Showing papers by "Başkent University published in 2013"

The effect of smoking on choroidal thickness measured by optical coherence tomography.

Abstract: Background/aims To investigate the effect of smoking on choroidal thickness using Fourier domain optical coherence tomography. Methods 17 otherwise healthy smokers (study group) and 17 non-smokers (control group) were enrolled. In the study group, all participants underwent optical coherence tomography scanning at baseline, and 1 and 3 h following smoking one standard cigarette. Also the participants of the control group underwent optical coherence tomography scanning in the morning which was followed by two further examinations at the first and third hours, respectively. Choroidal thickness measurements were performed. Results The mean choroidal thickness at the fovea prior to smoking was 301.1±63.1 μm, which decreased to 284.2±56.7 μm at 1 h and 270.8±80.0 μm at 3 h following smoking (p=0.001). The mean choroidal thickness was significantly decreased following smoking at all five extrafoveal points. The difference in choroidal thickness was not statistically significant at 1 and 3 h of smoking at all six points. In the control group, the mean baseline choroidal thickness at the fovea was 270.6±57.9 μm, which was 272.5±52.4 μm at 1 h and 273.8±57.4 μm at 3 h (p=0.816). Conclusions Cigarette smoking causes a significant decrease in choroidal thickness following smoking. Fourier domain optical coherence tomography can effectively demonstrate choroidal thickness.

Missense mutation in the ATPase, aminophospholipid transporter protein ATP8A2 is associated with cerebellar atrophy and quadrupedal locomotion.

Abstract: Cerebellar ataxia, mental retardation and dysequilibrium syndrome is a rare and heterogeneous condition. We investigated a consanguineous family from Turkey with four affected individuals exhibiting the condition. Homozygosity mapping revealed that several shared homozygous regions, including chromosome 13q12. Targeted next-generation sequencing of an affected individual followed by segregation analysis, population screening and prediction approaches revealed a novel missense variant, p.I376M, in ATP8A2. The mutation lies in a highly conserved C-terminal transmembrane region of E1 E2 ATPase domain. The ATP8A2 gene is mainly expressed in brain and development, in particular cerebellum. Interestingly, an unrelated individual has been identified, in whom mental retardation and severe hypotonia is associated with a de novo t(10;13) balanced translocation resulting with the disruption of ATP8A2. These findings suggest that ATP8A2 is involved in the development of the cerebro-cerebellar structures required for posture and gait in humans.

Attitudes and experiences of nurses toward death and caring for dying patients in Turkey.

Abstract: BACKGROUND: Caring of the dying patients and facing the death can be a stressful and difficult experience for nurses. Besides personal and professional experiences, nurses' own attitudes toward death may affect the care given to dying individuals. OBJECTIVE: The aim of this study was to examine Turkish nurses' attitudes toward and experiences with death and caring for dying patients. METHODS: A descriptive, cross-sectional study was conducted at 2 university hospitals and 1 state hospital located in Ankara, Turkey. Data were collected via sociodemographics form, the Death Attitude Profile-Revised, and Frommelt's Attitude Toward Caring for Dying Patients. RESULTS: The attitudes of Turkish nurses toward death and caring for dying patients are less positive than the reported attitudes of nurses in other studies. Significant relationships were found among level of education, willingness to care for dying patients, and scores on Frommelt's Attitude Toward Caring for Dying Patients and on Death Attitude Profile-Revised subscales (P < .05). Although the majority of nurses (85%) stated that they had received education on end of life, most of them (82%) were not comfortable talking about death. CONCLUSIONS: A lack of education and experience may contribute to the negative attitudes. Providing a reflective narrative environment in which nurses can express their personal feelings about death and dying could be a potentially effective approach. IMPLICATIONS FOR PRACTICE: This study highlights the need for further educational research and development of better educational programs to help nurses to explore and understand their attitudes toward death, overcome fears, increase communication skills, and enhance coping strategies.

Thermodynamical, geometrical and Poincaré methods for charged black holes in presence of quintessence

Abstract: Properties pertaining to thermodynamical local stability of Reissner-Nordstrom black holes surrounded by quintessence as well as adiabatic invariance, adiabatic charging and a generalized Smarr formula are discussed. Limits for the entropy, temperature and electric potential ensuring stability of canonical ensembles are determined by the classical thermodynamical and Poincare methods. By the latter approach we show that microcanonical ensembles (isolated black holes) are stable. Two geometrical approaches lead to determine the same states corresponding to second order phase transitions.

Ultrasound-guided radial arterial cannulation: long axis/in-plane versus short axis/out-of-plane approaches?

Abstract: Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches The purpose of this study was to compare performance time and possible complications between two techniques After obtaining ethics committee approval and informed patient consent, a prospective and randomized trial was conducted at ASA I-III, patients between the ages of 20-70 years 108 patients were scheduled for radial arterial cannulaton in patients undergoing elective surgery under general anesthesia Patients were divided into two groups as LA-IP and SA-OOP approaches with sealed envelope randomized method After induction of anesthesia, the distance between skin-to-artery and the diameter of radial artery in US-imaging was recorded The successful cannulation time, the number of attempts, potential complications such as thrombosis, edema, vasospasm, hematoma and posterior wall puncture were recorded Demographic and hemodynamic parameters were similar in two groups The diameter and the depth of artery were also similar in both of groups Cannulation time was shorter in LA-IP Group compared to SA-OOP (24 ± 17 s vs 47 ± 34 s respectively, p < 005) The arterial cannulation by LA-IP approach increased the rate of cannula-insertion success at the first attempt (76 %) compared to SA-OOP approach (51 %) Posterior wall damage during arterial cannulation were found in 30 patients with SA-OOP Group (56 %) and 11 patients with LA-IP Group (20 %), (p < 005) In our study, the use of LA-IP approach during US-guided radial artery cannulation has higher success rate at first insertion We also found LA-IP approach results in shorter cannulation time and decreased the incidence of complications

Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study.

Abstract: Retrospective review of medical notes. To evaluate spinal cord injury (SCI) patients’ compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). Inpatient rehabilitation unit of tertiary research hospital. Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. Many factors, including urological complications, patient’s preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

Proinflammatory and anti-inflammatory cytokines in gingival crevicular fluid and serum of patients with rheumatoid arthritis and patients with chronic periodontitis.

Abstract: Background: The aim of this study is to evaluate proinflammatory and anti-inflammatory cytokine levels in gingival crevicular fluid (GCF) and serum of rheumatoid arthritis (RA) and chronic periodontitis (CP) patients to assess whether cytokine profiles distinguish patients with RA and patients with CP while using healthy patients as background controls.Methods: A total of 49 patients, 17 patients with RA (three males and 14 females; mean age: 47.82 ± 10.74 years), 16 patients with CP (10 males and six females; mean age: 44.00 ± 7.00 years), and 16 controls (eight males and eight females; mean age: 28.06 ± 6.18 years) were enrolled. Patients with RA were under the supervision of rheumatologists; 15 of the patients with RA were being treated with methotrexate–sulfasalazine combined therapy, and two of the patients were being treated with leflunomid therapy. Periodontal parameters (plaque index, gingival index, probing depth, and clinical attachment level) were recorded. Interleukin (IL)-1β, IL-4, IL-10, and...

Impaired glucose metabolism is a risk factor for increased thyroid volume and nodule prevalence in a mild-to-moderate iodine deficient area

Abstract: Objective Insulin resistance (IR) is a key factor involved in the pathogenesis of impaired glucose metabolism. IR is associated with increased thyroid volume and nodule prevalence in patients with metabolic syndrome. Data on the association of thyroid morphology and abnormal glucose metabolism are limited. This prospective study was carried out to evaluate thyroid volume and nodule prevalence in patients with pre-diabetes and type 2 diabetes mellitus (DM) in a mild-to-moderate iodine deficient area. Materials and Methods Data were gathered on all newly diagnosed patients with pre-diabetes and type 2 diabetes mellitus between May 2008 and February 2010. 156 patients with pre-diabetes and 123 patients with type 2 DM were randomly matched for age, gender, and smoking habits with 114 subjects with normal glucose metabolism. Serum thyroid-stimulating hormone (TSH) and thyroid ultrasonography was performed in all participants. Results Mean TSH level in the diabetes group (1.9 ± 0.9 mIU/L) was higher than in the control group (1.4 ± 0.8 mIU/L) and the pre-diabetes group (1.5 ± 0.8 mIU/L) ( P 0.0001 for both). Mean thyroid volume was higher in the pre-diabetes (18.2 ± 9.2 mL) and diabetes (20.0 ± 8.2 mL) groups than in controls (11.4 ± 3.8 mL) ( P 0.0001 for both). Percentage of patients with thyroid nodules was also higher in the pre-diabetes (51.3%) and diabetes groups (61.8%) than in controls (23.7%) ( P 0.0001 for both). Conclusions The results suggest that patients with impaired glucose metabolism have significantly increased thyroid volume and nodule prevalence.

