Pediatric Choledochal Cysts: Unknowns are Decreasing

Choledochal cysts (CCs) are congenital cystic dilatation of extrahepatic and/or intrahepatic bile ducts. CCs are more common in Asian population, the cause is still unknown. Although the etiology is controversial, the main elements in the natural historical emergence of the type I and type IV, which make up the majority of all types, have become clearer. The majority of CCs are diagnosed in childhood. Clinical presentation varies from jaundice in young patients to nonspecific abdominal pain in older, but morbidity increases with complications such as cholangitis, pancreatitis, perforation, hepatitis, liver failure, and malignancy in delayed diagnosed patients. MRCP is considered the current gold standard diagnostic modality that is able to accurately assess biliary anatomy. Although the treatment approach has been formed over the years, it still has not reached the last state. Eventually, the removal of the entire cyst and the reconstruction of the remaining biliary tract to drainage is the current treatment approach. But the dilemma is the way of reconstruction procedure (hepaticoduodenostomy or hepaticojejunostomy). All patients should be followed up for a long period of time, regardless of the surgery method

Denizli kentinin planlama deneyimi

Bu araştırmanın amacı: Denizli kentinin mekânsal ve işlevsel gelişim sürecini yönlendiren yaşanmış ya da yaşanmakta olan planlama deneyimlerinin, “kırılma noktaları” ve “gelişme dinamikleri” olarak tanımlanan faktörler eşliğinde ayrıntıda irdelenmesidir. Bu irdelemeler sonunda; 1960’lı yıllarda başlayan Nazım Plan çalışmalarının ilk gelişme dinamiği olduğu, ilk kırılma noktasının ise 1976 depremi olduğu belirlenmiştir. Özellikle 1980lerden 1990’lara dek uzanan süreçte ise hızlı sanayileşmeye koşut hızlı göç ve kentleşme olguları ile mücavir alan tartışmaları eşliğinde mevzii imar planlarının kentsel gelişmeleri yönlendirdiği bir deneyim yaşandığı belirlenmiştir. 2006 yılında yakın çevre belde belediyelerinin Denizli Belediyesine bağlanmasına ilişkin olarak çıkarılan yasal düzenlemenin ise kentin geleceğe dönük kentsel gelişme süreci ve planlama deneyimleri açısından önemli bir planlama aracı olacağı düşünülmektedi

Pathophysiology, Clinical Features and Treatment of Microvascular Angina: a Review

DergiPark: 819528tmsjMicrovascular angina is a non-obstructive coronary syndrome which presents itself as anginal chest pain with different features compared to other causes of angina pectoris. Although, it occurs through a similar mechanism with the better-understood variant (prinzmetal) angina, unlike the former, microvascular angina affects the subendocardial thin, therefore less compliant vessels. It is essential for every medical practitioner to recognize a patient with microvascular angina, as the disease has some characteristic presentations, does not respond well to the classical treatments for angina pectoris, and eventually may result in serious complications later

Küresel bombeli basınçlı kap analiz ve tasarımı

In this study, a hemispherical head with pad reinforced central nozzle opening that subjected to uniform internal pressure was investigated using Finite Element Methods (FEM) to understand the design procedure. This procedure is handled according to the ASME Boiler and Pressure Vessel Code Section VIII Division 2. This standard contains two parts for the design of pressure vessels, the first part is Design by rules and the second part is Design by analysis. With reference to the ASME standard, axisymmetric finite element models for Elastic, Limit Load and Elastic-Plastic Analysis are used to demonstrate protection against plastic collapse and local failure. Maximum allowable pressures are obtained in accordance with the mentioned design methods and discussed. According to the elastic and limit load analysis methods, obtained plastic collapse results are very close. Besides, the elastic analysis method is observed to be more conservative than the Elastic-Plastic method regarding the evaluation of plastic collapse. On the other hand, for the local failure results, Elastic-Plastic Analysis is observed to be slightly conservative than the Elastic Analysis.Bu çalışmada küresel bombe merkezinde ve kaynaklı plaka ile takviyelenmiş bir nozul açıklığı iç basınç yüklemesi altında sonlu elemanlar yöntemiyle tasarım prosedürünü anlamak amacıyla incelenmiştir. Bu prosedür ASME Boiler and Pressure Vessel Code Section VIII Division 2 standardına göre ele alınmıştır. Bu standart ilki “Formüller ile Tasarım” ve ikincisi “Analiz ile Tasarım” olmak üzere basınçlı kap tasarımı için iki farklı kısım içerir. ASME standardı referans alınarak, “Plastik Çökme” ve “Lokal Hasar” hasar modlarına karşı dayanımı doğrulamak için aksisimetrik sonlu eleman modelleri ile elastik, limit yük ve elastik-plastik analiz yöntemleri kullanılmıştır. Maksimum izin verilen basınçlar bu analiz yöntemlerine göre elde edilmiş ve değerlendirilmiştir. Elastik ve limit yük analiz metodlarına göre elde edilen plastik çökme sonuçları birbirine çok yakındır. Bunun yanında plastik çökme hasar modu için elastik analiz yönteminin elastik-plastik analiz yöntemine göre daha konservatif sonuçlar verdiği gözlemlenmiştir. Diğer yandan, lokal hasar modu için elastik-plastik analiz yönteminin elastik analize göre nispeten konservatif olduğu gözlemlenmiştir

