from our institutional database. Clinical, radiological, and pathological parameters were evaluated.Results:Non-early stage (IIB, III, IV) admission was signifi cantly correlated with the disease presenting with a non-lump symptom (p=0,022), not performing breast self-examination (p=0,019), and late admission to a doctor or surgeon (p=0,016 and 0,013 respectively).Conclusion:Breast self-examination and disease related education should be generalized nation-wide to improve the incidence of early stage presentation in breast cancer.

The ascorbate-glutathione (ASC-GSH) cycle has an important role in defensive processes against oxidative damage generated by drought stress. In this study, the changes that take place in apoplastic and symplastic ASC-GSH cycle enzymes of the leaf and petiole were investigated under drought stress causing leaf rolling in Ctenanthe setosa (Rose.) Eichler (Marantaceae). Apoplastic and symplastic extractions of leaf and petiole were performed at different visual leaf rolling scores from 1 to 4 (1 is unrolled, 4 is tightly rolled and the others are intermediate forms). Glutathione reductase (GR), a key enzyme in the GSH regeneration cycle, and ascorbate (ASC) were present in apoplastic spaces of the leaf and petiole, whereas dehydroascorbate reductase (DHAR), which uses glutathione as reductant, monodehydroascorbate reductase (MDHAR), which uses NAD(P)H as reductant, and glutathione were absent. GR, DHAR and MDHAR activities increased in the symplastic and apoplastic areas of the leaf. Apoplastic and symplastic ASC and dehydroascorbate (DHA), the oxidized form of ascorbate, rose at all scores except score 4 of symplastic ASC in the leaf. On the other hand, while reduced glutathione (GSH) content was enhanced, oxidized glutathione (GSSG) content decreased in the leaf during rolling. As for the petiole, GR activity increased in the apoplastic area but decreased in the symplastic area. DHAR and MDHAR activities increased throughout all scores, but decreased to the score 1 level at score 4. The ASC content of the apoplast increased during leaf rolling. Conversely, symplastic ASC content increased at score 2, however decreased at the later scores. While the apoplastic DHA content declined, symplastic DHA rose at score 2, but later was down to the level of score 1. While GSH content enhanced during leaf rolling, GSSG content did not change except at score 2. As well, there were good correlations between leaf rolling and ASC-GSH cycle enzyme activities in the leaf (GR and DHAR) and leaf rolling and GSSG. These results showed that in apoplastic and symplastic areas, ASC-GSH cycle enzymes leading ROS detoxification may have a role in controlling leaf rolling.

Phyllodes tumors (FT) are uncommon biphasic breast tumors that usually occur in adult females. They are fi broepithelial lesions that account for less than 1% of all breast neoplasms. Physical examination, mammography and ultrasound appearances were non-specifi c for FTs. The pre-operative diagnosis of phyllodes tumours is diffi cult, and rapid growth and/or large size of apparent fi broadenomas may be the only imaging fi ndings to suggest phyllodes tumour. Wide excision with a clear margin may be the preferable initial therapy. Invasive ductal carcinoma is the most common type which constitutes 47-75% of all breast carcinomas. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but the existance of phylloides tumor and invasive ductal carcinoma in the ipsilateral breast is very uncommon. We report herein the case of a 53-year old women in whom phylloides tumor and invasive ductal carcinoma was found in the histopathological examination of the ipsilateral breast specimen after mastectomy.

Cet article analyse, à partir d’un colloque international qui s’est tenu à Paris en 2014, la construction de la confiance à la fois dans les sciences et les politiques du climat. Comment, par quels méthodes et procédés, les communautés de modélisateurs établissent-elles la validité de leurs modèles ? Quel lien existe-t-il entre la confiance dans les simulations numériques du réchauffement et la capacité du système international à prendre en charge le risque climatique ? À partir du constat de l’existence d’un lien intime entre ces différentes formes de confiance, l’article met en cause une conception de l’expertise comme devant rester complètement indépendante du processus politique. Plus généralement, il pose la question d’une « constitution » pour les relations sciences-politiques au niveau global à l’heure où les nouveaux paradigmes de recherche et les paradigmes politiques convergent vers une importance accrue du niveau régional et de l’échelle locale.

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We present a 15-year-old female patient with medullary thyroid carcinoma, marfanoid habitus, and mucosal ganglioneuromatosis. Our case had a RET protooncogene mutation ser836 polymorphism in exon 14 and ser904 polymorphism in exon 15. Our patient is thought to be atypical MEN2B due to the absence of M918T or A883F mutations. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term “Chilaiditi syndrome” is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms as abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed with chest radiograph and thoracoabdominal CT. Our case is the first in the literature indicating the coexistence of Chilaiditi sign and MEN2B.