Staged, Open, No-Ischemia Nephron-Sparing Surgery for Bilateral-Multiple Kidney Tumors in a Patient with Birt-Hogg-Dubé Syndrome

Hereditary kidney cancer patients with bilateral multiple kidney tumors represent challenges in the era of rapidly growing minimal invasive treatment techniques. Birt-Hogg-Dubé Syndrome (BHDS) is an autosomal dominant genodermatosis characterized by a triad of benign skin tumors (fibrofolliculomas, trichodiscomas, acrochordons) together with an increased risk of developing malignant renal tumors and pulmonary disease such as pneumothoraces and multiple lung cysts. The morbidity and mortality of the affected patients is determined by the presence of the kidney tumors, which tend to be multifocal and bilateral, as observed in other hereditary kidney cancer syndromes like von Hippel-Lindau disease, familial leiomyomatosis, and hereditary papillary renal cell carcinoma. Herein, a patient with BHDS, presenting with synchronous bilateral multiple kidney tumors, is reported. The report describes the management of kidney tumors with two-stage open nephron-sparing surgery in which the nonvascular clamping technique was utilized

Anadolu Liselerinde Yabancı Dille Yapılan Öğretim ile İlgili Öğretmen, Öğrenci, Veli ve Denetçilerin Görüşleri

There are various types of secondary school in our country. Some of these are general high schools, Anatolian high schools, technical vocational high schools , teacher high schools and religious high schools. In the Anatolian High Schools some courses are provided in the medium of English. Science courses are among these lessons. The purpose of this study is to conduct research into curriculum and total quality administration in order to assess the extents to which these courses meet individual and community needs. For this purpose, different questionnaires were administered to students, parents, headmasters, inspectors and English Science teachers in these schools. As a result of wide resource collection, a scientific evaluation has been achieved.Ülkemizde ortaöğretim kademesinde çeşitli okullar bulunmaktadır. Bunlardan bazıları genel liseler, Anadolu liseleri,teknik meslek liseleri, öğretmen liseleri ve imam hatip liseleridir. Bu okullardan Anadolu liselerinde bazı dersler yabancı dille okutulmaktadır. Fen Bilimleri dersleri de bu şekilde okutulan derslerdendir. Bu çalışmanın amacı, Anadolu liselerinde İngilizce okutulan Fen Bilimleri derslerinin bireysel ve toplumsal ihtiyaçlara ne oranda hizmet ettiğini, eğitim programı ve toplam kalite yönetimi yönünden incelemektir. Bu amaçla, bu çalışmada İngilizce Fen Bilimleri dersleri uygulaması yapan Anadolu liselerinde okuyan öğrencilere, bu öğrencilerin velilerine, bu okulların müdürlerine, bu okulları denetleyen denetçilere ve Anadolu liselerinde Fen Bilimleri derslerini İngilizce okutan öğretmenlere ayrı ayrı anketler uygulanmıştır. Ayrıca, geniş bir yazın taraması yapılarak, bu tip bir uygulamanın bilimsel yönden değerlendirilmesi sağlanmıştır

Genomic alterations in low-grade, anaplastic astrocytomas and glioblastomas.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.To extend our understanding of potential stepwise genetic alterations that may underlie tumor progression from low-grade astrocytomas to glioblastomas, histopathologic and comparative genomic hybridization analyses were performed on tumor specimens from 68 primary lesions, including 40 glioblastomas, 10 anaplastic and 18 low-grade astrocytomas. The number of aberrations per case increased towards the higher grade tumors (grade II: 1.66+/-1.49; grade III: 2.80+/-1.68; grade IV: 3.02+/-1.07; F=6.955, p=0.002). A gain of 7/7q was common and the most frequently seen aberration in low-grade astrocytomas, whereas loss of 10q was the most frequently seen anomaly in anaplastic astrocytomas and glioblastomas. Chromosome 7p amplification was only detected in glioblastomas. Chromosome 10/10q deletion and combination of 1p, 19q and 17p deletions were specific to high-grade astrocytic tumors. Sequences of chromosome 7 and 10 seem to have pivotal roles in the biology of human gliomas. The genomic copy deletions of chromosomes 1p and 19q might provide an alternative mechanism in the genesis of astrocytomas

Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?

PURPOSEWith the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening.METHODSCharts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for ≥cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance. RESULTSBetween January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively. CONCLUSIONIn the first set of transrectal prostate biopsies, mp-MRI guidance did not increase the diagnostic yield significantly

Attitudes and Behaviors Regarding Smoking in Friends and Relatives of Patients in Emergency Room: A New Frontier in the Fight against Tobacco

Background: Emergency rooms (ERs) are usually crowded with friends and relatives (F&Rs) of the patients. This experience may result in changes in smoking behaviors and create opportunities for smoking cessation interventions. The study aims to investigate these changes and offers a new frontier in the fight against smoking.Methods: This cross-sectional study was conducted in the ERs of two universities in different cities. A questionnaire consisting of 18 questions was applied to F&Rs of the emergency patients. Statistical analysis was performed using Jamovi program.Findings: A total of 603 respondents were included in the study. Of them, 71.3% were first-degree relatives, 51.7% waited 5 or more times in ER before, and 68.6% spent 0-2 hours in a day around the ER. Upon witnessing patients in the ERs, 53.4% of the F&Rs had the idea of quitting smoking and 42.9% wanted to have smoking cessation therapy during their wait in the hospital. While 76.1% of the participants were not using different brands of cigarettes when offered in normal life, this rate was lower around the ERs (64.6%) (P < 0.001). Participants smoked 0.82 ± 0.34 cigarette per hour in normal life excluding sleeping time; this number raised almost 6 folds during the wait (4.85 ± 2.11) (P < 0.001).Conclusion: F&Rs smoked more during waiting around ERs. However, they also expressed desire to quit smoking and receive smoking cessation intervention during the wait. Providing smoking cessation counseling to F&Rs in the ER may be a valuable intervention

An interesting journey of an ingested needle: a case report and review of the literature on extra-abdominal migration of ingested Foreign bodies

Swallowed foreign bodies encounter a major problem especially in children, but fortunately they mostly do not cause any related complication and are easily passed with the stool. In this paper, an interesting journey of a needle is presented. A 20-year old female admitted to our emergency service after she had swallowed a sewing machine needle, which is initially observed in the stomach in the plain abdominal radiography. During the follow-up period, the needle traveled through bowels, and surprisingly was observed in the left lung on 10th day of the follow-up. It was removed with a thoracotomy and pneumotomy under the fluoroscopic guidance. The postoperative period was uneventful and the patient was discharged from the hospital on the day 5. We also review the literature on interesting extra-abdominal migrations of swallowing foreign bodies

Spatial and temporal heterogeneity in human mobility patterns in Holocene Southwest Asia and the East Mediterranean

We present a spatiotemporal picture of human genetic diversity in Anatolia, Iran, Levant, South Caucasus, and the Aegean, a broad region that experienced the earliest Neolithic transition and the emergence of complex hierarchical societies. Combining 35 new ancient shotgun genomes with 382 ancient and 23 present-day published genomes, we found that genetic diversity within each region steadily increased through the Holocene. We further observed that the inferred sources of gene flow shifted in time. In the first half of the Holocene, Southwest Asian and the East Mediterranean populations homogenized among themselves. Starting with the Bronze Age, however, regional populations diverged from each other, most likely driven by gene flow from external sources, which we term “the expanding mobility model.” Interestingly, this increase in inter-regional divergence can be captured by outgroup-f$_3$-based genetic distances, but not by the commonly used F$_{ST}$ statistic, due to the sensitivity of F$_{ST}$, but not outgroup-f$_3$, to within-population diversity. Finally, we report a temporal trend of increasing male bias in admixture events through the Holocene

Effiziente Pareto-Frontier-Algorithmen für Berechnung strukturierter Signaldarstellungen

