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This study investigated the factors influencing the Environment, Social and Governance (ESG) Disclosure of public listed companies in Malaysia, particularly before and during the Covid-19 pandemic. Using 62 Public Listed Companies in Malaysia and 248 firms’ years of observation from the year 2018 to the year 2021, it found that profitability, growth of the company, company’s size, board size, gender diversity, auditor tenure, and ESG disclosure highest during the Covid-19 pandemic outbreak period. It also discovered that profitability and independent board members had positively related to ESG disclosure before and during the Covid-19 pandemic outbreak. Keywords: ESG; Financial factors; Corporate Governance; Covid-19 eISSN: 2398-4287 © 2023. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v8i23.4493

Introduction: we aimed to investigate the efficacy and side effects of bendamustine in relapsed/refractory lymphoma patients in Turkey. Material and methods: in this retrospective study, we included relapsed/refractory Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients who underwent multiple lines of chemotherapy. The primary endpoint was to determine the objective response and toxicity. Results: ninety-nine patients with a median age of 59.8 years were included in the study. Eighty-one patients had NHL (follicular lymphoma: 10, diffuse large B- cell lymphoma: 27, mantle-cell lymphoma: 18, marginal zone lymphoma: 9, small lymphocytic lymphoma/chronic lymphocytic leukemia: 17) and 18 patients had HL. The patients had previously received a median of three lines of chemotherapy (range: 2-8) except autologous stem cell transplantation (ASCT); 19 patients (HL: 11, NHL: 8) had undergone ASCT. The objective response rate (ORR) was 74.3%, the complete response rate was 57% (= 53), and the partial response rate was 16.6% (= 19). The overall survival (OS) rate at 1 year was 74.6%. The progression-free survival (PFS) rate at 1 year was 62.5%. The most common side effects were lymphopenia, anemia and neutropenia. Side effects which were observed as grade 3 and higher levels were lymphopenia (14.1%), neutropenia (10.1%) and fatigue (7.1%). Conclusions: objective response rate of bendamustine was found to be 74.3% in relapsed/refractory HL and NHL patients. It appears to be an effective option as a salvage treatment for patients who have previously received multiple lines of therapy., NA

Aim: The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment. Method: Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey. Findings: Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3–4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%). Discussion: The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC. © 2021 Taylor & Francis Group, LLC.

Objective To compare the clinicopathological characteristics, treatment responses, survival analysis of osseous Ewing sarcoma (OES) and extraosseous ES (EES). Study design Observational study. Place and duration of study Ankara City Hospital and Ankara Numune Training Research Hospital Medical Oncology Clinics from January 2005 to February 2020. Methodology Clinicopathological characteristics of histologically confirmed ES/PNET and followed up, and treatment modalities were recorded from patients' registration data-base of the hospital. Lactate dehydrogenase (LDH), alkaline phosphatase (ALP), hemoglobin were measured before chemotherapy or surgery. The patients with a second cancer, gall bladder/biliary tract diseases, viral hepatitis and other bone diseases were excluded. Results Sixty seven patients evaluated retrospectively. Out of the total patients, 56.7% consisted of OES, and 43.3% consisted of EES. The median age of the EES group (26 years) was significantly higher than that of the OES group (22 years, p = 0.008). The most common metastasis region was lung in both the groups. Age, LDH levels and stage of the disease were found to be statistically significant prognostic factors in univariate and multivariate analysis. The median OS of patients who started with local treatment (surgical, surgical ± radiotherapy) and followed up with chemotherapy was 82.6 months (95% CI, 55.2-110.1), while the median OS of patients who received local treatment between or after chemotherapy was 43.4 months (95% CI, 13.2-73.6, p = 0.042). Conclusion Patients with extrosseus ES were significantly older. Age, LDH levels, stage of disease, local treatment followed by systemic therapy are important associated factors. Key Words: Osseous ewing sarcoma, Extraosseous ewing sarcoma, Chemotherapy, Local treatment.

Objective The successful results obtained in trials may not necessarily translate into prolonged survival of metastatic colorectal cancer (mCRC) patients in real life. This multinational registry study aimed to evaluate the real-life data effecting the survival of patients with mCRC. Methods This is a multinational, retrospective registry study. Turkish and Greek mCRC patients diagnosed between 2005 and 2012, with at least 3 years of follow-up data or who died before 3 years of follow-up were included in the study. Results A total of 364 were included in the study. RAS and BRAF mutation rates were found to be 36% and 39%, respectively. As first-line therapy, 196 (54%) patients received bevacizumab and Anti-EGFR treatments in combination with chemotherapy. The objective response rate was 42% (n = 152) and 32% (n = 78) for 1(st) line and 2(nd) line treatments, respectively. While the median progression-free survival (PFS) with the 1(st) line treatment was 10 months, it was 7 months with the 2(nd) line treatments. In the total study population median PFS and overall survival (OS) were 10 (95% CI, 8.3-11.6) and 35 (95% CI, 30.7-39.2) months, respectively. In Turkish and Greek patients, median OS (36 months versus 29 months, p = .81) and PFS (10.2 versus 9.2, p = .42) were not different. In multivariate analysis, ECOG PS of >= 2 and having metastases in more than one region decreased overall survival (p = .002 and p = .003), it was found that wild RAS and BRAF mutations and second metastasectomy contributed to overall survival (p = .047 and p < .001). Conclusion In conclusion, it seems that the patient's performance status, tumor location, number of metastatic lesions at the time of diagnosis affect the prognosis of mCRC. Although access to molecular tests and first-line treatments differ between Greece and Turkey, no significant difference was found in survival times.

