Avrupa Yönetişimi ve Ulusaltı Yönetimlerin Ulusötesi Ağ Faaliyetleri

Literatürde ulusaltı yönetimlerin ulusötesi ağ faaliyetleri (transnational networking)- yerel ve bölgesel yönetimlerin muadilleri ile işbirliği ve ortaklık bağlamında çeşitli etkileşim süreçleri içine girmesi- AB yönetişiminin dikkat çeken unsurlarından biri olarak değerlendirilebilmektedir. Bu bağlamda söz konusu ağ faaliyetlerinin ulusaltı yönetimlerin AB yönetişim süreçlerine dahil olmalarında kolaylaştırıcı bir rol üstlendiği ifade edilebilmektedir. Bununla birlikte, ulusaltı yönetimlerin karşılıklı bilgi paylaşımı, işbirliği, ortak proje geliştirme, en iyi uygulama paylaşımı, lobi faaliyetleri yürütme, finansal kaynaklara erişim gibi amaçlarla bir araya geldikleri ve ağ faaliyeti gerçekleştirdikleri belirtilebilirken, bu yolla söz konusu idarelerin AB yönetişim süreçleri içinde hareketlilik kazandıkları, etkileşim ve görünürlüklerini arttırdıkları tartışılabilmektedir. Bu çalışma çerçevesinde ulusaltı yönetimler ve AB yönetişimine ilişkin bağlam yönetişim ağları perspektifinden tartışılmakta; farklı yaklaşımlara dair değerlendirmeler vurgulanırken, bu alanda yapılacak çalışmaların yerel yönetim literatürüne sağlayacağı katkı ele alınmaktadır

Predictors of Outcome in Patients with Advanced Nonseminomatous Germ Cell Testicular Tumors

Background: Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs). Materials and Methods: Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers. Results: The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease. Conclusions: Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches

Does maternal serum progesterone level in early pregnancy predict placental dysfunction in third trimester?

Objective Progesterone, which is necessary for maintenance of pregnancy, is secreted by corpus luteum until 10 weeks of gestation, and is produced from the placenta afterwards. Aim of this study is to investigate the relationship of serum progesterone concentrations measured in 6–8 weeks and 12 weeks of gestation with the parameters that may demonstrate placental dysfunction in the third trimester. Methods Relationship of the progesterone values measured at 6–8 weeks and 12 weeks of gestation with indicators of placental dysfunction, including hypertensive disorders of pregnancy, intrauterine growth restriction, preterm delivery and low birth weight, were evaluated. Furthermore, based on a previous study, two groups with progesterone levels below and above 11 ng/mL in early pregnancy were formed, and the difference between these groups regarding gestational outcomes were investigated. Results Progesterone concentrations at 6–8 and 12 weeks of gestation were not significantly different between the subgroups with and without gestational complications indicating placental dysfunction (p>0.05 for all parameters). As for the two groups, significant difference was not found in terms of third trimester complications due to progesterone cut-off of 11 ng/mL at 6-8 weeks of gestation. Conclusion In this study, we did not find progesterone values measured at early and late first trimester periods to be associated with placental dysfunction in the third trimester. Also, we did not validate a previously suggested threshold value to predict gestational outcome. Therefore, routine first trimester progesterone screening in guiding pregnancy follow-up may not be appropriate

Organik Sultani Çekirdeksiz Üzüm Yetiştiriciliği

Bu projede, organik ürün olarak, talebi oldukça fazla Sultani Çekirdeksiz kuru üzüm üretimi ele alınmıştır. Çalışma, iki alt projeden oluşturulmuştur. I. Alt projede organik tarımda istenen minimum toprak işlemesi yanında ülkemizde bulunan ve birçok olumlu özelliklere sahip Zeolit (Klinoptilolitie mineral [Agro-clıno (NMF 900)]) kullanımı da denemede yer almıştır. II. Alt proje de ise Ege Bölgesi bağlarının ana hastalığı olan külleme mücadelesinde NaHCO3’ (içme sodasının) mevcut koşullardaki kullanım olanakları projede ele alınmıştır Bağlardaki ana zararlı da salkım güvesi olup her iki alt projede, salkım güvesi mücadelesinde tuzaklar asılarak zararlının ergin populasyonu bu tuzaklarla ilk ergin çıkışından uçuşlar sona erinceye kadar haftalık olarak izlenmiştir. Uçuş eğrileri ile tahmin-uyarı istasyonlarından elde edilen meteorolojik veriler ışığında gerekli uygulamalar yapılmıştır. Çalışmanın sonucunda, KULTIVATOR ile toprak işleme sisteminin toprağa olumsuz etkisinin de en az düzeyde olduğu da dikkate alınarak önerilebileceği ortaya çıkmıştır. Yeşilyurt yöresi topraklarındaki mikrobiyal aktiviteyi arttırmada malç uygulaması önerilmesine karşın, bu uygulama diğer disiplinler tarafından uygun görülmediğinden alternatif olarak KULTIVATOR uygulaması tercih edilmektedir. Kükürt ve içme sodası uygulanan parsellerde külleme hastalık şiddeti konvansiyonel olan şahit parsele göre istatistiki öneme sahip düzeyde azalma kaydetmiştir. Konvansiyonel koşullardaki hastalığın daha fazla görülmesini uygun koşulları yaratacak yoğun vejetatif gelişmenin yaratmış olduğu düşünülmektedir. Kükürdün zararlıları baskılayıcı etkisi de bilindiğinden organik yetiştiricilikte Külleme mücadelesinde içme sodasına nazaran özellikle kükürdün tercih edilmesi uygun bulunmaktadır. Denemenin başladığı 2003 yılı baz alındığında Zeolit (Klinoptilolitie mineral [Agro-clıno (NMF 900)]) uygulamalarında verim ve kalite kriterlerinde artış olduğu tespit edilmiştir. Toprak işleme uygulamalarından toprağı çizerek işleme salkım sayısı ve verim bakımından önemli bulunurken pulluk+ diskharow ile işleme salkım ağırlığını; malç uygulamasının ise kuru maddeyi ve tane tutumunu arttırdığı görülmektedir. Yaprak alma uygulamalarından, 6 adet yaprak alınması kontrole nazaran verim, salkım sayısı ve salkım ağırlığını nispeten arttırmıştır. Proje konusu çalışma birimleri itibarıyla değerlendirildiğinde toprağın çizilerek işlenmesi (KULTIVATOR sistemi) ön plana çıkmaktadır

COVID-19 in pediatric nephrology centers in Turkey

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10–15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients’ susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub