Anal fissürde semptom süresinin botulinum toksini uygulaması sonrası sonuçlara etkisi

Aim: To assess the effect of duration of the symptoms on outcome after botulinum toxin injection in anal fissure treatment. Method: Data of the patients who underwent botulinum toxin injection for chronic anal fissur were reviewed. Patients with a minimum follow-up of 18 months were included. One-hundred IU botulinum toxine was injected in the internal anal sphincter through 4 quadrants. Follow-up was carried out by clinic visits on post-procedure days 7, 15 and 30 and by telephone survey in 3, 6, 12 and 18th months. Refractory symptoms or recurrence were recorded as failure. The relationship between duration of the symptoms and failure was investigated and a cut-off value was determined. Patients were divided into two groups according to duration of the symtoms and outcome was compared with the patients who underwent lateral internal sphincterotomy within the same period. Results: There were 56 patients fulfilling inclusion criteria. Mean age was 33.1±9.4 and 39 (69.6%) patients were female. Presence of the symptoms longer than 8.5 months was predicting treatment failure (Area under curve: 0.721, confidence interval: 0.500-0.942, p=0.037). There were 38 patients in shorter symptoms group, 18 patients in longer sypmtoms group and 32 patients in lateral internal sphincterotomy group. The compelte healing rates after 21 (18-28) months of median survival were 61.1% in longer symptom botulinum toxin group, 94.7% in shorter symptom botulinum toxin group and 96.2% in lateral internal sphincterotomy group (p=0.003). One patient in botulinum toxin groups had local hematoma and one (3.1%) had minor incontinence in lateral internal sphincterotomy group. Conclusion: Botulinum toxin has similar outcome with lateral internal sphincterotomy in patients with shorter suration of sypmtoms. Proper patient selection may contribute to the success of the treatment in chronic anal fissur.Amaç: Anal fissürde semptom süresinin botulinum toksini uygulaması sonrası tedaviye yanıtsızlık ve nüks üzerindeki etkisini araştırmaktır. Yöntem: Mart 2016’dan itibaren anal fissür nedeniyle botulinum toksini uygulanan hastaların verileri incelendi. Takip süresi en az 18 ay olan hastalar çalışmaya dahil edildi. Hastalara internal sfinktere 4 kadrandan 100 IU botulinum toksin-A uygulandı. İşlem sonrası 7, 15, 30. günlerde poliklinik kontrolü ile; 3, 6, 12 ve 18. aylarda telefonla aranarak değerlendirme yapıldı. Botulinum toksini uygulamasına yanıtsızlık ya da nüks başarısızlık olarak kaydedildi. Semptom süresi ve başarısızlık arasındaki ilişki alıcı işletim karakteristiği analizi ile araştırıldı ve bulunan kesme değerine göre iki gruba ayrılan botulinum toksini uygulanan hastalar aynı dönemde lateral internal sfinkterotomi ile tedavi edilmiş hastalarla karşılaştırıldı. Bulgular: Botulinum toksini uygulanan 56 hastada ortalama yaş 33,1±9,4 idi. Hastaların 39’u (%69,6) kadındı. Ortalama semptom süresi 8,5±7,4 aydı. Ortanca 21 (18-28) aylık izlem süresinde 47 (%83,9) hastada iyileşme oldu. Semptom süresinin 8,5 aydan uzun olması tedavi başarısızlığını öngörmekteydi (Eğri altındaki alan: 0,721, güven aralığı: 0,500-0,942, p=0,037). Hastalar semptom süresine göre 2 gruba ayrılarak aynı dönemde lateral internal sfinkterotomi yapılan 32 hasta ile sonuçları karşılaştırıldı. İyileşme oranları semptom süresi uzun olan botulinum toksini grubunda %61,1, semptom süresi kısa olan botulinum toksini grubunda %94,7 ve lateral internal sfinkterotomi grubunda %96,2 idi (p=0,003). Botulinum toksini uygulaması sonrası 1 hastada lokal hematom, lateral internal sfinkterotomi uygulaması sonrası 1 (%3,1) hastada minör inkontinens görüldü. Sonuç: Anal fissür tedavisinde botulinum toksini uygulaması semptom süresi kısa olan hastalarda lateral internal sfinkterotomi ile benzer etkinliktedir. Botulinum toksini uygulamasında hasta seçimi tedavi başarısını etkileyebilir