Objective:Unlike left testicular vein, right testicular vein drains into inferior vena cava. Consequently, the systemic spread of testicular cancers in each side is expected to differ based on the vascular structures of the right and left testis. In this study, we investigated the effect of tumour localization on survival of nonseminomatous testicular cancer patients.Materials and Methods:We included three hundred and twenty-one (321) non-seminomatous testicular cancer patients who were followed-up at Gülhane Training and Research Hospital between January 1981 and December 2015.Results:The primary tumour found in the left testis in 152 (47.2%) patients, while 170 (52.8%) patients had the primary tumour in the right testis. The lungs (n=62, 42.5%) was the most common site of metastasis. During follow-up and primary treatment, 74 (23.1%) patients had recurrence, which was common in retroperitoneal lymph nodes (10.3%) and lung (5%). Median follow-up period was 88.3 (range: 1-386) months, while median survival was 337 months in all cases. Median 10 year survival rate was 74.1%, while median 20 year survival rate was 70.7%. We found that survival of patients with the primary tumour was significantly different between the left and right testis (337.6 months vs denotes not reached, p=0.001). The recurrence rate was significantly higher (84.7% vs 68.2%; p=0.002) in patients with right testicular tumour when compared to patients with left testicular tumour.Conclusion:The survival of the patients with tumour localized in the right testis was higher than patients with tumour localized in the left testis.

Classical Hodgkin lymphoma (cHL) is considered a curable disease; however, approximately one-third of responders experience disease relapse following first-line therapy. Several studies have shown the efficacy of brentuximab vedotin (BV) in patients with relapsed/refractory HL. We present a retrospective analysis of 58 patients with relapsed/refractory HL treated with BV in a named patient program from 11 centers. The median follow-up duration was 20 (range, 4-84) months. The best overall response rate was 64% (complete response [CR], 31%; partial response [PR], 33%). The 5-year progression-free survival (PFS) and overall survival (OS) rates were 12% (95% confidence interval [CI], 0.05-0.22) and 26% (95% CI, 0.16-0.38), respectively. Among patients who achieved CR, the estimated 5-year PFS and OS rates were 32% (95% CI, 0.13-0.54) and 60% (95% CI, 0.33-0.78), respectively. A total of 26 patients underwent subsequent stem cell transplantation. The 5-year PFS and OS rates for 10 patients who had consolidative stem cell transplantation were 28% and 30%, respectively. Twenty-seven patients required further therapy following BV. At the time of the analysis, 12 patients (21%) were alive. Five patients (9%) had long-term remission after achieving CR with BV monotherapy, with a median PFS of 76 months. Three of them (5%) did not receive any other treatment following BV and their median PFS was 75 months. Our long-term results showed that a small subset of patients with relapsed/refractory cHL may benefit from and even be cured with BV monotherapy.

The AETHERA trial reported an increased progression-free survival (PFS) when brentuximab vedotin (BV) was used as maintenance therapy in high-risk Hodgkin lymphoma (HL) after autologous stem cell transplantation (ASCT). Thus, we aimed to determine the impact and safety of BV as maintenance after ASCT in real-world patients. Seventy-five patients with relapsed/refractory HL started on BV consolidation therapy after ASCT due to high risk of relapse, between January 2016 and July 2019, from 25 institutions, were included in the study. The median follow-up time was 26 months. The most common high-risk features were primary refractory or relapsed disease

Background: Atezolizumab (ATZ) has demonstrated antitumor activity and manageable safety in previous studies of patients with metastatic platinum-resistant urothelial carcinoma. However, the response rate of Atezolizumab was modest. In the current study, we evaluated the pretreatment prognostic factors for overall survival in patients with metastatic urothelial carcinoma who have progressed after first-line chemotherapy in the Expanded-Access Program of Atezolizumab. Patients and methods: In this study, we present a retrospective analysis of 113 patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy. Data of the patients was obtained from patient files and hospital records. Eligible patients included metastatic urothelial carcinoma patients treated with at least one course of ATZ. Univariate analysis was used to identify clinical and laboratory factors that significantly impact OS. Variables were retained for multivariate analysis if they had a statistical relationship with OS (p < 0.1), and then included a final model of p < 0.05. Results: The median follow-up duration was 23.5 months. Of the patients, 98 (86.7%) were male and 13.3% were female. The median age was 65 years of age (37–86). In univariate analysis, primary tumor location in the upper tract, increasing absolute neutrophil count (ANC), increasing absolute lymphocyte count, neutrophil-to-lymphocyte ratio (NLR) > 3, liver metastases, baseline creatinine clearance less (GFR) than 60 ml/min, Eastern Cooperative Oncology Group (ECOG) performance status (1 ?), and hemoglobin levels below 10 mg/dl were all the significantly associated with OS. Three of the five adverse prognostic factors according to the Bellmunt criteria were independent of short survival: liver metastases HR 3.105; 95% CI 1.673–5.761; p < (0.001), ECOG PS (1 ?) HR 2.184; 95% CI 1.120–4.256; p = 0.022, and Hemoglobin level below 10 mg/dl HR 2.680; 95% CI 1.558–4.608; p < (0.001). In addition, NLR > 3 hazard ratio [HR] 2.092; 95% CI 1.031–4.243; p = 0.041 and GFR less than 60 ml/min HR 1.829; 95% CI 1.1–3.041; p = 0.02, maintained a significant association with OS in multivariate analysis. Conclusions: This model confirms the Bellmunt model with the addition of NLR > 3 and GFR less than 60 ml/min and can be associated with clinical trials that use immunotherapy in patients with bladder cancer. © 2021, Japan Society of Clinical Oncology.

The aim of this study is to determine the power of he international prognostic scoring systems (IPS-7 and IPS-3) and to obtain indices by integrating leukocyte lymphocyte ratio (LLR) and prognostic nutritional index (PNI) factors as prognostic indicators in cases with classical Hodgkin lymphoma (cHL). 1012 patients with cHL were evaluated with 2 different IPS-4 scores with four parameters: stage, age, hemoglobin level, and either LLR or PNI. Statistical package SPSS v 22.0 was used. Two different Cox regression models were obtained for OS and PFS. Model 1 showed LLR ≥ 5,8 as the highest risk for OS and anemia as the highest risk for PFS. Model 2 showed PNI ≤ 45,2 as the highest risk for OS and anemia as the highest risk for PFS. IPS-4 scores obtained by integrating either LLR or PNI to IPS-3 integration of a biologic parameter either LLR or PNI need to be determined with clinical risk scoring parameters.

