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Outcomes of transvaginal natural orifice transluminal endoscopic hysterectomy: a multi-centre retrospective study from Turkey (TR-MIGS)
No full textBackgroundVaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is gaining increasing popularity among gynaecological surgeons worldwide due to its minimally invasive nature and associated benefits. However, despite its growing adoption, it remains a relatively novel surgical technique that continues to be evaluated and refined in clinical practice. The primary objective of this study is to share and analyse our initial experiences with the implementation of vNOTES hysterectomy across six specialised gynaecological centres in Turkey.MethodsThis retrospective analysis included all women who underwent vNOTES hysterectomy, with or without salpingo-oophorectomy, for benign or malignant conditions. All procedures adhered to the standardised protocol described by Baekelandt et al. Data on baseline patient characteristics, intraoperative details, and postoperative outcomes were collected and analysed.ResultsA total of 685 patients underwent vNOTES procedures. Among them, 64 women (9.3%) had a history of one caesarean delivery, 38 (5.5%) had two prior caesareans, and 11 (1.6%) had three or more. Myoma, with or without accompanying metrorrhagia, was the most common surgical indication (53.0%). The mean operative time was 72.4 +/- 40.2 min, and the average haemoglobin decrease was 1.3 +/- 1.0 g/dL. The mean uterine weight was 204 +/- 145 g. Intraoperative complications occurred in 1.7% of cases (n = 12), while postoperative complications were observed in 1.4% (n = 10). Conversion to conventional laparoscopy occurred in six cases (0.9%), primarily due to an obliterated pouch of Douglas or intraoperative complications. The average hospital stay was 2.3 +/- 1.4 days.ConclusionsThese findings support vNOTES as a safe and effective surgical approach, offering a viable alternative to traditional laparoscopic or vaginal techniques in select patient populations
Exploring capacitance-based stress and deformation sensing in asphalt for smart infrastructure
No full textThis study investigates capacitance-based self-sensing for monitoringstress and deformation in asphalt materials. Cylindrical asphaltsamples equipped with aluminium foil electrodes undergo compressiveand tensile loading while capacitance is measured in real time. Theresults show that capacitance effectively tracks the mechanicalresponse of asphalt. Under cyclic compressive loading, thecapacitance changes reversibly, indicating that the material remainswithin the elastic deformation range without permanent damage. Stresssensitivity is observed in two regimes: 9.07 x 10-6 P-1at low stress (1.5-7.5 kPa) and 0.22 x 10-6 P-1 athigh stress (17.5-87.5 kPa), suggesting higher sensitivity atlower stress levels. In tensile tests, the specimens experiencesplitting tensile failure, with a clear decrease in capacitance asdeformation increases. The maximum deformation sensitivity, definedas the fractional decrease in capacitance per unit deformation,reaches 8.75 x 10-2mm-1 at a load of 5.6 kN-approximately one order of magnitude higher than thestress sensitivity. A strong correlation (R-2 = 0.96) betweendeformation and capacitance change confirms the robust sensingcapability. These findings demonstrate the potential of asphalt toserve as a self-sensing material for smart infrastructure andstructural health monitoring applications, without requiring theintegration of additional functional materials
Avelumab maintenance in patients with metastatic urothelial carcinoma in a real-life expanded-access program
No full textMakalede bulunan 41 adet yazarın, sadece Bursa Uludağ Üniversitesi mensubu yazarların girişi yapılmıştır.Background This study evaluates the real-world efficacy and safety of avelumab maintenance therapy in patients with metastatic urothelial carcinoma (mUC) who did not progress following first-line platinum-based chemotherapy, using data from the Expanded Access Program (EAP). Patients and methods Safety and effectiveness were assessed in patients who received at least one cycle of avelumab. The primary endpoints were overall survival (OS) and progression-free survival (PFS), while secondary endpoints included safety. PFS and OS were estimated using the Kaplan-Meier method. Results The 12-month OS rate was 78% (95% CI, 74.5%-79%), with the median OS not reached. The 12-month PFS rate was 32% (95% CI, 29%-35%), and the median PFS was 5.3 months (95% CI, 3.4-7.1). Univariate analysis showed a median PFS of 2.9 months in patients with liver metastases versus 5.4 months in those without (p = 0.001), 2.8 months in patients with hemoglobin levels below 10 mg/dL versus 5.3 months in those above (p = 0.06), and 8.8 months in patients with lymph node - only metastases versus 4.1 months in patients with metastases at other sites (p = 0.05). No significant differences in PFS were observed based on chemotherapy type (cisplatin vs. carboplatin, p = 0.7), chemotherapy cycle count ( 4 cycles, p = 0.4), or first-line chemotherapy response (complete response vs. partial response/stable disease, p = 0.4). Conclusions Avelumab demonstrated efficacy and tolerability as maintenance therapy for mUC patients without progression following first-line platinum-based chemotherapy
An empirical analysis on the international competitiveness of the Turkish tourism sector
No full textRekabet gücüne sahip olmanın ana amacı, ülkedeki yaşam standartlarını iyileştirmek ve ülke vatandaşlarının refah artışını sağlamaktır. Uluslararası hizmet ticareti açısından dünya ekonomilerinde giderek artan bir öneme sahip olan rekabetçi sektörlerden biri de turizm sektörüdür. Bu bağlamda çalışmada, Türkiye özelinde turizm sektörün uluslararası rekabetçiliğini araştırmak amaçlanmıştır. Bu amaç doğrultusunda turizm ihracatı ve bazı makroekonomik değişkenlerin uluslararası ticarette rekabet gücüne katkısının olup olmadığı çalışmanın temel sorudur. Bu temel sorunun cevabını araştırırken ise, bağımlı değişken RCA olmak koşuluyla; verimlilik, reel döviz kuru, insani gelişme endeksi, yerliyabancı patent sayısı, AR-GE harcamaları bağımsız değişkenleri ile bir model kurulmuştur. 1990-2024 dönemi yıllık verileri kullanılarak gerçekleştirilen zaman serisi analizi bulgularına göre uzun dönemde açıklanmış karşılaştırmalı üstünlükler (RCA)’yı en olumlu etkileyen değişken İnsani Gelişme Endeksi (HDI)’dir. Bunu reel döviz kuru ve AR-GE harcaması değişkenleri izlemektedir. Başka bir deyişle, reel döviz kuru turizm sektörü rekabet gücü üzerinde önemli belirleyici olsa da beşerî sermayenin sektörün rekabet gücüne etkisi reel döviz kurundan daha baskındır. Literatüre katkı açısından değerlendirildiğinde, turizm sektörünün rekabet gücünü araştıran diğer çalışmalardan farklı olarak bu çalışmada 34 yıllık yeni bir veri seti ile çalışılmasının yanı sıra ampirik analiz sonuçların Türkiye’nin 2024 yılı Seyahat ve Turizm Kalkınma Endeksi’ndeki yeri çerçevesinde yorumlanmıştır. Ampirik analiz sonuçları ve Türkiye’nin 2024 yılı TTDI endeksindeki yeri birlikte düşünüldüğünde, Türkiye’nin rekabetçi, sürdürülebilir ve kapsayıcı bir turizm sektörüne sahip olmasının yolu, turizm odaklı ekonomik kalkınma fırsatı sunabilen doğal ve kültürel varlıkları sürdürülebilir bir şekilde kullanmak, beşerî sermayenin gelişmesine katkı sağlayacak sürdürülebilir yatırım politikalarına öncelik vermektir.The main purpose of having competitive power is to improve living standards in the country and to increase the welfare of the country's citizens. One of the competitive sectors that has an increasing importance in terms of international service trade is the tourism sector. In this context, the study aims to investigate the international competitiveness of the tourism sector in Turkey. In line with this purpose, the main question of the study is whether tourism exports and some macroeconomic variables contribute to the competitiveness in international trade. While investigating the answer to this basic question, a model was established with the independent variables of productivity, real exchange rate, human development index, number of domestic-foreign patents, and R&D expenditures, with the dependent variable being RCA. According to the findings of the time series analysis conducted using annual data for the period 19902024, the variable that most positively affects the revealed comparative advantages (RCA) in the long term is the Human Development Index (HDI). This is followed by the real exchange rate and R&D expenditure variables. In other words, although the real exchange rate is an important determinant of the competitiveness of the tourism sector, the effect of human capital on the competitiveness of the sector is more dominant than the real exchange rate. When evaluated in terms of contribution to the literature, unlike other studies investigating the competitiveness of the tourism sector, this study works with a large 34year data set and the empirical analysis results are interpreted within the framework of Turkey's place in the 2024 Travel and Tourism Development Index. When the empirical analysis results and Turkey's place in the 2024 TTDI index are considered together, the way for Turkey to have a competitive, sustainable and inclusive tourism sector is to use natural and cultural assets that can provide tourism-focused economic development opportunities in a sustainable way and to prioritize sustainable investment policies that will contribute to the development of human capital
Effect of pore structure, mechanical performance, and operational temperature on damping behavior of thermal expandible rubber-based adhesives
No full textAdhesives exhibit multifaceted functionalities beyond adhesion as improving acoustic performance by reducing motion of parts, filling gaps, and facilitating homogeneous stress distribution. The expandable nature of certain adhesives allows them to absorb and dissipate energy effectively, which is beneficial in applications requiring impact resistance. The objectives of this study are acoustic performance measurement by utilizing Oberst and Frequency Response Function (FRF) methods to evaluate the damping capabilities of various rubber-based thermally expandable adhesive formulations; mechanical strength assessment by measuring the lap shear strength to determine the adhesives' performance under different operational temperatures; pore structure analysis using Scanning Electron Microscopy (SEM) to analyze pore morphology and to investigate its effects on acoustic performance. Differential Scanning Calorimetry (DSC) analysis was conducted to evaluate the thermal properties of rubber adhesive formulations. Glass transition temperatures were determined for the adhesives to understand behavior of damping during the Oberst and FRF tests. Pore structures, amounts, and distribution affected damping behavior of materials directly, but these properties did not cause a reduction on lap shear separtion strength. Operating temperatures and aging conditions affect damping behavior, Young modulus, and adhesion. Salt spray aging did not have significant effect on lap shear strength of rubber adhesive formulations
Process of social change in Turkey and poverty songs
No full textBu çalışma, Erken Cumhuriyet döneminde yaşanan yoksulluğu türküler üzerinden tahlil etmeyi amaçlamaktadır. Yoksulluk, insanlığın varoluşundan bu yana mücadele edilen ve henüz üstesinden gelinememiş bir sorundur. Bu çalışmada yoksulluğu çözmek ya da çözümlemekten ziyade, yoksulluğun müzik gibi güçlü bir kültürel unsur vasıtasıyla nasıl ifade edildiği araştırılmıştır. Türküler, toplumun yaşam deneyimlerini, duygularını ve karşılaştıkları zorlukları aksettiren önemli bir kültürel mirastır. Yoksullukla mücadele eden bireylerin ruh hali, yaşam şartları ve sosyal ilişkileri türküler aracılığıyla güçlü bir biçimde dile getirilmiştir. Dönemin yoksulluk türküleriyle beraber köy yaşamının zorlukları, açlıkla mücadele, zengin ile yoksul ayrımı, kentlere göçün sonuçları ve kadercilik gibi konular da işlenmiştir. Dolayısıyla türkü içeriklerindeki çeşitlilik ve değişimden hareketle, toplumdaki değişimin türküler üzerinde belirleyici olduğu çıkarımı yapılabilir. 1923-1960 arasını kapsayan Erken Cumhuriyet döneminin kendine mahsus özelliklerinden biri, ekseriyetle modernleşme ile beraber anılmasıdır. Bu dönemde ülkeyi modern bir ulus devlet haline dönüştürmek için bir dizi reform gerçekleştirilmiş ve sosyal, ekonomik ve kültürel yapıda önemli değişimler yaşanmıştır. Dolayısıyla bu dönemde yoksulluk ile sosyal değişim arasında anlamlı bir ilişki vardır. Dönemin yoksulluğunu anlamada sosyal değişim ve modernleşme yol göstericidir. Bu çalışmada nitel araştırma yöntemleri kullanılmıştır. Dönemin sosyal ve ekonomik koşulları göz önünde bulundurularak, türkü sözlerine içerik analizi uygulanmıştır. Erken Cumhuriyet dönemine ait türkülerden seçilen örnekler, yoksulluğun yansımalarını anlamak ve değerlendirmek için incelenmiştir.This study aims to analyze poverty in the Early Republican period through folk songs. Poverty is a problem that has been struggled against since the existence of humanity and has yet to be overcome. This study does not resolve or analyze poverty, but rather explores how poverty is expressed through a powerful cultural element such as music. Folk songs are an important cultural heritage that tells the life experiences, emotions and difficulties faced by the society. The mood, living conditions and social relations of individuals struggling with poverty were expressed powerfully through folk songs. Along with the poverty folk songs of the period, topics such as the difficulties of village life, the struggle against