A real context problem for consolidating the similarity

Bu çalışma, 5-7 Şubat 2015 tarihleri arasında Atina[Yunanistan]'da gerçekleştirilen 7. World Conference on Educational Sciences'de bildiri olarak sunulmuştur.Constructing a new mathematical structure depends on conceptual understanding and connection with previous constructs. For the purpose of obtaining a new mathematical structure, the process of constructing a concept is defined as abstraction. The weaknesses of new structures that are generated create need their consolidation and so consolidation has been added as a step of the abstraction process. The purpose of this case study is to examine the solving process of a real context problem for consolidating similarity of triangles. The participants are two mathematics education master students. Consequently, it has been determined that participants have similarity knowledge theoretical but in order to consolidate it, they have to encounter more real context problems

Factors associated with postoperative chronic pain and recurrence after laparoscopic total extraperitoneal inguinal hernia repair

Objective: To assess the risk factors for chronic pain and recurrence after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Methods: Data of the patients who underwent laparoscopic TEP repair were analyzed. Clinical and surgical characteristics, including learning curve, mesh weight, the pore size of the mesh, use of mesh fixation, and fixation methods, were assessed. Fixation by absorbable or nonabsorbable tackers was performed in all procedures except for self-fixating meshes. Mesh brands were tiered into groups regarding pore size and weight. Operative time was defined as the duration between skin incision and dressing. The minimum follow-up was 24 months. Postoperative chronic pain was defined as moderate to severe groin pain, which was accepted as a Visual Analog score ≥3 longer than three months. Pain and recurrence were evaluated at 1 and 6 weeks in clinic visits and at 3, 12, and 24 months by telephone questionnaires. The occurrence of a fascial defect in physical examination or ultrasound was defined as recurrence. Results: Three-hundred and eighty-two procedures were included. Postoperative chronic pain was seen in 31 (8.1%) patients and was higher with micropore mesh (p=0.004), mesh fixation (p=0.002), fixation with titanium tacks (p<0.001) and at first 50 cases (p=0.043). Fifteen (3.9%) patients had a recurrence. Older age (p=0.046), prolonged operative time (p=0.040), body mass index (BMI) (p=0.008) and learning curve (p=0.034) were significantly associated with higher recurrence rate. In multivariate analysis pore size [Odds ratio (OR): 2.911, 95% confidence interval (CI): 1.153-7.351, p=0.024] and fixation with titanium tacks (OR: 8.776, 95% CI: 4.040-14.893, p=0.004) were independent risk factors for chronic pain; BMI (OR: 1.307-95% CI:1.138-1.501, p<0.001) was the only independent risk factor for recurrence. Conclusion: The outcome of laparoscopic TEP repair is related to the technic as well as patient-based factors. Titanium tacks and micropore meshes increase postoperative pain risk without any benefit on recurrence. Patients with higher BMI have an increased recurrence risk

Determination of the Activities Affected Due to Cold Intolerance after Peripheral Nerve Disorders

Objective:Our study was designed to determine the activities affected due to cold intolerance (CI) after peripheral nerve disorders.Methods:Participants aged 18-65 who were diagnosed as having peripheral nerve disorder in the last year and whose activities were affected due to CI and who scored 30 or higher on the Turkish version of the CI Symptom Severity (CISS) questionnaire were included. The problematic activities due to CI were determined by a semi-structured interview. Activities were examined according to the third edition of the Occupational Therapy Practice Framework as activities of daily living (ADL), instrumental ADL (IADL), rest and sleep, education, work, play, leisure and social participation.Results:Fourty-five individuals (15 men, 30 women) with a mean age of 42.28±13.25 were included. The mean of the CISS score was 51.18±16.69. Twenty three different activities were identified. Due to CI, the most difficult activity for women was dishwashing and hand washing for men.Conclusion:Participants with peripheral nerve disorders had difficulty mostly in the ADL and IADL due to cold intolerance. It was found that exposure to cold air and water, decreased fine motor skills due to cold, grasping of cold objects, and exposure to cold in the workplace caused difficulties in these activities. We think that it should be considered that the activities in which individuals have problems may be caused by CI