Neurologic involvement in atypical hemolytic uremic syndrome and successful treatment with eculizumab

Abstract: Background Atypical hemolytic uremic syndrome (aHUS) is associated with defective regulation of the complement pathway. Neurological involvement is the most common extrarenal complication and represents a major cause of mortality and morbidity.

Development of a decision support system for robot selection

Abstract: With the availability of more different robot types and models along with their separate specifications, selecting the most appropriate robot is becoming more difficult and complicated for companies. Furthermore, a common set of robot selection criteria is not available for the decision makers. In this study, a two-phase robot selection decision support system, namely ROBSEL, is developed to help the decision makers in their robot selection decisions. In development of ROBSEL, an independent set of criteria is obtained first and arranged in the Fuzzy Analytical Hierarchy Process (FAHP) decision hierarchy. In the first elimination phase of the decision support system, the user obtains the feasible set of robots by providing limited values for the 15 requirements. ROBSEL, then, uses FAHP decision hierarchy to rank the feasible robots in the second phase. ROBSEL is illustrated and tested and several critical issues in its practical usage are explored in the paper. The applications of ROBSEL show that ROBSEL is a useful, practical and easy to use robot selection tool and improves robot selection decisions in the companies.

Hydrogen peroxide pretreatment of roots enhanced oxidative stress response of tomato under cold stress

Abstract: In the view of physiological role of H2O2, we investigated whether exogenous H2O2 application would affect short-term cold response of tomato and induce acclimation. Pretreatments were performed by immersing roots into 1 mM H2O2 solution for 1 h when transferring seedlings from seedling substrate to soil (acclimated group). Cold stress (3 °C for 16 h) caused significant reduction in relative water content (RWC) of control and non-acclimated (distilled water treated) groups when compared with unstressed plants. H2O2 promoted maintenance of relatively higher RWC under stress. Anthocyanin level in leaves of acclimated plants under cold stress was significantly higher than that of unstressed control and non-acclimated plants. Malondialdehyde (MDA) levels demonstrated low temperature induced oxidative damage to control and non-acclimated plants. MDA remained around unstressed conditions in acclimated plants, which demonstrate that H2O2 acclimation protected tissues against cold induced lipid peroxidation. H2O2 acclimation caused proline accumulation in roots under cold stress. Ascorbate peroxidase (APX) activity in roots of cold stressed and unstressed H2O2 acclimated plants increased when compared with control and non-acclimated plants, with highest increase in roots of acclimated plants under cold stress. CAT levels in roots of acclimated plants also increased, whereas levels remained unchanged in unstressed plants. Endogenous H2O2 levels significantly increased in roots of control and non-acclimated plants under cold stress. On the other hand, H2O2 content in roots of acclimated plants was significantly lower than control and non-acclimated plants under cold stress. The results presented here demonstrated that H2O2 significantly enhanced oxidative stress response by elevating the antioxidant status of tomato.

Value of Tertiary Cytoreductive Surgery in Epithelial Ovarian Cancer: An International Multicenter Evaluation

Abstract: The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival. Retrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia. We evaluated 406 patients (median age, 55 years; range, 16–80 years). Median time from first to second recurrence was 18 months (2–204 months). Median follow-up from TCS was 14 months (0–182 months), and median OS was 26 months (95 % CI, 19.62–32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5–56.4 months) versus 12 months (95 % CI 9.3–14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS. In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC.