Context The AETHERA trial reported an increased progression-free survival (PFS) when brentuximab vedotin (BV) was used as maintenance therapy in high-risk Hodgkin lymphoma (HL) after autologous stem cell transplantation (ASCT). Objective To determine the impact and safety of BV as maintenance after ASCT in real-world patients. Design Patients with relapsed/refractory HL started on BV consolidation therapy after ASCT due to high risk of relapse, between January 2016 and July 2019, from 25 institutions, were retrospectively analyzed. Setting All patients were followed by the bone marrow transplantation team of their hospital. Patients or Other Participants Seventy-five patients were included in the study. The median follow-up time was 26 months. The most common high-risk features were primary refractory or relapsed disease Interventions BV consolidation was initiated within 6 months of ASCT and administered at a dose of 1.8 mg/kg intravenous infusion over 30 min every 3 weeks for up to 16 cycles in an outpatient setting. Main Outcome Features The primary endpoint of the study was PFS; secondary endpoints were safety and overall survival (OS). Results At the time of analysis, 42 patients completed consolidation courses, and BV was discontinued in 33 patients. Fifty patients had an ongoing response (CR in 41, PR in six, and SD in three patients), 25 had progressed. Ten died in the follow-up, eight with progressive disease and two due to infection while in CR. The 2-years PFS and OS rates were 67.75% (95% CI:0.55–0.77) and 87.61% (95% CI:0.76–0.94), respectively. Seventeen patients (23%) received BV in the pre-ASCT treatment lines, and there was no survival difference between the BV naive and BV exposed groups. The most common adverse events were neutropenia (27%) and peripheral neuropathy (21%). Sixteen patients (21.3%) experienced grade 3 or 4 toxicity. BV was discontinued due to AE in 12 patients. Conclusions Consolidation with BV after ASCT can achieve a 2-year PFS of 67.75% (95% CI: 0.55–0.75) with an acceptable toxicity profile.

Background: Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine carcinoma of the skin. In this study, we aimed to evaluate the clinicopathologic characteristics, treatment outcomes, and survival of MCC cases in Turkey. Materials and methods: The patients diagnosed with MCC between 1999 and 2018 at twenty different centers in Turkey were included in the study. Patient and tumor characteristics and adjuvant and metastatis treatment outcomes were analyzed retrospectively. Results: The median age of totally 89 patients was 70 (26-93). The most common primary location was lower limbs (n = 29, 32.5%). Immunohistochemically, CK20 positivity was present in 59 patients (66.3%). Only two patients had secondary malignancy. The majority of the patients (n = 76, 85.4%) were diagnosed at the localized stage. Surgery was performed for all patients in the early stage, and adjuvant radiotherapy or/and chemotherapy was applied to 52.6% (n = 40) of nonmetastatic patients. The median follow-up was 29 months. Recurrence developed in 21 (27.6%) of the 76 patients who presented with local or regional disease. Two-year disease-free survival (DFS) was 68.1% and 5-year DFS was 62.0% for localized stage. The 5-year DFS was similar for patients receiving adjuvant treatment (chemotherapy, radiotherapy, or sequential chemoradiotherapy) and without adjuvant therapy (P > 0.05). Two-year overall survival in patients who presented with localized disease was 71.3% and 18.5% in metastatic patients (P < 0.001). In the metastatic stage, platinum/etoposide combination was the most preferred combination regimen. Median progression-free survival (PFS) in first-line chemotherapy was 7 months (95% confidence interval: 3.5-10.5 months; standart error: 1.78). Conclusions: Although MCC is rare in Turkey, the incidence is increasing. Gender, CK20 status, tumor size, lymph node involvement, and adjuvant treatment were not associated with recurrence.

Background: Growing teratoma syndrome (GTS) is a very uncommon phenomena. Given its lower prevalence, there is little data about clinichopathological features and management of GTS. Literature about disease mostly composed of case reports. In this study, we aimed to report patients characteristics and treatment modalities in our center within a relatively large cohort. Patients and Methods: We retrospectively reviewed the clinical records 21 patients who fulfilled criteria of GTS. Survival analysis was performed by using the Kaplan-Meier method with the Long-rank test. p Results: The median age at diagnosis was 25 (range 17-51). A total of 12 patients could have undergone surgery. Of patients who underwent surgery, 5 patients remained fully disease free, and 7 patients had experienced disease recurrences. Nine patients had unresectable disease, and treated with either platin-based chemotherapy or interferone α2b. Of those, 5 patients eventually had undergone autologous stem cell transplantation (ASCT) with surprisingly promising response rates. One patient had complete response and three patients had partial response. One patient died soon after ASCT due to infectious complication. Conclusion: GTS is an unique entity with regard to its clinicopathological features and available treatment options as we mentioned in the text. Despite various agents reported to have efficacy in case reports, surgery remains as the mainstay of treatment. According to result of our study, ASCT and platin-based chemotherapy regimens may be feasible options for patients with unresectable disease.

Introduction and aim To demonstrate the real-life data about patients who underwent AHSCT due to GCT. Methods Between November 2016 and April 2020, 64 patients who received CE as high-dose chemotherapy for AHSCT in the Gulhane Education and Research Hospital were included in the study. Sixty-one patients received one AHSCT with CE chemotherapy regimen. Survival data and clinical characteristics were evaluated retrospectively. Results The mean age of the patients were 31.9 ± 9 (min-max:18–55). With a median follow-up of 10.7 ± 8.7 months, the 1-year progression-free survival (PFS) rate was 57.8%, and the 1-year overall survival rate was 77.5%. Median overall survival (OS) and progression-free survival (PFS) times were 21.5 ± 1.8 (95% CI: 14.5–33.4) and 20 ± 2 months, respectively. The response rate was 72%. There were three treatment-related deaths. Conclusion This sizeable single-centre study shows that patients with relapsed metastatic GCT are curable by CE as high dose chemotherapy plus AHSCT with reliable toxicity even for a single cycle.