Triangle inequality concept teaching: The theory of didactic situations case

The purpose of this study is to implement an a-didactical activity relating to the acquisition of the triangle inequality, prepared within the framework of the Didactic Situations Theory (TDS), and to report the experiences of the students during the implementation process. The study employs a case study method based on a qualitative approach. Six seventh-grade students in a middle-low socioeconomic secondary school in the Marmara Region of Türkiye participated in the study. The researchers prepared an a-didactical activity in which students discovered triangle inequality. Data were collected through observation, video recording, and worksheets. A descriptive analysis was performed on the data obtained. As a result of the analysis, it was concluded that students completed the activity with the correct expressions by experiencing different phases of the a-didactical situation

Prognostic value of the morphological features of postperfusion liver biopsies in liver transplantation

Purpose: The aim of this study was to show the potential prognostic effects of morphological findings for the graft function, rejection and survival by evaluating the postperfusion liver biopsies. Materials and Methods: Sixty six cases who underwent cadaveric liver transplantation between 2006-2010 were included. The representative slides of postperfusion subcapsular wedge biopsies were evaluated for intrasinusoidal neutrophilic infiltration, microvesicular steatosis, hepatocyte swelling, hepatocellular necrosis, endothelial swelling, bile duct epithelial changes, cholangiolar proliferation and sinusoidal congestion/hemorrhage. The associations between the histopathological features and early allograft dysfunction, mortality rate and rejection status were statistically analysed. Results: Intrasinusoidal neutrophilic infiltration was grade 1 in 40 (60%), grade 2 in 24 (36%), and grade 3 in 2 cases (4%). The presence of grade 2-3 intrasinusoidal neutrophils was found to be significantly associated with mortality rate. The presence of sinusiodal congestion/hemorrhage was statistically related to the rejection. The presence of sinusiodal congestion/hemorrhage was significantly associated with shorter overall survival. Conclusion: Intrasinusoidal neutrophilic infiltration is promising to be a possible histopathological predictor for mortality. In addition, the presence of sinusoidal congestion can be a candidate as a prognostic factor both for rejection and overall survival based on our study.Amaç: Bu çalışmada, perfüzyon sonrası karaciğer biyopsileri değerlendirilerek morfolojik bulguların greft fonksiyonu, rejeksiyon durumu ve sağkalım üzerindeki potansiyel prognostik etkilerinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: 2006-2010 yılları arasında kadavradan karaciğer nakli yapılan 66 olgu çalışmaya dahil edildi. Postperfüzyon kama biyopsilerine ait kesitler, intrasinüzoidal nötrofilik infiltrasyon, mikroveziküler steatoz, hepatosit şişmesi, hepatoselüler nekroz, endotelyal şişme, safra kanalı epitel değişiklikleri, kolanjiyolar proliferasyon ve sinüzoidal konjesyon/hemoraji açısından değerlendirildi. Histopatolojik özellikler ile erken allogreft disfonksiyonu, mortalite oranı ve rejeksiyon durumu arasındaki ilişkiler istatistiksel olarak analiz edildi. Bulgular: İntrasinüzoidal nötrofilik infiltrasyon 40 olguda (%60) derece 1, 24 olguda (%36) derece 2 ve 2 olguda (%4) derece 3 idi. Derece 2-3 intrasinüzoidal nötrofil varlığının mortalite oranı ile, sinüzoidal konjesyon/kanama varlığının rejeksiyon ile istatistiksel olarak anlamlı şekilde ilişkili olduğu saptandı. Ayrıca sinüzoidal konjesyon/hemoraji varlığının, daha kısa sağkalım süresi ile istatistiksel olarak anlamlı şekilde ilişkili olduğu bulundu. Sonuç: İntrasinüzoidal nötrofilik infiltrasyon, mortaliteyi öngörmek için olası bir histopatolojik belirleyici olma umudu taşımaktadır. Ayrıca çalışmamıza göre sinüzoidal konjesyon varlığı hem rejeksiyon hem de sağkalım için prognostik faktör olarak aday olabilir