Comparison of ultrasound guidance with the traditional palpation and fluoroscopy method for the common femoral artery puncture

Abstract: Objectives To compare the success and complication rates of ultrasound-guided or palpation-guided punctures of the common femoral artery in a prospective randomized study. Background Percutaneous femoral arterial access is sometimes difficult to perform and is the source of complications. It has not been established whether ultrasound-guided puncture of the common femoral artery is the standard practice for angiography. Materials and Methods Two hundred and eight patients were randomized into two groups. One had ultrasound-guided puncture and the other had palpation-guided puncture of the common femoral artery. The technical success, first pass success rate, total number of attempts required for access, time to sheath insertion, pain during puncture, and access-related complication were compared. Results Technical success tended to be higher and the complication rates tended to be lower in the ultrasound-guided group but the difference did not reach statistical significance (P = 0.052 and P = 0.052). The first pass success rate was higher, total number of attempts required for access and time to sheath insertion were lower in the ultrasound-guided group. Atheromatous plaques on the common femoral artery, iliac artery obstructive lesion, previous ipsilateral puncture of the common femoral artery, obesity, and blood pressure during puncture did not change the outcome. Conclusions Ultrasound guidance improves secondary outcomes of the common femoral artery puncture when compared to palpation-guided puncture. Technical success and complication rates seem lower in the presence of ultrasound guidance but larger study populations are needed to verify the result. © 2013 Wiley Periodicals, Inc.

Prognostic value of pretreatment 18F-fluorodeoxyglucose uptake in patients with cervical cancer treated with definitive chemoradiotherapy.

Abstract: Objective We analyzed the correlation of 18F-fluorodeoxyglucose (FDG) uptake into primary tumors using the maximum standardized uptake value (SUVmax) and clinicopathological factors of disease. The impact of the pretreatment SUVmax of the primary tumor on survival was investigated. Materials and Methods The records of 149 patients with biopsy-proven cervical cancer treated with definitive chemoradiotherapy (ChRT) were reviewed. All patients underwent pretreatment FDG positron emission tomography with computed tomography, and posttherapy FDG positron emission tomography with computed tomography was performed within a median interval of 4.2 months (range, 3.0–11.2 months) after the completion of chemoradiotherapy. Results The mean SUVmax in patients with lymph node metastasis was significantly higher than that in patients without metastasis (19.7 ± 8.2 vs 16.4 ± 8.2, respectively; P = 0.01). A significant difference existed between tumor size ( Conclusion The primary tumor pretreatment SUVmax is correlated with increased tumor size and lymph node involvement at diagnosis, how well the primary tumor responds to treatment, the likelihood of disease recurrence, and OS.

Autoimmune encephalitis in children.

Abstract: Autoimmune encephalitis is a heterogeneous group of disorders characterized by cognitive and behavioral decline due to an immune reaction against neuronal antigens. There is increasing evidence that autoimmune encephalitis represents a significant subgroup of encephalitis in children, which are defined by the presence of antibodies against important proteins involved in neurotransmission. The distinction between the different causes of autoimmune encephalitis is important for the patient, as there is a marked difference in therapeutic response; specifically, autoimmune encephalitis associated with the classical onconeuronal antibody is unresponsive to treatment, while autoimmune encephalitis in association with antibodies against surface proteins may respond to immunomodulation. Autoimmune encephalitis may be classified into forms with prevalent involvement of the grey matter (polioencephalitis), white matter (leucoencephalitis), or endothelial cells (vasculitis). The subject of this review includes polioencephalitis, which encompasses syndromes in which there is a loss and/or alteration of neuronal function and in which autoantibodies can be detected in the serum or CSF.

Impact of Weight Change During the Course of Concurrent Chemoradiation Therapy on Outcomes in Stage IIIB Non-Small Cell Lung Cancer Patients: Retrospective Analysis of 425 Patients