The purpose of this study was to determine whether primary tumor localization may be a risk factor for relapse and survival in seminomatous germ cell tumors (GCT) patients.In our study, 612 seminomatous GCT patients diagnosed in 22 centers between 01.01.1989 and 03.02.2019 were retrospectively evaluated. Patient interview information, patient files and electronic system data were used for the study.The primary tumor was localized in the right testis in 305 (49.9%) patients and in 307 (50.1%) in the left testis. Mean age of the patients was 36 years (range 16-85±10.4). The median follow-up period was 47 months (1-298). Recurrence was observed in 78 (12.7%) patients and 29 (4.7%) died during the follow-up period. Four-year overall survival (OS) was 95.4% and 4-year progression-free survival (PFS) was 84.5%. The relationship between localization and relapse was significant in 197 patients with stage 2 and stage 3 (p=0.003). In this patient group, 41 (20.8%) relapses were observed. Thirty (73.2%) of the relapses were in the right testis and 11 (26.8%) in the left testis. Four-year OS was 92.1% in patients with right tumor; and 98.7% in patients with left tumor (p=0.007). When 612 patients were evaluated with a mean follow-up of 4 years, there was a 6.6% survival advantage in patients with left testicular tumor and this difference was significant (p=0.007).Survival rates of patients with primary right testicular localization were worse compared with left testicular localization, and relapse rates were higher in stage 2 and 3 patients with right testicular localization.

Testicular cancer is the most commonly diagnosed solid organ malignancy in 15 to 35 year-old men with 1% incidence among all malignancies. Sixty percent of patients with mild and poor-risk factors need additional treatments. Starting in 1980s, high dose chemotherapy regimens (HDCT) that were not applicable before due to hematological toxicity have been brought into use, and survival and cure possibility have increased. To date, no randomized trial has been conducted to demonstrate superiority of high-dose chemotherapy protocols used for autologous stem cell transplantation (ASCT). Our study aims to compare two commonly used HDCT regimens for a long period, with real-life data.Approval for thiss retrospective study was obtained from the ethics committee of Gülhane Training and Research Hospital. Fifty refractory testicular cancer patients above 18 years were treated with HDCT and ASCT at Gülhane Training and Research Hospital (January 2011-July 2018).Fifty metastatic, refractory testicular carcinoma patients with a median age of 34 were included in the study. Ninety per cent of the cases had stage III disease at diagnosis. Except for 8 patients (16%) at mild risk group, all the other patients were at high risk. CE was used as salvage treatment for half of the patients and ICE was used for the other half. Four patients responded completely and 30 responded partially to ASCT. Post transplantation median progression-free survival (PFS) was 22 months. Median overall survival (OS) in the general population was 223.4 months (76.1-370.7). Although there was a difference in OS between chemotherapy groups, the difference was not statistically significant. The mean duration of engraftment in patients treated with CE was 11.2 ± 2.3 days, while in patients receiving ICE it was 15.5 ± 2.1 days. This difference between chemotherapy groups was statistically significant (p0.001).

[No abstract available], Amer Soc Clin Oncol

Aim: Even though ABO blood group surface antigens are expressed in red blood cells, they can be observed in many normal and pathologic cells. Relationship between ABO blood groups and progression and prognosis of cancer has been mainly demonstrated in gastric and pancreatic cancer. However there is no study in current literature about its relation with testicular cancer. The aim of this study is to demonstrate the prognostic value of the ABO blood group in nonseminomatous testicular cancer patients who treated with high dose chemotherapy and autologous stem cell transplantation. Material and method: 64 patients who diagnosed as non-seminomatous testicular cancer and treated with HDC and OSCT in Gulhane Medical Oncology Clinic between January 2011 and December 2016 were enrolled to the study. Patients' age, TNM stage, chemotherapy protocols and blood group characteristics were obtained retrospectively. Results: The mean age of patients was 31.4 (18–61) years. Blood groups of patients' were as follows: A blood group 19 (29.7%), B blood group 7 (10.9%), O blood group 34 (53.1%), AB blood group 4 (6.3%). Rh was negative in 3 patients (4.7%) and Rh positive in 61 patients (95.3%). 1-year progression-free survival (PFS) was 72.5% and 2-year PFS was 68.4%. 1-year overall survival (OS) was 82% and 2-years OS was 72%. While 1-year and 2-year OS was 88.2% and 84.4% in O blood group individuals, respectively, it was 75.6% and 59.5% in all other blood types, respectively. Although the OS was superior in individuals with O blood group, the difference was not reached the statistically significance (p = 0.071). When O blood group was compared with other blood groups in terms of PFS, 1 year PFS was 79.1% in O blood group and 65.2% in the all other blood groups (p = 0.19). Conclusion: OS and PFS were superior in O blood group than other blood groups, however the difference was not reached statistical significance. In the literature, there is no study that focused on the relationship between stem cell transplantation and blood groups. ABO blood groups are the phenotype of a person's genotype and may reflect differences in the individual's immune mechanisms. However, due to small number of cases and heterogeneity of the group, the results and the strength of the study may have affected negatively. So, the prognostic importance of ABO blood groups can be shown with multi-center studies that performed with larger number of cases. Keywords: High dose chemotherapy, Autologous stem cell transplantation, Testicular cancer, ABO blood group

ÖZFİNANSAL RAPORLARIN ANALİZİNDE METİN MADENCİLİĞİ KULLANIMI[1]İşletme ile ilgili alınacak kararlarda menfaat sahiplerinin ilk başvurduğu kaynak genel amaçlı finansal tablolardır. Genel amaçlı finansal tablolardan işletme ile ilgili tüm bilgilerin elde edilmesi mümkün değildir. Bu nedenle menfaat sahipleri başka kaynaklara yönelmektedirler. Faaliyet raporları, sürdürülebilirlik raporları, entegre raporlar bu kaynaklara örnek olarak verilebilir. Ancak burada bu raporlarda yer alan verilerin analizi menfaat sahipleri için bir sorun olmaktadır. Çünkü, büyük oranda yapısal olmayan veri içeren bu raporların analizinde mevcut istatistiksel yöntemler yetersiz kalmaktadır. Metin madenciliği bu soruna çözüm getiren ve muhasebe alanında da son yıllarda sıklıkla kullanılan bir büyük veri analiz yöntemidir. Bu çalışmada muhasebe alanında metin madenciliği çalışmaları incelenerek, metin madenciliğinin muhasebe alanında uygulama alanları hakkında araştırmacılara yol göstermek amaçlanmaktadır.Anahtar Kelimeler: Metin Madenciliği, Büyük Veri, Yapısal Olmayan Veri, Finansal Rapor, Faaliyet Raporu, Finansal Olmayan VeriJel Kodları:M41, C49 [1] Bu çalışma “Finansal Raporların Analizinde Metin Madenciliğinin Kullanımı:Borsa İstanbul Şirketlerinin Kurumsal Yönetim Niteliklerinin Tahmini” adlı doktora tezinden türetilmiştir.

