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Breast Cancer-Related Lymphedema: From Description to Management
No full textBreast cancer-related lymphedema (BCRL) stands as a potentially debilitating consequence of breast cancer treatment, often irreversible in nature. It arises from either a diminished drainage capacity or an overload on the lymphatic system, wherein the interstitial fluid volume surpasses the lymphatic system’s transport capacity in the arm and affected areas due to the mechanical limitations of the lymphatic system. Research has shed light on the intricate pathogenesis of BCRL, revealing a complex interplay of inflammatory processes, disrupted lymphatic remodeling, and impaired lymphatic angiogenesis, compounded by various risk factors. These risk factors include the body mass index at diagnosis, subclinical edema, and cellulitis on the affected side. Treatment-related independent risk factors encompass the type of surgical procedure, the extent of lymph node removal, radiation to regional lymph nodes, and chemotherapy. BCRL can manifest at different intervals post-surgery, with the majority of cases surfacing within the initial 2 years, although it is noteworthy that BCRL can emerge even years after the conclusion of initial treatment, underscoring the necessity for prolonged monitoring and support for breast cancer survivors. Hence, early identification and timely interventions play pivotal roles in BCRL prevention. Diagnosis hinges on a comprehensive assessment of risk factors, associated symptoms, clinical signs, and physical examination. The literature offers an array of non-invasive techniques for evaluating secondary arm lymphedema. Complex decongestive therapy (CDT) stands as the widely endorsed therapeutic approach for BCRL patients, comprising manual lymphatic drainage, skin care, compression, and decongestive exercises. To improve patient outcomes and enhance their quality of life, healthcare professionals should utilize evidence-based techniques such as CDT for risk reduction, prevention, and adaptation. It is essential to address all components of CDT proactively from the outset. In addition to employing exercises and compression as preventive measures, comprehensive CDT encompasses various domains aimed at addressing BCRL. Further research is needed to determine whether CDT is more effective as a risk reduction behavior compared to its role as a management and treatment strategy. © 2025 Elsevier B.V., All rights reserved
Spectroscopic Ellipsometry-Based Linear and Nonlinear Optical Characterization of GaSe Crystals for Optoelectronic Applications
No full textGallium selenide (GaSe), with its layered crystal structure and attractive optoelectronic characteristics, has emerged as a compelling material for next-generation devices. In this study, comprehensive spectroscopic ellipsometry analyses were performed to investigate the linear and nonlinear optical properties of GaSe over a wide photon energy range. The dielectric function parameters were modeled using the Wemple-DiDomenico single-oscillator approach, enabling accurate extraction of refractive index dispersion and related optical constants. Furthermore, the optical and electrical conductivity were derived and analyzed, revealing distinct features that reflect the interband transitions and charge transport behavior of the material. Nonlinear optical parameters, including the first- and third-order susceptibility as well as the nonlinear refractive index, were evaluated based on the linear dispersion data. The results confirm that GaSe exhibits strong optical responses in both the linear and nonlinear regimes, highlighting its potential for integration into optoelectronic and nonlinear frequency conversion devices
Training of trainers program in interprofessional education for health professionals in Türkiye
