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Flood Management with Flood Galleries in a Reservoir Basin
No full textFuture precipitation patterns are expected to shift toward sudden, intense rainfall events. Therefore, existing water reserves must be adapted, and new management systems developed to address these changing conditions. Galleries can serve a dual role by diverting potentially threatening floodwater to delay its arrival at the dam while also contributing to groundwater recharge through infiltration. This study focuses on 25-year return period floods at Yuvacık Dam, Turkey. Water levels at the reservoir inlet were raised via a regulating structure, allowing the gravitational diversion of floodwater into galleries. Approximately 2.2 hm³ of floodwater was diverted; 1.8 hm³ was directed to galleries, and 0.4 hm³ infiltrated into groundwater. Changes in peak discharge and flood duration before and after diversion were analyzed using a MATLAB-based flood routing model. Sensitivity analyses were conducted to examine the effects of gallery diameter, slope, and permeability coefficient on infiltration performance. Results indicate a 16% reduction in peak flood discharge. The proposed system is expected to enhance both flood safety and water resource management by enabling controlled diversion and partial infiltration of potentially wasteful floodwaters
An enhanced attention and dilated convolution-based ensemble model for network intrusion detection system against adversarial evasion attacks
No full textArticle number : 191Network Intrusion Detection System (NIDS) is a system for recognizing suspicious activities in the network traffic. Numerous machines learning and deep learning-aided IDSs have been implemented in the past, however, most of these techniques face challenges based on class imbalance issues and high false positive rates. Other primary problems of the conventional techniques are their vulnerability to adversarial attacks and also there is no analysis done on how NIDS sustain their performance over various attacks. Moreover, recent studies have demonstrated that while handling the attackers in real-time, the deep learning-based IDS shows slight variations in accuracy. To defend against adversarial evasion attacks, an enhanced deep learning-based NIDS model is designed in this work. For this purpose, at first, the required data is collected from available websites. From the collected data, effective features are extracted to improve the accuracy of the process. To select the optimal features, this work employed the Improved Cheetah Optimizer (ICO) that eliminates the unwanted features efficiently. Further, an Attention and Dilated Convolution based Ensemble Network (ADCEN) is implemented to detect the intrusions from the optimal features. The Deep Temporal Convolutional Neural Network (DTCN), Long Short Term Memory (LSTM), and Gated Recurrent Unit (GRU) models are integrated to develop the ADCEN. The outcomes from each technique are considered for the fuzzy ranking mechanism to generate the final detected outcome. Thus, recognized intrusion is attained as the outcome and to demonstrate how well the recommended deep learning-based NIDS defends against adversarial evasion assaults, experiments are conducted against conventional models. The accuracy and the FPR values of the recommended model are 95 and 4.9 when considering the first dataset which is superior to the conventional techniques. Thus, the findings indicated that the implemented NIDS against adversarial evasion attacks attained more effective solutions than the baseline approaches
Early Relapse with Isolated Myeloid Sarcoma in a Patient Diagnosed Acute Myeloid Leukemia with FLT3- D835Y Mutation
No full textIntroduction: FLT3-TKD (tyrosine kinase domain) mutations are identified in approximately 4% of acute myeloid leukemia (AML) cases, and their prognostic significance remains unclear. While the association between myeloid sarcoma (MS) and FLT3-ITD positivity has been well documented, there is currently no definitive data regarding the relationship between FLT3-TKD mutations and MS, nor their impact on prognosis. We aim to present a case of a pediatric AML patient with the FLT3 D835Y mutation who initially presented with symptoms of mastoiditis and was subsequently diagnosed with MS. Case Presentation: An 11-year-old male patient with AML harboring the FLT3 D835Y mutation was in remission following treatment according to the AML-BFM 2019 protocol. After completing five cycles of chemotherapy, he was on maintenance therapy and receiving sorafenib. In the third month of maintenance, he presented to the emergency department with complaints of left ear pain and hearing loss. Initial suspicion was otomastoiditis, and he was treated with antibiotics. However, due to the persistence of symptoms, a biopsy was performed, which confirmed the diagnosis of MS. There was no evidence of bone marrow involvement. The patient was treated with chemotherapy and radiotherapy and was subsequently referred for bone marrow transplantation. Unfortunately, he passed away one month after transplantation due to sepsis. Conclusion: When mastoiditis-like symptoms appear in a patient with a history of AML, clinicians should consider the possibility of MS, particularly in cases with rare mutations such as FLT3 D835Y. Although the prognosis is generally poor, hematopoietic stem cell transplantation may offer a chance for cure. This case is noteworthy due to the uncommon immunophenotypic features and the rare localization of MS in the mastoid region
