Protein Substitute Requirements of Patients with Phenylketonuria on BH4 Treatment: A Systematic Review and Meta-Analysis

The traditional treatment for phenylketonuria (PKU) is a phenylalanine (Phe)-restricted diet, supplemented with a Phe-free/low-Phe protein substitute. Pharmaceutical treatment with synthetic tetrahydrobiopterin (BH4), an enzyme cofactor, allows a patient subgroup to relax their diet. However, dietary protocols guiding the adjustments of protein equivalent intake from protein substitute with BH4 treatment are lacking. We systematically reviewed protein substitute usage with long-term BH4 therapy. Electronic databases were searched for articles published between January 2000 and March 2020. Eighteen studies (306 PKU patients) were eligible. Meta-analyses demonstrated a significant increase in Phe and natural protein intakes and a significant decrease in protein equivalent intake from protein substitute with cofactor therapy. Protein substitute could be discontinued in 51% of responsive patients, but was still required in 49%, despite improvement in Phe tolerance. Normal growth was maintained, but micronutrient deficiency was observed with BH4 treatment. A systematic protocol to increase natural protein intake while reducing protein substitute dose should be followed to ensure protein and micronutrient requirements are met and sustained. We propose recommendations to guide healthcare professionals when adjusting dietary prescriptions of PKU patients on BH4. Studies investigating new therapeutic options in PKU should systematically collect data on protein substitute and natural protein intakes, as well as other nutritional factors

A Systematic Review and Meta-Analysis

Funding Information: A.P. received an educational grant from Cambrooke Therapeutics and grants from Vitaflo International, Nutricia, Merck Serono, Biomarin, Mevalia and Applied Pharma Research to attend scientific meetings. This project is also part of A.P’s. PhD, which is funded by Vitaflo International. J.C.R. was a member of the European Nutritionist ExpertPanel (Biomarin), the Advisory Board for Applied Pharma Research, Vitaflo, Synlogic, Biomarin and Nutricia, and received honoraria as speaker from APR, Merck Serono, Biomarin, Nutricia, Vitaflo, Cambrooke, PIAM and Lifediet. A.M. has received research funding and honoraria from Danone Nutricia, Vitaflo International, Biomarin, MetaX, Applied Pharma Research, and Merck Serono; she is a member of the advisory board for Danone Nutricia, Arla, and Applied Pharma Research. The remaining authors declare no conflicts of interest. ® Publisher Copyright: © 2023 by the authors.In phenylketonuria (PKU), natural protein tolerance is defined as the maximum natural protein intake maintaining a blood phenylalanine (Phe) concentration within a target therapeutic range. Tolerance is affected by several factors, and it may differ throughout a person’s lifespan. Data on lifelong Phe/natural protein tolerance are limited and mostly reported in studies with low subject numbers. This systematic review aimed to investigate how Phe/natural protein tolerance changes from birth to adulthood in well-controlled patients with PKU on a Phe-restricted diet. Five electronic databases were searched for articles published until July 2020. From a total of 1334 results, 37 articles met the eligibility criteria (n = 2464 patients), and 18 were included in the meta-analysis. The mean Phe (mg/day) and natural protein (g/day) intake gradually increased from birth until 6 y (at the age of 6 months, the mean Phe intake was 267 mg/day, and natural protein intake was 5.4 g/day; at the age of 5 y, the mean Phe intake was 377 mg/day, and the natural protein intake was 8.9 g/day). However, an increase in Phe/natural protein tolerance was more apparent at the beginning of late childhood and was >1.5-fold that of the Phe tolerance in early childhood. During the pubertal growth spurt, the mean natural protein/Phe tolerance was approximately three times higher than in the first year of life, reaching a mean Phe intake of 709 mg/day and a mean natural protein intake of 18 g/day. Post adolescence, a pooled analysis could only be performed for natural protein intake. The mean natural protein tolerance reached its highest (32.4 g/day) point at the age of 17 y and remained consistent (31.6 g/day) in adulthood, but limited data were available. The results of the meta-analysis showed that Phe/natural protein tolerance (expressed as mg or g per day) increases with age, particularly at the beginning of puberty, and reaches its highest level at the end of adolescence. This needs to be interpreted with caution as limited data were available in adult patients. There was also a high degree of heterogeneity between studies due to differences in sample size, the severity of PKU, and target therapeutic levels for blood Phe control.publishersversionpublishe

Long-Term Growth in Phenylketonuria: A Systematic Review and Meta-Analysis

There is an ongoing debate regarding the impact of phenylketonuria (PKU) and its treatment on growth. To date, evidence from studies is inconsistent, and data on the whole developmental period is limited. The primary aim of this systematic review was to investigate the effects of a phenylalanine (Phe)-restricted diet on long-term growth in patients with PKU. Four electronic databases were searched for articles published until September 2018. A total of 887 results were found, but only 13 articles met eligibility criteria. Only three studies had an adequate methodology for meta-analysis. Although the results indicate normal growth at birth and during infancy, children with PKU were significantly shorter and had lower weight for age than reference populations during the first four years of life. Impaired linear growth was observed until the end of adolescence in PKU. In contrast, growth impairment was not reported in patients with mild hyperphenylalaninemia, not requiring dietary restriction. Current evidence indicates that even with advances in dietary treatments, "optimal" growth outcomes are not attained in PKU. The majority of studies include children born before 1990s, so further research is needed to show the effects of recent dietary practices on growth in PKU.info:eu-repo/semantics/publishedVersio

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Disfaji Diyetinde Kullanılan Ksantan Gamı ve Modifiye Mısır Nişastasının in Vivo İlaç Salımı Üzerindeki Etkileri

Swallowing of oral solid dosage forms without modification may be difficult or dangerous in patients with dysphagia. The most common method to facilitate drug administration in these patients is to mix the powdered drug with a small amount of thickened water, however little is known about the effects of this method on in vivo bioavailability of drugs. This study aimed to evaluate the impact of thickened fluids designed to use in dysphagia treatment on bioavailability of levetirasetam as a model drug. Powdered drugs were mixed with water thickened at three thickness levels (nectar, honey and pudding) with two commercial thickeners (modified maize starch, MS and xanthan gam, XG) in test groups and they were mixed with only deionized water in control groups during the study period. At the first stage, the effects of thickened water on in vitro drug release of 4 drugs (levetirasetam, carbamazepine, atenolol and cefixim) were tested by using dialysis membrane method. Addition of both thickeners significantly reduced the release of three drugs compared to the control group, except carbamazepine. Levetirasetam which showed the highest solubility was chosen as the model drug for in vivo experiments. New Zeland albino female rabbits (n=24) were divided into two groups as: control group (water+drug, n=6) and test group (thickened water+drug, n=18). Powdered drug was mixed with water thickened with XG (n=9) and MS (n=9) at 3 thickness levels, and administered to the rabbits. All of the samples were administered by an intragastric gavage, and blood samples were collected at 9 time points following administration. After two-weeks of wash-out, test groups were crossed over and sample collection was repeated. Blood samples were analysed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The maximum observed concentration (Cmax) was lower and the time to reach Cmax (tmax) was relatively higher in test groups compared to control group. The lowest Cmax was detected at the highest thickness level, however, the differences between groups were not statistically significant (p=0.117 and p=0.495 for Cmax and tmax, respectively). No significant difference in total amount of levetirasetam absorbed (AUC) was found between groups (p=0.215 and p=0.183 for AUCinfinity and AUClast, respectively). The comparisions according to the type of thickener also revealed that pharmacokinetic parameters did not significantly differ between groups, except for a significantly lower Cmax when drug was mixed with MS-thickened water at nectar consistency compared to drug mixed with XG at the same thickness level (p=0.038). These results suggest that regardless of the thickness level, the administration of levetirasetam with two commercial thickening agents commonly used in dysphagia for safe swallowing, do not affect the pharmacokinetic efficiency and thus, the bioavailability of the drug.Disfaji hastalarında katı oral dozaj formundaki ilaçların modifiye edilmeden yutulması zor ya da riskli olabilmektedir. Bu hastalarda en sık başvurulan yöntem toz haline getirilen ilacın bir miktar kıvam artırıcı eklenmiş su ile karıştırılarak verilmesidir; ancak bu uygulamanın, ilaçların in vivo biyoyararlanımı üzerindeki etkileri tam olarak bilinmemektedir. Bu araştırma disfaji tedavisinde kullanılan kalınlaştırılmış sıvıların, model ilaç olarak seçilen levetirasetamın biyoyararlanımı üzerindeki etkilerini değerlendirmek amacıyla yapılmıştır. Çalışma süresince toz haline getirilen ilaçlar deney gruplarında modifiye mısır nişastası (MN) ve ksantan gamı (KG) kullanılarak 3 farklı viskozite düzeyinde (nektar, bal ve puding) hazırlanan sulu çözeltilerle karıştırılmış, kontrol grubunda ise yalnızca deiyonize su içerisinde çözdürülmüştür. İlk aşamada, diyaliz membran yöntemi kullanılarak, kalınlaştırılmış suyun 4 farklı ilacın (levetirasetam, karbamazepin, atenolol ve sefiksim) in vitro salım hızına etkisi incelenmiş ve her iki kıvam artırıcının da kontrol grubuna göre karbamazepin haricindeki üç ilacın salım hızını anlamlı olarak azalttığı belirlenmiştir. Çalışmanın bir sonraki aşaması olan in vivo deneylere, çözünürlüğü en yüksek olan levetirasetamla devam edilmiştir. In vivo deneylerde, 24 adet dişi Yeni Zelanda albino tavşan kontrol grubu (su+ilaç, n=6) ve deney grubu (kalınlaştırılmış su+ilaç, n=18) olmak üzere iki gruba ayrılmıştır. Deney grubundaki hayvanların yarısına KG, diğer yarısına MN ile 3 farklı konsantrasyonda hazırlanan örnekler intragastrik gavaj yoluyla verilerek, kulak arterinden 9 zaman noktasında kan örneği alınmıştır. İki haftalık arınma döneminin ardından deney grupları çaprazlanmış ve gavaj uygulaması sonrasında kan alma işlemleri tekrarlanmıştır. Örneklerdeki miktar tayini sıvı kromatografi-kütle spektrometresi/kütle spektrometresi (LC-MS/MS) kullanılarak gerçekleştirilmiştir. Kontrol grubuna göre deney gruplarında plazma doruk derişiminin (Cmax) daha düşük, plazma doruk süresinin (tmax) ise kısmen daha uzun olduğu ve en düşük Cmax’ın en yüksek viskozite düzeyinde olduğu saptansa da, gruplar arasındaki farkın istatistiksel olarak anlamlı olmadığı belirlenmiştir (Cmax ve tmax için sırasıyla p=0,117 ve p=0,495). Emilerek kana geçen toplam levetirasetam miktarı (AUC) açısından da kontrol ve deney grupları arasında istatistiksel açıdan anlamlı bir fark olmadığı belirlenmiştir (AUCtüm ve AUCson için sırasıyla p=0,215 ve p=0,183). Kıvam artırıcıların türünün etkisi karşılaştırıldığında, nektar düzeyinde iki kalınlaştırıcı ajanın Cmax değerlerinin farklı olduğu (p=0,038) ancak diğer farmakokinetik parametrelerde, kalınlaştırıcı ajanın türüne göre istatistiksel açıdan anlamlı bir farkın olmadığı saptanmıştır. Bu sonuçlar, disfajinin diyet tedavisinde sıvı aspirasyonunu önlemek amacıyla yaygın olarak kullanılan iki kalınlaştırıcı ajanın, ilaçlarla birlikte alınması durumunda, sıvının viskozite (kalınlık) düzeyine bağlı olmaksızın, levetirasetamın farmakokinetik etkinliğini ve biyoyararlanımını değiştirmediğini göstermiştir

Doğu Batı ekseninde Türk Sineması’nda kimlik sorunu : “Valiz”

ÖZETDoğu ve Batı ekseninde Türk Sineması’nın kimlik sorununu incelemek demek, en baştan bir kimlik sorunu olduğunu kabul etmek anlamına geliyor. Bizim düşüncemiz aslında kimlik konusunu bir sorun olarak ele almak değil, hali hazırda bulunan kimliği anlamaya çalışmaktır. Çalışmamızda Türkiye Cumhuriyeti’nin kurulmasıyla birlikte başlayan yeniden yapılanma sürecinde Atatürkçü Kişilik Modeli önerileri ile başlayan kimlik arayışlarının bugün hangi noktada olduğuna bakıldı. Bu arada ulusal kimlik oluşturmaya çalışan sinemacıların görüşleri incelendi. Muhafazakâr sinemacıların “milli” kimlik oluşturma çabalarını, sinemamızı Batı etkilerinden, muhafazakâr olmayan sinemacılarımızın ise hem Doğu hem Batı unsurlarından arındırmak üzerine oturtmaya çalıştığını saptadık. Hepsi de kendi “öz” unsurlarımıza ve kökenlerimize yönlendirilmiş bir bilimsel çalışmayı esas alıyorlardı ama ulusal geçmişimizi birbirlerinden farklı tanımlıyorlardı. Sınırlarımızın dışından gelen, adına küreselleşme denen etkileri katiyetle hoş görmeyen bu iki yaklaşım, sınırlarımızın içindeki renkliliği de ortak bir renge dönüştürme paydasında birleşiyorlardı. Ulusal ya da milli olmayı tek seslilik ve tek renklilik olarak algılıyorlardı. Ayrıca bu sinemacılarımız; bütün bunlar tartışılıyorken, sinemamızın anlatım yollarıyla ilgili estetik sorunlarını tartışmayı unutuyorlardı.Avrupa’da, Sovyetler Birliği’nde ve Amerika’da ise çeşitli avant-garde sinema akımları, bağımsız sinema hareketleri, ulusal dil oluşturma adına yapılan deneysel çalışmalar, Türkiye’yle mukayese edilemeyecek kadar yayılmıştı. Bizde ise bağımsız söylem geliştirmeye gayret eden ve ana akımdan ayrılan sinemacılar sadece “Genç Sinemacılar” hareketiyle kısıtlı kalmıştı.Tam bu noktada, o sinema hareketinden Enis Rıza ile ve günümüzde o sinema hareketinin benzeri olan “Yeni Sinema Hareketi”nden Hüseyin Yaman ve Yamaç Okur’dan, bu tür hareketlerin destekçisi olarak bilinen Mithat Alam’ın görüşleri alındı. Sonuç olarak bağımsız sanat yapabilmenin yolunun bağımsız şahsiyetler geliştirmekten geçtiği ve bireyselleşmenin ülkemiz için ne kadar aciliyetle önem taşıdığı sonucuna varıldı. İçimizdeki renkler de, dışarıdan gelen etkileşim de kaçınılmaz olduğuna göre, kendi renklerimizi muhafaza etmeli ve dış etkenlere rağmen özgün bir sinema oluşturabilmeliyiz.Bağımsız, Underground, Avant-garde ve Deneysel Sinema tanımlamalarına değinilirken yapılan örneklemeler aracılığıyla çeşitli ulusal sinemaların gelişimlerinin de bir tablosu ortaya kondu. Buradan Batı ve Doğu toplumlarının sinemaya yaklaşımlarını mukayese etmek daha açıklıkla mümkün oldu. Biz de kendi özgün düşünce ve bakış açımızı tezin ışığı altında çekeceğimiz filmde ortaya koyduk. Bir sinema manifestosu nasıl ortaya çıkar, önce böyle bir manifestoyu hazırlayanların görüş ve düşüncelerine başvurarak, sonra da kendimiz böyle bir manifesto yazmayı deneyerek anlamayı istedik. Özetle, bizim tavrımız ve duruşumuz Türk sinemasının kimlikliliğini ya da kimliksizliğini eleştirmekten ziyade hali hazırdaki kimliğini anlamaktan yana oldu.ABSTRACTThe fact that the identity issue of Turkish Cinema in East-West direction is analysed signifies that first and foremost, it is accepted that there exists an identity isssue.Our intentions is not to handle the identity matter as a problem, but to comprehend the identity which exist currently. In this study it is analysed where the identity seek which started with the suggestion of Kemalist personality pattern in the process of the Turkish Republic’s foundation arrived in our day. In the meanwhile, the opinions of the film makers who tried to form an identity were examined. It was figured out that conservative film makers struggled to form a “national” identity and protect Turkish Cinema from western effects, while the non-conservatives struggled to purify Turkish Cinema both from eastern and western effects. They all based on a scientific study oriented to our “own” constituents and roots. However, each of them identified our national history differently. These two approaches never tolerated the effects of “globalisation” which came from off-limits and they both aggreed that the “colourfulness” within our boundaries should be eliminated to one unique colour. They considered that to be “national” or “civil” meant to be monophonic and monochromic. In the meantime, these film makers forgot all about the aesthetic concerns of Turkish Cinema.In Europe, The Soviet Union and America avant-garde cinema movements, independent cinema movements and various experimental studies in the name of forming a national language were being carried out and they were too widespread to be compared to what happened in Turkish Cinema. On the other hand, there was only “Young Movie Makers” movement who tried to have an independent discourse in Turkey.At this point, the opinions of Enis Rıza and Hüseyin Yaman from “New Cinema Movements”, Yamaç Okur and Mithat Alam who was a defender of the movements were received. Consequently, it was aggreed that in order to create independent art, independent individuals should be generated and it is something very urgent for our country. Provided that the colours inside us and the interaction from outside are inevitable, we should preserve our colours and we should form an “authentic” cinema despite the external factors.As the definitions of Independent, Under Ground, Avant-Garde and Experimental Cinema were being given, the portrait of the progress of national cinemas were presented through the samples. Thus, the approaches of Eastern and Western Civilisations to cinema were made possible to be compared clearly. We presented our own thought and standpoint via the film we shot with this thesis. We tried to understand how a cinema manifest came out by consulting to the ones who had prepared a manifest before and then tried to write ours.In brief, our manner and attitude toward Turkish Cinema were to understand the identity which exists currently, rather than criticising the identitiy or disidentification of Turkish Cinema

Doğu Batı ekseninde Türk Sineması’nda kimlik sorunu : “Valiz”

Doğu ve Batı ekseninde Türk Sineması’nın kimlik sorununu incelemek demek, en baştan bir kimlik sorunu olduğunu kabul etmek anlamına geliyor. Bizim düşüncemiz aslında kimlik konusunu bir sorun olarak ele almak değil, hali hazırda bulunan kimliği anlamaya çalışmaktır. Çalışmamızda Türkiye Cumhuriyeti’nin kurulmasıyla birlikte başlayan yeniden yapılanma sürecinde Atatürkçü Kişilik Modeli önerileri ile başlayan kimlik arayışlarının bugün hangi noktada olduğuna bakıldı. Bu arada ulusal kimlik oluşturmaya çalışan sinemacıların görüşleri incelendi. Muhafazakâr sinemacıların “milli” kimlik oluşturma çabalarını, sinemamızı Batı etkilerinden, muhafazakâr olmayan sinemacılarımızın ise hem Doğu hem Batı unsurlarından arındırmak üzerine oturtmaya çalıştığını saptadık. Hepsi de kendi “öz” unsurlarımıza ve kökenlerimize yönlendirilmiş bir bilimsel çalışmayı esas alıyorlardı ama ulusal geçmişimizi birbirlerinden farklı tanımlıyorlardı. Sınırlarımızın dışından gelen, adına küreselleşme denen etkileri katiyetle hoş görmeyen bu iki yaklaşım, sınırlarımızın içindeki renkliliği de ortak bir renge dönüştürme paydasında birleşiyorlardı. Ulusal ya da milli olmayı tek seslilik ve tek renklilik olarak algılıyorlardı. Ayrıca bu sinemacılarımız; bütün bunlar tartışılıyorken, sinemamızın anlatım yollarıyla ilgili estetik sorunlarını tartışmayı unutuyorlardı. Avrupa’da, Sovyetler Birliği’nde ve Amerika’da ise çeşitli avant-garde sinema akımları, bağımsız sinema hareketleri, ulusal dil oluşturma adına yapılan deneysel çalışmalar, Türkiye’yle mukayese edilemeyecek kadar yayılmıştı. Bizde ise bağımsız söylem geliştirmeye gayret eden ve ana akımdan ayrılan sinemacılar sadece “Genç Sinemacılar” hareketiyle kısıtlı kalmıştı. Tam bu noktada, o sinema hareketinden Enis Rıza ile ve günümüzde o sinema hareketinin benzeri olan “Yeni Sinema Hareketi”nden Hüseyin Yaman ve Yamaç Okur’dan, bu tür hareketlerin destekçisi olarak bilinen Mithat Alam’ın görüşleri alındı. Sonuç olarak bağımsız sanat yapabilmenin yolunun bağımsız şahsiyetler geliştirmekten geçtiği ve bireyselleşmenin ülkemiz için ne kadar aciliyetle önem taşıdığı sonucuna varıldı. İçimizdeki renkler de, dışarıdan gelen etkileşim de kaçınılmaz olduğuna göre, kendi renklerimizi muhafaza etmeli ve dış etkenlere rağmen özgün bir sinema oluşturabilmeliyiz. Bağımsız, Underground, Avant-garde ve Deneysel Sinema tanımlamalarına değinilirken yapılan örneklemeler aracılığıyla çeşitli ulusal sinemaların gelişimlerinin de bir tablosu ortaya kondu. Buradan Batı ve Doğu toplumlarının sinemaya yaklaşımlarını mukayese etmek daha açıklıkla mümkün oldu. Biz de kendi özgün düşünce ve bakış açımızı tezin ışığı altında çekeceğimiz filmde ortaya koyduk. Bir sinema manifestosu nasıl ortaya çıkar, önce böyle bir manifestoyu hazırlayanların görüş ve düşüncelerine başvurarak, sonra da kendimiz böyle bir manifesto yazmayı deneyerek anlamayı istedik. le, bizim tavrımız ve duruşumuz Türk sinemasının kimlikliliğini ya da kimliksizliğini eleştirmekten ziyade hali hazırdaki kimliğini anlamaktan yana oldu. ABSTRACT The fact that the identity issue of Turkish Cinema in East-West direction is analysed signifies that first and foremost, it is accepted that there exists an identity isssue. Our intentions is not to