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Solar gravitational multipolar moments have not been yet extensively analysed. However, they are at the crossroads of solar physics, solar astrometry, celestial mechanics, and General Relativity. Their values reflect the physics of solar models: non-rigid rotation, solar latitudinal rotation, solar-core properties, solar-cycle variations, and structure evolution. Their temporal variations are still often neglected; they are yet an essential aspect for constraining solar-cycle modelling or solar-evolution theories. They induced planet-planet inclinations in multi-transiting systems gravitating in the neighbouring of a star, leading to key issues future studies. This paper is devoted to an analytical analysis; a second part will address a helioseismology analysis.

Background Collateral ligament injuries of the thumb and lesser digits are simple injuries, but they may lead to disabilities in hand function. This study aimed to evaluate the accuracy and cost-effectiveness of magnetic resonance imaging (MRI) in diagnosing proximal interphalangeal (PIP) collateral ligament injuries of lesser digits. Methods A retrospective evaluation was conducted on 18 fingers that had undergone surgery for PIP joint complete collateral ligament injury. Pre-operative MRI results were compared with the intra-operative findings. The data from MRI and direct intraoperative findings were analyzed by the Chi-square test in paired groups. The McNemar test analyzed the accuracy of the MRI test for detecting volar plate injuries. Statistical Packages for Social Sciences (SPSS) version 25 (IBM Inc., Armonk, New York) software program was used for the analysis. Results In digits other than the thumb, the accuracy of MRI for detecting collateral injuries was 38.89%, and detection was incorrect in 11 (61.11%) of 18 patients. There are significant differences between MRI and Intraoperative results (p0.001). MRI findings for seven fingers (38.89%) of the 18 fingers involved were compatible with the surgery results (38.88%). By comparison, the MRI findings of 11 fingers (61.11%) were inconsistent with the intra-operative results. Eight patients (44.44%) were diagnosed preoperatively with MRI as having volar plate ruptures, three patients (16.67%) were diagnosed with open surgery, but only three of the volar plate diagnosed patients with MRI were verified as ruptures during open surgery (38.0%). In addition, preoperatively undetected volar plate injuries by MRI (n=10) were detected intra-operatively in three cases (30.0%). Therefore, the accuracy of MRI was found not to be statistically significant for the detection of volar plate injuries (p=0.727). Conclusion This study concluded that a 1.5-Tesla MRI with a slice thickness of 2-3 mm should not be relied on as a decisive tool for diagnosing collateral ligament injuries of the PIP joint of the lesser digits. Additionally, MRI was found insufficient for diagnosing volar plate injuries that accompanied collateral ligament injuries. Given these findings, one might conclude that MRI is not cost-effective in diagnosing collateral ligament injuries of the lesser digits PIP joint.

Duplication of the spleen, classified as a polysplenia syndrome, is a very rare anomaly. Polysplenia is a complex syndrome with a broad spectrum of abnormalities. Other abnormalities accompanying polysplenia have been previously reported. In this paper, we present a case of duplication of the spleen accompanied by multiple anomalies in the thorax and abdomen.

Background Determining if paraclinoid aneurysms are intradural or extradural is critical for surgical planning. Objective To create an easily reproducible diagnostic method based on bony anatomy that precisely locates the distal dural ring (DDR) to determine the position of paraclinoid aneurysms as intradural, transitional, or extradural. Methods Bilateral anatomic dissections of 10 cadaveric heads (20 sides) were performed to evaluate DDR anatomy. We observed a plane that reflects the position of the DDR passes through 4 bony landmarks: 1) The anterior clinoid-internal carotid artery intersection, 2) the optic strut, 3) the optico-carotid elevation, and 4) the base of the posterior clinoid process. This landmark-based plane can thus define the location of the DDR using 3-dimensional computed tomography angiography (CTA). This was confirmed in 27 surgical patients with intradural/transitional aneurysms and 7 patients with extradural aneurysms confirmed with magnetic resonance imaging (MRI). The DDR plane method easily classified aneurysm locations as intradural (above the DDR plane), extradural (below the DDR plane), or transitional (the DDR plane crosses the aneurysm). The aneurysm's location was subsequently confirmed intraoperatively or with MRI. Results The DDR plane method determined if paraclinoid aneurysms were intradural, transitional, or extradural in all 34 cases examined. The visibility of the anatomic features that define the DDR plane was also verified in 82% to 89% of CTA images from 100 patients. Conclusion The DDR plane method provides a useful diagnostic tool to evaluate the position of the DDR and determine the anatomic location of paraclinoid aneurysms.

The aim of our study was to present our case series of the trial of labor after a caesarean (TOLAC) and determine significant predictors for a successful vaginal birth after a caesarean (VBAC).Women with previous single caesarean deliveries who underwent TOLAC between January 2016-December 2019 were included in the study (n = 474). All files were analyzed in terms of demographic characteristics, obstetric history, history of index pregnancy and medical characteristics of previous caesarean delivery. For each current pregnancy, we recorded time from the previous delivery, the BISHOP and TOLAC scores at admission, induction of labor, gestational age at delivery, estimated fetal weight, intrapartum characteristics, mode of delivery and intra-operative findings.Among 474 women who had a previous caesarean delivery and gave consent for TOLAC, 216 resulted in a successful vaginal delivery, whereas 258 underwent repeat caesarean delivery. One hundred and seventy-nine women gave up trial of vaginal delivery during labor. The success rate of VBAC after exclusion of caesarean cases due to maternal requests was 73.2%. The induction rate was significantly higher in cases with successful VBAC (40% vs. 29.1%). The risk of uterine rupture was 0.42% in cases with labor induction. ROC analysis showed significant predictive values of the TOLAC score, body mass index (BMI), the number of previous VBACs and the number of previous vaginal deliveries, birth weight and the BISHOP score at admission.Our data showed us that major determinants for successful VBAC following labor are the BISHOP score at admission, number of previous vaginal deliveries, body mass index, birth weight and the TOLAC score calculated at admission.

To evaluate the Meibomian glands and presence of dry eye in patients with unilateral pseudoexfoliation.The study included 32 patients with clinical pseudoexfoliation (PEX) in one eye and 30 controls. Schirmer and tear film break-up time (TBUT) tests were performed, along with a detailed ophthalmological examination, meibography and evaluation of areas of meibomian gland loss. Subjective symptoms were evaluated using the ocular surface disease index (OSDI).Schirmer test results for eyes with or without PEX were similar (10.438±4.47mm and 11.563±4.35mm, respectively), vs. 15.967±9.75mm in the control group. While measurements of TBUT were found to be similar in both eyes of the patient group (6.188±2.66s in eyes with PEX and 6.250±1.87s in eyes without PEX), this was 8.233±2.66s in the control group. Schirmer and TBUT test results were found to be significantly lower in both eyes of patients with unilateral pseudoexfoliation compared to control eyes. The rate of meibomian gland loss in the upper and lower eyelids in the patient group was found to be significantly higher than in the control group. Similarly, meiboscores of both eyelids in the control group were significantly lower than those in patient group; however, there were no differences between patient eyes with or without pseudoexfoliation.The patients with unilateral pseudoexfoliation had a significant loss of meibomian gland area in both eyes compared to the control group, and their meiboscore was higher. It should be considered that meibomian gland loss may be one of the causes of dry eye in patients with pseudoexfoliation.

In total, 74 pediatric oncology patients with hematologic malignancies (n=56) or solid tumors (n=18) and a median age of 78.5 months were included in this prospective study. The aims were to assess malnutrition risks and nutritional status over a 6-month treatment period measured at regular intervals. The rate of patients with high risk for malnutrition at diagnosis was 28.4% by Screening Tool for Risk of Impaired Nutritional Status and Growth tool and 36.5% by Pediatric Yorkhill Malnutrition Score. Body mass index (BMI) z-scores at diagnosis showed 12.3% undernutrition (-2 SD) and 6.8% overnutrition (2 SD), which changed to 6.7% and 11.1% at the sixth month, respectively. Malnutrition (BMI5th age percentile) was detected in 13.7% at diagnosis. Despite an initial deterioration noted in BMI, BMI for age percentile, and z-scores at month 1 in all malignancy subgroups (at month 3 for acute lymphoblastic leukemia), the scores improved later on. There was an increase in weight from baseline in 88.2% of patients over 6 months. This study revealed a decrease in the prevalence of undernutrition and malnutrition over a 6-month treatment period with improved anthropometrics despite an initial deterioration in all malignancy subgroups and even in patients with high risk for malnutrition at baseline screening. Solid tumors and acute lymphoblastic leukemia seem to be associated with higher likelihood of undernutrition and overnutrition, respectively, during treatment.

WOS: 000471726700008, PubMed ID: 30989418, Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

We report on the properties of coronal loop foot-point heating with observations at the highest resolution, from the CRisp Imaging Spectro-Polarimeter (CRISP) located at the Swedish 1-m Solar Telescope (SST) and co-aligned NASA Solar Dynamics Observatory (SDO) observations, of Type II spicules in the chromosphere and their signatures in the EUV corona. Here, we address one important issue, as to why there is not always a one-to-one correspondence, between Type II spicules and hot coronal plasma signatures, i.e. beyond TR temperatures. We do not detect any difference in their spectral properties in a quiet Sun region compared to a region dominated by coronal loops. On the other hand, the number density close to the foot-points in the active region is found to be an order of magnitude higher than in the quiet Sun case. A differential emission measure analysis reveals a peak at $\sim 5 \times 10^5$ K on the order of 10$^{22}$~cm$^{-5}$~K$^{-1}$. Using this result as a constraint, we conduct numerical simulations and show that with an energy input of $1.25 \times 10^{24}$ erg (corresponding to $\sim$10 RBEs contributing to the burst) we manage to reproduce the observation very closely. However, simulation runs with lower thermal energy input do not reproduce the synthetic AIA $171 {\AA}$ signatures, indicating that there is a critical number of spicules required in order to account for the AIA $171{\AA}$ signatures in the simulation. Furthermore, the higher energy ($1.25 \times 10^{24}$ ergs) simulations reproduce catastrophic cooling with a cycle duration of $\sim$5 hours, matching a periodicity we observe in the EUV observations.

Background: This national cross-sectional survey aimed to assess the iodine status in pregnant women and their offspring, and also to demonstrate regional differences by measuring urinary iodine concentration (UIC). For each woman and her newborn a questionnaire was prepared with basic facts as age, parity number or birth weight and additional information regarding thyroid diseases, use of iodized salt in the household, extra iodine supplementation during pregnancy, education level and wage income. Methods: The target population represented 1444 pregnant women who gave birth between January 1 st, 2018 and 2019, and their offspring. Iodine deficiency for pregnant women and their offspring were defined as urine iodine level

Background There is neither a surveillance system nor a study to reveal the HD related infection rates in Turkey. We aimed to investigate the infection rate among HD outpatients and implement CDC’s surveillance system. Methods A multicenter prospective surveillance study is performed to investigate the infection rate among HD patients. CDC National Healthcare Safety Network dialysis event (DE) protocol is adopted for definitions and reporting. Results During April 2016–April 2018, 9 centers reported data. A total of 199 DEs reported in 10035 patient-months, and the overall DE rate was 1.98 per 100 patient-months. Risk of blood culture positivity is found to be 17.6 times higher when hemodialysis was through a tunneled catheter than through an arteriovenous fistula. DE rate was significantly lower in patients educated about the care of their vascular access site. Mean body mass index was significantly higher in patients with any DE. Staphylococcus aureus was the most causative microorganism among mortal patients. Outcomes of DEs were hospitalization (73%), loss of vascular access (18.2%), and death (7.7%). Conclusions This first surveillance study in Turkey gave insight into current DE status and will guide to generate a national surveillance system for maintaining much lower DE rates.