A Cross-sectional Analysis of Immunological and Hematological Parameters in Patients With Chronic Opioid Use
No full textBackground and Aim: Previous research has recognized the dual role of opioids [agonists at μ-opioid receptors (MOP-r agonists)] in modulating immunity and neuroinflammation in individuals with opioid use disorder (OUD). This cross-sectional study investigates the interplay between chronic use of MOP-r agonists and inflammatory parameters in individuals with OUD, with the goal of providing insights into the relationship between immunological responses and OUD. Materials and Methods: A cohort of 129 patients with OUD seeking treatment at an addiction detoxification center underwent detailed clinical assessments. Blood samples were collected for analyses of serum alanine aminotransferase, aspartate aminotransferase, and C-reactive protein levels, and a complete blood count. Participants were categorized into inflammation and noninflammation groups based on C-reactive protein levels. Hematological and inflammation indices, along with pain severity, were compared between these groups. Results: Significant differences were observed between the inflammation and noninflammation groups on variables such as duration of MOP-r agonist intake, daily buprenorphine/naloxone dose, consumption route, severity of withdrawal symptoms, and level of self-reported pain. The inflammation group exhibited higher neutrophil counts and an increased neutrophil-to-lymphocyte ratio. The binary logistic regression models revealed that self-reported pain level, daily buprenorphine/naloxone dosage, Beck Depression Inventory scores, and age were significant predictors of inflammation. Conclusions: This study contributes to our understanding of OUD as a chronic inflammatory condition, shedding light on the intricate relationships between MOP-r agonist addiction, inflammatory responses, and withdrawal-related parameters. The findings offer valuable perspectives on effective management, emphasizing the need for further research in diverse populations to enhance understanding of this complex condition
A real-time web-based telemedicine framework based on AI and IoMT for emergency triage and initial diagnostics: the TeleMedQuick solution
No full textBackground: Rapid medical decision-making for emergency and chronic conditions remains a global challenge, especially in under-resourced and remote settings. Traditional triage models often rely on narrowly focused algorithms or limited sensor inputs, which can hinder timely diagnosis and treatment.
The goal of this study is to introduce telemedquick: This web-based telemedicine system helps with emergency triage and initial diagnosis by using organised clinical rules based on medical guidelines and approved by doctors.
Methods: TeleMedQuick integrates Internet of Medical Things (IoMT) devices with a rule-based expert inference engine comprising 76,229 clinical rules. These rules were developed through a combination of medical guideline reviews and direct consultations with certified emergency physicians. The system evaluates vital signs, symptoms, demographics, and patient history for conditions such as stroke, diabetes, hypertension, respiratory disorders, and heart attacks.
Results: The system was evaluated on a medically annotated dataset of 750 patients under expert review. It achieved a triage accuracy of 99.1%, confirmed through expert validation and performance metrics, including F1-scores across all urgency levels. Rule design minimises symptom overlap and allows understandable, rapid decisions.
Conclusion: As an expert system, TeleMedQuick bridges the gap between IoMT sensing and clinical reasoning in telemedicine. It enables scalable, real-time triage and initial diagnostic support with validated transparency, making it suitable for prehospital care, especially in low-access or high-demand contexts
Efficacy and safety of first-line maintenance therapy with lurbinectedin plus atezolizumab in extensive-stage small-cell lung cancer (IMforte): a randomised, multicentre, open-label, phase 3 trial
No full textFunding agency : Menarini Korea ; Novartis Korea ; Pfizer ; Takeda Pharmaceutical Company Ltd ; Roche Holding ; AstraZeneca ; GlaxoSmithKline ; Merck & Company ; OSE Immunotherapeutics, PharmaMar ; BioNTech ; Bristol Myers Squibb, F Hoffmann-La Roche ; PharmaMar ; BeiGene ; European Organisation for Research and Treatment of Cancer Lung Group ; Daiichi Sankyo, F Hoffmann-La Roche ; Novartis ; Gilead Sciences ; Amgen ; BeiGene, Bristol Myers Squibb ; Boehringer Ingelheim ; Daiichi Sankyo Company Limited ; Eli Lilly ; Mirati ; Sanofi.Background: Despite improved efficacy with first-line immune checkpoint inhibitors plus platinum-based chemotherapy for extensive-stage small-cell lung cancer (ES-SCLC), survival remains poor. In this study, we aimed to compare lurbinectedin plus atezolizumab and atezolizumab alone as maintenance therapies in patients with ES-SCLC without progression