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Patterns of disease progression (PD) and efficacy associated with tumour burden from the phase III IMforte study of lurbinectedin (lurbi) plus atezolizumab (atezo) as first-line (1L) maintenance treatment (tx) in ES-SCLC
No full textInvestigation of the Atmospheric Turbulence Effects on Electro-Optical Reconnaissance Imaging Systems in the Marine Environment
No full textAtmospheric turbulence has a disruptive effecton the optical spectrum of the atmosphere in reconnaissance surveillancesystems and especially in military laser operations. The main cause ofatmospheric turbulence is that the atmosphere is composed of different gas andaerosol contents and is also subject to meteorological effects. To eliminatethe disturbing effects of atmospheric turbulence, it is important to know theturbulence intensity. However, due to the complex structure of the atmosphere,knowing the atmospheric turbulence intensity is a difficult problem to solve.Due to the impossibility of turbulence measurements, especially at longdistances, atmospheric turbulence prediction models have been developed. It ispreferred to use estimated atmospheric turbulence values for fast information,when navigating over the sea because of this measurement difficulty. This studydiscusses, the effects of atmospheric turbulence on electro-opticalreconnaissance and surveillance systems in the marine environment have beendiscussed. For this purpose, atmospheric turbulence predictions were made bycollecting meteorological parameters in 4 different seasons of 2023 in theMarmara region and using the Sadot-Kopeika prediction model. Atmosphericturbulence measurements were also made at the same location and in the sametime periods and compared with the prediction results. To investigate theeffects of the atmospheric turbulence on the performance of electro-opticalreconnaissance and surveillance systems, DRI (Detection-Recognition-Identification)analyses of an electro-optical sensor were carried out with the NVIPM (NightVision Integrated Performance Model) software. The predicted and the measuredatmospheric turbulence values have been used in the DRI analyses. When the DRIanalysis results were evaluated, it was seen that the performance percentagesusing the predicted atmospheric turbulence values were compatible with theperformance percentages using the measured atmospheric turbulence values. Basedon these results, it has been foreseen that by predicting atmosphericturbulence, countermeasures to be taken against turbulence can be developed andelectro-optical reconnaissance surveillance systems can also gain the abilityto estimate turbulence based on turbulence-induced distortions in the pixels ofthe cameras.</p
Fonksiyonel Derecelendirilmiş Ti6Al4V/Grafit Kompozitlerin Tribolojik Davranışlarının İncelenmesi
No full textConventional single-phase materials often exhibit insufficient thermo-mechanical stability and surface durability under engineering conditions involving high temperature, friction, and complex stress gradients. Functionally graded materials (FGMs) have emerged as advanced engineering solutions, providing superior performance through the gradual variation of material properties. In this study, graphite-reinforced functionally graded Ti6Al4V metal matrix composites were fabricated using pressure-assisted sintering, and their microstructural, mechanical, and tribological behaviors were comprehensively investigated. After homogeneous mixing of the composite powder containing 10 wt.