Recurrent Her-2 positive occult breast cancer presenting with zosteriform cutaneous metastases: a case report

Various cutaneous metastasis patterns are described in breast cancer. Zosteriform metastases are rare cutaneous metastases, which appear in a dermatomal distribution. A 66-year woman presented with a 1-month history of nodular lesions on the left posterior hemithorax area. Biopsy was reported as human epidermal growth factor receptor (Her) 2 positive, hormone receptor-negative breast carcinoma metastasis. Dual blockade therapy targeting Her-2 overexpression was initiated for the patient. Treatment response was obtained after 3 cycles. There was a significant improvement in skin lesions. Zosteriform cutaneous metastases can be the early sign of systemic spread and can show an initial response to therapy. Therefore, physicians should perform an exhaustive physical examination including that of skin

Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report

Introduction. The development of a second primary malignancy (SPM) following small cell lung cancer (SCLC) has been previously reported in the literature. Especially smoking-related malignancy coupling is well known. The development of multiple myeloma (MM) in long-term survivors after treatment for SCLC is unknown. Here, we report the first case in the literature who developed MM 5 years after treatment for limited-stage SCLC. Case report. A 67-year-old male patient was diagnosed with limited-stage SCLC. After he received chemotherapy and radiotherapy, he was followed up without medication. He was admitted to the hospital with back pain and dyspnea 5 years after the diagnosis of small cell lung cancer. MRI revealed osteolytic lesions in the vertebrae. Laboratory testing revealed a markedly elevated serum IgA and an elevated serum beta-2 microglobulin level. Serum immunofixation revealed IgA lambda-type M-protein. Lambda excretion in urine immunofixation electrophoresis was observed. Bone marrow aspiration revealed the frequency of plasma cells to be 80% of all nucleated cells. Hence, the final diagnosis revealed IgA lambda free light chain MM. Treatment was given for multiple myeloma. In the follow-up, the patient experienced increased dyspnea and developed bilateral pleural effusion. The cytology sent from thoracentesis sampling was reported as plasmocyte-rich material. The patient fell into a coma and died in an intensive care unit. Conclusion. We presented the development of MM 5 years after treatment in a patient with SCLC who were treated for one year and then followed up with stable findings. It should be kept in mind that a patient with SCLC who is a long-term survivor and presents with back pain may have developed a primary malignancy originating from bone marrow rather than a bone metastasis. Patients should be advised smoking cessation after the treatment and diagnosis of SCLC. Also, the patients with SCLC who are long-term survivors should be closely monitored for the development of SPM

Molecular Characterization of Fasciola Spp. Isolated From the Gallbladder of Infected Cattle in Duhok Province, Kurdistan Region Iraq

Fascioliasis caused by the liver flukes of the genus Fasciola is considered as the most significant Trematodes infection of ruminants in both temperate and tropical countries. In the present study fifty adult Fasciola flukes (Platyhelminthes: Trematoda: Digenia) were collected from the bile ducts and gallbladder of infected bovine hosts (cattle) slaughtered at Duhok abattoir, Kurdistan region, Iraq.  Genomic DNA extraction was performed using a Genomic DNA Extraction kit. ITS-1 and ITS-2 ribosomal DNA sequences have been used to characterize these liver flukes as a specific marker. The PCR products were separated by electrophoresis in 1.5% agarose gel, visualized by staining with ethidium bromide, and photographed. ITS-2 marker for F. hepatica was amplified successfully and the length of produced band for ITS-2 was 330 bp. The present study is the first trail for molecular characterization of F. hepatica in cattle in Duhok, Kurdistan Region, Iraq  using the ITS-2 rDNA as a reliable genetic marker

Performance evaluation of a building integrated photovoltaic (BIPV) system combined with a wastewater source heat pump (WWSHP) system