after induction therapy with atezolizumab, carboplatin, and etoposide. Methods: IMforte was a randomised, open-label, phase 3 trial done at 96 hospitals and medical centres in 13 countries (Belgium, Germany, Greece, Hungary, Italy, Mexico, Poland, South Korea, Spain, Taiwan, Türkiye, the UK, and the USA). Eligible patients were aged 18 years or older with treatment-naive ES-SCLC. Patients received four 21-day cycles of induction treatment (atezolizumab, carboplatin, and etoposide). After completing induction treatment, eligible patients without disease progression were randomly assigned (1:1) using permuted blocks (Interactive Voice/Web Response System) to receive maintenance treatment intravenously every 3 weeks with lurbinectedin (3·2 mg/m2; with granulocyte colony-stimulating factor prophylaxis) plus atezolizumab (1200 mg) or atezolizumab (1200 mg). The two primary endpoints were independent review facility-assessed (IRF) progression-free survival and overall survival, measured from randomisation into the maintenance phase. Efficacy endpoints were assessed in the full analysis set, which included all patients who were randomly assigned to maintenance phase treatment, regardless of whether they received their assigned study treatment. Safety was assessed in all patients who received at least one dose of lurbinectedin or atezolizumab, and was analysed according to the treatment received. This study is registered with ClinicalTrials.gov, NCT05091567, and is closed for recruitment. Findings: Between Nov 17, 2021, and Jan 11, 2024, 895 patients were screened for enrolment, of whom 660 (74%) were enrolled into the induction phase. Between May 24, 2022, and April 30, 2024, 483 (73%) of 660 patients entered the maintenance phase and were randomly assigned to lurbinectedin plus atezolizumab (n=242) or atezolizumab (n=241). At the data cutoff (July 29, 2024), IRF progression-free survival was longer in the lurbinectedin plus atezolizumab group than the atezolizumab group (stratified hazard ratio [HR] 0·54 [95% CI 0·43–0·67]; p<0·0001), as was overall survival (stratified HR 0·73 [0·57–0·95]; p=0·017). 92 (38%) of 242 patients in the lurbinectedin plus atezolizumab group and 53 (22%) of 240 patients in the atezolizumab group had grade 3–4 adverse events. The most common grade 3–4 events in the lurbinectedin plus atezolizumab group were anaemia (20 [8%] of 242 patients), decreased neutrophil count (18 [7%] patients), and decreased platelet count (18 [7%] patients) and the most common events in the atezolizumab group were hyponatremia (five [2%] of 240 patients), dyspnoea (four [2%] patients), and pneumonia (four [2%] patients). Grade 5 adverse events occurred in 12 (5%) of 242 patients in the lurbinectedin plus atezolizumab group and six (3%) of 240 patients in the atezolizumab group. The incidence of myelosuppressive toxicities (eg, neutropenia and leukopenia) was higher in the lurbinectedin plus atezolizumab group than the atezolizumab group. Interpretation: IRF progression-free survival and overall survival were longer in the lurbinectedin plus atezolizumab group than the atezolizumab group for patients with ES-SCLC, albeit with a higher incidence of adverse events. Lurbinectedin plus atezolizumab represents a novel therapeutic option for first-line maintenance treatment in this setting. Funding: F Hoffmann-La Roche and Jazz Pharmaceuticals
الشخصیة المستندة إلى DCGAN تعزیز التعتعزیز التعرف على الحالات الباردة بالطب الشرعي من خلال إعادة بناء الصورة DCGAN الشخصیة المستندة إلىرف على الحالات الباردة بالطب الشرعي من خلال إعادة بناء الصورة
Full text linkWith the improvement of artificial intelligence and deep learning techniques, especially deep convolutional generative adversarial network (DCGAN), there has been a significant development in personal identity and generating images through facial reconstruction systems. This study focuses on proposing a model of personal image reconstruction from forensic sketches using DCGAN. The model comprises two networks: a generator to convert sketch images into real images and a feature network to determine the similarity of the generated images to real ones. Forensic sketches provided by relevant authorities are used as inputs to the proposed model. These sketches include details and information on the perpetrators or missing persons obtained from witnesses or the missing person parents. Prominent facial features extracted from the reconstructed images aid in the process of personal image reconstruction. The proposed model shows good results, achieving up to 99% accuracy in the generated images. The error ratio is reported to be as low as 0.92% based on the evaluation using the CUHKFaces dataset. This study presents a new approach to reconstructing human face images from forensic sketches using DCGAN
KÜÇÜK HÜCRELİ VE KÜÇÜK HÜCRELİ OLMAYAN AKCİĞER KANSERLERİNDE ROL OYNAYAN MİRNA’LARIN BİYOİNFORMATİK ANALİZLERLE KARŞILAŞTIRILMASI