Background: Lung involvement, an uncommon initial presentation of Hodgkin Lymphoma (HL), may appear as primary or secondary pulmonary HL. Although the combination of Brentuximab vedotin (BV) with AVD is suggested as an alternative treatment to combinations including bleomycin for patients with pulmonary involvement. The efficacy and adverse effects of BV have not been specialized on pulmonary HL. There is insufficient data about neutrophil to lymphocyte ratio (NLR) of cases treated with BV. We performed this retrospective study to evaluate the efficacy and toxicity of BV in patients with pulmonary HL and to demonstrate the prognostic role of NLR in patients treated with BV. Methods: Data of 10 CD 30 (+) HL patients who treated with BV between years 2011–2016 were analyzed retrospectively. Relapsed cases after autologous bone marrow transplantation (ABMT) and/or resistant cases to at least two lines of chemotherapy, and treated with BV were included in the study. Results: Patients underwent a median of 8.5 cycles BV. Eight patients (80%) achieved an objective response including 2 of them (20%) with complete response and six of them (60%) with a partial response at the end of the 3rd cycle. At a median follow-up of 16.8 months, median progression-free survival for all patients was 6 months and 3 patients died because of progression. BV, as a single agent, revealed well response in HL cases with pulmonary involvement and other clinical types. No pulmonary toxicity has been occurred due to BV. NLR was found to be o good indicator of prognosis and mortality in pulmonary HL patients and other HL patients. While NLR was not influenced by BV, it can be suggested as an easy prognostic marker in patients treated with BV. Conclusion: BV may be used as a bridge therapy to the next curative treatment in order to obtain minimal tumor burden in pulmonary HL patients, and NLR can be used as a prognostic marker in these patients. We believe that this study contributes the current literature in terms of being the first research on the referred issue. Keywords: Brentuximab vedotin, Hodgkin lymphoma, Pulmonary infiltration

Nesrin Ocal,1 Birol Yildiz,2 Nuri Karadurmus,2 Deniz Dogan,1 Sukru Ozaydin,2 Ramazan Ocal,3 Mustafa Ozturk,2 Fikret Arpaci,4 Hayati Bilgic1 1Department of Chest Diseases, 2Department of Oncology, Gulhane Military Medical Faculty, Ankara, Turkey; 3Department of Hematology, Medical Faculty, Gazi University, Ankara, Turkey; 4Department of Oncology, Liv Hospital, Ankara, Turkey Objective: Even though the primary mediastinal extragonadal germ cell tumors (EGCTs) are rare, they are noteworthy in the differential diagnosis of mediastinal masses. In this study, we aimed to identify the clinical features of mediastinal malignant GCTs and compare the results of hematopoietic stem cell transplantation between mediastinal and nonmediastinal malignant EGCTs.Method: Data of the patients with EGCT who were treated and underwent hematopoietic stem cell transplantation at our hospital between 1988 and 2015 were retrieved retrospectively. Results were compared between mediastinal and nonmediastinal EGCTs.Results: Data of 65 patients diagnosed with EGCT (37 [56.92%] cases with mediastinal EGCT and 28 [43.07%] cases with nonmediastinal EGCT) were assessed. The clinical stages, frequency of pretransplant status, mean pretransplant time, and mean number of chemotherapy lines before hematopoietic stem cell transplantation were not significantly different between groups. Although the overall survival did not significantly differ between groups, the 5-year survival was significantly higher in mediastinal EGCTs (P=0.02). Yolk sac tumor was significantly more common in mediastinal EGCTs (P=0.05). Mortality rates were higher in seminomas and yolk sac tumors in all cases, higher in embryonal carcinomas in mediastinal EGCT group and higher in yolk sac tumors in nonmediastinal EGCT group. While choriocarcinomas had more aggressive courses in mediastinal EGCTs, seminomas and yolk sac tumors had poorer prognosis in nonmediastinal EGCTs. Short pretransplant time and persistence of elevated posttransplant βhCG and AFP levels were the significant mortality risk factors both in mediastinal and nonmediastinal EGCTs.Conclusion: Mediastinal placement of EGCT was not a poor prognostic factor; furthermore, the 5-year survival was significantly higher in mediastinal EGCTs. According to our knowledge, this is the first study that compares the clinical outcomes of hematopoietic stem cell transplantation of mediastinal and nonmediastinal malignant EGCTs. Keywords: mediastinum, extragonadal germ cell tumor, hematopoietic stem cell transplantation, survival, tumor marker, βhCG, α-fetoprotein

Introduction and aim To investigate the effect of the prognostic nutritional index on treatment response and survival in patients with metastatic renal cell cancer. Methods We retrospectively analyzed the treatment modalities; the demographic, clinical and pathological features of 396 patients with RCC and prognostic nutritional index. Based on the median value, patients were grouped as having low and high prognostic nutritional index values. Kaplan-Meier method was used for survival analysis, and Cox-regression analysis was used for multivariate analysis. Results The median overall survival was 39 months (95% CI 26.1–51.8), 28 months (95% CI 17.9–38) and 7 months (95% CI 4.7–9.2) in patients with favorable, intermediate and poor International Metastatic Renal Cell Carcinoma Database Consortium risk group, respectively. The difference between the groups was statistically significant (p 38.5) group (p Conclusion In patients with renal cell cancer, prognostic nutritional index is closely related to survival and has prognostic significance.

WOS:000628753200001 PMID: 33556744 The aim of this study is to validate the IPS-3 scoring system as a prognostic indicator in 1012 patients with advanced stage classical Hodgkin Lymphoma (cHL) treated by doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD). According to the IPS-3 scoring system only 3.5 % had high risk and 50.8 % had low risk disease disease and 45.8 % of the cases had intermediate risk disease. Each factors of IPS-7 and IPS-3 scoring systems (age, sex, stage hemoglobin, albumin, lymphocyte count and white cell count) were found to be significant for overall survival (OS) and progression free survival (PFS) according to univariate analyses. Two different multivariate Cox analyses were performed for OS and PFS including the IPS-3/ IPS-7 scoring system parameters. Among 7 risk factors of IPS scoring system, gender and albumin were not found as independent risk factors for both OS and PFS according to cox regression model. But all parameters such as age, stage and hemoglobin those included in IPS-3, were found to be independent significant risk factors for both models obtained for OS and PFS. The results of the study shows that the IPS-3 scoring system can be used as a prognostic indicator in ABVD treated patients in every day practice which is more easily calculate according to the IPS-7.

Objective: Cancers have been reported to worsen the clinical course of coronavirus disease 2019 (COVID-19) infection. We aimed to demonstrate the real-life data on health outcomes in COVID-19-infected cancer patients. Materials and Methods: We analyzed the data of 43 COVID-19-infected cancer patients in our COVID-19 clinics between March 25, 2020, and May 9, 2020, retrospectively. Results: We determined that 1051 patients were followed up with COVID-19 infection and 43 (4%) of them were cancer patients. The mean age of the patients was 64.3 ± 12.3 years. Lung cancer is the most common cancer type among the patients (23.2%). Dyspnea (51.2%) was the most common symptom in the first admission. Typical ground-glass consolidation or patchy appearance with peribronchial thickening resembling bronchopneumonia on high-resolution computed tomography (HRCT) was present in 29 (67.4%) patients. COVID-19 was diagnosed in 14 (32.5%) patients based on reverse transcriptase-polymerase chain reaction analysis of nose-throat swab samples without any sign of lung involvement on HRCT. Total mortality of the COVID-19 infection was 46.5% (n = 20). Presence of heart disease (hazard ratio [HR]: 3.5; 95% confidence interval [CI]: 1.29–9.4), previous surgeries to the respiratory system (HR: 6.95; 95% CI: 1.29–27.7), and presence of dyspnea at admission (HR: 4; 95% CI: 1.31–12.3) were statistically significantly associated with death (P = 0.01, 0.02, and 0.01, respectively). Conclusion: Our practices supported that cancer patients were more affected by COVID-19 disease than the normal population. However, our findings can not be generalized due to being retrospective and single centered study, Also, we did not compare the findings with noncancer patients with COVID19 disease.

Aim: To determine the power of the International Prognostic Scoring systems (IPS-7 and IPS-3) and to obtain more explanatory indexes by integrating LLR and PNI as prognostic indicators to IPS in cases with HL. Patients and Methods: 1,060 patients with HL were included in this study from 8 centers in Turkey. IPS-7 using seven parameters (age, sex, stage hemoglobin, albumin, lymphocyte count, and white cell count) and the modified IPS-3 score with three parameters (stage, age, and hemoglobin level) were calculated. An alternative IPS-4 score with four parameters (stage, age, hemoglobin level, and LLR or PNI) was also calculated. LLR and PNI were integrated to IPSs. Statistical Analyses: Chi square test or Student t test was used to compare the groups. The cut-off points of this population for the LLR and PNI were evaluated using AUC (area under ROC curve) statistics and median values of the distributions of the variables. Possible alternative cut-off points for the LLR and PNI were evaluated using AUC statistics and median values of the distributions of the variables. For LLR, 5.7 was detected as cut-off point based on ROC analysis and 5.1 based on median. Cut-off for PNI was 45.2 based on ROC analysis and 47.5 based on median. The Kaplan-Meier method and Cox proportional regression model were used to estimate the mean-median overall survival (OS), failure-free survival (FFS) rates, and hazard ratios (HRs). Log-rank test was used to compare the survival distributions between groups. The prognostic ability of parameters was evaluated for OS and FFS in both univariate and multivariate Cox regression models. p value < 0.05 was considered as significant. The analyses were performed using the statistical package SPSS v 22.0. Results: Female/male ratio was 396/664; mean age was 37.6±15.8 (15-88). About 75% of the patients had stage II-III disease and two thirds of the patient had nodular sclerosis subtype. All factors of IPS-7 and IPS-3 scoring systems were found to be significant factors that related with OS and FFS according to univariate analyses. PNI and LLR were also found to be prognostic factors for OS and FFS. PNI ≤45.2 and LLR ≥5.8 were found to be poor prognostic indicators. Among 7 factors of IPS-7, gender and albumin were not found to be significant according to multivariate Cox regression model. Hence albumin and gender were excluded from the models and PNI and LLR as prognostic factors were added to obtain easier and more explanatory indexes to the model, respectively. Two different Cox regression models were obtained for OS and FFS. Model 1 showed LLR ≥5.8 as the highest risk for OS (OR: 2.7) and Hb Conclusion: IPS-4 score obtained by integrating LLR or PNI to IPS systems can be used as an explanatory index for prognostic indicator in HL. Citation Format: Semra Paydas, Sahin Lacin, Mutlu Dogan, Ibrahim Barista, Birol Yildiz, Gulsah Seydaoglu, Nuri Karadurmuş, Sinem Civriz, Muhammed Ali Kaplan, Munci Yagci, Emel Gurkan, Vehbi Ercolak. Is it more explanatory to integrate the leukocyte/lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to international prognostic systems (IPS) in cases with Hodgkin lymphoma (HL)? [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-30.

451 Background: Anti-tumor activity and manageable safety profile of atezolizumab (ATZ) has been demonstrated in the previous clinical trials in patients with locally advanced or metastatic platinum-resistant urothelial carcinoma. In this study, we reported the results of real-life data of urothelial carcinoma patients in Turkey who were treated with ATZ. Methods: Data of the patients with metastatic urothelial carcinoma registered to ATZ Expanded-Access Program and treated with at least one course of ATZ from 36 oncology centers in Turkey were collected. The primary endpoint was the overall response rate (ORR); secondary endpoints were overall survival (OS), progression-free survival (PFS), duration of the ATZ treatment and safety. Results: Data of 115 eligible patients were analyzed. Of the patients, 100 (87%) were male and 13% were female. The median age was 65.3 years (37-86). Most of the patients (92.3%) had received only one chemotherapy regimen prior to ATZ. The median follow-up time was 23.5 months. The complete response rate to ATZ, partial response rate, and ORR were 8.7% (n=10), 20.0% (n=23), and 28.7% (n=33), respectively. The median duration of response was 20.4 months (95% CI 6.47–28.8). Of the thirty-three patients who responded to treatment, 20 (60%) had an ongoing response at the time of the analysis. PFS and OS with ATZ were 3.8 months (95% 2.25–5.49) and 9.8 months (95% 6.7–12.9), respectively. The 12-month PFS rate was 22.3% and the 24-month PFS rate was 16.9%. The 12-month OS rate was 42.2% and the 24-month OS rate was 23.5%, respectively. Sixty-four percent of patients experienced a treatment-related adverse event of any grade, and 24 (20%) of patients had a grade 3–4 treatment-related adverse event. Because of treatment-related side effects, dose reduction was performed in 9 (7.8%) patients and ATZ was discontinued in 8 patients (7.0%). Adverse event that required systemic steroid use was reported in only 7 (6.1%) patients. Four patients (3.5%) died due to treatment-related causes. Conclusions: ATZ is an effective and tolerable treatment for patients with metastatic platinum-resistant urothelial carcinoma.

WOS: 000442916006728, …

Aims: Germ cell tumors (GCT) are the most common malignancies, especially in males of 15 to 35 years of age. Tandem autologous hematopoietic stem cell transplantation (AHSCT) with carboplatin and etoposide (CE) has been performed for many years in relapsed and refractory germ cell patients, but information about AHSCT in patients with germ cell tumors is limited. We aimed to demonstrate some real-life data about patients who underwent AHSCT due to germ cell tumors. Methods: In this retrospective study, medical records of 20 patients who received CE as high-dose chemotherapy for AHSCT betweeen November 2016 and April 2018 were reviewed. Response rates at 12th month and toxicity profiles were evaluated. Results: A complete response was obtained in 15% (n=3) and a partial response was obtained in 20% (n=4) of the cases after AHSCT. The survival rate during AHSCT was calculated as 95%. When the progression-free survival time of the patients was examined, the median recurrence time was 6 months (95% CI: 5.08-6.91). The rate of recurrence was 57% in 6 months. Neutropenia, thrombocytopenia and anemia were observed during AHSCT in all patients. Conclusions: High dose chemotherapy as CE in AHSCT is a safe and effective treatment option in relapsed refractory GCT with an acceptable PFS and mortality rate. Also, highdose CE was associated with low treatment-related mortality and reasonable side effects in patients with poor prognosis. © Gülhane Faculty of Medicine 2018.

Aims: Testicular tumors are one of the most common malignancies in males, between 15 and 35 years of age. Testicular cancer patients are treated with the combination of gemcitabine, oxaliplatin and paclitaxel (GOP) in relapsed and refractory disease, but the literature about the GOP treatment is limited. We aimed to demonstrate the real-life data of progressive testicular cancer patients who received GOP treatment. Methods: Medical records of 17 patients who received GOP treatment at the Gulhane Training and Research Hospital were reviewed retrospectively. Overall response rate (ORR), overall survival (OS) rate and progression-free survival (PFS) of the patients were evaluated. Results: Overall response was obtained in 58.8% (n=10), and a complete response was achieved in 11.2% (n=2) of the cases. OS time was 14.2 months and the OS rate in the first year was 73.1%. The PFS time was 7.6 months. In most of the patients, thrombocytopenia, anemia and leukopenia were observed during GOP treatment. Conclusions: GOP is a safe and effective treatment option for relapsed refractory testicular cancer patients with an acceptable ORR, OS and PFS time. Additionally, GOP treatment was associated with cognitive side effects in patients.

Background 5-year survival with platinum-based combination chemotherapies in testicular cancer is 95%. Existing prognostic scoring scales may be insufficient to predict which patient will benefit from treatment. Additional prognostic factors should be determined. Unlike left testicular vein, right testicular vein drains to vena cava. Therefore, the systemic spread of the testicular cancers of each side considered to be different due to the difference of vascular structures of the right and left testis. In this study, we aimed to investigate the effects of tumor localization on survival in patients with nonseminomatous testicular cancer. Methods We enrolled 321 non-seminomatous testicular cancer patients who followed up at Gulhane Research and Training Hospital in between January 1981, and December 2015. We retrospectively obtained data of demographic features, histopathological results, information of surgical operations and chemo-radiotherapy protocols, history of autologous stem cell transplantation from patients’ files. Results We enrolled 321 non-seminomatous testicular carcinoma patients and summarized demographic information and treatment methods in the table. Median age was 34 (18-77) years. The primary tumor was in left testis in 152 (47.2%) patients and in right testis in 170 (52.8%) patients. The most common histopathological diagnosis was mixed non-seminomatous germ cell tumor (39.4%). One hundred forty-six (44.3%) cases were metastatic at the time of diagnosis. Median follow-up period was 88.3 months (1-386). Median 10-year survival rate was 74.1%, and the 20-year survival rate was 70.7%. We examined the effect of primary tumor localization and found that primary tumor localization was significantly different regarding survival between left and right testis (337.6 months vs. NR, p = 0.001). In patients with a right testicular tumor the recurrence rate was significantly higher (84.7% vs. 68.2%; p = 0.002). Conclusions The localization of primary testicular tumor (left or right) was statistically significant regarding survival. The effect of tumor localization on survival was independent of the presence of metastasis at the time of diagnosis, histopathological type, site of metastasis, and disease stage. Legal entity responsible for the study Gulhane Education and Research Hospital. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

