Management of traumatic pneumothorax in isolated blunt chest trauma

Objectives: Pneumothorax is an important complication of blunt chest trauma. The aim of this study was toreport our experience in treatment strategy and outcomes of traumatic pneumothorax.Methods: A total of 78 patients who developed pneumothorax due to isolated blunt chest trauma were evaluatedin terms of age, gender, size of pneumothorax, treatment methods, complications and length of hospital stay.The size of pneumothorax was calculated with computer-aided volumetry.Results: Tube thoracostomy was performed for 48 patients while observation was undertaken for 30 cases.Chest tubes were inserted in 6 patients after 24 hours following the traumatic event. A total of 8 patients whodeveloped prolonged air leakage and hemothorax as complications underwent video-assisted thoracoscopicsurgery. None of the patients developed any mortality or morbidity.Conclusions: Traumatic pneumothorax demands prompt diagnosis and treatment. Monitoring all patients evenwith small sizes of traumatic pneumothorax for at least 24 hours onset of their initial assessment and applyingchest tubes for cases who have pneumothorax larger than 50% at first examination should be an appropriatemodality for treatment. Moreover, the minimally invasive approach of video-assisted thoracoscopic surgerybenefits to overcome the complications of thoracic trauma

Identification of chronic urticaria subtypes using machine learning algorithms

Chronic urticaria (CU) comes as chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Across its types and subtypes, CU is a heterogeneous disease that has different phenotypes with distinct clinical characteristics and different endotypes with distinct underlying pathophysiological mechanisms. It may be possible that subtypes of CU patients exhibit distinct phenotypic disease signatures that can point to differences in what drives their condition and in their response to treatments. Cluster analysis is a popular unsupervised machine learning (ML) method for discovering previously undetected data patterns. ML-based cluster analysis has been used in several diseases for the identification and characterization of patient subgroups. As of now, no study has attempted to identify CU subtypes with this method. Here, we performed a proof-of-concept study to test whether cluster analysis using ML algorithms can identify subgroups of CU patients based on clinical and routine laboratory characteristics.This project benefitted from the support (non-financial) of the GA2LEN network of urticaria centers of reference and excellence (UCARE, www.ga2len-ucare.com)

Stratejik stok yönetimi: Bir kamu hastanesi örneği

Businesses have to develop and implement effective stock policies to maximize profits by minimizing costs in today's market conditions. Since the stocks enterprises between 20% to 60% within total assets of manufacturings,  effective implementation of stock control and management policies, has great importance for the future of business.Businesses’ execution of it’s stock policies at the lowest cost depends on the forecasting amount of stock based on demand at least error, and minimum stock level determination and the appropriate time and amount of orders given to it. Thus, time and cost savings will be achieved by ensuring balance of continuity and speed in production of goods and services in the production process.By the rapid changes in consumer preferences, the variety of products, technologies and competitors are rapidly changing and increasing in rate. By increases in product variety, stock control and management is becoming even more difficult and complex.In recent years, effective and efficient resource use and management began to be kept in the foreground in public institutions as well as private sector. Public hospitals have been diverged from other business such as restaurant and hotel since it  is an inpatient treatment business.It’s obligation of keeping right supplies in right amount, in the right place at the right time and cost is more strict comparing other institutions.İşletmeler, günümüz piyasa koşullarında, maliyetleri minimize ederek karı maksimize edecek etkin stok politikalarını geliştirmeye ve uygulamaya mecburdur. Stoklar, üretim işletmelerinin toplam varlıklarının % 20 ile % 60’ı arasında bir yere sahip olduğundan etkin stok kontrol ve yönetim politikalarının uygulanması, işletmenin geleceği için büyük önem taşımaktadır. İşletmelerin stok politikasını en düşük maliyetle yürütebilmesi, talebe dayanan stok miktarının en az hatayla tahmini, asgari stok seviyesinin tespiti ve siparişlerin uygun zaman ve miktarda verilmesine bağlıdır. Böylece, ürün ve hizmet üretim sürecinde, üretim akış hızının denge ve sürekliliğini sağlanarak, zaman ve maliyet tasarrufu elde edilecektir.Tüketici tercihlerinin hızlı bir şekilde değişmesiyle birlikte piyasadaki ürün çeşitliliği, teknolojilerin ve rekabetçilerin değişim oranı da hızlı bir değişmekte ve artış göstermektedir. Ürün çeşitleri arttıkça stok kontrolü ve yönetimi daha da zorlaşmakta ve karmaşık hale gelmektedir.Son yıllarda kamu kurumlarında etkili ve verimli kaynak kullanımı ve yönetimi özel sektör kadar ön planda tutulmaya başlanmıştır. Kamu hastanelerinin yataklı tedavi kurumu olması nedeniyle restoran, otelcilik gibi yan uygulamaları ile diğerlerinden ayrılmaktadır. Doğru malzemeyi doğru miktarda, doğru zamanda ve uygun maliyetle ve doğru yerde bulundurma gerekliliği diğer kurumlara göre biraz daha fazladır