handle the identity matter as a problem, but to comprehend the identity which exist currently. In this study it is analysed where the identity seek which started with the suggestion of Kemalist personality pattern in the process of the Turkish Republic’s foundation arrived in our day. In the meanwhile, the opinions of the film makers who tried to form an identity were examined. It was figured out that conservative film makers struggled to form a “national” identity and protect Turkish Cinema from western effects, while the non-conservatives struggled to purify Turkish Cinema both from eastern and western effects. They all based on a scientific study oriented to our “own” constituents and roots. However, each of them identified our national history differently. These two approaches never tolerated the effects of “globalisation” which came from off-limits and they both aggreed that the “colourfulness” within our boundaries should be eliminated to one unique colour. They considered that to be “national” or “civil” meant to be monophonic and monochromic. In the meantime, these film makers forgot all about the aesthetic concerns of Turkish Cinema. In Europe, The Soviet Union and America avant-garde cinema movements, independent cinema movements and various experimental studies in the name of forming a national language were being carried out and they were too widespread to be compared to what happened in Turkish Cinema. On the other hand, there was only “Young Movie Makers” movement who tried to have an independent discourse in Turkey. At this point, the opinions of Enis Rıza and Hüseyin Yaman from “New Cinema Movements”, Yamaç Okur and Mithat Alam who was a defender of the movements were received. Consequently, it was aggreed that in order to create independent art, independent individuals should be generated and it is something very urgent for our country. Provided that the colours inside us and the interaction from outside are inevitable, we should preserve our colours and we should form an “authentic” cinema despite the external factors. As the definitions of Independent, Under Ground, Avant-Garde and Experimental Cinema were being given, the portrait of the progress of national cinemas were presented through the samples. Thus, the approaches of Eastern and Western Civilisations to cinema were made possible to be compared clearly. We presented our own thought and standpoint via the film we shot with this thesis. We tried to understand how a cinema manifest came out by consulting to the ones who had prepared a manifest before and then tried to write ours. In brief, our manner and attitude toward Turkish Cinema were to understand the identity which exists currently, rather than criticising the identitiy or disidentification of Turkish Cinema

Geographical distributions and taxonomical states of Telescopus fallax (Fleischman, 1831) and Vipera barani Böhme-Joger, 1983

Taxonomical states and the distribution of 40 Telescopus fallax specimens collected from various regions of Turkey over the past 35 years were evaluated. Information relating to a female Vipera barani and its 2 male juveniles, which were collected 35 km south of the provincial capital Adapazari is presented. Biological information regarding the latter species is provided for the first time. © Tübi̇tak