The effects of body ıron stores on metabolic control, ınsulin resistance and microalbuminuria in patients with type 2 diabetes mellitus

Objective: Free iron is involved in processes including oxidative stress, inflammation and insulin resistance which play key roles in the development of type 2 diabetes. The aim of this study is to investigate the role of body iron stores in metabolic control, insulin resistance and microalbuminuria. Materials and Methods: Our study included 50 patients with newly diagnosed type 2 diabetes mellitus and 50 healthy subjects as controls. Groups were compared for sex, age, body mass index, various biochemical and metabolic parameters. Correlation between these parameters with mean ferritin levels of patients was also calculated. Diabetic patients were grouped according to metabolic control, insulin resistance and microalbuminuria and the correlation between these paremeters and ferritin level was analyzed. Results: There was no difference in mean ferritin levels between two groups In the patient group, significant correlation was determined between mean ferritin level and fasting blood glucose, hemoglobin A1c, C-peptide, insulin andHOMAscore. There was no difference in mean ferritin levels between diabetic patients with good or bad metabolic control. The mean ferritin level was significantly higher in diabetic patients with insulin resistance than non-insulin resistant diabetics. Mean ferritin level was significantly higher in microalbuminuric patients. Conclusion: Our findings support that body iron stores are involved in the pathogenesis of type 2 diabetes

Cost-effectiveness of sorafenib for treatment of radioactive iodine (rai)-refractory locally advanced/metastatic differentiated thyroid cancer (dtc) in Turkey

WOS: 000354498503198OBJECTIVES: Sorafenib is the first product approved for treatment of RAI refractory locally advanced/metastatic DTC patients. This study was conducted in order to analyze cost-effectiveness of sorafenib for treatment of patients with RAI refractory locally advanced/metastatic DTC in Turkey. METHODS: A cohort partition model assigning patients to one of three health states according to the proportion of patients who are progression-free, progressed, or dead in each 28-days cycle was adapted to Turkish setting. The incremental cost-effectiveness ratios (ICER) were calculated per quality-adjusted life years (QALYs) and life-years (LYs) gained. Turkish payer’s perspective was taken and time-horizon was set as patient’s lifetime (maximum 30 years). Sorafenib was compared to the best supportive care (BSC) within the model since there are no agents for treatment of patients on this stage of the disease. Essential clinical inputs were derived from DECISION trial and local resource-utilization data were based on expert opinions through an expert panel. Sensitivity of the results was evaluated in terms of key inputs by deterministic oneway and probabilistic sensitivity analyses. All costs were calculated in Turkish Liras (TL) and converted to USD using TL/USD currency rate as 2.2 (mid-2014). RESULTS: Total cost of sorafenib-treated patients is 24,384 USD higher compared to BSC. Besides, sorafenib is associated with increments of 1.29 LYs and 0.80 QALYs compared to BSC. The ICER of sorafenib per LYs and QALYs gained compared to BSC were determined as 18,851 USD and 30,485 USD respectively. One-way sensitivity analysis demonstrated that results are not sensitive to the changes in model inputs and pharmacoeconomic analysis results were validated by probabilistic sensitivity analysis. CONCLUSIONS: Sorafenib is cost-effective for treatment of patients with RAI refractory locally advanced/metastatic DTC compared to BSC with an ICER value below the willingness-to-pay threshold (3-times GDP per capita ─ 32,346 USD) for Turkey

Pleomorphic Carcinoma of the Lung with High Serum Beta-human Chorionic Gonadotropin Level and Gynecomastia

Although gynecomastia is a well-defined paraneoplastic syndrome in patients with non-small cell lung cancer, the association with pleomorphic carcinoma has not been reported. A 50-yr-old man presented with bilateral gynecomastia and elevated serum beta-human chorionic gonadotropin (βhCG) level. Chest tomography showed a mass in the right middle lobe. Right middle lobectomy and mediastinal lymph node dissection were performed. βhCG levels decreased rapidly after surgery. Histological examination revealed pleomorphic carcinoma with positive immunostaining for βhCG. Serum βhCG levels began to increase gradually on postoperatively 4th month. Computed tomography detected recurrence and chemotherapy was started. After second cycle of chemotherapy, βhCG levels decreased dramatically again and tomography showed regression in mass. Patient died 6 months later due to brain metastasis. βhCG expression may be associated with aggressive clinical course and increased risk of recurrence, also βhCG levels may be used to evaluate therapy response in patients with pleomorphic carcinoma

Contextualizing consumer financial judgments and decisions

This dissertation investigates how changes to a decision’s frame or the decision-maker’s perspective affect consumers’ financial judgments and decision-making. The first chapter examines how different ways of constructing a donation portfolio affect the amount of money people allocate to charitable giving. I find that the order in which people decide how much of their money to allocate to charitable giving and identify which charities to support affects their total donation amount. Specifically, individuals contribute more money when they first determine which charities to support in advance of determining how much to allocate for charitable giving than vice versa. This effect is driven by the pain of paying consumers experience when allocating money to charity: the more consumers have a concretely identified set of charities to support, the less pain of paying they feel when allocating money for charity, causing them to donate more than they would before they have determined the target charities. The second chapter investigates how different perceptions of the self influence one’s tendency to commit sunk-cost bias. The results show that individuals who have a weak sense of psychological connectedness to their past self that had made the initial investment decision are less likely to display sunk-cost bias because they anticipate less negative feelings associated with abandoning substantial investments. The findings identify high past-self-continuity as a potential cause of sunk-cost bias and propose interventions that reduce past-self-continuity as a means to reduce this bias. The third chapter focuses on subjective judgments of resource allocations and documents how individuals compare their resource allocation to others who face similar budgetary constraints as they do. I observe that people, on average, tend to believe that others at their income level have more money to allocate across a range of expenditure categories than they do. I argue that individuals are insensitive to the financial constraints of others; while most people 4 are aware of the limits on their money that inhibit their expenditures, they fail to realize that others are as inhibited as they are. These results suggest that people may feel poorer than others, even when those others do not have any more money than they do. Together, the three chapters of my dissertation demonstrate that contextual changes can potentially have significant impact on how consumers think about and manage their finances. The interventions identified can inform both managerial and policy decisions to improve consumers’ financial decision-making and wellbeing

Predictive and prognostic importance of PTEN, p27 and PI3K expression in HER2 positive metastatic breast cancer

İstanbul Bilim Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim DalıGİRİŞ: PTEN, HER2 aşırı ekspresyonu olan meme kanserinde trastuzumab duyarlılığını etkileyen en önemli düzenleyicidir. PI3K/Akt yolu aktivasyonunun HER2 pozitif metastatik meme kanserinde trastuzumab tedavisine direnç ve kötü prognozla ilişkili olduğuna dair bulgular mevcuttur. Bu çalışmada HER2 pozitif metastatik meme kanserinde PTEN ve PI3K/Akt yolunun diğer komponentlerinden PI3K ve p27 ekspresyonunun prediktif ve prognostik önemi araştırıldı. GEREÇ VE YÖNTEM: Çalışmamıza İstanbul Bilim Üniversitesi Tıbbi Onkoloji Bilimdalı’ nda takip edilen ve meme dokusu örnekleri Patoloji Anabilimdalı tarafından incelenerek histolojik olarak tanısı konmuş, HER2 pozitif metastatik meme kanseri olan ve birinci basamakta trastuzumab içeren tedavi alan 25 hasta dahil edildi. Hastaların mevcut meme dokusu bloklarında bulunan invaziv tümör, in situ tümör ve çevre normal meme dokusu komponentlerinde IHK yöntemi kullanılarak saptanan PTEN, PI3K ve p27 ekspresyonu ile tümör karakteristikleri, tedavi yanıtı, ilk meme kanseri tanısı tarihinden (OS1), metastatik hastalık tanısı tarihinden (OS2) ve trastuzumab içeren tedavinin başlandığı tarihten itibaren değerlendirilen genel sağkalım, progresyona kadar geçen süre (TTP) ve rekürrense kadar geçen süre (TTR) arasındaki ilişki araştırıldı. BULGULAR: Hastaların %76’ sında (n=19) PTEN ekspresyonu negatif ve %80’ inde (n=20) p27 ekspresyonu negatif saptandı, 24 hastada (%96) PI3K ekspresyonu pozitif bulundu. İn situ PTEN ile çevre meme dokusu PTEN ekspresyonu arasında pozitif, invaziv PTEN ile çevre meme dokusu PTEN ekspresyonu arasında ise negatif korelasyon tespit edildi (p değerleri sırasıyla 0.036 ve 0.042). İnvaziv tümör komponentindeki PTEN, p27 ve PI3K ekspresyonunun kendi aralarındaki ilişkisi incelendiğinde; PTEN ile p27 arasında istatistiksel olarak anlamlı pozitif korelasyon bulundu (p=0.036). Trastuzumaba yanıtlı ve yanıtsız hastalar PTEN, p27 ve PI3K ekspresyonu açısından karşılaştırıldığında anlamlı ilişki bulunmadı. Tümör karakteristikleri açısından incelendiğinde PTEN, p27 ve PI3K ekspresyonu ile tümör çapı arasında anlamlı ilişki bulundu (p değerleri sırasıyla 0.009, 0.003 ve <0.001); tümör gradı, lenfatik invazyon, vasküler invazyon, lenf bezi metastazı ve uzak metastaz durumu ile ilişki saptanmadı. OS1 ve TTP, trastuzumab içeren tedaviye yanıtlı hastalarda yanıt vermeyen hastalarla karşılaştırıldığında anlamlı olarak uzundu (p değerleri sırasıyla 0.016 ve 0.006). İnvaziv tümör komponentindeki PTEN, p27 ve PI3K ekspresyonu pozitifliği ve negatifliği arasında trastuzumab yanıtı açısından istatistiksel olarak anlamlı bir farklılık saptanmadı. PTEN kaybı olan hastalarda daha kısa OS1, OS2, OS3, TTP ve TTR olduğuna dair bir trend izleniyordu, ancak aradaki fark istatistiksel olarak anlamlı bulunmadı.. Benzer trend p27 negatif olan hastalarda OS1, OS2, OS3 ve TTR açısından saptandı. PI3K ekspresyonu ve tümör karakteristikleri ile OS, TTP ve TTR arasında ilişki saptanmadı. SONUÇ: Çalışmamızda PTEN kaybı, düşük p27 ekspresyonu ve pozitif PI3K ekspresyonu HER2 meme kanserinde sık görülen bulgular olarak göze çarpmaktadır ve literatürde sporadik meme kanserinde bildirilenden daha yüksek sıklıkta bulunmuştur. Vaka sayımızın az olması çalışmanın sonuçlarının istatistiksel yorumunu güçleştirse de, çalışmamız PTEN ve p27 ekspresyonunun HER2 pozitif metastatik meme kanserinde trastuzumab yanıtını ve kısalmış sağkalımı predikte ettiğini destekler niteliktedir. Sonuçlarımız PI3K/Akt yolunun HER2 pozitif meme kanserinde aktif olduğunu göstermektedir.INTRODUCTION: PTEN is the key regulator for sensitivity to trastuzumab therapy in HER2 overexpressing breast cancer. There are data indicating the activation of PI3K/Akt pathway is associated with poor prognosis and resistance to trastuzumab therapy in HER2 positive metastatic breast cancer. In this study the predictive and prognostic significance of PTEN and expression of PI3K and p27 which are components of the PI3K/Akt signaling pathway in HER2 positive metastatic breast cancer was assessed. MATERIAL AND METHODS: 25 patients who carried a diagnosis of metastatic HER2 positive breast carcinoma and who have attended Istanbul Bilim University Medical Oncology Clinic were recruited for the study group. All of the patients breast tissue samples were examined by the institution’s pathology department. All patients in the study group received trastuzumab based therapies as their first line treatment. Invasive tumor, in situ tumor and surrounding normal mammary tissue components from all of the patients breast tissue blocks were evaluated for PTEN, PI3K and p27 expression by immunohistochemistry and their correlations with tumor characteristics, response to treatment, overall survival from the date of diagnosis of breast cancer (OS1), from the date of recognition of metastatic disease (OS2) and from the starting date of trastuzumab containing therapy (OS3), time to progression (TTP) and time to recurrence (TTR) were analyzed . RESULTS : In 76 % (n=19) of the patient group PTEN expression and in 80% (n=20) p27 expression was found to be negative. In 24 subjects (96%) PI3K expression was reported as positive. A positive correlation between in situ cancer and surrounding normal mammary tissue PTEN expression was found while the correlation between invasive cancer and surrounding normal mammary tissue PTEN expression was negative (p values 0.036 and 0.042, respectively ). When the correlation between PTEN, p27 and PI3K expression in invasive cancer tissue with each other was analyzed it was found that there was a positive statistically significant correlation between PTEN and p27 expression (p=0.036). When the group of patients who respond to trastuzumab treatment was compared to the group who did not respond to treatment with trastuzumab, there was no statistically significant association found for expression of PTEN, p27 and PI3K. When the same comparison was made for tumor characteristics a significant relation was found between tumor size and PTEN, p27 and PI3K expression (p values 0.009, 0.003 and <0.001, respectively ); but a statistically significant relation between expression of the above stated expression of the genes and tumor grade, lymphatic invasion, vascular invasion, and presence of distant metastasis was not found to be present. OS1 and TTP was significantly longer in the patient group who responded to trastuzumab based treatment compared to the group who was unresponsive to the treatment (p values 0.016 and 0.006, respectively). Although the status of PTEN, p27 and PI3K expression in the invasive tumor tissue was not found to be significantly correlated with response to trastuzumab treatment a trend towards lower OS1, OS2, OS3, TTP and TTR in patients with loss of PTEN expression which did not reach a statistical significance was observed. A similar trend for lower OS1, OS2, OS3 and TTR in patients whose invasive breast tissues did not express p27 was also found. A relation between PI3K expression and tumor characteristics with OS, TTP and TTR was not found . CONCLUSION: Loss of expression of PTEN, low expression of p27 and positive PI3K expression was found to be frequent in HER2 positive breast cancer. Their frequency was higher when compared to frequency of expression in sporadic breast cancer reported in the literature. Although the small number of our study group has made statistical interpretation of the results difficult, we propose the results of our study support the view that the presence of PTEN and p27 expression in HER2 positive metastatic breast cancer predicts response to trastuzumab treatment and shortened overall survival. Our results indicate that PI3K/Akt signaling pathway is active in HER2 overexpressing breast cancer

Concept of paraneoplasia

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Birçok kanser hastasında tümörün ya da metastazlarının invazyonu ya da kompresyonundan kaynaklanmayan belirti ve bulgular görülmektedir. Tümörün varlığı ile ilişkili olarak çeşitli organ ve sistemlere ait olabilen bu “uzak” etkiler “paraneoplazi” veya “Paraneoplastik sendrom” başlığı altında incelenmektedir. Paraneoplaziler sıklıkla tümör hücrelerince üretilen bazı hormonlar, peptidler ve uzun veya kısa etkili sinyal moleküllerine bağlı olarak ya da tümör-ilişkili antijenlerle immun reaksiyonlar sonucu gelişmektedir. Bu makalede paraneoplastik sendromların oluşum mekanizmaları ve sık görülen paraneoplaziler tartışılmıştır.In many cancer patients, various symptoms and signs not due to invasion or compression of tumor and its metastases are observed. These “remote” effects which can perta into various organs or systems are associated with the presence of tumor and examined under the title of “paraneoplasia” or “paraneoplastic syndrome”. Paraneoplasias are usually developed through hormones, peptides and long- and short-acting signal molecules produced by the tumoror immunereactions against tumor-associated antigens. Inthisarticle, mechanisms of paraneoplastic syndromes and commonly seen paraneoplasias were discussed

Design References In Contemporary Turkish Ceramic Tiles 1980-2014

Tez (Doktora) -- İstanbul Teknik Üniversitesi, Sosyal Bilimler Enstitüsü, 2017Thesis (Ph.D.) -- İstanbul Technical University, Institute of Social Sciences, 2017İnsanlığa eşlik eden 3 temel öğenin; toprak, su ve ateşin birleşiminden oluşan seramik, tarih boyunca günlük yaşamın içinde olmuştur. En basit tarifiyle kil ve su karışımının pişirilmesiyle elde edilen seramik malzemesi, sanat eserlerinden, ibadet ikonlarına, anlaşmaların yazıldığı tabletlerden, mimari öğelere kadar çeşitli işlevler için kullanılmıştır. Çalışmanın konusu olan seramik karolar ise, mimarlığın erken dönemlerinden itibaren yüzey kaplama malzemesi olarak kullanılmış, sanayi devriminden sonra ise mekanlarda kullanılan temel malzemelerden biri haline gelmiştir. Karo seramikler tarihin akışıyla beraber, üretim yöntemi ve üslup olarak değişmiş ve gelişmiş, sanat ve tasarımın çoğu evresine tanıklık etmiştir. Günümüzde de, seramik karolar yoğun olarak üretilmekte ve geniş bir tüketici kitlesine hitap etmektedir. Bu rekabetçi sektörde farklılığı yakalayabilmek adına, tasarımlarda çeşitli göndermelerin kullanıldığı görülmektedir. Tarihsel etkiler, yerel malzemeler, geleneksel üretim yöntemleri, tasarım eğilimleri, yeni teknolojiler gibi bir çok farklı çıkış noktası olan göndermelere, çağdaş Türk seramik karolarında da sıklıkla rastlanmaktadır. ‘Çağdaş Türk Seramik Karolarında Göndermeler 1980-2014’ başlıklı bu çalışmanın temel amacı, Türk Seramik Karo tasarımlarında kullanılan, tarihsel ya da tarih dışı çeşitli kaynaklardan ilham alan göndermelerin araştırılması, irdelenmesi ve değerlendirilmesidir. Çalışmanın amacının, kapsamının ve yönteminin ortaya konduğu Giriş Bölümü’nün ardından, tezin İkinci Bölümü’nde seramik karoların tanımı ve geçirdiği tasarım evreleri anlatılmıştır. Üçüncü Bölüm’de ise mimaride seramik kullanımı konusunda güçlü bir tasarım mirasına sahip olan Türk Seramik Sektörü’nün tarihçesi ve gelişimi ayrıca ele alınmıştır. Seramik karoların Dünya ve Türkiye’de geçirdiği evrelerin paylaşılması ile, Dördüncü Bölüm’de incelenecek tasarımlardaki değerlendirmenin daha sağlıklı anlaşılması amaçlanmıştır. Tez çalışmasının Dördüncü Bölümü’nde çalışmanın ana konusunu oluşturan seramik karo örnekleri yer almaktadır. Ele alınan tüm ürünlerin önce teknik bilgileri paylaşılmış, daha sonra olarak tasarımlarında kullanılan göndermeler hakkında değerlendirmeler yapılmıştır. Bölüm boyunca önemli görülen sektörel gelişmelere de yer verilmiştir. Ürünlerin analiz ve irdelenmesi ile elde edilen sonuçlar Beşinci Bölüm’de paylaşılmıştır.Ph.D

Beliefs of Turkish cancer patients on the genesis of cancer: "Why do I have cancer?"

WOS: 000279655900015PubMed ID: 20658726Purpose: To determine the beliefs of Turkish cancer patients about the etiology of carcinogenesis. Methods: The study was carried out at Istanbul Bilim University, European Florence Nightingale Hospital, Department of Medical Oncology. The data were collected during April-June 2008 from 39 women and 23 men. Sociodemographic data form and beliefs on the reasons of carcinogenesis rating scale were used while collecting the data. Results: Of the patients recruited in this study 29 (47%) took it as fate, 28 (45%) as a rightful punishment, 28 (45%) as a result of air pollution and toxins in food, 26 (42%) because of losing a beloved person, 26 (42%) as a result of wrong nutrition, smoking and alcohol consumption. In women the most common belief was fate (n=20, 51%), while in men it was air pollution and toxins in food (n=12, 52%). In primary school graduate patients or patients with no education the most common belief was rightful punishment (n=17, 62%), whereas in university graduate patients it was wrong nutrition, smoking and alcohol consumption (n=12, 63%). Conclusion: A considerable proportion of patients behaved in a fatalistic manner This may cause a risk of taking the responsibility of treatment and control of disease not by the doctor but by other persons. It seems that sex and educational status are important factors in relation with the beliefs of the patients. Meanings attributed to the disease by the patients should be found in order to increase their treatment compliance and be helpful to face off the disease. Patients should also be encouraged to change thoughts that affect treatment process negatively

It’s No Longer “Me”: Low Past-Self-Continuity Reduces the Sunk-Cost Bias

Study materials, data and synta