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Spontaneous Shrinking and Growing Skull Base Chordoma
Get PDFBackground Chordomas are rare slow-growing tumors occurring in the axial skeleton and can demonstrate local aggressive behavior, typically extending from the median axis, compressing surrounding tissue. Complete surgical resection and adjuvant radiotherapy are the preferred treatments. We present an unusual case of a spontaneously shrinking and growing off-midline petroclival chordoma. Case Description A 23-year-old woman presented with right abducens nerve palsy. Computed tomography and magnetic resonance imaging (MRI) revealed an off-midline petroclival lesion compressing the abducens nerve with characteristics of a chondrosarcoma. Preoperative MRI indicated spontaneous lesion regression, and the abducens nerve showed clinical improvement. Hence, the planned surgery was canceled. During the wait-and-scan period, abducens nerve palsy recurred. MRI confirmed lesion growth and showed an intratumoral linear structure indicative of blood. Even though preoperative MRI again demonstrated shrinkage, the lesion was surgically removed. Despite the unusual presentation, histopathological examination diagnosed a conventional chordoma. A second surgery was required to remove the residual tumor, after which the patient received high-dose photon beam therapy. Conclusion This article discusses the uncommon presentation and behavior of a petroclival chordoma, showing fluctuating cycles of off-midline growth and spontaneous regression. While intratumoral hemorrhage is hypothesized to explain this tumor behavior, the exact etiology needs further investigation. The case presented here emphasizes the importance of considering chordoma in the differential diagnosis despite an atypical disease course
Validation and reliability of the Turkish version of the surgical site infection assessment scale: a methodological study
Get PDFBackground Although the incidence of healthcare-associated infections has decreased over the past decade, surgical site infections (SSIs) have continued to constitute a significant proportion of these infections. Therefore, early identification and management of high-risk patients has been crucial in reducing the incidence of SSIs. Objectives In this study, we aimed to evaluate the validity and reliability of the Turkish version of the Surgical Site Infection Assessment Scale (SSIAS), which was developed to identify patients at risk of superficial incisional SSI. Methods In this methodological study, we evaluated the Turkish validity and reliability of the SSIAS in a prospective cross-sectional sample of 170 patients who underwent elective abdominal surgery at a tertiary healthcare center. The scale was adapted in accordance with international guidelines through a forward-backward translation process performed by three professional translators and content validation by a panel of 20 experts. We assessed the psychometric properties using univariate logistic regression and ROC analysis for construct validity (AUC calculation). Diagnostic accuracy was evaluated based on sensitivity, specificity, and predictive values at the optimal cutoff point (> 14), determined using the Youden index. Results The adaptation process was carried out based on Beaton et al.'s guidelines, and the content validity ratio (CVR) was calculated between 0.78 and 1.00. ROC analysis revealed an AUC of 0.935 (95% CI: 0.897-0.972), and at the > 14 cutoff point, we observed 91.8% sensitivity and 79.3% specificity. The scale demonstrated superior predictive performance compared to previously developed tools. Surgical site infections occurred in 49 patients. The mean scale score of infected patients was 16.76 +/- 1.85. For each one-point increase in the scale score, the risk of infection increased by 3.52 times. Smoking, comorbidities, abnormal laboratory findings, length of preoperative hospitalization, wound classification, body temperature, and prolonged presence of drains were identified as factors influencing the risk of infection. Conclusion The Turkish version of the Surgical Site Infection Assessment Scale (SSIAS), originally developed by Anwar et al., was found to be a valid and reliable tool for predicting SSI risk in T & uuml;rkiye. Due to its high predictive power, it offers practical potential for early risk identification and preventive action in clinical settings
Alt ekstremite amputelerinde ikili göreve ait akut etkilerin incelenmesi
Get PDFBu çalışma, alt ekstremite amputelerinde ikili göreve ait akut etkileri incelemeyi ve sağlıklı kontroller ile kıyaslamayı amaçlamaktadır. Çalışmaya, alt ekstremite amputasyonuna sahip 16 katılımcı ile benzer demografik özelliklerde seçilen 16 sağlıklı katılımcı olmak üzere toplam 32 gönüllü katıldı. Fonksiyonel değerlendirme; 2 Dakika Yürüme Testi (2DYT), Zamanlı Kalk Yürü Testi (ZKYT) ve Fonksiyonel Uzanma Testi (FUT) ile; bilişsel değerlendirme ise Stroop Testi TBAG Formu (ST), İz Sürme Testi (İST) ve Nelson El Reaksiyon Testi ile yapıldı. Otonom sinir sistemi ölçümleri POLAR H10 cihazı kullanılarak gerçekleştirildi. Katılımcılar, birinci görev olarak 2DYT'ni, ikinci görev olarak ise eş zamanlı bilişsel ve motor görevleri yerine getirdi; tüm değerlendirmeler ikili görev öncesinde ve sonrasında uygulanarak elde edilen sonuçlar karşılaştırıldı. Tüm verilerin analizinde SPSS v.26 (SPSS Inc., ABD) yazılımı kullanıldı. Kategorik veriler χ² testi ile değerlendirildi. Normal dağılım göstermeyen veya sıralı verilerin analizinde, grup içi karşılaştırmalar için Wilcoxon testi, gruplar arası karşılaştırmalar için Mann-Whitney U testi kullanıldı. Normal dağılım gösteren sayısal verilerin analizinde, grup içi karşılaştırmalarda eşleştirilmiş örneklem t-testi, gruplar arası karşılaştırmalarda ise bağımsız örneklem t-testi uygulandı. Tüm analizlerde anlamlılık düzeyi p<0,05 olarak kabul edildi. Ampute grubunda, ikili görev sonrası fiziksel performans testlerinden ZKYT süresinde istatistiksel olarak anlamlı bir düşüş, FUT mesafesinde ise istatistiksel olarak anlamlı bir artış gözlendi. Bilişsel değerlendirmelerde ST 1 süresi, ST 3 ve İST A1 süresi anlamlı düzeyde düştü ancak ST 3 düzeltme sayısında anlamlı bir artış kaydedildi. Otonom sinir sistemi yanıtlarından kalp hızı ve sempatik sistem aktivitesini yansıtan SNS İndeks anlamlı artış gösterirken parasempatik sistem aktivitesini yansıtan PNS İndekste ise anlamlı azalma kaydedildi. Kontrol grubunda ise ikili görev sonrası fiziksel performans testlerinden ZKYT süresi istatistiksel olarak anlamlı şekilde azalırken, FUT mesafesi arttı. Bilişsel performans değerlendirmelerinde, ST'nin 1., 3., 4. ve 5. bölüm süreleri ile İz Sürme Testi A1, A2, B1 ve B2 sürelerinde istatistiksel olarak anlamlı düşüş gözlendi; ayrıca B Formu - A Formu süre farkında da anlamlı azalma kaydedildi. Ancak, otonom sinir sistemi değerlendirmelerinde ikili görev öncesi ve sonrası arasında istatistiksel olarak anlamlı bir fark saptanmadı. Her iki grupta da denge parametrelerinde istatistiksel olarak anlamlı fark gözlenirken, gruplar arası karşılaştırmada yalnızca ZKYT süresinde ampute grup lehine anlamlı fark saptandı. Bu bulgu, ikili görev uygulamasının dinamik denge üzerinde daha belirgin bir etki yarattığını düşündürmektedir. Sonuçlar, ikili görev uygulamasının her iki grupta da özellikle dikkat ve yürütücü işlevleri akut olarak artırdığını gösterdi. Ancak ampute bireylerde ST'de inhibisyon yükü arttıkça hata yapma eğilimi yükseldi ve bilişsel kazanımlar daha sınırlı kaldı. İki grup arasında yalnızca bilişsel değerlendirmelerden İST A1 süresinde ampute grup lehine ve otonom sinir sistemi değerlendirmelerinden PNS indeksinde ise kontrol grubunun lehine anlamlı fark saptandı. Bu bulgular, ikili görev uygulamasının temel düzeyde bilişsel hız ve görsel-motor işleme becerileri üzerinde etkili olabileceğini ancak ampute bireylerin kısa süreli stres karşısında parasempatik dengeyi sürdürmekte güçlük yaşayabileceğini düşündürmektedir. Alt ekstremite amputelerinde motor becerilere ek olarak bilişsel işlevleri destekleyen ve otonom sinir sistemi regülasyonunu hedefleyen bütüncül yaklaşımların gerekliliğine işaret etmektedir.This study aimed to examine the acute effects of dual-task in individuals with lower limb amputation and to compare the outcomes with healthy controls. A total of 32 volunteers participated in the study, including 16 individuals with lower limb amputation and 16 healthy participants selected with similar demographic characteristics. Functional assessment was conducted using the 2-Minute Walk Test (2MWT), Timed Up and Go Test (TUG), and Functional Reach Test (FRT), while cognitive performance was evaluated using the Stroop Test TBAG Form (ST), Trail Making Test (TMT), and Nelson Hand Reaction Test. Autonomic nervous system measurements were obtained using the POLAR H10 device. Participants performed the 2MWT as the primary task and executed simultaneous cognitive and motor tasks as the secondary task. All assessments were administered both before and after the dual-task intervention, and the results were compared. Statistical analyses were conducted using SPSS v.26 (SPSS Inc., USA). Categorical variables were analyzed using the χ² test. For non-normally distributed or ordinal data, the Wilcoxon test was used for within-group comparisons and the Mann–Whitney U test for between-group comparisons. For normally distributed numerical variables, paired samples t-test was used for within-group comparisons, and independent samples t-test was applied for between-group comparisons. Statistical significance was set at p<0.05. In the amputee group, a statistically significant decrease in TUG duration and a significant increase in FRT distance were observed following the dual-task intervention. In cognitive assessments, significant reductions were found in ST-1, ST-3, and TMT A1 durations, whereas a significant increase was noted in ST-3 correction counts. Regarding autonomic responses, the SNS index reflecting sympathetic activity showed a significant increase, while the PNS index indicating parasympathetic activity decreased significantly. In the control group, post-intervention analysis revealed a statistically significant reduction in TUG duration and an increase in FRT distance. Significant decreases were observed in ST sections 1, 3, 4, and 5, as well as in TMT A1, A2, B1, and B2 durations; additionally, a significant reduction was found in the B Form – A Form time difference. However, no statistically significant differences were detected in autonomic nervous system parameters between pre- and post-task measurements. Although both groups showed statistically significant improvements in balance parameters, between-group comparisons revealed a significant difference only in TUG duration in favor of the amputee group. This suggests that the dual-task intervention had a more pronounced effect on dynamic balance. The findings indicated that dual-task practice acutely enhanced attention and executive functions in both groups. However, as inhibition demands increased in the Stroop Test, the tendency to make errors rose among amputee participants, and cognitive gains remained limited. Between-group comparisons revealed a significant difference only in the TMT A1 duration in favor of the amputee group and in the PNS index in favor of the control group. These findings suggest that dual-task interventions may improve basic-level cognitive speed and visuomotor processing skills, but individuals with amputation may have difficulty maintaining parasympathetic balance in response to short-term stress. Overall, the results highlight the necessity of integrative rehabilitation approaches in lower limb amputees that not only target motor skills but also support cognitive functions and autonomic nervous system regulation
Palyatif bakım alan terminal dönem kanser hastalarında solunum egzersizlerinin ağrı, dispne ve fonksiyonelliğe etkisi
Get PDFAmaç: Bu çalışmanın amacı, palyatif bakım alan terminal dönem kanser hastalarında yapılandırılmış solunum egzersizlerinin fizyolojik, hematolojik ve semptomatik etkilerini incelemektir. Yöntem: Çalışmaya Eyüpsultan Devlet Hastanesi palyatif bakım servisinde yatmakta olan terminal dönem kanser hastası 39 katılımcı dahil edildi. Katılımcılar, randomizasyon yöntemiyle müdahale grubu (n=22) ve kontrol grubu (n=17) olarak ikiye ayrıldı. Müdahale grubuna, fizyoterapist eşliğinde uygulanan diyafragmatik ve büzük dudak solunumu içeren yapılandırılmış bir egzersiz programı uygulandı. Müdahale 5 gün sürdü. Müdahale öncesi ve sonrası fizyolojik (SpO₂, nabız), hematolojik (hemoglobin, lökosit, trombosit, CRP) ve semptomatik veriler (VAS, CDS, ESAS-r) toplandı. Bulgular: En belirgin iyileşme SpO₂ değerlerinde gözlendi. Oksijen satürasyonu müdahale grubunda anlamlı şekilde artarken, kontrol grubunda düşme eğilimindeydi. Solunum egzersizi sonrası nabız düzeyinde izlenen düşüş, egzersizin parasempatik sinir sistemi üzerindeki düzenleyici, rahatlatıcı etkisini ortaya koymaktadır. Hemoglobin, lökosit ve trombosit düzeylerinde anlamlı fark saptanmadı; ancak CRP değeri müdahale grubunda stabil kalırken, kontrol grubunda artış eğilimindeydi. Müdahale grubu semptomlarında; dispne (çaba duygusu, rahatsızlık, anksiyete), ağrı, iştahsızlık ve yorgunluk düzeylerinde anlamlı azalmalar gözlendi. Kontrol grubunda ise bu parametrelerde belirgin bir düzelme görülmedi, bazı semptomlarda kötüleşme izlendi. Sonuç: Yapılandırılmış solunum egzersizleri, terminal evre kanser hastalarında güvenli, uygulanabilir ve etkili bir tamamlayıcı müdahale yöntemi olarak öne çıkmaktadır. Egzersizler, oksijenlenmeyi artırmakta, subjektif semptom yükünü hafifletmekte ve hastaların hem fiziksel hem de psikolojik iyilik hallerine katkı sağlamaktadır. Elde edilen bulgular, solunum egzersizlerinin palyatif bakım protokollerine entegre edilmesini desteklemektedir.Objective: We aimed to evaluate physiological, hematological, and effects of symptom with structured breathing exercises in terminal stage cancer patients receiving palliative care. Methods: This study consists of 39 participants of terminal stage cancer patients receiving palliative care in Eyüpsultan State Hospital. Participants were randomly assigned to an intervention group (n=22) and a control group (n=17). The intervention group joined in a structured breathing exercise program by a physiotherapist. This structured breathing exercise includes diaphragmatic and pursed-lip breathing techniques. Physiological parameters (SpO₂, pulse), hematological markers (hemoglobin, leukocyte, platelet, CRP), and symptom scales (VAS, CDS, ESAS-r) were assessed before and after the intervention. İntervention was continued 5 days. Data were analyzed using SPSS Statistics 27. Normality was tested using the Kolmogorov–Smirnov test, and appropriate parametric or non-parametric tests were applied accordingly. Results: The most significant improvement was observed in SpO₂ levels. Oxygen saturation significantly increased in the intervention group. But in the control groups SpO2 declined. At the same time, the pulse decreased in the intervention group. This situation shows enhanced parasympathetic activity and relaxation. Hemoglobin, leukocyte and platelet levels showed no significant change. However, CRP remained stable in the intervention group and tended to rise in the control group. Regarding symptom evaluation, the intervention group exhibited significant reductions in dyspnea (effort, discomfort, anxiety), pain, appetite loss, fatigue, and anxiety. In contrast, the control group showed no notable improvement, and some symptoms worsened. Conclusion: Structured breathing exercises are a safe, feasible, and effective complementary intervention in terminal-stage cancer patients. The exercises improved oxygenation, reduced the overall symptom burden, and contributed positively to both physical and psychological well-being. These findings support the integration of respiratory-based non pharmacological approaches into palliative care protocols
Experiences of Individuals Undergoing Bariatric Surgery Regarding Nutritional Behaviors: A Qualitative Study
No full textBackground: Bariatric surgical interventions lead to some nutritional changes in individuals in the postoperative period. This study aimed to determine the experiences of individuals undergoing bariatric surgery regarding their nutritional behaviors.Methods and Patients: This study was conducted as qualitative research with purposal sampling method in hermeneutical phenomenological design. Data were collected using a semi-structured interview form through in-depth interviews with 13 participants at a public hospital in T & uuml;rkiye between November 2021 and March 2023. Face-to-face interviews were audio-recorded and conducted until data saturation was reached. MAXQDA 2022 software was utilized to analyze the data. The study adhered to the consolidated criteria for reporting qualitative research checklist for reporting.Results: Through data analysis, four main themes (nutritional behavior after surgery, changes in eating behavior after surgery, challenges associated with bariatric surgery, and coping strategies) were created. The first main theme had two main themes and five subthemes. The second main theme had five subthemes. The third and fourth main themes had four subthemes.Conclusion: Our study highlights the changes in nutritional behavior, difficulties getting used to a new life, and coping mechanisms after bariatric surgery were clarified. Despite many changes and negative experiences, individuals developed coping strategies
Optimizing net-zero energy strategies in airports through a hybrid multi-method framework
Get PDFThis study introduces a hybrid decision-making framework to evaluate and prioritize energy retrofit strategies in airport infrastructure, addressing the dual goals of sustainability and operational feasibility. The proposed model integrates the Non-Dominated Sorting Genetic Algorithm II (NSGA-II) for generating Pareto-optimal solutions, K-Means clustering for classifying strategies, and the Pythagorean Fuzzy Analytic Hierarchy Process (PFAHP) for prioritizing alternatives under uncertainty. The framework was applied to a representative mid-sized international airport scenario, constrained by a maximum budget of 850,000 to 1,000,000, with an 11.03-month timeline and moderate disruption level (4.09). Cluster analysis grouped solutions into three profiles: low-cost (average cost 906,250, energy savings 23.75%), and high-impact (average cost $973,750, energy savings up to 30%). Sensitivity analysis further confirmed the robustness of the prioritization, with only minor score fluctuations under adjusted scenarios. These findings provide concrete, actionable guidance for airport decision-makers to support strategic energy retrofit investments aligned with ICAO's CORSIA framework and UN Sustainable Development Goals, enabling tangible progress toward net-zero operations
The effect of preoperative oral carbohydrate administration on postoperative glucometabolic response, subjective well being and quality of life in patients undergoing colorectal surgery: a randomized controlled double-blind study
No full textBackground Prolonged preoperative fasting may increase anxiety, insulin resistance, and surgical stress, whereas preoperative carbohydrate loading has been shown to improve metabolic response, reduce complications, and enhance recovery, as supported by ERAS protocols. Objectives This study aimed to examine the effects of preoperative oral carbohydrate ingestion on postoperative glucometabolic response, subjective well-being, quality of life, and surgical clinical outcomes in patients undergoing colorectal surgery. Methods A prospective, randomized controlled double-blind study was conducted in a hospital in the Aegean region of T & uuml;rkiye, including 50 patients scheduled for elective colorectal surgery. Data were collected using a structured form that included sociodemographic information, perioperative laboratory values, subjective well-being indicators, and the SF-36 Quality of Life Scale. The intervention group received 800 mL of a carbohydrate drink until midnight and 400 mL two hours before surgery; the control group received the same volumes of water. Participants, outcome assessors, and statistical analysts were blinded to group assignments. The researcher who administered the drinks was aware of group allocation but was not involved in outcome evaluation or data analysis.ResultsThe intervention group had shorter time to first flatulence (40.60 +/- 4.52 vs 46.00 +/- 