Low pass filter design with improved stop-band suppression and synthesis with transformer-free ladders

A new method to design transformer-free low pass (LP) ladder network with improved stop-band suppression performance is introduced. The parametric representation of back-end impedance of LP filter network is established with minimum impedance part and a Foster reactance part. The constructed impedance function is optimized by using real frequency technique. It has been shown that the proposed method provides LP filters which have superior stop-band suppression in comparison with classical transfer function-based filters with same complexity. The synthesis of the LP filter is obtained with the proposed element extraction procedure and resulted with fully realizable network elements in ladder form. An LP filter design and application by employing the proposed technique is provided. The measurement results of the prototyped filter are presented.Publisher's Versio

Subcutaneous C.E.R.A. for the Treatment of Chronic Renal Anemia in Predialysis Patients

Background: We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment Study Design: Single arm, open label study. Methods: A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 ?g/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). Results: Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. Conclusion: Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs

Peripheral vs. central cannulation in cardiac reoperations: Technical considerations and outcomes

Objective: To compare peripheral and central cannulation techniques in cardiac reoperation.Methods: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared.Results: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups.Conclusion: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival

Lymphocyte-to-monocyte ratio is a valuable marker to predict prostate cancer in patients with prostate specific antigen between 4 and 10 ng/dl

Objective: To evaluate the diagnostic value of serum inflammation markers derived from complete blood count in diagnosis of prostate cancer (PCa). Methods: We retrospectively analyzed the data of 621 patients who underwent prostate biopsy between March 2013 and April 2018. Age, prostate specific antigen (PSA), free PSA, platelet count, neutrophil count, lymphocyte count, monocyte count, prostate volume (PV) and pathology result of the patients were recorded. Patients were grouped as benign prostatic hyperplasia (BPH), prostatitis and PCa. Patients were also grouped according to PSA values, as PSA 10 ng/dl. Results: The mean lymphocyte-to-monocyte ratio (LMR) value of the patients with PCa was significantly lower in the entire cohort (p = 0.047). In the PSA 4-10 ng/dl range, LMR value wassignificantly lower in patients with PCa than those with BPH or prostatitis (p = 0.012). In this PSA range, free/total PSA ratio and LMR were significant factors to predict PCa. The cut-off values of LMR, free/total PSA were 3.05 and 0.15 respectively. The sensitivities, spesificities, positive predictive values (PPV) and negative predictive values using LMR cut-off, free/total PSA cut-off and their combination were assessed. Specificity and PPV of the combination group were higher (97.2%, 83.3% respectively) compared to free/total PSA cut-off group (91.6%, 76.6%) and LMR cut-off group (67.8%, 43.7%). Conclusions: LMR is a useful tool at detecting PCa especially in patients with PSA value between 4 and 10 ng/dl. The combination of free/total PSA ratio and LMR improves the diagnostic accuracy more than the use of free/total PSA ratio alone

Blastocystis i̇nfection frequency in cirrhosis and its correlation with hepatic encephalopaty

Amaç: Sirozlu hastalarda Blastocystis hominis enfeksiyonu sıklığı ve hepatik ensefalopatiye etkisinin değerlendirilmesi Metod: Gazi Üniversitesi Tıp Fakültesi Gastroenteroloji Klinik ve Polikliniğine Nisan 2014 - Nisan 2015 arasında başvuran ve çalışmaya katılarak gayta örneği vermeyi kabul eden tüm siroz hastaları ardışık olarak ve etyolojisine bakılmaksızın dahil edildi. Hastalar hastalık şiddeti açısından Child-Pugh-Turcotte (CTP) sınıflamasına göre gruplandırıldı. Hastaların gaita örneklerinde Blastocytis Hominis varlığı araştırıldı. Hastaların tamamı fizik muayene ile klinik hepatik ensefalopati (HE) ve Psikometrik Hepatik Ensefalopati Skoru (PHES) testleri ile Minimal Hepatik Ensefalopati açısından her kontrol muayenesinde tetkik edildi. Bulgular: Çalışmaya 49 hasta dahil edildi. Hastaların yaş ortalaması 58,5± 13,6 (19-87) olup %61,2'si kadındı. Siroz etiyolojisinde hastalarının %26,5'inde (n=13) Hepatit B, %18,4'ünde (n=9) Primer Biliyer Siroz, %14,3'sinde (n=7) Alkolik karaciğer hastalığı, %8,2'inde (n=4) Hepatit C tespit edildi. Olguların %12,5'inde (n=6) ise Non-Alkolik Steatohepatit (NASH), Budd-Chiari Sendromu, Otoimmun hepatit gibi diğer nedenler sorumluydu. Hastaların %20,4'ünde (n=10) herhangi bir etiyolojik neden saptanamadığından kriptojenik siroz olarak kabul edildi. Tüm siroz hastalarının %16,3'ünde (n=8) B.hominis üremesi oldu. Hepatik ensefalopatisi olmayan 30 hastanın 8'inde (%26,7) B.Hominis üremesi olurken, 49 Hepatik ensefalopatisi (klinik ensefalopati veya MHE) olan 19 hastanın hiç birinde (%0) B. Hominis üremesi olmadı (p=0,016 Fisher's Exact Test). Hafif derecede sirozu olan CTP A hastaların 7'sinde (%26,9), CTP B hastaların 1'inde (%7,1) B. Hominis saptanırken CTP C evresindeki hastalarda B Hominis üremesi olmadı (%0). Sonuç: Sirozlu hastalarda hastalık şiddeti yüksek, CTP evresi ileri ve Hepatik Ensefalopati olan hastalarda B. Hominis sıklığı azalmaktadır.Objective: Determining Blastocystis İnfection Frequency in Cirrhosis and its correlation Methods: All cirrhotic patients who applied to Gazi University Faculty of Medicine Gastroenterology Clinic and Policlinic between April 2014 - September 2015 and agreed to give stool samples by participating in the study included consecutively and regardless of etiology. Patients were grouped according to the Child-Pugh-Turcotte (GRP) classification in terms of disease severity. Blastocytis hominis in stool specimens of patients were investigated. Each patient was examined for clinical hepatic encephalopathy (HE) by physical examination and for Minimal Hepatic Encephalopathy by Psychometric Hepatic Encephalopathy Score (PHES) at each control. Results: 49 patients were included in the study. The mean age of the patients was 58.5 ± 13.6 (19-87) and 61.2% were female. In the etiology evaluation, 26.5% of the patients (n = 13) were determined as hepatitis B, 18.4% (n = 9) of the patients were determined as primary biliary cirrhosis, 14,3% (n = 7) of the patients were determined as alcoholic liver disease and 8,2% (n = 4) of the patients were determined as hepatitis C. In 12.5% of cases(n = 6), other reasons was responsible for the cirrhosis such as the non-alcoholic steatohepatitis (NASH), Budd-Chiari Syndrome and Autoimmune hepatitis. In 20.4% of patients (n = 10) any etiological factor could not be detected and considered cryptogenic cirrhosis. B.hominis was reproduced in 16.3%(n = 8) of all cirrhotic patients. In 8 of 30(26.7%) patients without hepatic encephalopathy B.hominis was reproduced while in none of the 19 patients with HE (both clinical and minimal hepatic encephalopathy) B. hominis wasn't reproduced (p = 0.016 Fisher's Exact Test). In none of CPT C patients , B.hominis was reproduced while in 7(26.9%)of CPT A patients with mild cirrhosis and 1(7.1%) of CPT B patients B. hominis was detected. Conclusion: In cirrhotic patients with high severity of the disease, hepatic encephalopathy and advanced stage of CPT, B. hominis frequency decreases

