Value of preoperative spirometry to predict postoperative pulmonary complications

AbstractIn order to determine the incidence of postoperative pulmonary complications (POPC) and the value of preoperative spirometry to predict pulmonary complications after upper abdominal surgery, 24 women and 36 men (total 60 patients) were studied prospectively (mean age 48·3 years). On the day before the operation and for 15 days after the operation, each patients's respiratory status was assessed by clinical examination, chest radiography, spirometry and blood gas analysis, and patients were monitored for pulmonary complications by a chest physician and a surgeon independently. In this study, postoperative pulmonary complications developed in 21 (35%) patients (pneumonia in 10 patients, bronchitis in nine patients, atelectasis in one patient, pulmonary embolism in one patient). Of 31 patients with abnormal preoperative spirometry, 14 (45·2%) patients showed complications, whereas among 29 patients with normal preoperative spirometry, 7 (24·1%) patients showed complications (P<0·05). The incidence of POPC was higher in patients with advanced age, smoking, preoperative abnormal findings obtained from physical examination of the chest, higher ASA class and longer duration of operation. The sensitivity (0·76) and specificity (0·79) of abnormal preoperative findings obtained from physical examination to predict POPC were higher than abnormal preoperative spirometry (0·67 and 0·56 retrospectively). There was no significant difference between patients with and without pulmonary complications in regard to weight, serum albumin, type of incision, incidence of abnormal preoperative blood gases and duration of postoperative hospital stay. We conclude that POPC is still a serious cause of postoperative morbidity. Multiple risk factors include preoperative abnormal spirometry responsible for development of POPC. If used alone, spirometry has limited clinical value as a screening test to predict POPC after upper abdominal surgery

