The ability and utility of diffusion-weighted magnetic resonance imaging with different 'b' values in the differentiation of benign from malignant lung lesions

Purpose: To evaluate the ability and the utility of diffusion-weighted magnetic resonance imaging (MRI) with different 'b' values to visualise benign and malignant lung lesions, and to determine which 'b' value (b = 300, 500, or 1000 s/mm2) was most useful in differentiating benign from malignant lung lesions. Material and methods: A total of 100 patients (28 women, 72 men; mean age = 57.19 ± 13.44 years; age range = 20-83 years). Diffusion-weighted imaging (DWI) was obtained with 'b' values of 300, 500, and 1000 s/mm². The signal intensity of lesions on DWI images was analysed, and the apparent diffusion coefficient (ADC) values of the lesions were calculated. MRI was performed in all patients after having presented at our department for thoracic computed tomography for various reasons. Results: A statistically significant difference in DWI signal scores was detected between benign and malignant lesions for all 'b' factors (p < 0.0001 for each). The sensitivity and specificity were 95% and 64%, respectively, when a score of 3 for b = 300 s/mm²; 90% and 69%, respectively, when a score of 3 for b = 500 s/mm²; and 84% and 74%, respectively, when a score of 3 for b = 1000 s/mm². ADC values showed significant differences between benign and malignant lesions for all 'b' factors (p < 0.0001 for each). Conclusions: Using 'b' values of 300, 500, and 1000 s/mm², DWI signal intensity scores and ADC values are effective methods for the differential diagnosis of malignant and benign pulmonary lesions

Yeni Mezun Zihin Engelliler Öğretmenlerinin Yaşadıkları Sorunlara ve Mezun Oldukları Lisans Programına İlişkin Görüşlerinin İncelenmesi

DergiPark: 674265tredÖzel eğitim öğretmenliği lisans programından mezun olan özel eğitim öğretmenleri özel gereksinimli bireylerle çalışmaktadır. Özel eğitim öğretmenleri alanda çalışırken çeşitli sorunlar yaşamaktadır. Onların yaşadıkları sorunlar lisans eğitimleriyle de ilgilidir. Bu nedenle lisans programlarının daha güçlü, nitelikli ve yeterli hale gelmesi özel eğitim öğretmenlerinin mesleki süreçlerine katkı sağlayacaktır. Bu çalışmanın amacı zihin engelliler öğretmenliği lisans programından yeni mezun olan kişilerin mesleki süreçlerinde yaşadıklarına ilişkin deneyimleri ve mezun oldukları lisans programının mesleki deneyimlerini nasıl etkilediğine ilişkin görüşlerini incelemektir. Belirtilen amaç doğrultusunda 6 öğretmenle yarı yapılandırılmış görüşmeler yapılmış ve bu görüşmeler içerik analiziyle çözümlenmiştir. Araştırma nitel araştırma yöntemlerinden fenomolojik desenle gerçekleştirilmiştir. Araştırma bulguları zihin engelliler öğretmenlerinin mesleki süreçlerinde yaşadıkları olumlu ve olumsuz deneyimlerin lisans eğitimleriyle ilişkili olduğunu göstermektedir. Ayrıca lisans programındaki derslerin yalnızca ilgili anabilim dalındaki yetersizlik gruplarını kapsamaması ve uygulamalarla desteklenerek yürütülmesi gerektiği ortaya çıkan diğer bulgulardandır. Araştırma bulguları doğrultusunda farklı yetersizlik gruplarına yönelik derslerin arttırılması, kuramsal derslerin içeriğinin farklılaştırılarak yürütülmesi ve derslerin uygulama boyutunun arttırılması önerilebilir

A Long View of Shareholder Power: From the Antebellum Corporation to the Twenty-First Century