This paper deals with both energetic and exergetic performance assessments of two combined systems as a whole. The first one is a Building Integrated Photovoltaic (BIPV) system while the second one is a wastewater (WW) Source Heat Pump (WWSHP) system. Both systems were installed at Yasar University, Izmir, Turkey within the framework of EU/FP7 and the Scientific and Technological Research Council of Turkey (TUBITAK) funded projects, respectively. The BIPV system was commissioned on 8 February 2016 and has been successfully operated since then while the WWSHP system was put into operation in October 2014. The BIPV system has a total peak power of 7.44 kW and consists of a total of 48 Crystalline Silicon (c-Si) modules with a gap of 150 mm between the modules and the wall, and a peak power per PV unit of 155 Wp. The WWSHP system consists of three main sub- systems, namely (i) a WW system, (ii) a WWSHP, and (iii) an end user system. Two systems considered have been separately operated while the measured values obtained from both systems have been recorded for performance assessment purposes. In this study, a combined system was conceptually formed and the performance of the whole system was evaluated using actual operational data and some assumptions made. Exergy efficiency values for the WWSHP system and the whole system were determined to be 72.23% and 64.98% on product/fuel basis, while their functional exergy efficiencies are obtained to be 20.93% and 11.82%, respectively. It may be concluded that the methodology presented here will be very beneficial to those dealing with the design and performance analysis and evaluation of BIPV and WWHP systems

Sustainability indicators of a naturally ventilated photovoltaic façade system

Building Integrated Photovoltaic (BIPV) systems have been increasingly used as a means to generate electricity on-site, and their diffusion will increase in the near future. The objective of this article is to carry out a sustainability assessment of a BIPV system installed in Turkey regarding the three pillars: environmental, economic and social potential impact, in order to develop different indicators. For the socioeconomic analysis, a Multiregional Input-Output (MRIO) method was used to estimate production of goods and services, value added creation and employment opportunities. For the environmental evaluation, an Environmental Footprint (EF) analysis was performed. The levelized electricity costs and the greenhouse gas emissions abatement costs were also calculated. Results showed that the socioeconomic effects are relevant, although only a 23% of these effects remain in Turkey. The environmental profile is also good in terms of climate change impacts, showing substantial reductions in greenhouse gas emissions compared to fossil fuel alternatives for electricity generation. Regarding the life cycle stages of the technology, the highest environmental impacts are produced in the PV manufacturing processes. The electricity produced is still more costly than fossil-based technologies and in the highest range of PV technologies, but greenhouse gases abatement costs are not so high when compared to other references

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Frequency of Neonatal Hypoglycemia in Large for Gestational Age Infants of Non-Diabetic Mothers in a Community Maternity Hospital

Large for gestational age (LGA) infants are at increased risk for hypoglycemia. The aim of the study was to determine the frequency of neonatal hypoglycemia in LGA infants of non-diabetic mothers in a Community Maternity Hospital in Gaziantep, Turkey. Hospital records of 5229 infants of non-diabetic mothers were examined retrospectively. Newborns with birth weight more than 4000 g were defined as LGA. The control group consisted of 100 appropriate for gestational age (AGA) newborns. Capillary blood glucose was measured at the second hour of life. Glucose values lower than 40 mg/dL (2.2 mmol/L) were defined as hypoglycemia. Ninety-six (1.8%) of the 5229 infants were found to be LGA. The mean capillary glucose levels of the LGA newborns were significantly lower than those of the AGA newborns (54 mg/dL (3.0 mmol/L) vs. 95 mg/dL (5.2 mmol/L), p<0.0001). Neonatal hypoglycemia was established in 16 of 96 LGA infants (16.7%). In the control group hypoglycemia was absent. The rate of hypoglycemia in LGA infants was significantly higher than the rate in the AGA infants (p=0.0000). As hypoglycemia is not rare in LGA infants and can have serious consequences, blood glucose levels should be screened routinely in LGA infants

Bir atıksu ısı pompası sisteminin enerjetik, ekserjetik, eksergoekonomik ve eksergoçevresel performansının deneysel olarak incelenmesi