Abstract: Purpose We retrospectively investigated the impact of weight change (WC) during concurrent chemoradiation therapy (C-CRT) on clinical outcomes of stage 3B non-small cell lung cancer (NSCLC) patients. Methods and Materials A total of 425 patients treated with C-CRT were included. All patients received 60 to 66 Gy of thoracic radiation therapy concurrently with 1 to 3 cycles of platinum-based chemotherapy. Pre- and posttreatment weight measurements on first and last days of C-CRT were used for WC. Patients were divided into 2 groups: group 1 = weight loss (WL); group 2 = weight preservation/gain (WP) for comparative analyses. Results Following C-CRT, 252 patients (59.3%) experienced WL, while 89 patients (20.9%) and 84 patients (19.8%) showed WP or WG. At median 24.2 months of follow-up, 142 patients (33.4%) were alive (84 WP [48.6%] and 58 WL [23.0%]), and 58 (13.6%) of them were free of disease progression (41 [23.7%] for WP and 17 [6.7%] for WL). Median overall survival (OS), locoregional progression-free survival (LRPFS), progression-free survival (PFS), and distant metastases-free survival (DMFS) for the entire population were 22.8, 14.4, 10.6, and 11.7 months, respectively. Intergroup comparisons between WP and WL cohorts revealed significantly superior OS, LRPFS, PFS, and DMFS in WP patients (P Conclusions Present results in 425 stage 3B NSCLC patients demonstrated that WL during C-CRT is strongly associated with inferior survival outcomes compared to WP. This emerging finding might be useful by forming an encouraging basis for future investigations in facilitating a way to improve the outcomes of these patients experiencing WL during C-CRT.

Long-term results of half-dose photodynamic therapy for chronic central serous chorioretinopathy with contrast sensitivity changes

Abstract: To evaluate the efficacy and safety of photodynamic therapy (PDT) with half-dose verteporfin in patients with chronic central serous chorioretinopathy (CCSC) and retinal functional changes, by functional acuity contrast test (FACT). In this study, 27 eyes of 24 patients with CCSC were treated with PDT with half-dose verteporfin. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and resolution of subretinal fluid on optical coherence tomography (OCT), and leakage on fluorescein angiography (FA) and indocyanine green angiography (ICGA) were assessed. Contrast sensitivity test was performed at baseline and at 12th month for investigating retinal functional changes. The mean follow-up period was 25.33±11.08 months. The mean age was 43.7±8.6 years. Seventeen patients were male (70.8%) and seven patients were female (29.2%). Post PDT at 1st, 3rd, 6th, 12th month and at last follow-up, BCVA were significantly improved compared with the baseline BCVA (P<0.001), and CFT post PDT were significantly thinner than the baseline measurement (P<0.001). There was significant difference between pre- and post-PDT 12th month contrast sensitivities at all five different spatial frequency channels (P<0.01). Half-dose PDT is an effective and safe method in the treatment of CCSC with anatomical and functional success. The measurement of contrast sensitivity by FACT can be useful for evaluating the functional effectiveness of half-dose PDT for CCSC.

Malignant lymphoma of bone: a review of 119 patients.

Abstract: Background Lymphoma of bone is uncommon. As a result of this, many aspects of primary lymphoma of bone (PLB) are controversial: the definition, treatment strategies, response criteria, and prognostic factors.

Comparison of two implant-supported molar distalization systems.

Abstract: Objective: To examine skeletal, dental, and soft tissue effects of the Miniscrew Implant Supported Distalization System (MISDS) and the Bone-Anchored Pendulum Appliance (BAPA). Materials and Methods: Among 28 patients displaying Angle Class II malocclusion, 14 patients with a mean age of 14.8 ± 3.6 years treated with MISDS were included in the first group, and 14 patients with a mean age of 14.5 ± 1.5 years treated with BAPA were included in the second group. The pretreatment and posttreatment lateral cephalograms were analyzed. Statistical evaluation was carried out using the paired Shapiro-Wilk test, the paired-sample t-test, and the unpaired t-test. Results: Upper posterior teeth were distalized successfully in both groups. Nearly bodily distalization was seen in the MISDS group, whereas significant distal tipping of the upper first molars was observed in the BAPA group (P < .001). There were no statistically significant changes in the sagittal position of the maxilla and mandible and in...

Microleakage of newly developed glass carbomer cement in primary teeth

Abstract: Objective: Glass carbomer cement represents a new generation of dental material, which mineralizes gradually into fluorapatite. The aim of this study was to evaluate the microleakage and marginal integrity of newly developed glass carbomer cement with and without protective surface coating (SC) in primary molars.