For most of the twentieth century, the conventional wisdom held—probably correctly—that shareholders in America’s large, public corporations were passive and powerless and that managers wielded the real power. Beginning in the 1980s, however, shareholders in the form of institutional investors started to push for a greater say in corporate decision-making. In the twenty-first century, hedge funds have upped the ante, fighting for major changes in corporations whose shares they own. Once-imperial CEOs have now become embattled as they fight, but often lose, against activist shareholders demanding policy changes, new dividends, board representation, and even the sale or break-up of corporations. In short, things have changed. This Article situates the present-day rise of shareholder power by taking a long view of the previous two centuries, moving beyond traditional accounts to reach all the way back to the beginnings of the American business corporation in the early nineteenth century, then following the story of shareholder power up to the present day. Its long view reveals the complicated and shifting nature of shareholder power, documenting how periods of greater shareholder power were interspersed with periods where shareholders had little power, how the focus of shareholder power has moved from controlling shareholders to autonomous managers, and how shareholder power has ebbed and flowed across the last two centuries. This Article not only provides the backstory to present-day developments, but also suggests that what has appeared as a hallmark of American corporate capitalism—the relative powerlessness of shareholders—may only have been typical of a few decades in the middle of the twentieth century.\u3c.p\u3

Comparative Evaluation of Argyrophilic Nucleolar Organizer Regions Parameters in Benign and Malignant Breast Tumors

The aim of the paper was to evaluate the AgNOR parameters for the discrimination of benign from malignant breast tumors via a new approach -the total AgNOR area/nuclear area (TAA/NA). Material and methods. Three groups, consisting of control (n = 14), benign (n = 18) and malignant (n = 28) participants were included in the study. The AgNOR staining technique was performed and both mean AgNOR number and TAA/NA ratio were evaluated.Results. While the differences between the control and patient groups were statistically significant for AgNOR number (p 0.05). For the ratio of TAA/NA, the differences between the control and benign group (p < 0.001), control and malignant group (p < 0.001), and malignant and benign patient groups were significant. (p < 0.05).Conclusion. We consider that the evaluation of the TAA/NA rate, when compared with the AgNOR number, can be more sensitive and useful tool for distinguishing benign from the malignant breast lesions

Comparison of body mass index level by triage level in the emergency department

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED.MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study.RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6–11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98; 28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma.CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management

Ultrastructure of the Natal and Primary Teeth

Aim: The teeth present in the oral cavity at birth are known as natal teeth and their etiology is still unknown. In this study, we aimed to compare the morphologic structures of natal and primary teeth at the ultra structural level using transmission electron microscope (TEM). Material and Methods: We investigated a natal tooth of a fourteen-day-old newborn baby. It was extracted due to the hypermobility with a risk of aspiration. As a control, a healthy primary incisor tooth was extracted from another child due to the physiologic root resorption. Immediately after extraction, both teeth were fixed in 10% formalin solution and decalcified by immersion in ethylenediaminetetraacetic acid (EDTA) solution. Following routine TEM preparation process, teeth were embedded in Epon 812. Results: Histologically, structures of enamel prism and dentin tubules were different in the natal tooth compared to the primary tooth. Light microscopic (LM) and TEM investigations of the primary tooth showed prominent crystal structures in the enamel prism and regular organization in both enamel and dentin. LM and TEM investigations of the natal tooth revealed an irregular enamel prism in the hypoplastic enamel, vacuolization in the interprismatic enamel and an irregular organization in the dentin tubules. Conclusion: We conclude that the structural differences of the enamel and dentin in the natal tooth might be a result of incomplete maturation

The effect of vitamin D deficiency on sexuality

D vitamini, obezite, kas iskelet sistemi, kronik hastalıklar, böbrek hastalıkları, kanserler (kolon, prostat, meme vb.), kardiyovasküler hastalıklar, metabolik sendrom, otoimmün hastalıklar (multipl skleroz, romatoid artrit vb.) ile ilişkili olduğu bilinmektedir. Son yıllarda yapılan çalışmalarda, D vitaminin cinsellik üzerine de etkisi olduğu belirtilmektedir. D vitamini her iki cinste de cinsel yaşamın yanı sıra üreme fonksiyonunu da etkilemektedir. D vitamini eksikliğinin cinsel yaşamı primer olarak etkilediği gibi, neden olduğu hastalıklar nedeniyle sekonder olarak da etkileyebileceği düşünülmektedir. Bu derleme, D vitaminin cinsellik üzerine etkisinin gözden geçirilmesi amacıyla yapılmıştır.Vitamin D is known to be related with obesity, musculoskeletal, chronic diseases, kidney diseases, cancers (colon, prostate, breast, etc.), cardiovascular diseases, metabolic syndrome, autoimmune diseases (multiple sclerosis, rheumatoid arthritis, etc.). Recent studies indicate that vitamin D also has an effect on sexuality. Vitamin D affects sexual life as well as reproductive function in both sexes. As of vitamin D deficiency affects sexual life as the primary cause is thought to affect as secondary diseases that are due. This review was conducted to review the effect of vitamin D on sexuality