Agent based distributed event system

Geleneksel istemci-sunucu mimarisinin kullanıldığı k&uuml;&ccedil;&uuml;k &ouml;l&ccedil;ekli dağıtılmış sistemler u&ccedil;tan uca ve senkron haberleşmeleri sebebi ile statik uygulamaların geliştirilmesinin &ouml;tesine ge&ccedil;memiştir. Bu haberleşmenin b&uuml;y&uuml;k &ouml;l&ccedil;ekli sistemlerde kullanılması ise uygulamaların hantal ve kullanışsız olmalarını sağlamıştır. Bu kısıtlamalar, dinamik olan ve bağlantısız uygulamaların &ccedil;alıştığı bir ortamda, daha esnek haberleşme modellerini kullanan yazılım sistemlerinin geliştirilmesi gerekliliğini ortaya &ccedil;ıkarmıştır. Yapılan &ccedil;alışmada sistem bileşenleri arasında haberleşme i&ccedil;in kullanılan olay kavramının &uuml;retim niteliği geliştirilmesi ama&ccedil;lanmış olup olaylar sadece ham veri &uuml;retiminin yanı sıra, eylemlerin de &uuml;retildiği ve saklandığı ileri bir d&uuml;zeye yerleştirilmiştir. Bu d&uuml;zeydeki bir olay, işlenebilir veriler &uuml;retebileceği gibi, kendine &ouml;zg&uuml; bir kontrol akışına sahip olan bir eylemler dizisinin tetikleyicisi de olabilir. S&ouml;z konusu eylemler belirli bir amacı ger&ccedil;eklemeye y&ouml;nelik işlem dizisine, karar mekanizmalarına ve &ccedil;oğunlukla birlikte &uuml;retildikleri bir veri k&uuml;mesine sahip olmaktadır. Sistemde olay yapısı, i&ccedil;erdiği eylem dizisinin ve bu eylemleri yerine getirmede kullanacağı veri bloğunun yer aldığı bir &ldquo;gezgin etmen&rdquo; yapısıyla temsil edilmektedir. Bu yeni yapıdaki olaylara &ldquo;agvent-agent event&rdquo; adı verilmiş olup sistem bir b&uuml;t&uuml;n olarak &ldquo;Etmen Tabanlı Dağıtılmış Olay Sistemi&rdquo; veya kısaca &ldquo;ABDES Sistemi&rdquo; olarak adlandırılmıştır. Geliştirilen sistem, kayıt/yayım haberleşme modelinin asenkron haberleşme, bir u&ccedil;tan &ccedil;ok uca haberleşme ve zayıf bağlı haberleşme &ouml;zellikleri ile gezgin-zeki etmenlerin amaca y&ouml;nelik davranmalarını, sosyal yeteneklerini, tepkisel davranabilmelerini ve otonom olma &ouml;zelliklerini esnek bir ortamda birleştirmiştir. Anahtar Kelimeler: Dağıtılmış olay sistemi, gezgin etmenler, kayıt/yayım modeli.In recent years, a growing attention has been paid to the publish/subscribe communication paradigm as a means for disseminating information, also called as events, through distributed systems on wide-area networks. As it allows events to be propagated in a way that is completely hidden to the component that has generated them as well as to its receivers, it is particularly interesting when easy reconfiguration and decoupling among components in a distributed system is required. The historical development of publish/subscribe systems has followed a line which has evolved from channel-based systems, to subject-based systems, next content-based systems and finally type (object) based systems. In this study, we propose a new model for agent based distributed event systems, called as ABDES system, which combines the advantages of distributed event systems (like loosely coupled, asynchronous and one to many communication) and the advantages of intelligent mobile agents (like autonomy, reactivity, social ability and goal driven execution) into a flexible and extensible distributed execution environment. The major novelty of the model is that an event is represented by a mobile agent, (called as agvent-agent event), which is treated as a first class citizen of the system and given autonomy features to travel between system components. ABDES system differs from other distributed event systems with its distinct characteristics that are described below. Event Definition: In most event systems, events are defined as low-level messages, which consist of record like structures, list of strings, tuple based structures, etc. In type-based systems, events are defined as objects and viewed as main component of the system. Nevertheless, they are not autonomous. In ABDES system, events are represented as mobile agents that have their own goals, beliefs and behaviors that they acquire at their creation. When an agvent reaches to an agvent server, it examines the routing table of the server and selects its targets autonomously. This approach reduces the load and complexity of agvent servers as well. Subscription Mechanism: In most distributed event systems, subscribers register on a channel, on a specific topic or on a specific content of an event message. In ABDES system, subscribers register on types of agvents. For example, a subscriber can register on an agvent, which is an instance of "Agv_type1" class, specifying certain constraints based on its advertised attributes and behaviors. Information hiding: In previously developed event systems, an event server can, actually has to, access the content of the published event data. If you have a valuable data and you want to keep it secret it is really a hard work. In ABDES system, a published agvent searches the knowledge base of the agvent server, selects the registered subscribers, clones itself and sends clones of agent to each subscriber on the selected list. Therefore, the agvent server has no access to the content of the published event data, which simplifies its role and consequently facilitates the server development process. Information hiding also meets requirements of certain applications where secrecy of event data is essential for them. User defined agvent types: Distributed event systems generally use predefined event types. Therefore, to add a new event type you have to make changes in the dispatch service and also at publisher and subscriber sites. In ABDES system, a publisher can create its own agvent type and declare its properties and behaviors through an advertisement message. Once an agvent type is announced to the system, subscribers can register on agvents of that type. Filtering Mechanism: Distributed event systems use client side filtering. A client defines its profile by a subscription message and system forwards incoming events to this client according to its profile. There is not any possibility for producers to put their dispatching criteria to select the clients. Because of the agvents autonomous and self routing structure we can achieve the producer side filtering also. Faults and failures are inevitable in a distributed system built over a wide area network and they should be tolerated for continuing system transactions. Therefore we also developed a fault tolerance mechanism by dynamically reconfiguring the connections among agvent servers in order to create paths that increase the performance of message routing. We think the new model will serve as an effective choice for large scale distributed computing application, automatic virus updating and several information oriented applications, such as e-commerce and information retrieval.Keywords: Distributed event system, mobile agent, publish/subscribe model