% graphite, a bilayer structure consisting of an upper Ti6Al4V/graphite layer (1000 µm) and a lower 100% Ti6Al4V layer (3000 µm) was produced. The processing parameters were fixed at 950 °C, 45 MPa, and 45 min under a vacuum atmosphere of 10-4 mbar. Microstructural observations revealed uniform distribution of graphite along the Ti6Al4V particle boundaries, accompanied by grain refinement across the upper, transition, and lower layers. The graphite addition suppressed the β phase and promoted an α-phase-dominant structure in the upper layer. Consequently, the hardness increased from 355 ± 4.2 HV0.5 in the lower layer to 407 ± 3.5 HV0.5 in the upper layer due to microstructural refinement. Tribological tests demonstrated that graphite reduced the coefficient of friction by approximately 50% confirming its effective solid-lubricant behavior. Overall graphite reinforcement markedly enhanced the microstructural integrity, mechanical strength, and wear resistance of Ti6Al4V-based functionally graded composites.</div
Baş Boyun Cerrahisinde Nadir Bir Anatomik Varyasyon: Internal Juguler Ven Duplikasyonu
No full textGİRİŞ-Amaç:Literatürde baş-boyun bölgesi cilt kanserleri, tümkanser vakalarının yaklaşık %4–5’ini oluşturmaktadır.Cilt kanserleri, genellikle bazal hücreli karsinom (BCC),skuamöz hücreli karsinom (SCC) ve malign melanom olmaküzere üç ana grupta sınıflandırılmaktadır. Bu kanserlerinyaklaşık %80–90’ı, güneş ışınlarına en fazla maruz kalananatomik bölge olması nedeniyle, baş-boyun bölgesindegelişmektedir. Baş-boyun kanserlerinde bölgesel lenfnodu metastazı sıklığı; tümörün lokalizasyonu, evresive histopatolojik alt tipine bağlı olarak değişkenlikgöstermektedir.Literatürdeki bulgulara göre, baş-boyun skuamöz hücrelikarsinomlarında (en yaygın histolojik tip) %30–50 oranındabölgesel lenf nodu metastazı izlenmektedir. Orofarenks,hipofarenks ve supraglottik larenks tümörlerinde bu oran%60’a kadar çıkabilmektedir. Dilin arka üçte biri gibiyüksek riskli alanlarda ise metastatik yayılım riski daha daartmaktadır. Özellikle ağız tabanı, dil, tonsil ve hipofarenkskaynaklı tümörlerde lenf nodu tutulumu riski yüksektir.Lenf nodu metastazı, hastalığın prognozunu belirleyen enönemli faktörlerden biri olup, 5 yıllık sağkalım oranlarını%50’ye kadar azaltabilmektedir. Bu nedenle, baş-boyunkanserlerinde bölgesel lenf nodu diseksiyonu (boyundiseksiyonu) endikasyonu; tümörün anatomik yerleşimine,klinik evresine ve lenfatik yayılım potansiyeline görebelirlenmektedir.Baş-boyun SCC olgularında hastaların yaklaşık %50–70’ine boyun diseksiyonu uygulanmaktadır. Bu bağlamda,cerrahi sırasında bölgedeki anatomik yapıların ve olasıvaryasyonların ayrıntılı şekilde bilinmesi, komplikasyonlarıen aza indirmek açısından cerrah açısından kritik önemesahiptir. İnternal juguler venin perkütan kateterizasyonuher zaman risk içermekle birlikte, özellikle duplikasyongibi anatomik varyasyonlar varlığında bu risk artmaktadır.Diğer tüm anatomik anomalilerde olduğu gibi, bu türvaryasyonlar da cerrahi girişimler sırasında iatrojenikyaralanma olasılığını artırabilir. Bu olguda, internaljuguler ven varyasyonlarının anatomik özelliklerini veklinik etkilerini değerlendirmek amacıyla kliniğimizdegözlemlenen bir vaka üzerinden tartışma yapılmasıhedeflenmiştir.Olgu:82 yaşında erkek hastada, sol nazolabial bölgede yerleşimlimalign melanom tanısı ile eksizyon, tam kalınlıkta deri greftiile rekonstrüksiyon ve sentinel lenf nodu biyopsisi (SLNB)uygulanmıştır. SLNB sonrası nodal metastaz saptanmasıüzerine, sol boyun bölgesinde Level I, II ve III’ü kapsayanselektif boyun diseksiyonu gerçekleştirilmiştir.İntraoperatif değerlendirmede, internal jugulervenin infrahiyoid seviyede posterior yerleşimli olarakduplike olduğu gözlemlenmiştir. Cerrahi sırasındasternokleidomastoid (SKM) kas ve aksesuar sinir (n.accessorius) tanımlanmış ve anatomik bütünlüklerikorunmuştur.Tartışma- Sonuç:İnternal juguler ven (IJV), kafatası, yüz ve boyunbölgelerinden kan toplayan, boynun temel derin venözyapısıdır. Sigmoid sinüsün devamı olarak, kafatasıtabanındaki juguler foramen aracılığıyla başlar veklavikulanın arkasında subklavyen vene drene olur.Internal juguler ven duplikasyonu, boyun cerrahilerisırasında nadiren karşılaşılan anatomik bir varyasyondur.Literatürdeki verilere göre insidansı, yaklaşık 1000 tektaraflı boyun diseksiyonu vakasında yalnızca 4’tür. Buanormallik, normalde tek olarak seyreden IJV’nin, ikiayrı damar olarak bulunması şeklinde tanımlanır. Sözkonusu varyasyonun tanınması ve anlaşılması, cerrahlarınintraoperatif komplikasyonlardan kaçınmaları ve başarılıbir cerrahi sonuç elde etmeleri açısından büyük önemtaşımaktadır.IJV duplikasyonu, varyasyonun başladığı seviyeye göreSandeep P. Nayak ve arkadaşları tarafından üç tipeayrılarak sınıflandırılmıştır:Tip A: Duplikasyon, venter posterior musculi digastrici’ninalt sınırının üzerinde başlar ve omohyoid kasın tendinözkısmı seviyesinde birleşir. Bu tip, bildirilen IJVD vakalarının%75’inden fazlasını oluşturur ve morfolojik açıdan en azkarmaşık varyasyondur.Tip B: Duplikasyonun omohyoid kasın tendinöz kısmınınaltına kadar uzanması, Tip B’yi Tip A’dan ayıran temelözelliktir. Bu varyasyon daha kaudaldir ve cerrahiplanlamada dikkate alınmalıdır. Tip C: En kompleks varyasyonlardan biridir. Duplikasyon,hyoid kemik seviyesinde veya daha altında başlar.Literatürde, bu tipin jugular bulbus, vertebral venve subklavyen venöz sinüs ile ilişkili olduğu vakalarbildirilmiştir.Internal juguler ven, genellikle tutarlı bir anatomik seyirizlediğinden, boyun diseksiyonları sırasında önemlibir referans noktasıdır. Gerçekleştirilen diseksiyonunkapsamına bağlı olarak, IJV çevresindeki nodal doku,damarın kendisi, aksesuar sinir ve/veya sternokleidomastoidkas için yönlendirici bir yapı niteliği taşır.İnternal juguler ven duplikasyonu, halen tam olarakanlaşılmamış nadir bir konjenital anomalidir. Bu nedenle,mevcut literatürde bildirilen duplikasyon morfolojilerinedayanan sınıflandırma sistemlerinin iyi bilinmesi vecerrahi sırasında dikkate alınması, olası komplikasyonlarınönlenmesi açısından büyük önem arz etmektedir.Kaynakça:1-Pittman K, Fan CY. Neck dissection: current conceptsand future directions. Oncologist. 2005;10(6):472-482.2-Lydiatt WM, et al. Head and Neck cancers—majorchanges in the American Joint Committee on Cancereighth edition cancer staging manual. CA Cancer J Clin.2017;67(2):122-137.3-Internal Jugular Vein Duplication: Review andClassification, Indian J Surg Oncol (June 2017) 8(2):222–226 DOI 10.1007/s13193-015-0452-64-Shah JP, et al. “Cervical lymph node metastases—diagnostic, therapeutic, and prognostic implications.”Oncology (Williston Park).5-Robbins KT, et al. “Neck dissection classification update:revisions proposed by the American Head and NeckSociety.” Arch Otolaryngol Head Neck Surg.6-Denys BG, Uretsky BF (1991) Anatomical variations ofinternal jugular vein location: impact on central venousaccess. Crit Care, Med 19:1516–1519 Munoz GuerraMF, Campo FR, Gias LN et al (2000) Double internal jugular vein. Plast Reconstr Surg 106:1434–14357-Sylaidis P, Bardsley A, Montgomery P (1997) Duplicationof inter-nal jugular vein. Arch Otolaryngol Head Neck Surg123:13588-Mumtaz S, Singh M. Surgical review of the anatomicalvariations of the internal jugular vein: an update for headand neck surgeons. Ann R Coll Surg Engl 2019;101 (1):2–6.9-Kapre M, Mangalgiri AS. Clinical importance of duplicationof internal jugular vein. Indian J Otolaryngol Head NeckSurg 2012 Dec;64:386–8.Anahtar Kelimeler: Baş boyun kanserleri, BoyunDiseksiyonu, Duplikasyon, İnternal juguler ven</p
Şeyh Alâuddin Ohinî'nin "Hidâyetü's-Sıbyân" adlı manzum tecvid eserinin Nurullah Godişkî'ye ait "El-Himyân bi Şerh-i Hidâyeti's-Sıbyân" isimli şerhi (İnceleme ve tahkîk)
No full textPrevalence of Juvenile Fibromyalgia Syndrome in Turkish Patients with Juvenile Idiopathic Arthritis: A Multicenter Study.