4.22 h, p < 0.001), earlier defecation (68.64 +/- 7.94 vs 81.84 +/- 8.97 h, p < 0.001), earlier oral feeding (43.80 +/- 4.84 vs 48.44 +/- 3.87 h, p < 0.001), and shorter hospital stay (10.64 +/- 1.52 vs 14.32 +/- 3.69 days, p < 0.001) compared to the control group. Postoperative albumin levels were significantly higher and CRP levels significantly lower in the intervention group at 24 h. The SF-36 physical functioning score was significantly higher in the intervention group compared to the control group (82.00 +/- 11.81 vs 61.40 +/- 16.17, p < 0.001). No significant differences were found in insulin resistance (HOMA-IR), gastric volume, or pH between groups. Conclusion Preoperative oral carbohydrate intake was associated with improved clinical recovery indicators and quality of life outcomes. In particular, it contributed to earlier return of bowel function, reduced postoperative discomfort, and significantly shorter hospital stay, indicating enhanced postoperative recovery in patients undergoing colorectal surgery. Trial registration First registered on 30.05.2022, NCT05402592 by ClinicalTrials.gov
Exergy and economic approaches for integrating power and green hydrogen production with a novel solar-ORC system
No full textIn this study, a hydrogen production system integrated with a solar-organic Rankine cycle (S-ORC) system is examined. Experimental studies on the generation of electrical energy at low temperatures are relatively limited in the literature, as low temperatures are typically preferred for thermal energy production in domestic applications. This study presents experimental results regarding the use of different working fluids in the ORC system. A evacuated tube heat pipe solar collector (ETHPSC) was employed to harness solar energy. The thermal energy obtained from the collector was utilized in the integrated ORC system. Various fluids were comparatively analyzed within the S-ORC system. The net energy produced by the ORC system was entirely used for hydrogen production in an electrolyser. The results indicate that the exergy efficiencies of the entire system for hydrogen production were calculated as 6.67 %, 7.13 %, 9.56 %, and 7.59 % when using R134a, R1234yf, R410a, and R32 as working fluids in the ORC system, respectively. Furthermore, at higher collector outlet temperatures, the lowest hydrogen production cost of $0.9793/kg was achieved when R1234yf was used as the working fluid
Molecular and thermal signatures of dental tissues in third molars: An in vitro comparative study using fourier-transform infrared spectroscopy and differential scanning calorimetry
No full textObjective: To characterize and compare the molecular and thermal characteristics of enamel, dentin, cementum, and the dentin-pulp complex in permanent third molars using Fourier-transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC). Design: Samples from extracted third molars (n = 15) were prepared and analyzed using FTIR to assess molecular composition and DSC to evaluate thermal transitions, including dehydration, collagen degradation, and mineral phase transformation. All measurements were conducted in triplicate. Results: FTIR revealed enamel as highly mineralized with minimal organic content, dentin and cementum as collagen-rich, and the dentin-pulp complex as a hybrid tissue. DSC analysis identified consistent thermal transitions: water loss (110-125 degrees C), collagen breakdown (300-320 degrees C), and mineral decomposition (455-470 degrees C). Enamel displayed the highest crystallinity, while cementum exhibited the highest enthalpy change. Tissues with stronger FTIR collagen peaks corresponded to higher DSC energy release during protein degradation. Conclusion: Molecular and thermal profiling of dental tissues provide baseline reference data for biomaterial design and regenerative strategies. Clinical significance: Understanding tissue-specific molecular and thermal properties can guide the development of biomimetic restorative materials, inform safer thermal thresholds during clinical procedures, and support diagnostic approaches for aging and pathological changes
