ALLOJENEİK HEMATOPOİETİK KÖK HÜCRE NAKLİ YAPILAN HASTALARDA AKUT GRAFT VERSUS HOST HASTALIĞI VE KRONİK GRAFT VERSUS HOST HASTALIĞI’NIN RETROSPEKTİF DEĞERLENDİRİLMESİ

Enfeksiyon proflaksisinde, immünsüpresif stratejilerde, DNA bazlı doku tiplendirmesinde ve destekleyici bakım önlemlerinde kaydedilen gelişmelerle birlikte allojeneik hematopoietik kök hücre nakli (Allo-HKHN) ile önemli oranda hastalık kontrolü ve kür sağlama başarısı sağlanmıştır. Nakil sayılarının artmasına paralel olarak görülen komplikasyonların sayısı ve çeşitliliği de artış göstermektedir. Graft Versus Host Hastalığı (GVHH) da Allo-HKHN sonrasında görülen en ciddi morbidite ve mortalite nedeni olan komplikasyonlardan biridir. Bu gözlemsel çalışmanın amacı; Allo-HKHN yapılan hastalarda nakil sonrası GVHH’nin görülme sıklığı, akut GVHH (aGVHH) ve kronik GVHH (krGVHH) gelişiminde ki risk faktörlerinin belirlenmesi, proflakside kullanılan ilaçların GVHH gelişimi üzerine etkisi, GVHH’nin mortalite ve morbidite üzerine etkisini araştırmaktır. Çalışmada Adnan Menderes Üniversite Hastanesi ve Özel Kent Hastanesi Erişkin Kemik İliği Nakil Merkezlerinden Ocak 2013 ile Mayıs 2019 tarihleri arasında Allo-HKHN yapılan ve yeterli dosya verilerine ulaşılan 162 hasta GVHH açısından geriye dönük olarak değerlendirildi. Hastaların tıbbi değerlendirme ve izlem amaçlı yapılmış olan laboratuvar incelemeleri, patoloji ve epikriz raporları hastane otomasyon sisteminden ve hastanede kayıtlı dosyalarından elde edildi. Hastalara ait tüm bilgiler SPSS for Windows versiyon 19.0 modüllüne girilerek istatistiksel analiz yapıldı. Çoğunluğunu akut lösemilerin oluşturduğu Allo-HKHN yapılan hastaların %54,3’ünde nakil sonrasında GVHH tanısı saptandı. GVHH tipinin ve derecesinin sağkalım sürelerini etkilediği görüldü. Sağkalım süreleri açısından GVHH tipinden en çok etkilen tanı AML idi. CMV-Reaktivasyonunun pozitifliği ile GVHH tipi arasında da anlamlı bir ilişki bulundu. GVHH’den en sık etkilen organ deri olarak saptandı. Enfeksiyon en sık ölüm nedeni olarak saptanırken, GVHH’den ölen hastaları oranı %3,06 idi. Bu çalışma sonucunda GVHH tipi ve derecesi ile CMV-Reaktivasyonunun sağkalımı çok önemli oranda düşürdüğü gösterilmiştir. Ayrıca aGVHH derecesinin de özellikle AML tanılı hastaların sağkalımını ciddi oranda düşürdüğü gösterilmiştir.KABUL ONAY ………..………………………………………………………………..…….. i TEŞEKKÜR ……………………………………………..……………….……………..…..... ii İÇİNDEKİLER ……………………………………….………………………………..…….. iii SİMGELER VE KISALTMALAR DİZİNİ ………………..……………………………......... v ŞEKİLLER DİZİNİ ……………………………………………………………………......... vii RESİMLER DİZİNİ…………………………………………………………...……………. viii TABLOLAR DİZİNİ …………………………………………………………….………...… ix ÖZET …………………………………………………………………………...……….……. x ABSTRACT…………………………………………………………………….…….……... xii 1. GİRİŞ …………..……………………………………………………………..…….……... 1 2. GENEL BİLGİLER …………………………………………………………………...…… 3 2.1. Hematopoietik Kök Hücrelerin Genel Özelliklerine Kısa Bir Bakış …………………….. 3 2.1.1. Hematopoietik Kök Hücre Nakli Çeşitleri ………………………………………...…… 4 2.1.2. Hematopoietik Kök Hücre Naklinin Tarihçesi ………………………………………… 5 2.1.3. Allojeneik Hematopoietik Kök Hücre Nakli Öncesi Verici Seçimi ve HLA ………….. 6 2.1.4. Allojeneik Hematopoietik Kök Hücre Toplanması ……………………………………. 8 2.2. Hazırlama Rejimleri ………..…………………………………………………………… 10 2.2.1. Myeloablatif Hazırlama Rejimleri …………………………………………………… 10 2.2.2. Non-myeloablatif Hazırlama Rejimleri ……………………………………………… 11 2.3. Allojeneik Hematopoietik Kök Hücre Nakli .…………………………………………... 11 2.4. Allojeneik Hematopoietik Kök Hücre Nakli Komplikasyonları ………………………. 12 2.4.1. Graft Versus Host Hastalığı (GVHH) ………………………………………………... 13 2.4.1.1. Akut Graft Versus Host Hastalığı ………………………………………………….. 15 2.4.1.2. Akut Graft Versus Host Hastalığı’nın Patogenezi …………………………………. 17 2.4.1.3. Akut Graft Versus Host Hastalığı’nın Önlenmesi ve Tedavisi …………………….. 17 2.4.1.4. Kronik Graft Versus Host Hastalığı ………………………………………………... 18 2.4.1.5. Kronik Graft Versus Host Hastalığı’nın Patogenezi ……………………………….. 18 2.4.1.6. Kronik Graft Versus Host Hastalığı’nın Önlenmesi ve Tedavisi ………………...... 19 2.4.1.7. Akut ve Kronik GVHH’de Yeni Yaklaşımlar ……………………………………… 20 2.4.1.8. Graft Versus Host Hastalığı’nda Yeni Sınıflandırma Sistemi ....…………………… 22 2.4.2. Enfeksiyonlar ...………………………………………………………………………. 26 vi 2.4.3. Graft Yetmezliği ……………………………………………………………………… 26 2.4.4. Diğer Komplikasyonlar ………………………………………………………………. 27 3. GEREÇ VE YÖNTEM …………………………………………………………………… 28 3.1. Hastalar ……………………………………………………………………….………… 28 3.2. İstatistiksel Analizler ……………………………………………………….…………… 29 4. BULGULAR ………………………………………………………………………..…….. 30 5. TARTIŞMA ………………………………………………………………………………. 42 6. SONUÇLAR VE ÖNERİLER ..…………………………………………………….…….. 46 KAYNAKLAR …………………………………………………………………………….... 48 EKLER ……………………………………………………………………………………… 59 EK 1 – ADÜ Araştırma ve Uygulama Hastanesi Etik Kurul Onayı ………………………. 59 EK 2 – Olgu Rapor Formu …………………………………………………………………… 60 ÖZGEÇMİŞ ...…………………………………………………………………………..…… 6

Towards unimolecular luminescent solar concentrators: bodipy-based dendritic energy-transfer cascade with panchromatic absorption and monochromatized emission

Cataloged from PDF version of article.Ein in ein Polymer eingebetteter, panchromatischer Bodipy-Absorber mit eingebautem Energiegradienten konzentriert einfallende Sonnenstrahlung an einem endständigen Chromophor und erzeugt so eine monochromatische Emission an den Seiten des Polymer-Wellenleiters (siehe Bild). Dieses besondere Design minimiert Selbstabsorptionsverluste der peripheren Antennen-Einheiten mit einem beeindruckenden S-Faktor von 10 000

Supersymmetric approach to exactly solvable systems with position-dependent effective masses

We discuss the relationship between exact solvability of the Schr\"{o}dinger equation with a position-dependent mass and the ordering ambiguity in the Hamiltonian operator within the frame of supersymmetric quantum mechanics. The one-dimensional Schr\"{o}dinger equation, derived from the general form of the effective mass Hamiltonian, is solved exactly for a system with exponentially changing mass in the presence of a potential with similar behaviour, and the corresponding supersymmetric partner Hamiltonians are related to the effective-mass Hamiltonians proposed in the literature.Comment: 12 pages article in LaTEX (uses standard article.sty). Please check http://www1.gantep.edu.tr/~ozer for other studies of Nuclear Physics Group at University of Gaziantep. [arXiv admin note: excessive overlap with quant-ph/0306065 and "Supersymmetric approach to quantum systems with position-dependent effective mass" by A. R. Plastino, A. Rigo, M. Casas, F. Garcias, and A. Plastino - Phys. Rev. A 60, 4318 - 4325 (1999)

Counting molecules with a mobile phone camera using plasmonic enhancement

Cataloged from PDF version of article.Plasmonic field enhancement enables the acquisition of Raman spectra at a single molecule level. Here we investigate the detection of surface enhanced Raman signal using the unmodified image sensor of a smart phone, integrated onto a confocal Raman system. The sensitivity of a contemporary smart phone camera is compared to a photomultiplier and a cooled charge-coupled device. The camera displays a remarkably high sensitivity, enabling the observation of the weak unenhanced Raman scattering signal from a silicon surface, as well as from liquids, such as ethanol. Using high performance wide area plasmonic substrates that enhance the Raman signal 10(6) to 10(7) times, blink events typically associated with single molecule motion, are observed on the smart phone camera. Raman spectra can also be collected on the smart phone by converting the camera into a low resolution spectrometer with the inclusion of a collimator and a dispersive optical element in front of the camera. In this way, spectral content of the blink events can be observed on the plasmonic substrate, in real time, at 30 frames per second

Reversible Electrical Reduction and Oxidation of Graphene Oxide

Cataloged from PDF version of article.We demonstrate that graphene oxide can be reversibly reduced and oxidized using electrical stimulus. Controlled reduction and oxidation in two-terminal devices containing multilayer graphene oxide films are shown to result in switching between partially reduced graphene oxide and graphene, a process which modifies the electronic and optical properties. High-resolution tunneling current and electrostatic force imaging reveal that graphene oxide islands are formed on multilayer graphene, turning graphene into a self-assembled heterostructure random nanomesh. Charge storage and resistive switching behavior is observed in two-terminal devices made of multilayer graphene oxide films, correlated with electrochromic effects. Tip-induced reduction and oxidation are also demonstrated. Results are discussed in terms of thermodynamics of oxidation and reduction reactions

Grating coupler integrated photodiodes for plasmon resonance based sensing

Cataloged from PDF version of article.In this work, we demonstrate an integrated sensor combining a grating-coupled plasmon resonance surface with a planar photodiode. Plasmon enhanced transmission is employed as a sensitive refractive index (RI) sensing mechanism. Enhanced transmission of light is monitored via the integrated photodiode by tuning the angle of incidence of a collimated beam near the sharp plasmon resonance condition. Slight changes of the effective refractive index (RI) shift the resonance angle, resulting in a change in the photocurrent. Owing to the planar sensing mechanism, the design permits a high areal density of sensing spots. In the design, absence of holes that facilitate resonant transmission of light, allows an easy-to-implement fabrication procedure and relative insensitivity to fabrication errors. Theoretical and experimental results agree well. An equivalent long-term RI noise of 6.3 x 10(-6) RIU/root Hz is obtained by using an 8 mW He-Ne laser, compared to a shot-noise limited theoretical sensitivity of 5.61 x 10(-9) RIU/root Hz. The device features full benefits of grating-coupled plasmon resonance, such as enhancement of sensitivity for non-zero azimuthal angle of incidence. Further sensitivity enhancement using balanced detection and optimal plasmon coupling conditions are discussed

PPLICATION OF TRICKLING FILTER WITH HYBRID BIOFILM SUPPORT MEDIA IN THE TREATMENT OF PETROLEUM EFFLUENT

The use of biological trickling filter (TF) system in the treatment of petroleum effluent using Luffa cylindrica-polystyrene hybrid as biofilm support medium for microbiological growth was evaluated. The efficiency of the treatment process was measured in terms of turbidity, chemical oxygen demand (COD) and biological oxygen demand (BOD5). The TF was set up with Luffa cylindrica-polystyrene hybrid biofilm support. The pilot scale trickling system was performed at an ambient temperature and the effluent from the system was measured for turbidity, COD and BOD5. The result showed that the turbidity of the effluent was reduced to 94 % at a hydraulic retention time of 6 hrs. The COD was also reduced from 327-26 mg/l at 6 hrs. representing 92 % reduction in the COD value. The results obtained also showed that the TF achieved 78 % reduction in BOD5.Therefore, the biological trickling filter treatment process appears to be a promising wastewater treatment method for petroleum effluent with respect to the turbidity, COD and BOD5 remova