ANXIETY DISORDER IN PATIENTS WITH NONSPECIFIC CHEST PAIN

Acil servise göğüs ağrısı şikayeti ile başvuran hastaların çoğu, akut koroner sendrom ve hayatı tehdit eden diğer durumlar dışlandıktan sonra nonspesifik göğüs ağrısı tanısı ile taburcu edilmektedir. Yapılan çalışmalar, nonspesifik göğüs ağrısı tanısı alan hastalarda yüksek oranda anksiyete bozukluğu bulunduğunu göstermiştir. Anksiyete bozukluğu, tanısı konulduğunda etkin bir şekilde tedavi edilebilen bir hastalıktır. Anksiyete bozukluğu hastalarının çoğu ilk olarak psikiyatri kliniklerinden daha çok acil servis veya kardiyoloji bölümlerine başvurur. Bu nedenle göğüs ağrısı şikayeti ile başvuran hastalarda göğüs ağrısını açıklayacak organik bir patoloji saptanamadığı durumlarda, hekimlerin anksiyete bozukluğunu, ayırıcı tanılar arasında göz önünde tutmaları ve hastayı ilgili birimlere yönlendirmeleri önemlidir. Nonspesifik göğüs ağrısı tanısını alan hastaların; ağrılarının akut koroner sendrom açısından atipik karakterde olması, yineleyen acil servis başvurularının olması ve göğüs ağrısına eşlik eden birçok semptom tanımlaması, acil servis hekiminin anksiyete bozukluğundan şüphelenmesine yardımcı olabilir. Most patients admitted to the emergency department (ED) with chest pain are discharged with a diagnosis of "nonspecific chest pain" (NSCP) after ruling out acute coronary syndrome and other life-threatening conditions. Recent studies have shown that anxiety disorder commonly accompanied NSCP. Anxiety disorder is an entity which can be efficiently treated and cured once suspected and diagnosed. Provided that patients commonly enter the health care system via EDs and cardiology outpatient clinics, a high index of suspicion pursued by EPs is of utmost importance to detect anxiety disorder in patients with chest pain. Emergency physicians should always consider anxiety disorder in patients presenting with chest pain provided that organic pathologies are ruled out. Atypical definitions of pain in the history, recurrent visits to the ED and having numerous adjunctive complaints should raise suspicions having anxiety disorder

Serum SCUBE-1 levels and return of spontaneous circulation following cardiopulmonary resuscitation in adult patients

Background SCUBE 1-has been used as a biomarker for the diagnoses of myocardial infarction, stroke, mesenteric ischemia, and gastric cancer in some recent studies. In this study, we investigated the relationship between serum SCUBE-1 levels and return of spontaneous circulation (ROSC) in patients who received cardiopulmonary resuscitation (CPR). Methods Patients over 18 years of age who were not pregnant and received CPR were divided into two groups: those who achieved ROSC and those who died. There were 25 patients in each group. SCUBE-1 and other routine biochemical parameters were studied in blood samples taken at the time of admission. Results There was no significant difference between the age and gender distribution of the patients between the two groups. The SCUBE-1 value of the ROSC group was significantly higher than that of the non-survivor group ( p ˂ 0.05). At a cut-off value of 9 ng/mL, SCUBE-1 had a sensitivity of 100%, a positive predictive value of 65.8%, specificity of 48%, and a negative predictive value of 100% in predicting ROSC. Conclusions The SCUBE-1 values were found to be significantly higher in the ROSC group compared with the non-survivor group

Polatuzumab vedotin, rituximab, and bendamustine combination in relapsed or refractory diffuse large B-cell lymphoma: A real-world data from Turkey

