Turkey's Iran card: energy cooperation in American and Russian vortex

This thesis analyzes the consequences of Turkey's natural gas cooperation with Iran. Two countries initiated cooperation in natural gas sales and transportation to Turkey and Europe. However, conflicting interests of many actors in energy issues make finding a solution harder. With the signing of the gas agreement between Turkey and Iran, the calculations became complicated even further. Turkey's efforts to industrialize its economy, Iran's struggle against the U.S. sanctions along with its ideological reputation, the emergence of new independent former Soviet republics that are not very independent economically from Russia and the U.S. objectives in enhancing the political and economic advance of those republics as well as containment of Iran are the major issues on the scene. If a compromise that would address the needs and interests of all actors in the region could be reached, the regional political and economic stability could have a substantial contribution to global security and stability. In this sense, Turkey's natural gas cooperation with Iran plays an important role for future prospects, since it may distribute prosperity and stability through the pipelines established between two countries that can connect Central Asia to Europe.http://archive.org/details/turkeysircardene1094511561st Lieutenant, Turkish Air ForceApproved for public release; distribution is unlimited

A Case of Biliary Pancreatitis Which Subsided after Endoscopic Sphincterotomy during Pregnancy

A 24-year-old pregnant patient was referred to us because of pain and tenderness in the right upper quadrant. Her liver enzymes and bilirubin levels were elevated; an abdominal ultrasound examination revealed gallstones within the gallbladder. Diagnosis of biliary pancreatitis was established based on elevated amylase levels. Oral intake was withheld; intravenous antibiotic therapy and total parenteral nutrition were administered. An endoscopic sphincterotomy without the use of fluoroscopy was performed. Abdominal pain and elevated serum amylase levels subsided after this procedure. In our case, biliary pancreatitis, which developed during pregnancy, responded well to the endoscopic sphincterotomy, and this procedure obviated the need for surgical intervention and prevented the recurrence of pancreatitis

Osseous Metastases

Abstract A 62-year-old female patient received adjuvant chemotherapy after a mastectomy due to a locally advanced invasive ductal carcinoma eight years ago. During the follow-up, she complained of extensive backache, so a plain radiography was taken. The radiography showed diffuse lytic lesions located primarily around the vertebrae and sternum. Given that the bone lesions could be related to osseous metastases of the breast cancer, a bone scintigraphy was performed and no positive involvement was observed. Magnetic resonance imaging was subsequently applied and diffuse hypointense areas were found on the vertebrae. The patient had also accompanying bicytopenia (thrombocytopenia and luecocytopenia), albumin/globulin inversion and hyperglobulinemia. As the patient did not have such involvement in regard to her overall body scintigraphy and there were accompanying abnormal biochemical parameters, it was concluded that the patient's bone lesions were an outcome of a hematological malignity. Bone marrow aspiration and the biopsy result were found to be consistent with multiple myeloma (MM). It was thus confirmed that the lytic lesions were not related to breast cancer but rather MM bone lesions. We are able to conclude, based on the case presented herein, that newly-developing bone lesions on patients with breast cancer must be approached with suspicion, and their other laboratory analyses and imaging diagnostic processes must be evaluated carefully. It is necessary to keep in mind that such a condition might be related to other diseases, however rare the occurrence

THE EFFECT OF MEMBER GROUPING ON THE OPTIMUM DESIGN OF GRILLAGES VIA SEARCH TECHNIQUES

Member grouping of a steel grillage system has an important effect in the minimum weight design of these systems. In the present research, this effect is investigated using an optimum design algorithm which is based on two stochastic search techniques called particle swarm (PSO) and harmony search (HS) optimization methods. The optimum design problem of a grillage system is formulated by implementing LRFD-AISC (Load and Resistance Factor Design-American Institute of Steel Construction) limitations. It is decided that W-Sections are to be adapted for the longitudinal and transverse beams of the grillage system. 272 W-Section beams given in LRFD code are collected in a pool and the optimum design algorithm is expected to select the appropriate sections from this pool so that the weight of the grillage is the minimum correspondingly the design limitations implemented from the design code are satisfied. The solution for this discrete programming problem is determined by using the PSO and HS algorithms. Design example is presented to demonstrate the effect of beam spacing and performances of stochastic search techniques in the optimum design of grillage systems

Evaluation of macular choroidal and microvascular network changes by activity scores and serum antibodies in thyroid eye patients and healthy subjects

AIM: To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease (TED) patients at different stages and the relationship of those changes with risk factors, serum antibodies and the severity of TED. METHODS: A total of 85 participants were enrolled. All participants underwent ophthalmology and endocrinology examinations. Subfoveal choroidal thickness (SFCT), superficial (s) and deep (d) foveal avascular zone (FAZ) area, mean (m) and central (c) superficial vascular density (SVD), deep vascular density (DVD) measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography (OCT)/OCT angiography (OCTA) DRI OCT Triton. Multiple linear regression analysis was used to explore the associations between SFCT, FAZ area, SVD, DVD and the relevant factors of TED. RESULTS: Those with active TED patients had higher c-DVD and m-DVD levels (P<0.05), however there is no statistically significant difference in SFCT between active and stable TED patients. Among the serum antibodies, it was observed that s-FAZ and d-FAZ increased, c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies (TRAB) level, whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin (hTG). There was no significant difference in SFCT, FAZ, SVD and DVD measurement at gender, between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma. CONCLUSION: The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density. It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity

