Lymphatic mapping and sentinel node biopsy in gynecological cancers: a critical review of the literature

Although it does not have a long history of sentinel node evaluation (SLN) in female genital system cancers, there is a growing number of promising study results, despite the presence of some aspects that need to be considered and developed. It has been most commonly used in vulvar and uterine cervivcal cancer in gynecological oncology. According to these studies, almost all of which are prospective, particularly in cases where Technetium-labeled nanocolloid is used, sentinel node detection rate sensitivity and specificity has been reported to be 100%, except for a few cases. In the studies on cervical cancer, sentinel node detection rates have been reported around 80–86%, a little lower than those in vulva cancer, and negative predictive value has been reported about 99%. It is relatively new in endometrial cancer, where its detection rate varies between 50 and 80%. Studies about vulvar melanoma and vaginal cancers are generally case reports. Although it has not been supported with multicenter randomized and controlled studies including larger case series, study results reported by various centers around the world are harmonious and mutually supportive particularly in vulva cancer, and cervix cancer. Even though it does not seem possible to replace the traditional approaches in these two cancers, it is still a serious alternative for the future. We believe that it is important to increase and support the studies that will strengthen the weaknesses of the method, among which there are detection of micrometastases and increasing detection rates, and render it usable in routine clinical practice

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Disiplinler Arası Bir Yaklaşımla Ceza Hukukunda Hareket Kavram ve Terimi

Ceza hukukunda hareket kavramı, genellikle ceza kanunlarında tanımlanmadığı gibi kanunlarda da yeknesak bir kullanıma sahip değildir. İlgili mevzuatta, hareketin yanı sıra fiil, eylem, davranış gibi deyimlere, aynı veya farklı anlamlarda rastlanabilmektedir. Bu noktada kavramın sözlüklerdeki tanımlarına müracaat edildiğinde de tablo farksız olup eş anlamda çok sayıda kelimeyle karşılaşılmakta ve daha önemlisi bu kelimelerin birçoğu için fizik, psikoloji, felsefe gibi değişik bilim dallarına referans verilmektedir. Kanunilik ilkesinin egemen olduğu bir alan olarak ceza hukukunda, hareket gibi temel bir kavram açısından bu denli bir belirsizliğin olması esasen şaşırtıcıdır. Ne var ki başta sözlüklerdeki terim çeşitliliği olmak üzere ilgili bilim dallarındaki hareketle ilgili derin tartışmalar göz önüne alındığında, bu konuda tatmin edici bir tanım vermenin güçlüğü dolayısıyla belirsizliğin sebebi kolayca anlaşılacaktır.Bu çalışmada ceza hukukunda klasikleşmiş hareket teorilerinden ziyade adeta bir ön mesele olarak hareket, kavram ve terim düzeyinde ele alınmıştır. Bu amaçla öncelikle sözlüklerde hareket ve bağlantılı terimler incelenmiş, devamında fizik, biyoloji gibi doğa bilimlerinde ve psikoloji, sosyoloji, felsefe ve hukuk gibi sosyal bilimlerde hareket kavramına ilişkin görüşler ve terim tercihleri ortaya konmaya çalışılmıştır. Nihayet ceza hukukunda kanuni düzenlemeler ve öğretideki görüşler temelinde hareket terimi irdelenmiştir. Tüm bu incelemelerde Almanca ve İngilizce literatürden yararlanılmış, Türk, Alman, Amerikan ve İngiliz hukuk sistemleri karşılaştırılmıştır. Eserin sonunda görece yeni hareket kuramı olarak anlamsal hareket teorisinin takdimi yapılmıştır