ℓp-norm minimization plays a significant role in a variety of disciplines. It is not only important for the signal recovery in compressed sensing but also beneficial for finding meaningful signal representations as for the sparse and anti-sparse coding related applications. Therefore, minimizing ℓp-norms in an efficient manner sparked interest in a variety of works. This thesis is concerned with the noise-constrained ℓp-norm minimization for 1 ≤ p ≤ ∞. Although there are various optimization problem formulations that may be used to minimize an ℓp-norm, constraining the noise can offer a more meaningful optimization problem definition since when there is a known noise tolerance in an application, one can simply canalise it into the optimization problem and formulate exactly what to solve. Thus, it is often easier to set the noise tolerance from the optimization perspective. Despite this, there is a lack of computationally efficient algorithms in the literature for the noise-constrained ℓp-norm minimization problem because its feasible area can be complicated. Different optimization problem formulations can provide equivalent solutions and some of them might be easier to solve than the others. Therefore, it might be tempting to solve a computationally efficient problem in order to have the solution to another one. In this thesis, we solved constrained ℓp-norm regularization to reach the solution of the noise-constrained ℓp-norm problem. We introduce optimality tracing based ℓp-norm minimization approaches with simple root finding iterations for 1 ≤ p ≤ ∞. The optimality trade-off between both objectives, the ℓp-norm and a loss function that measures the data misfit, is formulated as a nonlinear equation root finding problem. We present and employ several simple, derivative-free and cost-efficient nonlinear equation root finding methods to trace this optimality over a Pareto frontier. Some of these root finding methods do not require differentiable loss functions and are applicable for both convex and nonconvex data misfits and extend such problems to a broader class of applications. We also introduce a warm-start strategy of taking linear least-squares solution with the one that has minimum ℓ2-norm which is named method of frames (MOF) as an input to require fewer iterations. This warm-start may provide flexible and meaningful starting point initialization for many applications where MOF already exists and can be improved with a better understanding of finitedimensional geometry, e.g. n-widths. The impact of the overcomplete matrix on the convergence rate of some of the presented approaches is demonstrated for matrices fulfilling the Uniform Uncertainty Principle and Uncertainty Principle. These properties were formerly introduced to analyze the performance of random matrices for ℓ1 and ℓ∞-norm related applications respectively. In the last part of the thesis, i.e. in Chapter 7, ℓp-norm minimization related applications are probed with using several loss functions such as least-squares, Huber and a nonconvex penalty Student’s t. ℓ1-norm is minimized with a typical compressed sensing example. Also, a generic test benchmark is utilized for the comparison of the nonlinear equation root finders for ℓ1-norm minimization. A new communication scheme is introduced by minimizing ℓ∞-norm. Outlier detection problem is studied with the minimized ℓ∞-norm, and a prior is offered for the minimized ℓ∞-norm with its performance on peak-to-average power ratio (PAPR). Noise-constrained nuclear norm is minimized as well for the Euclidean distance matrix completion problem with the application of wireless sensor network localization.Die Minimierung von ℓp-Normen spielt in einer Vielzahl von Disziplinen eine bedeutende Rolle. Sie ist nicht nur wichtig für die Signalwiederherstellung bei der komprimierten Abtastung, sondern auch