Acute brucella melitensis M16 infection model in mice treated with tumor necrosis factor-alpha inhibitors

Introduction: There is limited data in the literature about brucellosis related to an intracellular pathogen and anti-tumor necrosis factor alpha (anti-TNFα) medication. The aim of this study was to evaluate acute Brucella infections in mice receiving anti-TNFα drug treatment. Methodology: Anti-TNFα drugs were injected in mice on the first and fifth days of the study, after which the mice were infected with B. melitensis M16 strain. Mice were sacrificed on the fourteenth day after infection. Bacterial loads in the liver and spleen were defined, and histopathological changes were evaluated. Results: Neither the liver nor the spleen showed an increased bacterial load in all anti-TNFα drug groups when compared to a non-treated, infected group. The most significant histopathological findings were neutrophil infiltrations in the red pulp of the spleen and apoptotic cells with hepatocellular pleomorphism in the liver. There was no significant difference among the groups in terms of previously reported histopathological findings, such as extramedullary hematopoiesis and granuloma formation. Conclusions: There were no differences in hepatic and splenic bacterial load and granuloma formation, which indicate worsening of the acute Brucella infection in mice; in other words, anti-TNFα treatment did not exacerbate the acute Brucella spp. infection in mice. © 2015 Kutlu et al

Comparison of the Shear Bond Strengths of Ceramic Brackets Using Either a Self-Etching Primer or the Conventional Method after Intracoronal Bleaching

Objective:To evaluate the initial shear bond strengths (SBSs) of ceramic brackets using either a self-etching primer (SEP) or the conventional method (CM) after intracoronal bleaching with sodium perborate and distilled water.Methods:Eighty human incisors were divided into four groups according to bleaching and bonding procedures: Group 1, bleaching was not applied and the brackets were bonded with a self-etching primer; Group 2, bleaching was not applied and the brackets were bonded with the conventional method; Group 3, intracoronal bleaching with sodium perborate was applied for three weeks and the brackets were bonded with a self-etching primer; and Group 4, intracoronal bleaching with sodium perborate was applied for three weeks and the brackets were bonded with the conventional method. A self-etching primer (Transbond Plus) was applied as recommended by the manufacturer. After SEP application, the ceramic brackets were bonded with a light-curing adhesive (Transbond XT). For the conventional method, the teeth were etched with 37% phosphoric acid. After etching, a thin uniform coat of primer (Transbond XT Primer) was applied and the ceramic brackets were bonded with a light-curing adhesive (Transbond XT). SBSs were measured after water storage for 30 days, after 1000 cycles of thermocycling between 5°C and 55°C. Bond failure location was determined with the Adhesive Remnant Index (ARI).Results:For the SEP method, there was no significant difference between SBS values of the bleaching and non-bleaching groups. Furthermore, for the conventional method, the SBS value of the non-bleaching group was not significantly different from that of the bleaching group. SBS values of the SEP method presented significant differences from those of the conventional method (p<0.001). SBS values of SEP application decreased with and without bleaching. The ARI scores did not show any significant difference among the groups (p=0.174).Conclusion:Intracoronal bleaching with sodium perborate and distilled water did not affect the SBS values of ceramic brackets