Updates on the diagnosis and management of hepatocellular carcinoma

Introduction: Globally, the incidence, as well as mortality, related to hepatocellular carcinoma (HCC) is on the rise, owing to relatively few curative options. Underlying cirrhosis is the most common etiology leading to HCC, but risk factors of cirrhosis show great regional variability. Over the years, there has been a steady development in the diagnostic and therapeutic modalities of HCC, including the availability of a wide range of systemic chemotherapeutic agents. We aim to review the recent advancements in the diagnostic and therapeutic strategies for HCC.Methodology: The literature search was done using databases PubMed, Cochrane, and Science Direct, and the latest relevant articles were reviewed.Findings: Screening of HCC is a pivotal step in the early diagnosis of the disease. Current guidelines recommend using ultrasound and alfa fetoprotein but various new biomarkers are under active research that might aid in diagnosing very small tumors, not picked up by the current screening methods. Treatment options are decided based upon the overall performance of the patient and the extent of the disease, as per the Barcelona classification. There are very few options that offer a cure for the disease, ranging from liver resection and transplantation to tumor ablation. Downstaging has proven to have a significant role in the course of the disease. An attempt to control the disease can be made via radiological interventions, such as transarterial chemoembolization, transarterial radioembolization, or radiation therapy. For advanced disease, sorafenib used to be the only option until a couple of years ago. Recently, many other systemic agents have received approval as first-line and second-line therapies for HCC. Genomics is an area of active clinical research as understanding the mutations and genomics involved in the evolution of HCC might lead to a breakthrough therapy

Web uygulamaları için model bazlı test süreci otomasyonu

Yazılım sistemlerinin boyutları ve karmaşıklıkları arttıkça, bu sistemlerin test edilmesi daha maliyetli olmaktadır. Maliyeti düşürmek ve verimliliği artırmak için model bazlı test teknikleri geliştirilmiştir. Bu teknikler ile sistem kullanım modelinden otomatik olarak test senaryoları oluşturulabilmektedir. Fakat sistem modelinin manuel bir şekilde oluşturulması gerekmektedir. Ayrıca, model ile oluşturulan test senaryolarının sistem üzerinde otomatik çalıştırılmalarını sağlamak için betikler veya özel programlar geliştirilmesi gerekmektedir. Bu çalışmada, Web uygulamaları için model bazlı test sürecini otomasyon desteği ile iyileştirmekteyiz. Farklı araçları birleştirerek, sistem modelinin yarı-otomatik bir yöntem ile oluşturulmasını ve bu model ile oluşturulan test senaryolarının, ayrı bir program geliştirilmesine gerek olmaksızın, sistem üzerinde otomatik çalıştırılmalarını sağlamaktayız