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΠΕΡΙΛΗΨΗ, In this study, the occurrence of the ciprofloxacin-resistant (CR) Escherichia coli in chicken meat was determined, and their clonal relations were investigated by using pulsed-field gel electrophoresis (PFGE). Antimicrobial resistance patterns of E. coli isolates were determined by using disc diffusion assay, and minimum inhibitory concentration of ciprofloxacin was determined by E-test. Plasmid-mediated quinolone resistance (PMQR) and extended spectrum beta-lactamase (ESBL) resistance genes were also screened through polymerase chain reactions. Sixty chicken meat samples were collected from different supermarkets and butchers in Sivas, Turkey. CR E. coli strains were determined in 59 (98.3%) chicken meat samples. By analyzing PFGE fingerprint data, 34 different pulsotypes were determined. All E. coli strains were found to be resistant to nalidixic acid, enrofloxacin, and norfloxacin. In addition, isolates were resistant to levofloxacin (40.7%), ampicillin (94.9%), trimethoprim-sulfamethoxazole (76.3%), tetracycline (69.5%), and chloramphenicol (44.1%). However, isolates were susceptible to imipenem and colistin. In this study, 81.4% of CR E. coli isolates were observed to have a multidrug-resistant profile, which is defined as resistance to three or more classes of antibiotics. Through phenotypic confirmation tests, five isolates (8.3%) were determined to be ESBL-producing. The PMQR genes were not determined in any of the isolates. Two isolates (3.4%) possessed the blaCTX-M and blaCMY-2 genes, and 40 isolates (67.8%) had the blaTEM gene. Taken together, retail raw chicken meat is highly contaminated with CR E. coli. However, these isolates are not found to be carriers of the PMQR genes, indicating a low public health problem.

Genital infections are one of the most common reasons for a hospital visit in the scope of reproductive health problems. The information-motivation-behavioral skills (IMB), therefore, is an appropriate model to provide women with accurate genital hygiene behaviors and develop effective sexual and reproductive health training programs.This interventional study was conducted to assess the effectiveness of genital infection awareness training provided to women based on the IMB model.Study sample consisted of 62 women (nThe mean (SD) age was 39.1 (8.4) years for the women in the experimental group and 37.5 (6.7) for the women in the control group (P = 0.481). Pretest knowledge mean scores M (SD)Based on these findings, it was concluded that the genital infection awareness training provided to women based on the IMB model, improved knowledge and acted as a positive reinforcer for the hygiene behaviors of the women.

The prevalence of co-morbid gastrointestinal symptoms is high in dialysis patients, and dyspeptic symptoms, such as nausea, vomiting, and epigastric burning are the most common symptoms. Upper gastrointestinal disorders e.g., peptic ulcer disease and gastroparesis underlie most of these symptoms, while less common but severe complications are also likely that include gastrointestinal bleeding from gastric antral vascular ectasia, erosions or ulcers. Incidence of gastrointestinal disorders is considered to increase with the duration of renal failure, independent of dialysis modality. While uremia and dialysis have been linked to an increased risk of gastrointestinal tract lesions, pathogenesis of gastrointestinal dysfunction in end-stage renal disease is considered to be multifactorial and has not yet been clarified. In addition, conflicting data exist on the association of renal dysfunction with gastrointestinal disorders, and there are no explicit guidelines for the management of co-morbid gastrointestinal problems in patients with concomitant renal failure. Herein, we review the common upper gastrointestinal disorders that occur among dialysis patients, with an emphasis on prevalence, pathogenesis and diagnostic strategies