Seismic load tests on exterior beam-column connections of existing RC structures

U radu su izneseni prijedlozi za poboljšanje svojstava spojeva greda-stup postojećih AB konstrukcija uslijed potresnog djelovanja. Analizirana je uporaba betona niske čvrstoće, glatkog armaturnog čelika bez spona u spojevima te je ispitano ponašanje spojeva u uvjetima pod cikličnim opterećenjem. U okviru eksperimentalnog istraživanja proizvedeno je i ispitano pet uzoraka s različitim rasporedom armature. Na temelju rezultata zaključeno je da su kritični parametri koji određuju svojstva postojećih konstrukcija, raspored spona u spojevima i upotreba kuka za sidrenje uzdužne armature koje su savijene pod kutom od najmanje 90°.Suggestions for improving seismic performance of beam-column connections of the existing RC structures are presented in this paper. The use of low-strength concrete with plain bars without stirrups in joints is analysed, and behaviour of joints in the aforementioned conditions under cyclic load is investigated. Five specimens with different reinforcement configurations were produced and tested in the experimental process. Based on results, it was concluded that critical parameters for the performance of existing structures are: stirrup arrangement in joints, and the use of at least 90-degree hooks in longitudinal reinforcement of beams

The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis

IntroductionIn the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem.ObjectiveIn this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis.MethodTo reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results.ResultsExposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues.ConclusionDramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations

Evaluation of public’s perception of scar cosmesis after thyroidectomy: Results of a survey of Turkish versus South Korean individuals

Purpose: Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. Methods: This survey was prepared to collect participants’ demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. Results: There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar’s length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). Conclusion: Patients’ expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea

Köy elektifikasyon sistemleri

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Elektrik enerjisinin kullanım miktarı ve elektrik şebekesinin büyüklüğü, ülkelerin gelişmişliğini göstermektedir. Ülkemizde HES, RES ve Termik santrallerde üretilen elektrik enerjisi, iletim hatları ile tüketim bölgelerine taşınır. Tüketim bölgelerinde ise dağıtım hatları ve trafo postaları yardımı ile son kullanıcıya ulaştırılır.İletim ve dağıtım hatlarında kullanılan malzemeler bölgelere göre değişiklik gösterir. Elektrik arz güvenliğinin sağlanması, kaliteli, verimli ve ekonomik elektrik iletim ve dağıtım projesi hazırlanabilmesi için bu tesislerde kullanılan teçhizatın özelliklerinin bilinmesi gerekir.Köy elektrifikasyon projesi hazırlanırken şebekenin tesis edileceği bölge özellikleri etüt edilir. Bu özellikler proje teknik hesaplarında ve malzeme seçimlerinde dikkate alınır. Ayrıca proje ve teknik hesapların yapılabilmesi için güç yoğunluğu ve trafo gücünün hesaplanması gerekir. Bu hesapların yapılabilmesi için genel tanımların bilinmesi gerekir.Bu çalışmada bölüm 1'de köy elektrifikasyonları hakkında genel bir giriş yapıldıktan sonra Bölüm 2'de elektrifikasyonda kullanılan malzemeler tanıtılmıştır. Bölüm 3'de ise projelendirme safhasında kullanılan genel tanımlar anlatılmıştır. Bölüm 4'de Sakarya ili Geyve ilçesi Halidiye köyü incelenerek yeniden projelendirilmiştir. Bölüm 5'de ise örnek köyün eski durumu ile yeni durumu karşılaştırmalı olarak gösterilmiştir.Anahtar Kelimeler: Köy elektrifikasyonu, İletim hatları, dağıtım hatları, iletim hatları ve proje.Electrical energy consumption and electrical system size, denotes countries development status. In our country, electrical energy which is generated at HES, WES and Thermal power plants, is transmitted to consumption zones by transmission networks. At consumption zones, electrical energy is transported to end users by distribution networks and transformers.Equipments which are used in transmission and distribution systems vary according to the zones. Properties of the equipments which are used in these systems should be known in order to get the energy more reliable, efficient and economic.When rural electrification project is prepaired, properties of the area which the system will be installed, is researched. These properties are used in project?s technical calculations and equipment selection. In addition, to make the Project and technical calculations, power density and transformer power are needed to be calculated. General definitions should be known to make these calculations.In Part 1 of this study, a general introduction is made about rural electrifications. Then; in Part 2, used equipments in electrification is introduced. In Part 3, general definitions which are used in project stage are explained. Sakarya?s Geyve Town?s Halidiye Village is examined and electrical system is reprojected. In Part 5, old and new statuses of the sample village are compared.Key Words: Rural electrification, Transmission systems, Distribution systems, Transmission systems and projec