Selenoprotein P levels in patients with diabetes mellitus with complications

Aims: Increasing evidence has shown that selenoprotein P levels are elevated in type 2 diabetes mellitus and are associated with insulin resistance and release. This study aimed to determine if there was a connection between selenoprotein P levels and metabolic parameters in patients with diabetes with microvascular complications. Methods: Serum selenoprotein P concentrations were measured by ELISA in 44 patients with diabetes with complications and 36 patients with diabetes without complications. Results: There was no statistically significant difference in selenoprotein P levels between the groups [1.9 (0.9–2.6) and 1.9 (0.8–2.4) ng/mL, respectively, p = 0.565]. Selenoprotein P, glucose, glycosylated hemoglobin, C-reactive protein, triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels were not statistically significantly correlated in patients with complications. However, there was a significant correlation with high-density lipoprotein cholesterol (r = − 0.401, p = 0.042). Conclusions: We did not find high selenoprotein P levels in patients with complications, but its inverse association with high-density lipoprotein cholesterol indicates that it may play a role in developing cardiovascular disease in this community of patients. © 2021, The Author(s), under exclusive licence to Research Society for Study of Diabetes in India

The Effects of Fin Spacing and Tube Outer Diameter of Evaporator on System Performance in Heat Pump Tumble Dryers

In heat pump tumble dryers, moisture separates from the laundry and leaves the dryer system at the evaporator. Moist air goes out the drum and enters the evaporator whose outer surface is below the dew point temperature. Air cools and then leaves its moisture. At the airside of the evaporator the wet surface develops and simultaneous heat-mass transfer occurs. Fin-and-tube heat exchangers are used as evaporators in household heat pump tumble dryers. In addition to optimum operating conditions, optimum evaporator geometry can significantly affect system performance. In this study, a model was developed for household heat pump tumble dryer. The model was validated by experimental data collected from the literature. MATLAB software was used in programming, and fluid properties were taken from Refprop software. The model was run with different fin spacing (2–5 mm) and tube outer diameter (6–12 mm) for evaporator, whereas operating conditions and all other geometrical parameters stayed the same. Then, coefficient of performance (COP), moisture extraction rate (MER), and specific moisture extraction rate (SMER) were calculated. As a result, the effects of fin spacing and tube outer diameter of evaporator were determined depending on the input characteristics of the dryer model. In the working range, SMER was changed up to 20% and 15% depending on the fin spacing and the tube outer diameter of evaporator, respectively

The Effects of Gas Cooler Inlet Pressure on System Performance in Heat Pump Tumble Dryers

Heat pumps working with CO2 as a refrigerant have low energy consumptions if right application areas and operating conditions are selected. The use of CO2 in heat pump dryers is feasible if operating temperatures are appropriate. In heat pump dryers working with CO2 according to the transcritical cycle, one of the most important operating conditions is optimum gas cooler inlet pressure, which gives the maximum coefficient of performance (COP). In this study, a model was developed by using MATLAB software for heat pump tumble dryer working with CO2. The model was validated by experimental data taken from existing literature. Then, COP, moisture extraction rate (MER), and specific moisture extraction rate (SMER) were found by running the model at different gas cooler inlet pressures (80–140 bars). All results were calculated in the same geometry for evaporator, gas cooler, and compressor. Thus, effects on the results of variation of the geometrical features were eliminated. Optimum gas cooler inlet pressure was determined as 100 bars for the system with data input to the model. In the optimum gas cooler inlet pressure working condition, SMER increased 24% and 12% by comparison with 80 bars and 140 bars gas cooler inlet pressure, respectively

Extracorporeal photopheresis in the treatment of acute and chronic graft-versus-host disease: A position statement from the Turkish Society of Apheresis (TSA)

Graft versus host disease (GVHD) is still the most important cause of mortality and morbidity after allogeneic stem cell transplantation. Though perfect response rates are not achieved, steroids are still the first-line treat-ment. In the face of the presence of the drugs approved by FDA in recent years for acute and chronic GVHD as second-line therapy in the steroid-refractory group, there exists no standard approach. Extracorporeal photopheresis (ECP) with an immunomodulatory effect, is favored in the treatment of both acute and chronic steroid refractory GVHD as it does not increase the risk of relapses or infections. Having a low profile of side effects, ECP is also generally well-tolerated by patients. Being a time requiring procedure, the fact is that it is not able to be practiced in all health centers and requires central venous catheters in patients unfit for venous access may be enumerated among its shortcomings. No complete standard is available with respect to ECP application frequency-time; it varies from one center to another. The Turkish Society of Apheresis established the Turkish ECP (TECP) group and sought some answers to the questions regarding the use of ECP in the treatment of GVHD, and issued a position statement