Dieulafoy Lesion in the Stomach

Dieulafoy disease is an uncommon cause of gastrointestinal system bleeding. Although the exact cause is not known, it is characterized by bleeding from abnormal submucosal vessels. There are many methods for diagnosis and treatment. In this case, a patient with a long-time undiagnosed stomach Dieulafoy lesion had a surgical resection. During the postoperative period the patient was discharged without any complication

Designing microcapsules to save energy in buildings

Buildings consume the major portıon of the world’s energy. Improvements in building elements have been proven to significantly reduce this consumption. Integrating phase change materials (PCM) into a building’s parts is an effective solution to reduce energy consumption. PCMs help to maintain thermal comfort, reduce heating, cooling loads as well as improve passive storage of solar energy in buildings. Previous studies have concentrated on impregnating PCMs into materials like concrete mixes, gypsum wall boards, plasters, textured finishes, as well as PCM trombe walls, PCM shutters, PCM building blocks, air-based heating systems, floor heating systems, suspended ceiling boards, etc.[1]. The current challenge is to find a suitable PCM that can be safe, thermally effective and at the same time not adversely effect the durability of a building. PCMs may be in microcapsulated form to meet these challenges. The most common PCM studied previously is paraffin, be it in bulk or microencapsulated. Leakage of paraffin from porous structures, the breaking of microcapsules and the low thermal capacities of microencapsulated PCMs are the main problems that have been observed [2]. The current challenge is to find a suitable PCM that can be safe, thermally effective and at the same time not adversely effect the durability of a building. PCMs may be in microcapsulated form to meet these challenges. The most common PCM studied previously is paraffin, be it in bulk or microencapsulated. Leakage of paraffin from porous structures, the breaking of microcapsules and the low thermal capacities of microencapsulated PCMs are the main problems that have been observed [2. Paraffin is a fossil fuel derivative; thus, it is unsustainable. This study focuses on bio-based fatty acid mixtures as PCMs. We developed microcapsules of fatty acid mixtures that were tried in concrete mixes. Our design approach involved the following steps: determining and characterizing PCMs with suitable thermal properties; developing a method to synthesize microencapsulated PCMs; and finally incorporate these materials in buildings for improving thermal comfort and energy conservation. Please click Additional Files below to see the full abstract

Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic.

Background: This study investigates university students' digital health literacy and web-based information-seeking behaviours during the early stages of the COVID-19 pandemic in England. It compares undergraduate and postgraduate students in non-health related subjects with health care students, many of whom were preparing for, or working in, frontline roles. The survey was conducted as part of a wider study by the COVID-HL research consortium. Methods: A cross-sectional study was conducted among n=691 university students aged ≥18 years from 25 universities across England using an adapted digital survey developed by COVID-HL. Data were collected regarding sociodemographic characteristics and specific measures drawn from the Future Anxiety Scale and the Digital Health Literacy Instrument (DHLI). These had been adapted for use in an English setting and to the specific context of the COVID-19 pandemic. Other data collected included students’ anxiety or worries about the future using the Dark Future Scale as well as behaviours in online information-seeking. Data were analysed using correlations to test for relationships between constructs and also between group comparisons to test for differences between students studying health and non-health related subjects. Results: Across digital health literacy dimensions, there was no significant difference between students studying health-related subjects and other students. Health care students did report greater difficulties in relation to how to behave online. They also relied less on public body sources for information about the pandemic. A significant difference was found between the two student populations in relation to their anxiety about the future with health care students reporting fewer fears about the future. Conclusions: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with evaluating online information which may frustrate public health efforts. This could be addressed by ensuring health students’ curriculum in particular encompasses digital health literac