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279-2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454-0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142-23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046-5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216-0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037-0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes

MRI of pneumonia in immunocompromised patients: comparison with CT

PURPOSE:Pneumonia is an important cause of mortality and morbidity in immunocompromised patients. Computed tomography (CT) is the most sensitive imaging modality for the diagnosis and surveillance of these patients. Since CT exposes the patient to ionizing radiation, we investigated the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia.METHODS:The study included 40 immunocompromised patients with pneumonia documented on CT. The patients were examined by MRI within 48 hours of CT examination. All images were obtained with three different sequences: balanced fast field echo, T1-weighted turbo spin-echo (TSE), and T2-weighted TSE. Lung abnormalities were evaluated using CT and MRI.RESULTS:Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P 20 mm nodules (к=0.844, P < 0.001).CONCLUSION:Although CT is superior to MRI in the diagnosis of pneumonia in immunocompromised patients, MRI is an important imaging modality that can be used, particularly in the follow-up of these patients, thus decreasing to avoid ionizing radiation exposure

Sedoanalgesia Administration with Propofol and Ketamine for Minor Urologic Interventions

Aim: In this study we aimed to administer sedoanalgesia with propofol and ketamine combination in patients undergoing planned minor urologic interventions with limited anesthesia. By combining these two medications, lower doses may be used, and we aimed to provide sufficient sedation, analgesia and amnesia without disrupting hemodynamic and respiratory stability and to increase patient and surgeon satisfaction. Material-Method: The study included 53 patients with planned minor urologic interventions aged from 19 to 85 years and physical situation ASA I-III. After six hours starvation, patients were taken to the surgery. Patients were monitored for electrocardiography (ECG), oxygen saturation (SPO2 ) and non-invasive blood pressure. For use if necessary a nasal O2 cannula was inserted. A vein in the back of the left hand was opened and 5 ml/min isotonic sodium chloride infusion was begun. Patient heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and oxygen saturation (SpO2 ) values were measured and a 5 point sedation scale (Table 1) was used to measure sedation scores. Basal values were recorded (0 min). Later patients were randomly divided into two groups with Group I administered intraurethral lidocaine gel for local anesthesia by the surgeon, while Group II were administered intravenous 0.015 mg/kg midazolam, 0.5 mg/kg 1% ketamine and 0.5 mg/kg 1% propofol by the authors for sedoanalgesia. At five minute intervals the HR, SAP, DAP, MAP, SpO2 values and sedation scores were measured and recorded. Results: Statistical evaluation found a statistically significant increase in SAP, DAP and MAP values measured at the 5th minute in Group I patients compared to preoperative values. In Group I patients, when the heart rate measured in the 1st and 5th minutes are compared with preoperative values there was a statistically significant increase identified. In Group II patients, there was a statistically significant fall in SpO2 values in the 1st and 5th minutes compared with preoperative values. When patient and surgeon satisfaction are compared with Group I, Group II was found to be statistically significantly higher. Though the blood pressure and heart rate increases in Group I patients were statistically significant, they were not at levels that required clinical intervention and/or treatment. Similarly the SpO2 decrease observed in Group II patients did not fall below 90% in any patient in spite of being statistically significant and rose again without clinical intervention and/or treatment. Conclusion: In this study we showed that sedoanalgesia administration with propofol and ketamine may be an alternative method for patients undergoing minor urology interventions that does not disrupt hemodynamic and respiratory stability, does not delay patient discharge, has low side effect incidence and has high patient and surgeon satisfaction