Bu tez çalışması kapsamında, bir atıksu ısı pompası sisteminin performansı enerji, ekserji, eksergoekonomik ve eksergoçevresel analiz yöntemleri kullanılarak, deneysel olarak incelenmiştir. Bu kapsamda bir deney sisteminin tasarımı ve Yaşar Üniversite'sinde kurulumu gerçekleştirilmiş ve farklı koşullar altında deneyler gerçekleştirilmiştir. Elde edilen deney sonuçları kullanılarak kütle, enerji, ekserji, eksergoekonomik ve eksergoçevresel bağıntılar tüm sistem elemanlarına uygulanmıştır. Bu tez çalışmasının ilk kısmında, bir giriş verilerek konunun önemi vurgulanmıştır. Sonrasında, bir literatür araştırması yapılmış ve önceki çalışmaların özetleri verilerek bu çalışmalardan elde edilen sonuçlar kronolojik olarak bir tabloda özetlenmiştir. Daha sonra, atıksudan ısı geri kazanım yolları özetlenmiş ve atıksu kaynaklı ısı pompaları (ASKIP) detaylı bir şekilde sunulmuştur. Dünya'da yer alan çeşitli ASKIP uygulamaları da tarihsel gelişim süreci de açıklanarak bu bölümde verilmiştir. Dördüncü bölümde, enerji, ekserji, eksergoekonomik ve eksergoçevresel analiz yöntemleri detaylı olarak aktarılmıştır. Bunun ardından, deney sistemi ve çalışma mekanizması oldukça detaylı bir şekilde açıklanmış ve sistem üzerinde yapılan deneylerin bir listesi verilmiştir. Altıncı bölümde ise daha önce dördüncü bölümde verilmiş olan denklemler sisteme uygulanmış ve her bir sistem elemanı için enerjetik, ekserjetik, eksergoekonomik ve eksergoçevresel bağıntılar elde edilerek sunulmuştur. Bulguların değerlendirilmesi ve tartışma kısmında, farklı sistem konfigürasyonları ile yapılan deneylerden elde edilen sonuçlar özetlenmiş ve Doğru Akım (DA) kompresör - Alternatif Akım (AA) kompresör, plakalı - daldırılmış atıksu ısı değiştiricisi ve fancoil - havalı ısı değiştirici performansları karşılaştırılmıştır. Bu bölümde aynı zamanda, ısıtma ve soğutma modundan birer deney seçilerek, eksergoekonomik ve eksergoçevresel analiz sonuçları parametrik çalışmalar ile birlikte verilmiştir. Son olarak, sonuç ve öneriler kısmında bu tez çalışmasından elde edilen sonuçlar özetlenmiş ve ileride yapılabilecek çalışma önerileri sunulmuştur. Elde edilen sonuçlara göre, Doğru Akım (DA) kompresör alternative akım (AA) olana göre daha düşük ekserji yıkımına sahip olduğu görülürken, daldırımış Atıksu ısı değiştiricisi (ASID) ve fancoil için plakalı ve havalı ısı değiştiricilere oranla bunun tam tersi bir durum söz konusu olduğu anlaşılmıştır. Eksergoekonomik sonuçlara bakıldığında, fancoil ünitesinin hem ısıtma (0,114) hem soğutma (0,179) modlarında en düşük eksergoekonomik faktör değerlerine sahip olduğu görülmüştür. Öte yandan, en yüksek eksergoekonomik faktör değerine ısıtma modu için 0,701 ile yoğuşturucu, soğutma modu için ise 0,668 ile buharlaştırıcının sahip olduğu görülmüştür. Eksergoçevresel sonuçlara bakıldığında ise, hem ısıtma hem soğutma modları için hemen hemen tüm sistem elemanlarının 0,5'ten düşük eksergoçevresel faktör değerlerine sahip olduğu ve dolayısıyla çevresel etki için ana parametrenin ekserji kayıp ve yıkımları ile ilgili olduğu görülmüştür. Yapılan parametrik çalışmalar sonucunda yıllık çalışma süresindeki artışın eksergoekonomik ve eksergoçevresel faktör değerleri ile ürünlere ait birim ekserji başına ortalama maliyetlerinde bir düşüşe neden olduğu anlaşılmıştır. Öte yandan, faiz oranında tam tersi bir eğilim gözlemlenmiştir. Yani, faiz oranı artığında söz konusu indikatörlerde eksergoekonomik ve eksergoçevresel faktör değerleri ile ürünlerin birim ekserji başına ortalama maliyetleri düşmektedir.In this thesis, a PV/T assisted wastewater source heat pump (WWSHP) system was experimentally evaluated using energy, exergy, exergoeconomic and exergoenvironmental analysis methods. Within this context, first, an experimental setup was designed and installed at Yasar University, Izmir, Turkey and experiments were conducted using different system configurations. Experimental data were gathered and mass, energy, exergy, exergoeconomic and exergoenvironmental balance equations were applied to all system components. In this thesis, a PV/T (Photovoltaic/Thermal) assisted wastewater source heat pump (WWSHP) system was experimentally evaluated using energy, exergy, exergoeconomic and exergoenvironmental analysis methods. Within this context, first, an experimental setup was designed and installed at Yasar University, Izmir, Turkey and experiments were conducted using different system