Polatuzumab vedotin (Pola) with bendamustine and rituximab (BR) is a promising option for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We analyzed the data of 71 R/R DLBCL patients who had been treated with Pola-BR in the named patient program from March 2018 to April 2021 from 32 centers in Turkey. All patients received up to six cycles of Pola 1.8 mg/kg, rituximab 375 mg/m2 on day 1, and bendamustine 90 mg/m2 on days 1–2 of each cycle. Median age at Pola-BR initiation was 55 (19–84). The overall response rate was 47.9%, including 32.4% CR rate when a median of 3 cycles was applied. With a median follow-up of 5 months, the median OS was 5 months. Grade 3–4 neutropenia and thrombocytopenia were the most common hematological toxicities. The real-world data from our cohort showed the Pola-BR is an effective option with a manageable toxicity profile

A novel approach for rapid screening of mitochondrial D310 polymorphism

BACKGROUND: Mutations in the mitochondrial DNA (mtDNA) have been reported in a wide variety of human neoplasms. A polynucleotide tract extending from 303 to 315 nucleotide positions (D310) within the non-coding region of mtDNA has been identified as a mutational hotspot of primary tumors. This region consists of two polycytosine stretches interrupted by a thymidine nucleotide. The number of cytosines at the first and second stretches are 7 and 5 respectively, according to the GeneBank sequence. The first stretch exhibits a polymorphic length variation (6-C to 9-C) among individuals and has been investigated in many cancer types. Large-scale studies are needed to clarify the relationship between cytosine number and cancer development/progression. However, time and money consuming methods such as radioactivity-based gel electrophoresis and sequencing, are not appropriate for the determination of this polymorphism for large case-control studies. In this study, we conducted a rapid RFLP analysis using a restriction enzyme, BsaXI, for the single step simple determination of 7-C carriers at the first stretch in D310 region. METHODS: 25 colorectal cancer patients, 25 breast cancer patients and 41 healthy individuals were enrolled into the study. PCR amplification followed by restriction enzyme digestion of D310 region was performed for RFLP analysis. Digestion products were analysed by agarose gel electrophoresis. Sequencing was also applied to samples in order to confirm the RFLP data. RESULTS: Samples containing 7-C at first stretch of D310 region were successfully determined by the BsaXI RFLP method. Heteroplasmy and homoplasmy for 7-C content was also determined as evidenced by direct sequencing. Forty-one percent of the studied samples were found to be BsaXI positive. Furthermore, BsaXI status of colorectal cancer samples were significantly different from that of healthy individuals. CONCLUSION: In conclusion, BsaXI RFLP analysis is a simple and rapid approach for the single step determination of D310 polymorphism of mitochondrial DNA. This method allows the evaluation of a significant proportion of samples without the need for sequencing- and/or radioactivity-based techniques

Pushing the Envelope—Aside

Despite successes, there are still significant limitations to speech recognition performance, particularly for conversational speech and/or for speech with significant acoustic degradations from noise or reverberation. For this reason, authors have proposed methods that incorporate different (and larger) analysis windows, which are described in this article. Note in passing that we and many others have already taken advantage of processing techniques that incorporate information over long time ranges, for instance for normalization (by cepstral mean subtraction as stated in B. Atal (1974) or relative spectral analysis (RASTA) based in H. Hermansky and N. Morgan (1994)). They also have proposed features that are based on speech sound class posterior probabilities, which have good properties for both classification and stream combination

Kolorektal kanser gelişim riski ile p53 gen polimorfizmi arasındaki ilişkinin önemi