Full text linkCODEN : AUEDEObjective: Lung cancer is a major cause of cancer-related deaths worldwide. There are two main types of lung cancer, small cell and non-small cell. Finding new methods for achieving a good prognosis, developing targeted therapy and identifying potential biomarkers is crucial for improving the clinical efficacy of lung cancer. The aim of this study was to investigate the pathogenesis and potential molecular markers by finding differentially expressed miRNAs in 2 subtypes of lung cancer. Materials and Methods: The datasets GSE19945 and GSE135918 containing miRNA data were downloaded from the GEO database. Analyzed with GEO2R online analysis tool with P<0.05 and log fold change |(FC)|≥ 1. Target genes of differentially expressed miRNAs have been identified. Network visualisation and module identification were performed using Cytoscape PPI. Three of the miRNA target genes were selected and validation of the genes was performed in the non-small cell lung cancer cell line A549. Results and discussion: 17 common miRNAs with decreased expression and 2 with increased expression include hsa-miR-1249, hsa-miR-326, hsa-let-7c, hsa-miR-199a-5p, hsa-miR-940, hsamiR-139-3p, hsa-miR-142-3p, hsa-miR-142-5p, hsa-miR-455-5p, hsa-miR-146b-5p,hsa-miR-152hsa-miR-133b, hsa-miR-498, hsa-miR-199b-5p, hsa-miR-140-3p, hsa-miR-203 and hsa-miR-139-5p. Defining the molecular functions and signaling pathways of miRNAs may deepen the current understanding of the molecular mechanisms of the 2 cancer types and contribute to the development of treatment options
Donor impact on allogeneic transplant outcomes with PTCy for severe aplastic anemia: a study of the SAAWP EBMT
No full textThe use of post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis in severe aplastic anemia (SAA) remains understudied, particularly beyond haploidentical transplants. We analyzed outcomes of SAA patients who underwent stem cell transplantation (SCT) with PTCy from haploidentical donors (n = 209), HLA-matched sibling donors (MSD, n = 70), and unrelated donors (UD, n = 69) using EBMT data from 2010 to 2022. Median age was 22 years, and median time to transplantation was 8.6 months. For haploidentical, MSD, and UD cohorts, the 100-day cumulative incidence of grade II-IV acute GVHD was 19%, 11%, and 14% (p = 0.15), while grade III-IV was 6%, 3%, and 2% (p = 0.1). Two-year chronic and extensive chronic GVHD were 14%, 13%, and 14% (p = 0.1) and 5%, 6%, and 2% (p = 0.5), respectively. Non-relapse mortality at two years was 24% for haploidentical, 7% for MSD, and 10% for UD (p = 0.003). Two-year overall survival (OS) and GVHD- and relapse-free survival were 66% and 54% for haploidentical, 92% and 70% for MSD, and 81% and 66% for UD (p < 0.001, p = 0.06). In multivariable analysis, MSD and UD were associated with superior OS and GRFS compared to haploidentical. PTCy is safe and effective in SAA patients, though haploidentical SCT had higher NRM, leading to lower survival
Barriers to healthcare access and continuity of care among Ukrainian war refugees in Europe: findings from the RefuHealthAccess study
No full textIntroduction: The Russian invasion of Ukraine displaced over 14 million people. By 2024, around 6 million Ukrainian refugees settled in Europe under the EU Temporary Protection Directive, providing permit of residence, work and health care. This influx strained European healthcare systems, particularly in addressing acute injuries. As the stay of refugees in EU countries prolongs, the management of chronic conditions becomes increasingly important. However, there is limited information available about Ukrainian refugees' access to various healthcare services. Aim: The aim of this study was to evaluate perceived accessibility of healthcare services in Europe for Ukrainian war refugees and to identify barriers to healthcare access, in order to inform improvements in healthcare provision. Methods: A cross-sectional online survey was conducted across Europe from July 2023 to April 2024, targeting adult Ukrainian war refugees. Survey explored areas defined as key health care needs. Descriptive, parametric and non-parametric statistical analysis methods were employed in data analysis. Results: Of 659 respondents, 550 (83.4%) were included in the final analysis due to having reported need to use healthcare services in the past year. The most prevalent needs included dental care (82.9%), prescription medication (81.6%), care for acute (78.4%), and chronic conditions (64.0%). Perceived access to care varied across services, with vaccinations rated highest, while chronic condition care rated lowest. Around ¼ of respondents reported that they had to temporarily return to Ukraine for services not available in the countries where they stayed, these being mostly dental and gynaecologic care. The most prevalent barriers reported were long waiting times (64.2%), information barriers (55.5%), and high service costs (49.1%). Discussion: The survey identified several barriers in the access to healthcare system for Ukrainians, particularly for chronic conditions care. Some barriers may be subjective, relating to limited access to information. However, others point to potential shortcomings within national healthcare systems, suggesting areas that require further review and improvement. Conclusions: Addressing language barriers, improving information dissemination, and enhancing chronic condition management were identified as crucial for improving healthcare access for Ukrainian war refugees. Coordinated strategies are needed to support refugees and ensure the sustainability of host healthcare systems