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Banliyö alanlarda çok yüksek çözünürlüklü gerçek ortofotolardan nesne-tabanlı makine öğrenmesi sınıflandırması ile arazi örtüsü haritalama
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Pregnancy outcomes in women with heritable thoracic aortic disease: data from the EORP ESC Registry of Pregnancy and Cardiac disease (ROPAC) III.
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Early Changes in Volumetric Body Composition Parameters Predict Survival Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated with Targeted Therapy
No full textBackground/Objectives: The precise role of volumetric body composition (VBC) parameters, visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and skeletal muscle index (SMI) on the survival of metastatic renal cell carcinoma (mRCC) is not fully elucidated. Herein, the present study investigated the clinical significance of baseline VBC parameters and their changes after 3-4 months from treatment initiation in patients with mRCC treated with first-line targeted therapy. Methods: A total of 108 patients were enrolled. VBC parameters were depicted from computerized tomography (CT) images at the third lumbar vertebra level. Kaplan-Meier curves were used to estimate survival probability, and the differences between prognostic subgroups were compared with the log-rank test. The association of baseline VBC variables and their change values (First CT value minus baseline CT value) with progression-free survival (PFS) and overall survival (OS) was evaluated in univariate and multivariate analyses. Results: The median PFS and OS of the whole patients were 11 and 46 months, respectively. Patients with increased VATI and SATI change values had poorer OS than those with decreased values. However, patients with higher SMI change values had superior OS than those with lower values. Among VBC variables, the independent predictors of worse OS were high VATI change (HR 5.10, p = 0.001) and low SMI change values (HR 2.66, p = 0.007), in addition to International Metastatic Renal Cell Carcinoma Database Consortium prognostic stratification (p = 0.001). Conclusions: Our findings showed that high VATI and low SMI changes were associated with worse OS in mRCC patients treated with first-line targeted therapy
Comparison of clinical features of aquaporin-4 positive neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disorder (MOGAD), and double seronegative NMOSD - A single center experience
No full textThis retrospective study investigates Aquaporin-4 Antibody Positive Neuromyelitis Optica Spectrum Disorder (NMOSD), Myelin Oligodendrocyte Glycoprotein Associated Disorder (MOGAD), and Seronegative NMOSD at a tertiary care university hospital, over a 13 year period (November 2010 to November 2023) involving 78 patients. It distinguishes between the clinical and radiological features of AQP4 + NMOSD (41 patients, 52.5 %), MOGAD (22 patients, 28.2 %), and Seronegative NMOSD (15 patients, 19.3 %). A significant female majority was noted in AQP4+ NMOSD (90.2 %) compared to MOGAD (45.5 %) and Seronegative NMOSD (66.7 %). Age of disease onset and annualized relapse rates were similar across groups. Myelitis was a common initial symptom in AQP4+ NMOSD (48.8 %) and Seronegative NMOSD (40 %), but less so in MOGAD (18.2 %). Optic neuritis was more frequent in MOGAD (68.2 %) and Seronegative NMOSD (53.3 %) than AQP4+ NMOSD (31.7 %). Relapsing disease was less observed in MOGAD (57.1 %) compared to the other groups. Time to the first relapse varied: 12 months for Seronegative NMOSD, 18 months for AQP4+ NMOSD, and 7 months for MOGAD. A higher incidence of autoimmune disorders was found in AQP4+ NMOSD (36.6 %) versus MOGAD (9.5 %). This study delineates a pronounced female and concurrent autoimmune disorder predominance in AQP4+ NMOSD compared to seronegative NMOSD and MOGAD
Robotic-assisted neovaginal creation: stepwise approach to the Davydov technique in a patient with Mayer-Rokitansky-Ku<euro>ster-Hauser syndrome
No full textObjective: To demonstrate the robotic-assisted Davydov technique for neovaginal creation in Mayer-Rokitansky-Kuster-Hauser syndrome. Design: Stepwise demonstration of the technique with narrated video. Subjects: A 27-year-old patient has been diagnosed with Mayer-Rokitansky-Kuster-Hauser syndrome since the age of 18 years. Three months ago, vaginal dilation was attempted at another medical center but was unsuccessful because of intolerance. Pelvic examination revealed a shallow vaginal dimple. Exposure: After identification of the anatomical structures, the rectovaginal and vesicovaginal spaces were dissected, creating a space for the neovaginal canal and forming anterior and posterior peritoneal flaps. After complete dissection of the rectum from the posterior pelvic peritoneum, the vaginal remnant was bluntly dissected externally under guidance of a blunt-tipped curette handle and connected adequately to the introitus. Subsequently, the created anterior and posterior flaps were individually interrupted with sutures to form the neovaginal entrance. After the neovaginal entrance was established, the robot was used again to continuously suture the uterine remnants to create the anterior neovaginal wall. The uterine remnants, rectal serosa, and internal portions of the flaps were then joined together to form the neovaginal vault. Main Outcome Measures: Demonstration of the steps for the robotic management of neovaginal creation in Mayer-RokitanskyKuster-Hauser syndrome. Results: The patient was discharged on postoperative day 1 with a soft mold in the vagina. On postoperative day 3, the soft mold was replaced with a medium-sized rigid mold. By postoperative day 6, the patient could insert a full-size rigid mold. The patient achieved full penetration and engaged in sexual activity within 1 month, with no postoperative complications observed. At the 8-month follow-up, the neovaginal cavity measured 13.4 cm in depth and 4.7 cm in diameter. Conclusion: Creating a neovagina using the robotic-assisted Davydov technique in patients with Mayer-Rokitansky-Kuster-Hauser syndrome is a safe, feasible, beneficial, and highly effective method. Although the superiority of robotic systems over laparoscopy has not yet been fully established through extensive publications, the advantages provided by high-image quality, magnification, and maneuverability are highlighted in this study. Robotic technology could be particularly beneficial for patients with obesity or those with complex pelvic anatomy because of prior surgeries
Cancers in Different Conditions, Cancer Research Methods and Diagnosis: An Interdisciplinary Approach
No full textInborn errors of immunity (IEI) are genetic disorders that impair the immune system, contributing to complications such as lymphoproliferation/malignities in addition to infectious, autoimmune/lymphoproliferative, and allergic diseases. This chapter delves into the complex relationship between immune deficiency, viral infections, and cancer development to stress the importance of early detection, targeted therapies, and preventive measures and to improve cancer outcomes. Epstein-Barr virus (EBV), human papillomavirus (HPV), and human herpesvirus 8 (HHV8) significantly contribute to lymphoproliferation/cancer development in IEI due to impaired immune response, chronic inflammation, and viral-driven cellular transformation. Genetic defects that affect DNA repair, stem cell function, and immune signaling pathways further elevate malignancy risk in these patients. Diagnosing virus-associated malignancies in these patients involves comprehensive clinical evaluation, viral serology, polymerase chain reaction (PCR) testing, imaging, and biopsies to detect viral markers. Infection control is vital due to the high risk of opportunistic infections. Therapies, such as intravenous immunoglobulin replacement, hematopoietic stem cell transplantation, granulocyte or plasma infusions, and chemotherapy and radiotherapy regimens, are directed at the specific IEI type. Managing virus-associated cancer in IEI requires a multidisciplinary approach that includes restoration of immune function, antiviral therapies, and tailored treatments. Diagnosing the genetic predisposition to virus-induced cancers is also critical and highlights the need for IEI gene-specific and individualized therapies, family screening, and genetic counseling. Advanced therapies such as gene therapy and virus-specific T cell therapy show promise in managing persistent viral infections. Future research directions aim to improve diagnostic biomarkers, develop gene-editing technologies, and advance personalized immunotherapies to meet the needs of individuals with IEI and reduce their long-term complications.</p
Optimizing insurance investments: The role of liquidity risk in asset-liability management
No full textIn the insurance sector, the timing and amount of liabilities are inherently uncertain, which makes it difficult for companies to evaluate their assets accurately. This study argues that companies should optimize assets and insurance products by considering their liquidity to manage the effects of these uncertainties. In the study, the assets are assumed to consist of a Treasury bill, cash, and a bond subject to default risk with liquidity risk. In addition, the liquidity factor is added to the liability process to examine the effect of the liquidity of the insurance product on the optimization of assets. The study provides closed-form solutions for optimal investment strategies under both exponential and power distribution functions using the Hamilton-Jacobi-Bellman (HJB) equations to optimize the asset-liability ratio. Finally, the effect of critical parameters such as default probabilities and liquidity on these strategies is examined with a numerical example