KOLOREKTAL KANSER GELİŞİM RİSKİ İLEp53 GEN POLİMORFİZMİ ARASINDAKİ İLİŞKİNİN ÖNEMİAdı ve Soyadı: Özgür SönmezDanışman adı: Prof.Dr. Ayşe ÖzerKabul tarihi: 04.08.2004Program: Sağlık Bilimleri-Yüksek LisansAnabilim Dalı: Tıbbi Biyoloji ve GenetikÖZET:Kolon kanserleri birçok genetik değişimin ardı ardına meydana gelmesiyle biriken genetik hasarlar sonucunda oluşmaktadır. Bu genetik hasarları taşıyan hücrelerin çoğalmasıyla normal kolon mukozası karsinomaya doğru ilerlemektedir.Bu süreçte p53 tümör baskılayıcı gen değişimleri önemli bir yer tutmaktadır. Bugüne kadar bu gendeki değişimlerin mekanizması tam olarak ortaya konmuş olsa da bunun klinik önemi hala tartışma konusudur ve birbiri ile çelişen sonuçlar bulunmaktadır. KRK'lerde p53 mutasyonları %50-60 oranında görülmektedir. Mutasyonlara ek olarak, bu ölümcül hastalık için polimorfizmlerin de bir risk faktörü olabileceğini gösteren çalışmalar mevcuttur.Bu çalışmada 57 KRK'li hastada, p53 ekzon 4, kodon 72 ve intron 3, 16 bç duplikasyon polimorfizmi sıklığı araştırılmıştır. Bulunan sonuçlar yaş ve cinsiyet olarak eşleştirilmiş, kendisinde ve birinci derece akrabasında kanser hikayesi bulunmayan kontrol grubuyla kıyaslanmıştır. Ekzon 4, kodon 72 bölgesi için çalışmaya alınan 57 KRK'li hastanın 11'i Arg/Arg; 30'u Arg/Pro ve 9'u ise Pro/Pro bulunmuştur. Kontrol grubunda ise 114 kişinin 48'i Arg/Arg; 51'i Arg/Pro ve 13'ü Pro/Pro genotipinde saptanmıştır. İntron 3, 16 bç duplikasyon polimorfizmi için aynı hasta grubunda homozigot duplike olmayan 31 kişi; heterozigot 18 kişi ve homozigot duplike 7 kişi bulunmuştur. Aynı polimorfizm açısından kontrol grubunda ise homozigot duplike olmayan 64 kişi; heterozigot 43 kişi ve homozigot duplike 5 kişi bulunmuştur.Bu sonuçlar X2 testine tabi tutulmuş ve hasta grubunda, kontrol grubuna göre ekzon 4, kodon 72 Arg/Pro polimorfizmi sıklığı açısından anlamlı bir fark bulunmuştur (P<0.05). Bununla beraber intron 3, 16 bç duplikasyon polimorfizmi için hasta grubu ile kontrol grubu arasında anlamlı bir fark tespit edilememiştir. Bu sonuçlar, Türk toplumunda, p53 geni ekzon 4, kodon 72 Arg/Pro polimorfizminin, KRK'i için bir risk faktörü olduğunu göstermektedir.Importance of between p53 Gene Polymorphism and Colorectal Cancer Progression RiskSUMMARYColon cancers occur with accumulations of many genetic alterations. Normal colon epithelium through carcinoma by proliferation the cells, which are carry the genetic alterations.In this process, p53 tumor suppressor gene alterations are very important, although recently studies show that, mechanism of alterations on this gene has known, at this time there are contradictions about clinical importance. p53 mutations are present in over 50% of sporadic colorectal carcinomas. There are studies about this malignant disease indicating that the polymorphisms are important as much as mutations.In this study, p53 exon 4, codon 72 and intron 3, 16 bp duplication polymorphisms were examined among 57 colorectal patients. These findings were compared with controls who have no family cancer history. Controls were matched to cases' age and sex. For exon 4, codon 72 among the 57 colorectal cancer cases; 11 Arg/Arg, 30 Arg/Pro, 9 Pro/Pro individual genotypes versus among the 114 controls; 48 Arg/Arg, 51 Arg/Pro and 13 Pro/Pro were found. For intron 3 16 bp duplication polymorphism; among the cases, 31 non-duplicated, 18 heterozygote and 7 duplicated individual genotypes versus in control 64 non-duplicate, 43 heterozygote and 5 duplicate individuals were found.These findings were evaluated by using Chi-square (X2) test. For exon 4 codon 72 polymorphism, there was significant differences between cases and controls were found. However there was no correlation between cases and controls for intron 3 16 bp duplication polymorphism. These findings indicate that p53 exon 4 codon 72 polymorphism as a risk factor for Turkish population with colorectal cancer