Over the last decades, global consumption of energy and environmental resources have been rapidly increasing due to advances in the production and transportation of goods, as well as reduced barriers to global trade markets. This trend raised sustainable consumption issues because of inefficient and wasteful use of resources, especially in resource-rich countries with high purchasing power and subsidized tariffs offered to residents. It is also well-known that resources abundance tends to lower financial development and limit productivity growth and social development. On the other hand, there is a growing acceptance that supply-side policies need to be complemented by demand-side management to support sustainable cleaner production and remedy aforementioned adverse impacts. In this study, we present the results of an investigation on demand-side management (DSM) opportunities and a framework developed for Qatar as a representative of an emerging resource-rich countries and discuss implications for cleaner production. The rationale behind is that Qatar is a commodity-dependent developing country, who, during the last five years, has experienced a population growth of 35%, and an increase in electricity and water demand of 46% and 35%, respectively. Similarly, during the same period, the national vehicle fleet has grown by more than twofold. These figures have ranked Qatar at the top of the per-capita energy, carbon, and water consumption list in the world and increased environmental vulnerability and reduced climate resilience. To that end, the objectives of this study are to: (1) construct a DSM framework tailored to the needs of resource-rich country like Qatar from economic, social, environmental, and technical aspects; (2) present, analyze, and discuss the results of a survey that reveals the perceptions, attitudes, and responses of local residents towards the applicability of DSM policies; and (3) discuss methods and solutions to achieve cleaner energy consumption. The conducted survey covered electricity, water, and transportation sectors and showed that residents have low awareness about their consumption habits, but they have high willingness to reduce their consumption levels. In the last section, we present the survey results and discussions as a reference for policy-makers to promote the most promising DSM options in Qatar. To the best of authors' knowledge, this is the first survey-based study conducted in the Gulf Cooperation Council region where a significant portion of world's oil and natural gas resources are extracted. Therefore, the results could provide insights to other resource-rich countries with similar characteristics to devise more efficient policies for promoting welfare-enhancing and sustainable consumption behavior.

Purpose The aim of this study is to investigate the effect of treatment modalities on survival among unoperat ed and locally-advanced non-small cell lung cancer (NSCLC) patients aged 70 years and older, representing real-life data. Methods From 2005 through 2017, medical records of 2259 patients with lung cancer from Okmeydani Training and Research Hospital-Istanbul/Turkey were reviewed retrospectively. Patients with locally advanced NSCLC ≥ 70 years of age who did not undergo surgery for lung cancer were reviewed. In total, 130 patients were eligible for the final analysis. Patients were stratified into four groups as: chemotherapy (CT), concurrent chemoradiotherapy (cCRT), sequential chemoradiotherapy (sCRT), and radiotherapy (RT) only. Results Of the 130 patients included in the analysis; CT, cCRT, sCRT, and RT only were applied to 25(19.2%), 30(23.1%), 31(23.8%), and 44(33.8%) patients, retrospectively. Twelve (9.2%) patients were female. Median age was 72 years (range, 70–88). Sixty (46.2%) patients had stage IIIA disease and 70(53.8%) patients had stage IIIB disease. Median progression-free survival(mPFS) in patients treated with CT, cCRT, sCRT, and RT were 8.0, 15, 10, and 9.0 months, respectively(p = 0.07). Corresponding median overall survival (mOS) were 10, 33, 20, and 15 months (p = 0.04). In multivariate analysis, stage IIIB disease [hazard ratio (HR), 2.8], ECOG-PS 2(HR, 2.10), and ECOG-PS 3–4(HR, 5.13) were found to be the negative factors affecting survival, while cCRT (HR, 0.45) and sCRT (HR, 0.50) were the independent factors associated with better survival. Conclusion This study showed that the use of combined treatment modality was associated with better survival in elderly patients with locally advanced NSCLC, with the greatest survival observed in patients treated with cCRT. We therefore suggest that cCRT, when feasible, should be strongly considered in locally advanced NSCLC patients 70 years and over.