No full textBackground Training of Trainers Program that combines both theoretical and practical components and effectively enhance educators'competencies in interprofessional education are rarely encountered.This study aimed to design and evaluate a Training of Trainers Program in Interprofessional Education intended to enhance participants ' awareness, knowledge, and self-perceived competencies related to the design, implementation, and improvements of interprofessional education practices among healthcare educators. Methods The study was planned and conducted between June 2023 and March 2024. The two-phase Training of Trainers Program (TTP) was implemented between February 20 and 24, 2024. The first phase consisted of three-day online interactive theoretical training. Two-day face-to-face practical training was the second phase of the TTP which included interactive studies with large groups and practical activities in professional skills rooms with small groups. The practical training was based on various scenarios created by the researchers themselves. Following the TTP, all participants were assessed using a demographic data form, reflection assignment, group assignment, and multiplechoice questions. Results The TTP was found to be effective and participants benefited from the TTP. The TTP significantly increased participants'competencies across all measured dimensions, including roles-responsibilities; team and teamwork; IPE communication; lifelong learner; collaborative leadership; relationships with patients and recognizing their needs; and ethics (p = 0.001). Participants' responses to the satisfaction questionnaire showed that the program generally provided high satisfaction. High scores were given to areas, such as the enrollment process, training content, effectiveness of the trainers, and overall program satisfaction. Participants also highlighted the program's comprehensive content, applied teaching strategies, and trainer competencies, while only one participant suggested improving time management. Conclusion The TTP provide important improvement in participants'competenciesThe TTP, which was developed by blending both online and face-to-face education, is a successful program in both developing interprofessional competences and reaching the goals.TUBITAK [1129B372300447]This study was supported by TUBITAK under program 2237_A (application period 2023/2), with project number 1129B372300447, titled Training of Trainers Program in Interprofessional Education for Health Professionals (in Turkish name of project is Sagl & imath;k Profesyonelleri icin Meslekler Aras & imath; Egitimde Egitici Geli & scedil;im Programi)
Pentablock thermoresponsive hydrogels for chemotherapeutic delivery in a pancreatic cancer model
No full textThe design of biodegradable and thermoresponsive polymeric hydrogels with tuneable properties holds immense promise for localised and sustained drug delivery. In this study, we designed and synthesised a library of novel pentablock copolymers, incorporating poly(d,l-lactide) (PLA) into methoxypoly(ethylene glycol)-poly(epsilon-caprolactone)-methoxypoly(ethylene glycol) (mPEG-PCL-mPEG, or PECE) hydrogels to enhance the hydrolytic degradation and drug release profiles. A pentablock copolymer, methoxypoly(ethylene glycol)-b-poly(d,l lactide)-b-poly(epsilon-caprolactone)-b-poly(d,l lactide)-b-methoxypoly(ethylene glycol) (mPEG-PLA-PCL-PLA-mPEG, or PELCLE), was selected based on its thermoresponsive sol-gel transition behaviour at a physiologically relevant temperature (37 degrees C). Physicochemical characterisation revealed that both PECE and PELCLE hydrogels self-assembled into micellar structures, with PELCLE exhibiting smaller micellar sizes compared to PECE. The incorporation of PLA led to reduced hydrogel stiffness, enhanced degradability, and decreased swelling compared to PECE. In vitro drug release studies demonstrated that both hydrogels exhibited sustained release of various anti-cancer drugs, with PELCLE generally showing slower release kinetics, highlighting its potential for prolonged drug delivery. For potential pancreatic cancer applications, we evaluated the biocompatibility and therapeutic efficacy of PELCLE hydrogels loaded with gemcitabine and oxaliplatin (GEMOX). In vitro and in vivo studies demonstrated safety and some anti-tumour efficacy of GEMOX-loaded PELCLE compared to free drug administration, attributed to enhanced tumour retention and sustained drug release. These findings highlight the potential of the PELCLE hydrogel as a versatile and effective local drug delivery platform for the treatment of pancreatic cancer and other solid tumours, warranting further investigation towards its clinical translation.University of Nottingham [EP/R035563/1, EP/S021434/1, EP/V049291/1]; UKRI/EPSRC; Little Princess Trust [WM150086, 2219]; Royal Society; TUBITAK; University of NottinghamWe thank UKRI/EPSRC for funding [grants EP/R035563/1, EP/S021434/1, EP/V049291/1], the Little Princess Trust in partnership with CCLG and the Royal Society [Wolfson Research Merit Award WM150086 to CA]. UCO is thankful for a fellowship (2219) from the TUBITAK. We acknowledge Dr Patricia Monteiro for expert assistance in polymer synthesis and characterisation. This work was also supported via Anne McLaren fellowship funding from the University of Nottingham (JCA). We also thank Tom Hyde, Esme Ireson and Paul Cooling for expert technical support. The Nanoscale & Macroscale Research Centre (NMRC) is acknowledged for providing the facilities for TEM, SEM, and related analysis
Structural and thermal insights into the luminescent behavior of Dy3+-Doped BaZrO3 with alkali metal codopants under UV radiation
No full textThis study investigates the structural, thermal, and photoluminescent properties of Dy3+-doped BaZrO3 (BZO) perovskites, synthesized via a co-precipitation method, incorporating alkali metal codopants (Li+, Na+, and K+). Xray diffraction (XRD) analysis confirmed the retention of the cubic perovskite phase following doping, with Rietveld refinement further revealing minor lattice distortions due to Dy3+incorporation. The Williamson-Hall (W-H) analysis revealed average crystallite sizes of 53 nm and 66 nm for undoped and 0.01 Dy3+-doped BaZrO3, respectively, with corresponding micro-strain values of 1.79 x 10-3 and 1.81 x 10-3, suggesting lattice distortions due to incorporation of Dy3+. Fourier transform infrared (FTIR) spectroscopy confirmed the cubic perovskite structure and subtle structural modifications upon doping. Notably, the absence of moisture-related peaks highlights the effectiveness of the synthesis process, including rigorous drying and calcination steps that prevented hydrous species. Photoluminescence (PL) analysis of Dy3+-doped BaZrO3 exhibited three prominent emission peaks at 452 nm, 573 nm, and 656 nm under 368 nm excitation. These peaks correspond to the characteristic intra-4f electronic transitions of Dy3+ ions, specifically, 4I13/2 to 6H15/2, 4F9/2 to 6H13/2, and 4F9/2 to 6H11/2, representing blue, yellow, and red emissions, respectively. Photoluminescence decay studies showed multi-exponential behavior, with the average lifetime decreasing from 641 mu s in undoped BZO to 492 mu s in Dy3+- doped samples attributed to enhanced non-radiative recombination pathways. Among the codopants, Li+ demonstrated the most significant improvement in luminescence intensity and thermal stability by mitigating defects and optimizing charge compensation.Research Funds of Balikesir University [BAP-2023/199]; Balikesir UniversityWe would like to thank the Research Funds of Balikesir University (Grant No. BAP-2023/199) and Balikesir University for their generous financial support
The effect of stress ball utilization on dyspnea severity and anxiety level in patients receiving nebulizer therapy: Randomized controlled study
No full textAim: The study primarily aimed at examining the effect of stress ball utilization on dyspnea and anxiety during nebulizer therapy. The secondary aim was to determine the effect of stress ball utilization on the duration of therapy and vital signs. Methods: The study has a randomized controlled experimental design. The study population consisted of inpatients receiving nebulizer therapy. A total of 80 patients, 40 in the intervention group and 40 in the control group, were included in the sample. The study was conducted between October 2023 and March 2024. Patients in the intervention group were asked to use a stress ball during nebulizer therapy. Data were collected using a Patient Information Form, the Visual Analog Scale, and the State-Trait Anxiety Inventory. Descriptive statistics, Chi-square, paired test, and one sample t-test were used in data analysis. Results: The mean age of the patients was 65 years and over and 78% of them had COPD. Stress ball utilization caused a significant effect on the severity of dyspnea (intervention: t = 2.862, p 0.05). Conclusions: Utilization of a stress ball during nebulizer therapy has a positive effect on reducing anxiety levels and prolonging the duration of nebulizer use
KİRA BEDELİNİN TARAF ANLAŞMASIYLA ARTTIRILMASINA İLİŞKİN SINIRLAMALAR VE SINIRLARI AŞAN ANLAŞMALARDA BEDELİN İADESİ
No full textTürk Borçlar Kanunu’nda konut ve çatılı işyerlerini konu alan kira sözleşmelerine özel önem atfedilmiş ve bu tarz sözleşmelere genel kira sözleşmesi hükümlerine nazaran ayrıksı düzenlemeler öngörülmüştür. Yıllar boyunca devam edebilen bu sözleşmelerde, kira bedelinin başlangıçta taraflarca öngörülen miktarda devam etmesi, zamanla paranın gücünün azalması ve edimler arasındaki dengenin bozulması sebebiyle hakkaniyetli olmayacaktır. Bu nedenle kira bedelinin tarafların anlaşmasıyla arttırılmasına kanun koyucu imkân tanımaktadır. Ancak konut ve çatılı işyeri kiralarında kira bedelinin arttırılmasına ilişkin özel düzenlemeler yapılarak, tarafların kararlaştırdıkları artış oranı/miktarı kiracıyı korumak gayesiyle sınırlandırılmaktadır. Tarafların bu sınırları aşan anlaşma yapmaları halinde kısmi hükümsüzlük yaptırımı uygulanarak fazla ödenen tutarın iadesi söz konusu olabilecektir. İadenin hukuki dayanağı konusunda doktrinde sebepsiz zenginleşmeye göre iade ile sözleşmeye dayalı iade şeklinde farklı görüşler bulunmaktadır. Çalışmamızda konut ve çatılı işyeri kiralarında yenilenen dönemde kira bedelinin artışına ilişkin anlaşmalardaki mevzuat sınırları belirtilerek, tarafların bedel artışına ilişkin anlaşmalarının geçerliliği ve geçersizlik hallerinde kiracının fazla ödediği tutarı isteyip isteyemeyeceği mevzuat, doktrin görüşleri ve yargı kararları ekseninde incelenmeye çalışılacaktır
Clinical and functional outcomes of hand surgery for recessive dystrophic epidermolysis bullosa
No full textRecessive dystrophic epidermolysis bullosa causes blistering and scarring of the hands, resulting in contractures fused web spaces and altered function. The aim of this study was to present the short- and mid-term clinical and functional results of a large case series of patients who underwent surgery for recessive dystrophic epidermolysis bullosa-related pseudosyndactyly. The study included 75 hands in 39 children (21 boys, 18 girls) with a mean age of 8 years (range, 4-15) and minimum follow-up of 1 year. Children were assessed with the Birmingham Epidermolysis Bullosa Severity Score Sheet and the ABILHAND-Kids questionnaire before operation and at final follow-up. There were varying degrees of recurrent scarring in all the hands by 24 months after operation. The ABILHAND-Kids questionnaire showed a significant improvement in ability to perform 17 of 21 tasks. In conclusion, despite recurrence that may develop in the short and mid term, surgical release can provide significant improvements in hand function.Level of Evidence: I
Duygu Odaklı Psikoterapi Ekolünün Bulimia Nervoza Olgularında Etkililiğine Dair Sistematik Bir Gözden Geçirme
No full textAbstract Bulimia nervosa is an eating disorder characterized by binge eating episodes and compensatory behaviors. Emotional regulation difficulties play a significant role in cases of bulimia nervosa. Individuals diagnosed with bulimia nervosa are known to experience challenges in regulating their emotions, particularly during negative emotional states, leading to loss of control, binge eating, and compensatory behaviors. In this context, Emotion-Focused Therapy (EFT) offers an effective approach by targeting emotional regulation in the treatment of bulimia. This review aims to examine the findings of studies investigating the effectiveness of Emotion-Focused interventions in the treatment of bulimia nervosa. For this purpose, 928 potential articles were identified, with four studies meeting the eligibility criteria included in this review. The selected studies involved participants with bulimia nervosa and were based on various research methodologies, such as randomized controlled trials, case studies, and time series designs. Emotion-Focused interventions have been found to improve emotional regulation skills in individuals diagnosed with bulimia nervosa, thereby reducing binge eating behaviors and bulimia symptoms. However, follow-up studies have yielded inconsistent findings regarding symptom relapse. While Emotion-Focused Therapies appear to be effective in the treatment of bulimia nervosa, there is a need for further research to expand the current knowledge in this area.Özet Bulimia nervoza, tıkınırcasına yeme atakları ve telafi edici davranışlarla karakterize bir yeme bozukluğudur. Bulimia olgularında duygusal düzenleme güçlükleri önemli bir rol oynar. Bulimia nervoza tanılı bireylerin duygu düzenleme zorluğu yaşadığı, özellikle olumsuz duygulanım durumlarında kontrol kaybı yaşayarak tıkınırcasına yeme ve telafi edici davranışlar sergilediği bilinmektedir. Bu bağlamda Duygu Odaklı Psikoterapi, bulimia tedavisinde duygusal düzenlemeyi hedef alarak etkili bir yaklaşım sunmaktadır. Bu derleme, bulimia tedavisinde Duygu Odaklı müdahalelerin etkililiğini inceleyen çalışmaların bulgularını gözden geçirerek meyi amaçlamıştır. İlgili amaç doğrultusunda potansiyel olarak 928 makale tespit edilmiş, uygunluk kriterlerini karşılayan 4 çalışma bu gözden geçirmeye dahil edilmiştir. Çalışmalar bulimia nervoza bozukluğuna sahip katılımcılarda yapılan, randomize kontrollü çalışmalar, vaka çalışmaları ve zaman serisi desenleri gibi farklı araştırma metodolojilerine dayanarak seçilmiştir. Duygu Odaklı Müdahalelerin bulimia nervoza tanılı bireylerde duygu düzenleme becerilerini geliştirdiği ve bu sayede tıkanırcasına yeme davranışlarını ve bulimia belirtilerini azalttığı görülmektedir. Bununla birlikte takip çalışmaları semptom nüksü konusunda tutarsız bulgular elde etmiştir. Duygu Odaklı Terapilerin bulimia nervoza tedavisinde etkili olduğu görülmekle birlikte mevcut alanın genişletilmesine ve daha fazla araştırmaya ihtiyaç duyulmaktadır
Clinical Characteristics and In-Hospital Prognosis of Myocardial Infarction With Nonobstructive Coronary Arteries in a Single-Center Experience
No full textBackground Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous syndrome presenting as acute infarction despite < 50% epicardial stenosis. Recognition remains low, and optimal management is unclear.Aims This study aims to analyze the clinical profile of MINOCA patients compared to those with myocardial infarction with obstructive lesions, and evaluate MINOCA patients.Methods A total of 1421 consecutive patients with acute MI admitted to our hospital between January 2016 and March 2019 were retrospectively screened. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, consisting of patients with lesions of the coronary artery. A total of 130 patients with MINOCA and 210 patients with MI-CAD were enrolled. Demographics, laboratory parameters, imaging findings, etiologies, in-hospital outcomes, and discharge therapies were analyzed.Results The prevalence of MINOCA was 9.7%. Patients with MINOCA were more frequently women (especially premenopausal women) and had a younger age (54.65 +/- 18.4 to 63.2 +/- 12.3, p < 0.001). The prevalence of traditional CAD risk factors was lower in MINOCA patients. Patients with MINOCA were more likely to have a history of upper-respiratory-tract infections (URIs) and use of antidepressant drugs compared to MI-CAD at admission. In-hospital mortality and event rates were comparable to those with MI-CAD. However, antiplatelets, statins, renin-angiotensin system blockers, and beta-blockers were less frequently prescribed to patients with MINOCA at discharge.Conclusions Patients with MINOCA constitute a population that differs from the classical MI profile. Compared with MI-CAD, MINOCA is accompanied by fewer traditional risk factors for CAD.The authors received no specific funding for this work.The authors have nothing to report