Kömür ve maseral gruplarının çeşitli çözücülerde şişme davranışları ve sıvılaşma üzerine etkileri

TEZ5962Tez (Doktora) -- Çukurova Üniversitesi, Adana, 2006.Kaynakça (s.86-93) var.x, 101 s. ; 29 cm.In this study; the solvent swelling behaviors of Nasifoğlu and Soma coals were investigated using the solvents which can/cannot form H bonds. The maceral concentrates obtained from Nasifoğlu coal were also examined. Liquefaction behaviors of Nasifoğlu coal and its macerals with NMP/CS2 mixed solvent and supercritical toluen were studied. The best swelling ratio was obtained using EDA. The swelling ratio for Nasifoğlu coal was 1.81 while that value was 2.16 for Soma coal. It was observed that swelling was increased significantly after demineralization. The highest and lowest swelling ratios were obtained with NSF 1.28 and NSF 1.32, respectively among all maceral compositions. The most efficient extraction was observed with NSF 1.30 which had high content of vitrinite while NSF 1.40 which with high content of inertinite had lowest extraction yield during NMP/CS2 extraction. The conversion of macerals was higher than parent coal Nasifoğlu during supercritical toluen extraction. The highest and lowest conversions were observed in NSF 1.28 and NSF 1.40, respectively. The extraction efficiency decreased by preswelling in NMP/CS2 extraction and increased at supercritical conditions. The experiment results show that the best model for Nasifoğlu coal and its macerals was covalent model.Bu çalışmada, Nasifoğlu, Soma kömürleri ve Nasifoğlu kömüründen elde edilen maseral konsantrelerin çözücü ile şişme davranışları H-bağı yapan ve H-bağı yapmayan çözücülerde incelenmiştir. Nasifoğlu kömürü ve maseral konsantrelerin oda şartlarında NMP/CS2 çözücü karışımı ve süperkritik şartlarda tolüen ile sıvılaşma davranışları çalışılmıştır.Tüm örnekler için en iyi şişme oranı, EDA kullanıldığında elde edilmiştir. Nasifoğlu kömürü için şişme oranı 1.81 iken, Soma kömürü için bu oran 2.16 olarak bulunmuştur. Deminerilazasyonun şişme oranını üzerinde önemli bir etkisinin olduğu tespit edilmiştir. Maseral konsantreleri içinde, tüm çözücüler için en yüksek şişme oranı NSF 1.28 de gözlenirken, en düşük şişme oranı NSF 1.32 de gözlenmiştir. NMP/CS2 ile ektraksiyonda, en yüksek ekstraksiyon verimi maseral konsantreleri içinde, vitrinitçe zengin olan NSF 1.30 da gözlenirken, en düşük ekstraksiyon verimi inertinitçe zengin olan NSF 1.40 da gözlenmiştir. Süperkritik tolüen ekstraksiyonunda ise maseral konsantrelerinin sıvı ürünlere dönüşüm miktarları orijinal kömürden yüksektir. En fazla dönüşüm liptinitçe zengin olan NSF 1.28 de gözlenirken, en düşük dönüşüm inertinitçe zengin olan NSF 1.40 da gözlenmiştir. Ön şişirme ile birlikte oda şartlarında ekstraksiyon verimi düşerken, süperkritik şartlarda ise artmaktadır. Elde edilen bulgular Nasifoğlu ve kömürü ve maseral konsantrelerin kovalent modele yakın olduğunu göstermektedir.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No:FBE2002D17