BACKGROUND The aim of this study was to determine the impacts of different administration modes on sensitivity and specificity of Edinburgh Claudication Questionnaire (ECQ) in estimation of Ankle Brachial Index (ABI) detecting lower extremity arterial disease (LEAD). METHODS Eligible respondents aged fifty years or older underwent first a self-administered (SA-) ECQ, and then an interviewer-administered (IA-) ECQ. Interviewing included additional guidance on symptoms relevant to claudication. ABI was measured by hand-held Doppler. RESULTS A total of 177 respondents (age: 64.67±9.19, male/female: 80/97) were enrolled. Questions 1, 2, 3, and 5 (collectively defines claudication) were responded significantly different on SA-ECQ and IA-ECQ modes. Markings of pain on the figure of ECQ also changed significantly when the procedure was guided. Of the respondents, none on SA-ECQ and 13.6% on IA-ECQ with positive claudication had a low ABI. Subjects with higher formal education level did similar to the whole group in both modes. Sensitivity and specificity of IA-ECQ was calculated as 25% and 88.5%, respectively, for ABI detected LEAD. CONCLUSIONS Respondents' perceptions of pain, discomfort, exertion or body regions described on ECQ may subject to errors without guidance. ECQ seems reliable in evaluating claudication only when specifically interviewed by an observer.

e19027 Background: Bendamustine is an old conventional agent which is used in the treatment of hodgkin's lymphoma (HL), non-hodgkin's lymphoma (NHL), and chronic lymphocytic leukemia (CLL) patients despite they are relapsed or refractory cases. In our study we wanted to reveal retrospectively the efficacy and side effects of bendamustine in relapse/refractory patients from Turkey. Methods: We included in the study relapse/refractory HL and NHL patients who underwent multiple line chemotherapy. Bendamustine was administered at 90 mg/m² on days 1 and 2, every 3 weeks by 60 minutes infusion. The primary endpoint of the study was to determine the objective response and toxicity. Results: Seventy-five patients (31 female) with a median age of 62.8 years (range 16-89 years) were included in the study. 58 of the patients were NHL (follicular lymphoma:8, diffuse large B-cell lymphoma: 17, mantle cell lymphoma: 11, marginal zone lymphoma: 4, Small lymphocytic lymphoma:11, Others:7) and 17 of them were HL patients. The patients were underwent median three lines chemotherapy (range 1-8) accept autologous stem cell transplantation, 20 patients (HL: 12, NHL:8) were underwent autologous stem cell transplantation. Bendamustine was performed an average of 6 cycles (range 1-38). The objective response rate was 73.3%, complete response rate was 44% (n = 33), partial response rate was 29.3% (n = 22), respectively. The response rate was 65% (11/17) in HL cases, 79% (30/38) in indolent NHL cases and 70% (14/20) in aggressive NHL cases. For median follow-up of 20.7 months, the median overall survival (OS) was 64.9 months, OS rate was 75.5% for 1 year, 67.6% for 2 years and 63.1% for 3 years. The most common side effects associated with treatment were lymphopenia, neutropenia, thrombocytopenia, abdominal pain, fatigue and diarrhea. Side effects which were seen as grade 3 and higher levels: 9.6% lymphopenia, thrombocytopenia 8% and 12% fatigue. Conclusions: Objective response rate of bendamustine with tolerable side effect profile was found to be 73.3% in relapsed / refractory HL and NHL patients as a rescue agent. It appears to be an ideal agent for rescue treatment which had previously received intensive treatment.

Çalışmada muhasebe mesleği sorumluluk sigortalarının hukuki risk faktörleri belirlenerek, hukuki risklerini değerlendiren yapay sinir ağı modeli geliştirilmiştir. Çalışmada yapay sinir ağı yöntemi uygulanmıştır. Muhasebe mesleği sorumluluk sigortalarında gerçekleşen hukuki riskle, yapay sinir ağı yönteminin öngördüğü hukuki risk mukayese edildiğinde sonuçların oldukça uyumlu olduğu tespit edilmiştir. Gerçekleşen sonuçlar ile yapay sinir ağı modelinden elde edilen sonuçların gerçek değerlere çok yakın çıktılar verdiği ve yapay sinir ağı modelinin %99 başarı oranında muhasebe mesleği sorumluluk sigortalarının hukuki risklerinde doğru öngörüde bulunduğu tespit edilmiştir, In this study, litigation risk factors were determined for accounting professional liability insurance and an artificial neural network was developed to determine the litigation risks. A training data set comprised of data from 201 policies was used to train an artificial neural network. The performance of the artificial neural network model was then assessed using a test data set comprised of data from 100 policies. In the research, a litigation risk estimation model was formed for liability insurance via an artificial neural network model. By comparing the litigation risks occurring in accounting professional liability insurance to those foreseen by the artificial neural network system, it was determined that the results were quite consistent. It was also determined that the realized results and the risks foreseen in the artificial neural network model provided data close to the real values and that the artificial neural network model could foresee the litigation risks in accounting professional liability insurance with a 99% success rate

43rd ESMO Congress (ESMO) -- OCT 19-23, 2018 -- Munich, GERMANY WOS: 000459277303171 … European Society for Medical Oncology, Japanese Society of Medical Oncology

This study performs fundamental analysis and cross-sectional prediction of stock return with neural network technology. Eighteen financial ratios are used as the input vector and one-year ahead stock returns are used as the output vector. The fundamental analysis trading strategy generated by artificial neural networks yields an average annual abnormal return of 22.32% after controlling for market risk, book-to-market, size and momentum effects. Our results highlight neural network’s ability to predict future returns in NYSE/AMEX/Nasdaq securities for the period 1990-2005. Artificial neural network technology stands out as a valuable tool for fundamental analysis and forecasting equity returns in the U.S. markets.

The purpose of this study is to estimate the long run IPO (Initial Public Offerings) returns using artificial neural network (ANN). In wide-ranging literature OLS (Ordinary Least Squares) is commonly preferred to estimate long run IPO returns. This study applies artificial neural network addition to OLS. As a result of comparing the performance of ANN and OLS, ANN has better estimation than OLS for long run IPO returns in Turkey.