Molecular investigation of mechanisms considered to cause preterm premature membrane rupture

Purpose: The aim of this study was to investigate the mRNA expression level of p16, CDK4, CDK6, Cyclin D, RB1, and E2F genes in preterm premature rupture of membrane (PPROM) cases and their roles in etiopathogenesis of PPROM.Materials and Methods: Twenty-one pregnancies with PPROM before 34th gestational weeks (study group) were compared with twenty pregnancies with no complication, who gave birth after 37th gestational-week (control group). Both groups chorioamniotic membranes were compared for mRNA expression of p16, cyclin D, CDK4, CDK6, RB1 and E2F genes.Results: The mRNA expression levels of p16, cyclin D, CDK4, CDK6, RB1and E2F genes decreased in the PPROM group compared to control group at a statistically significant level.Conclusion: Our findings have shown that oxidative stress may not act on the p16 pathway in these cases. In order to understand the molecular mechanism of PPROM, biomarkers of oxidative stress and aging should be evaluated together with other pathways related to aging and oxidative stress in future studies.Amaç: Bu çalışmanın amacı, preterm erken membran rüptürü (PEMR) vakalarında, p16 ile CDK4, CDK6, siklin D, RB1, E2F genlerinin mRNA ekspresyon seviyelerini ve bu genlerin etiyopatogenezdeki rollerini saptamaktır. Gereç ve Yöntem: Çalışmamızda 34. gebelik haftasından önce membran rüptürü olan 21 gebe (çalışma grubu) ile herhangi bir durumla komplike olmamış ve 37. gebelik haftasından sonra doğum yapmış 20 gebenin (kontrol) doğum sonu koryoamniyotik membranları incelendi ve bu iki grubun koryoamniyotik membran örnekleri p16, siklin D, CDK4, CDK6, RB1 ve E2F genlerinin mRNA ekspresyon seviyeleri açısından karşılaştırıldı. Bulgular: Çalışmamızda, kontrol grubu ile kıyaslandığında p16, siklin D, CDK4, CDK6, RB1 ve E2F genlerinin ekspresyon seviyelerinin PEMR grubunda anlamlı derecede azaldığı saptandı. Sonuç: Bulgularımız bu vakalarda oksidatif stresin p16 yolağı üzerinden etki etmeyebileceğini göstermiştir. PEMR’nin moleküler mekanizmasını anlamak için, gelecekteki çalışmalarda oksidatif stres ve yaşlanma biyobelirteçleri ile yaşlanma ve oksidatif streste görevli diğer yolaklar birlikte değerlendirilmelidir.Cukurova Universit

Licea pescadorensis, Türkiye için yeni bir miksomiset kaydı

Bu çalışmada Licea pescadorensis Chao H. Chung & C.H. Liu, Türkiye'de ilk defa rapor edilmiş, Türkiye miksobiotasına ilave edilmiştir. Bu tür laboratuvar çalışmaları sonucunda nem odası tekniği ile laboratuvarda elde edilmiştir. Yeni kayıt örneğe ait fruktifikasyonu ve mikroskobik yapısına ait özellikleri ışık mikroskobu yardımıyla verilmiştirIn this study, Licea pescadorensis Chao H. Chung & C.H. Liu was recorded for the first time from Turkey and added to the myxobiota of Turkey. As a result of laboratory studies we identified this species with moist chamber culture method in laboratory. Fruiting bodies and microscopic structures photographs belonging to new record was taken with light microscop