No full textRedesigning the Turkish Civil Litigation System in the Light of Online Dispute Resolution (ODR)
No full textCurrently, there are important developments across the world concerning online dispu-te resolution (ODR) methods. It would not be wrong to consider these ODR developments as a new movement, similar to the alternative dispute resolution (ADR) methods available in the European Union. Therefore, these developments may have effects throughout judicial sys-tems. In the long run, the existence of ODR-infused judicial procedures may be deemed es-sential for adequate access to justice. In this article, we tried to rethink the Turkish civil litiga-tion system in the light of ODR. It should be stressed that technology cannot solve all the problems of the judiciary. However, if technology can be applied properly and carefully, even-tually it would be possible to find solutions for some of the structural flaws inherent in the current Turkish civil litigation system. Such a result would not be a small achievement in terms of access to justice.</p
Emotional experiences, difficulties, and facilitators in patient care of nurses working in surgical units: a qualitative study
No full textBackground: Nurses working in surgical clinics have to cope with intense emotional processes in addition to providing physical care to patients. This situation causes nurses to expend significant emotional labor while performing their professional roles and to encounter various psychosocial effects. Objectives: The aim of this study is to identify the emotional states of nurses working in clinical settings and the factors that influence these states, and to establish a scientific basis for planning the development of nurses’ emotional competence. Methods: This study is a qualitative research that aims to explore the lived experiences of the participants. The data were collected between May and September 2024 at a hospital in Kocaeli province using a semi-structured interview form. In-depth interviews were conducted face-to-face with 15 nurses, and each interview lasted approximately 30 to 60 min. The data obtained were evaluated using thematic analysis. Qualitative data were collected in accordance with COREQ criteria. Results: Five main themes were identified as a result of the analysis: Emotions, emotional burdens, emotional impacts, facilitators and the barriers. The findings clearly show that nurses work not only with technical knowledge and skills but also with a high level of emotional labor. Surgical nurses’ efforts to respond to patients’ physical and psychological needs with a holistic approach highlight their human qualities such as empathy, patience, compassion, and emotional resilience. Conclusion: The emotional needs of nurses working in surgical clinics should be taken into consideration; they should be supported with in-service training on emotional intelligence, stress management, and clarity of nursing roles. Nurses need to be empowered with a strong social support network to prevent professional burnout. Additionally, it is important for managers to view nurses not merely as labor but as individuals with emotional needs to ensure sustainable healthcare services. Clinical trial number: Not applicable
Factors influencing the prescription of add-on long-acting muscarinic antagonists in real-world asthma management: Insights from a national registry
No full textCurrent guidelines recommend adding long-acting muscarinic antagonists (LAMAs) in patients with uncontrolled asthma, despite the use of moderate to high doses of inhaled steroid-long-acting beta agonists (ICS/LABA). This study aims to analyze the factors related to the prescription of add-on LAMA in clinical practice for asthma patients, shedding light on physicians' preferences. This study included adult asthma patients on add-on LAMA and ICS/LABA monitored for at least one year in a national registry comprising 2053 asthmatics. Patients' characteristics and disease profiles were analyzed to identify factors associated with the prescription of add-on LAMA across the entire cohort. A comparative analysis was performed among three groups: MART (ICS/formoterol as a maintenance and reliever therapy) plus LAMA, Conventional (ICS/LABA as a maintenance and short-acting beta agonist as reliever) plus LAMA and Triple (ICS/ LABA/LAMA single inhaler). LAMAs were added to ICS/LABA in 11.7 % of patients in the national registry. Logistic regression analysis revealed that older age, low FEV1 (%), Asthma Control Test (ACT) scores less than 20, and severe exacerbation were the main factors influencing the initiation of LAMA in our registry. However, demographic characteristics of asthma, control status, pulmonary function test results were similar among the three groups of LAMA users (p > 0.05). Physicians used LAMAs without phenotyping based on allergic status or eosinophil levels (p > 0.05). Mepolizumab was added after LAMA in all patients, while omalizumab was initiated before LAMA in 16.9 % of the patients receiving LAMA along with biologics. Add-on LAMAs were predominantly prescribed for older, uncontrolled, and exacerbated asthma patients with low FEV1