configurations. Mass, energy, exergy, exergoeconomic and exergoenvironmental balance equations were applied to all system components using the experimental data. In the first section of this thesis, an introduction was made by highlighting the importance of the topic. Then, a literature review was conducted, where summaries of the previous studies were given and the results obtained from these studies were summarized in a table in a chronological order. After that, ways for recovering heat from wastewater were explained and WWSHPs were explained in detail. WWSHPs from all over the world were also given in this section by explaining the historical development process. In the fourth section, energy, exergy, exergoeconomic and exergoenvironmental analysis methods were explained in detail. Next, experimental system and its operation were explained in detail and a list of all conducted experiments were given. In the sixth section, the general equations given in the fourth section were applied to the experimental WWSHP system and energetic, exergetic, exergoeconomic and exergoenvironmental balance equations were gathered for each system component. In the results and discussion section, the results gathered from each experiment were summarized and the performances of Direct Current (DC) and Alternative Current (AC) compressor, plate wastewater heat exchanger (WWHE) and submersed WWHE and fancoil unit and air source heat exchanger were compared to each other. Exergoeconomic and exergoenvironmental results along with some parametrical studies were also given and discussed in this section for a selected experiment from cooling and heating modes. In this section, also, one experiment from heating and cooling modes were selected and their exergoeconomic and exergoenvironmental results were given along with some parametric studies. Finally, the main results gained from this thesis were summarized and some possible future studies were addressed in the conclusion section. According to the results from the experiments with different system configurations, DC compressor had lower exergy destruction compared to the AC one, while it was the opposite for the fancoil and submersed WWHE in comparison with air and plate heat exchangers. The exergoeconomic results showed that the fancoil unit had the lowest exergoeconomic factor values with 0.114 (for heating) and 0.179 (for cooling) while the highest values occured in the evaporator for the heating mode with 0.701 and in the condenser for cooling mode with 0.668. When the exergoenvironmental results were examined, it was seen that the exergoenvironmental factor values of almost every component were below 0.5 for both heating and cooling and therefore the main parameter for the environmental impact is associated with the exergy losses and destructions. The parametric studies showed that the increase in working hours results in an decrease in exergoeconomic and exergoenvironmental factors as well as specific exergy costs of products. For the interest rate on the other hand, an opposite tendency was observed meaning that when the interest rate increases the exergoeconomic and exergoenvironmental factors and specific exergy costs of products increases. According to the results from the experiments with different system configurations, DC compressor had lower exergy destruction compared to the AC one, while it was the opposite for the fancoil and submersed WWHE in comparison with air and plate heat exchangers. The exergoeconomic results showed that the fancoil unit had the lowest exergoeconomic factor values with 0.12 (for heating) and 0.18 (for cooling) while the highest values occured in the condenser for the heating mode with 0.70 and in the evaporator for cooling mode with 0.67. The exergoenvironmental results showed that the exergoenvironmental factor values of almost every component were below 0.5 for both heating and cooling, which indicates that the main parameter for the environmental impact is associated with the exergy losses and destructions. The parametric studies showed that the increase in working hours results in an decrease in exergoeconomic and exergoenvironmental factors as well as specific exergy costs of products. For the interest, an opposite tendency was observed meaning that when the interest rate increases the exergoeconomic and exergoenvironmental factors and specific exergy costs of products increases