Introduction/Background Dedifferentiated endometrioid adenocarcinoma (DEAC) is rare and is known to be more aggressive than high-grade endometrioid carcinoma. DEAC may pose a variety of diagnostic challenges. DEAC is defined as a tumor which composed of a mixture of undifferentiated carcinoma and conventional endometrioid adenocarcinom. Methodology This is a case report of DEAC with repair of external iliac arter with endovascular graft which was diagnosed in Ankara University Gynecologic. A 48-year-old perimenopausal woman (BMI: 40 kg/m2) was referred us endometrioid carcinoma FIGO grade 2 diagnose. She suffered from vaginal bleeding for 2 months.Transvaginal ultrasound revealed abnormally thickened endometrium (5,1 cm) and on examination a gross mass protruding from cervix shown and the entire of endometrial cavity is filled with this mass.Pathology reevoluated the endometrial biopsy and revealed DEAC (endometrioid endometrial carsinom grade 1 (%80) and undifferantiated carsinom (%20). MRI showed a 62*52*42 mm mass at lower uterine segment (figure 1C) extending to the cervix. MRI showed a 194*11*95 mm lobulated mass filling right pelvis sidewall.Abdominal pelvic computed tomography (CT) revealed that the mass involving bladder and rectum. TAH+BSO+partial cystectomy+low anterior resection+right external iliac artery repair with endovascular greft was performed. In surgery, pelvic mass was involving the right pelvic sidewall and in order to remove tumor totaly we cutted and removed external iliak artery and there was a 7 cm lenght defect at right external iliac artery. A 12 mm diameter and 7 cm lenght stretch vascular graft (GORE-TEX®) was placed to vascular defect and the graft patency was intact. We achieved complete en bloc tumor resection. Results After surgery pathology revealed DEAC (endometrioid endometrial carsinom grade 3 and undifferantiate carsinom). And the patient died 1 week later after the surgery due to tumor lysis syndrome. Conclusion Differentiating is important because DEACs have fulminant clinical outcomes and poorer prognosis than high-grade endometrioid carcinoma. Disclosure Nothing to disclose.

The Bosniak classification of cystic renal lesions was first published in 1986 based on computed tomography (CT). In the present study, we aimed to investigate the effect of magnetic resonance imaging (MRI) on Bosniak category compared with CT, and to determine how this effect changed the treatment modality in the evaluation of complex renal cysts.Data of 144 patients were collected retrospectively. After exclusion criteria, 102 cystic renal lesions with a Bosniak category of at least IIF on CT or MRI between 2013 and 2016 were evaluated by 2abdominal radiologists. The demographic data, Bosniak category, interobserver agreement, and pathologic data of patients who underwent surgery were recorded.The coherence between MRI and CT was 75.5%. The Bosniak classification of 17 patients was upgraded with MRI, and the treatment modality changed in 10 patients, and they underwent surgery. The Bosniak category was downgraded from III to IIF in 6 patients out of 8 whose Bosniak category was downgraded with MRI and the treatment modality changed. Surgery was performed in one patient out of these 6 patients, and the pathology was reported as benign. Progression was detected in the follow-up at month 18 of 1 patient out of 5, and surgery was performed. The pathology was reported as renal cell carcinoma. The pathology result was reported as RCC in 35 (68.6%) patients out of 51 who underwent surgery. Progression was detected in 7 patients out of 51 who were followed up (13.7%), and the pathology results were reported as RCC. The majority of the malignant tumors were low stage and grade.MRI may be successfully used in the evaluation of renal cystic lesions. In particular, the challenging Bosniak IIF and all Bosniak III lesions must be evaluated using MRI before making the decision for surgery. The upgrading of Bosniak category with MRI is more possible compared with CT due to its high-contrast resolution, therefore further studies are required to identify whether it was the cause of overtreatment of Bosniak III lesions.