Comparison of pressure support (bi&#775;pap-S) and volume assured pressure support (s-avaps) modes in acute hypercapnic respiratory failure and determination of the effect of patient position on carbondioxide decline

Bu çalışmada, yoğun bakım ünitesine AHSY nedeniyle başvuran hastalarda kullanılacak BiPAP-S ve S-AVAPS modlarının karşılaştırılması ve uygulama esnasındaki hasta pozisyonlarının sonuçlara etkilerinin kıyaslanması amaçlanmıştır. Randomize-kontrol gruplu çalışmaya üçüncü basamak hastane yoğun bakım ünitesinde 2011-2013 yılları arasında takip edilen 62 hasta alınmıştır. Aynı tipte ventilatörler ile 33 hastaya BiPAP-S, 29 hastaya S-AVAPS modları ile NPBV uygulanmış ve sonuçlar PaCO2, pH, HCO3 yanıtları ve ventilatör ölçümlerinden MV, SS, kaçak, PIP değerleri arasındaki farklar açısından karşılaştırılmıştır. Takipleri boyunca hastalara benzer sürelerde supin ve lateral pozisyonlarda NPBV uygulanmış ve pozisyon değişiminin etkileri araştırılmıştır. Her iki modun takip boyunca elde edilen PaCO2, pH, HCO3 seyri ve hastanede kalış süresi üzerinde benzer etki yarattığı bulunmuştur. BiPAP-S grubunda ilk 2 gün içerisinde PaCO2 düzeylerinde istatistiksel olarak anlamlı olmayan artış izlenmiştir. PaCO2 düzeyinde uygulama başına S-AVAPS modu ile ortalama 5,7 ± 4,1 mmHg, BiPAP-S modu ile 2,7 ± 2,3 mmHg düşüş izlenmiştir. Her iki mod içerisinde farklı pozisyonlarda uygulamanın karbondioksit düşüşü üzerine etkisi izlenmemiştir. Çalışma sonuçlarımıza göre S-AVAPS modu ile uygulama başına gerçekleşen karbondioksit düşüşü BiPAP-S moduna göre belirgin yüksek bulunsa da, her iki mod ile elde edilen seyir benzer olmaktadır. Ayrıca uygulama esnasındaki hasta pozisyonunun karbondioksit yanıtı ve ventilatör mekanikleri üzerinde etkisi bulunmamaktadır.This study aims to compare the BiPAP-S and S-AVAPS modes in patients admitted to ICU with acute hypercapnic respiratory failure; also the effect of patient positions during their applications. 62 patients who were treated in a 3rd line hospital ICU between 2011-2013 were included in this randomized controlled study. 33 patients recieved NMV in BiPAP-S mode and 29 patients in S-AVAPS mode with the same ventilators. PaCO2, pH, HCO3 responses and MV, respiratory rate, leak, PIP values from ventilator measurements were compared. During their follow up, patients underwent NMV in supine and lateral positions for similar periods and effects of change in position was investigated. Both modes are found to have similar effects on course of PaCO2, pH, HCO3 levels and duration of hospitalization. In BiPAP-S group the PaCO2 levels showed an increase in the first 2 days but this increase was not statistically significant. The decrease in PaCO2 per application was 5,7 ± 4,1 mmHg with S-AVAPS mode and 2,7 ± 2,3 mmHg with BiPAP-S mode. There was no effect of changing positions on decrease in PaCO2 in both groups. Our study showed that even though a significantly higher decrease in carbodioxide levels can be achieved in S-AVAPS compared to BiPAP-S, course of change in parameters are similar with both modes. Additionally, position of the patient does not effect the carbondioxide response or ventilation mechanics