nützlich, um sinnvolle Signaldarstellungen zu finden, wie für Anwendungen mit geringer und anti-sparse Codierung. Daher hat die effiziente Minimierung von ℓp-Normen das Interesse an einer Vielzahl von Arbeiten geweckt. Diese Dissertation beschäftigt sich mit der rauschbeschränkten ℓp-Normminimierung für 1 ≤ p ≤ ∞. Obwohl es verschiedene Formulierungen von Optimierungsproblemen gibt, die verwendet werden können, um eine ℓp-Norm zu minimieren, kann die Beschränkung des Rauschens eine sinnvollere Definition des Optimierungsproblems bieten. Bei bekannter Rauschtoleranz in einer Anwendung kann man diese in das Optimierungsproblem kanalisieren/integrieren/einbauen und genau formulieren, was/welches Problem zu lösen ist. Daher ist es aus Optimierungssicht oft einfacher, die Rauschtoleranz einzustellen. Trotzdem fehlt es in der Literatur an recheneffizienten Algorithmen für das rauschbeschränkte ℓp-Norm-Minimierungsproblem, da sein zulässiger Bereich kompliziert sein kann. Verschiedene Formulierungen von Optimierungsproblemen können äquivalente Lösungen liefern und einige von ihnen sind möglicherweise einfacher zu lösen als andere. Daher kann es verlockend sein, ein recheneffizientes Problem zu lösen, um die Lösung für ein anderes zu erhalten. In dieser Arbeit wurde die eingeschränkte ℓp-Norm-Regularisierung gelöst, um die Lösung des rauschbeschränkten ℓp-Norm-Problems zu erreichen. Die auf der Optimalitätsverfolgung basierenden ℓp-Norm-Minimierungsansätze mit einfachen Wurzelfindungsiterationen für 1 ≤ p ≤ ∞ werden hierzu vorgestellt. Der Optimalitäts-Trade-off zwischen beiden Zielen, der ℓp-Norm und einer Verlustfunktion, die die Datenfehlanpassung misst, wird als nichtlineares Gleichungswurzelfindungsproblem formuliert. Mehrere einfache, ableitungsfreie und kosteneffiziente Methoden zum Auffinden von nichtlinearen Gleichungswurzeln werden präsentiert und verwendet, um diese Optimalität über eine Pareto-Grenze zu verfolgen. Einige dieser Wurzelfindungsverfahren erfordern keine differenzierbaren Verlustfunktionen und sind sowohl für konvexe als auch für nichtkonvexe Datenfehlanpassungen anwendbar und erweitern solche Probleme auf eine breitere Klasse von Anwendungen. Wir führen auch eine Warmstart-Strategie ein, die eine lineare Lösung der kleinsten Quadrate mit derjenigen mit minimaler ℓ2-Norm, die method of frames (MOF) heißt, als Eingabe verwendet, um weniger Iterationen zu erfordern. Dieser Warmstart kann für viele Anwendungen, bei denen MOF bereits existiert, eine flexible und sinnvolle Startpunktinitialisierung bieten und durch ein besseres Verständnis der endlichdimensionalen Geometrie verbessert werden, z.B. nwidths. Der Einfluss der übervollständigen Matrix auf die Konvergenzrate einiger der vorgestellten Ansätze wird für Matrizen gezeigt, die das Uniform Uncertainty Principle und das Uncertainty Principle erfüllen. Diese Eigenschaften wurden früher eingeführt, um die Leistung von Zufallsmatrizen für ℓ1- bzw. ℓ∞-normbezogene Anwendungen zu analysieren. Im letzten Teil der Arbeit, d. h. in Kapitel 7, werden ℓp-Norm-Minimierungsbezogene Anwendungen mit verschiedenen Verlustfunktionen wie Least-Squares, Huber und einer nichtkonvexen Penalty untersucht Student’s t. ℓ1-norm wird mit einem typischen Compressed-Sensing-Beispiel minimiert. Außerdem wird ein generischer Testbenchmark für den Vergleich der nichtlinearen Gleichungswurzelfinder für die ℓ1-Norm-Minimierung verwendet. Durch Minimierung der ℓ∞-Norm wird ein neues Kommunikationsschema eingeführt. Das Problem der Ausreißererkennung wird mit der minimierten ℓ∞-Norm untersucht und ein Prior wird für die minimierte ℓ∞-Norm mit ihrer Leistung auf peak-to-average power ratio (PAPR) angeboten. Die rauschbeschränkte Nuklearnorm wird auch für das Euklidische Distanzmatrix-Ergänzungsproblem mit der Anwendung der drahtlosen Sensornetzwerklokalisierung minimiert