hunger, the distinction between rich and poor, the consequences of migration to cities and fatalism were also covered. Therefore, based on the diversity and change in the content of folk songs, it can be inferred that the change in society was decisive on folk songs. One of the unique characteristics of the Early Republican period between 1923 and 1960 is that it is often associated with modernization. During this period, a series of reforms were carried out to transform the country into a modern nation-state and significant changes were experienced in the social, economic and cultural structure. Therefore, there is a significant relationship between poverty and social change in this period. It is possible to say that modernization can be a guide in understanding the poverty of the period. Qualitative research methods were used in this study. Considering the social and economic conditions of the period, content analysis was applied to folk song lyrics. Selected examples of folk songs from the Early Republican period were analyzed to understand and evaluate the reflections of poverty
Effects of different irrigation and fertilization levels on the yield and quality of sugar beet molasses
No full textThe aim of this research is to investigate the yield and quality effects of different irrigation and fertilization levels on sugar beet roots and molasses. Field studies of sugar beet were carried out in the Agricultural Research Area of BU & Uuml; Yeni & scedil;ehir & Idot;brahim Orhan Vocational School in the 2019-2020 trial years, physical analyses were carried out in the food Laboratory and nutritional content analyses of molasses were carried out at Bursa Food and Feed Control Research Institute. Twelve different study treatments were created by combining four different irrigation levels and three different fertilization levels. Drip irrigation system was used to carry out the irrigation and fertilization applications in the study subjects in a controlled manner. The amount of plant water consumption (ET) was calculated with the water balance equation (I + P - Dp +/- Delta SW). In the study, the maximum and minimum amounts of irrigation water applied in both years were calculated as 880.0-220.0 mm and 820.0-205 mm, respectively, while the lowest and highest plant water consumption values were calculated as 842.0-336.0 and 854.0-342 mm. While the root yields of sugar beet in the research years varied between 115.8-36.0 and 114.6-34.6 t ha-1, respectively, the molasses rates in sugar beet varied between 5.12-4.00 and 4.97-4.00, respectively. When the productivity and quality losses in sugar beet are evaluated together in response to the decrease in irrigation and fertilization levels, it is recommended that the I75F75 issue be preferred. The use of molasses obtained from sugar beet roots as animal feed is of great industrial importance
Atmospheric rivers catalyze snowmelt and contribute to chains of landslides
No full textAtmospheric rivers (ARs) significantly impact hydrometeorological conditions by transporting large amounts of heat and water vapor, often resulting in extreme weather events and geohazards such as landslides. While the role of ARs in producing extreme rainfall and related landslides is well established, their influence on landslides through temperature-driven snowmelt remains poorly understood. Here, we examine this mechanism using 330 recorded landslides from February to April 2022 across the North Anatolian Mountains (T & uuml;rkiye). Our results demonstrate that ARs significantly contributed to snowmelt (up to 250 mm per event), stimulated by abrupt temperature increases (up to +6 degrees C) and rain-on-snow conditions, with rainfall and snowfall reaching up to 100 mm and 40 mm, respectively; all differences were statistically significant (p < 0.01) when comparing AR and non-AR days. These processes shifted landslide activity to higher elevations and steeper slopes over time, with median values rising from 330 m to 549 m and 16 degrees to 21 degrees, respectively. The results highlight the compound effect of ARs on landslide initiation and suggest that warming-driven snowmelt can substantially contribute to slope destabilization. This study provides a framework for understanding AR-related landslide hazards in other midlatitude mountain regions, including the Pacific Rim, the Andes, High Mountain Asia, and the Alps. As climate change is projected to amplify the frequency, intensity, and spatial extent of ARs, the risk of AR-induced geohazards is therefore likely to intensify further in such mountainous regions