Evaluation in terms of primary schools of the learning organization approach

Bireysel, örgütsel ve toplumsal yapının değişimini etkilemesi bakımından son derece önemli bir öğe olan öğrenme, toplumsal yapı içerisindeki kurumların öğrenen örgütlere dönüşmesi ile daha etkin gerçekleşebilecektir. Öğrenen örgüt kavramı, sürekli olarak değişen, gelişen ve kendini yenileyen dinamik bir yapı olarak tanımlamıştır. Bu kavram tüm kurumlar içerisinde önemli bir yeri olan eğitim kurumları için de ayrı bir anlam taşımaktadır. Bu bağlamda, bilgi toplumu olma hedefine uygun insan kaynağını, sürekli öğrenmeyi ilke edinmiş bireyler olarak yetiştirme misyonuna sahip okulların, eğitim veren ve destek hizmeti sağlayan öğretmen kadrolarının öğrenen örgüte ilişkin algıları önem arz etmektedir. Bu öneme binaen gerçekleştirilen araştırmada, İstanbul ilinde hizmet vermekte olan bir kamu ve bir özel ilköğretim kurumunda görev yapan 95 öğretmene anket uygulanarak, öğrenen örgüte ilişkin algıların ve bunu engelleyen örgütsel engellerin karşılaştırmalı bir analiz ile belirlenmesi amaçlanmıştır. Literatürde yer alan esaslara bağlı kalarak yapılan araştırma sonunda, uygulamanın gerçekleştirildiği özel ilköğretim okulunun öğrenen örgüt özelliklerine haiz olduğu, buna karşın kamu ilköğretim okulunun öğrenen örgüt özelliklerini taşımadığı sonucuna ulaşılmıştır.Learning, an important element in terms of affecting the change of individual, organizational and social structures, will occur more effectively when the institutions in social structure turn into learning organizations. Senge (1993) concept of learning organization, constantly changing, evolving and renewing itself described as a dynamic structure. This concept has an important place in all institutions is also a separate meaning for educational institutions. In this context, schools training the human resources, appropriate for the aim of being information society, as individuals that have taken continuous learning as their principles, teachers providing educational and supporting services and their perceptions of learning organization are of the great importance. The study conducted virtue of this importance, in Istanbul, has been serving the public and a private institution serving 95 elementary teachers by surveys, perceptions of the learning organization and organizational barriers that prevent it is to be determined through a comparative analysis. As result of the survey, in the framework of the bases in literature, it has been found out that the state primary school doesn’t have the features of learning organization, unlike the private primary school

Incestuous childhood sexual abuse between siblings resulting in pregnancy without sexual intercourse

Victims of incest are usually women and children who are mostly girls. The abuse be-tween siblings may remain hidden because of the family's fear of social stigma, though it may result in pregnancy. This article presents a case of incestuous childhood sexual abuse between siblings resulting in pregnancy without intercourse, an event rarely reported in the literature. An 11-year-old girl was brought to the hospital because of a stomachache and was detected pregnancy from examinations. Forensic medicine experts determined that the girl's hymen was still intact and non-elastic in the genital examination. Gynecology and Obstetrics Department confirmed the pregnant com-patibility with 14 weeks, 4 days; after ultrasonographic monitoring. She was abused by her 14-year-old brother by rubbing for 1 year and this resulted in pregnancy. During the psychiatric examination, her attitude was negative and symptoms of post- traumatic stress disorder emerged. Medical abortion was applied after psychiatric and gynecological examinations. The girl's brother was confirmed as the biological father after the DNA paternity test was conducted on the fetus. Based on this case, this article aimed to examine the medical, social, and legal problems caused by incestuous childhood sexual abuse and contribute to the literature by emphasizing what forensic medicine and preventive medicine approaches should consider in such cases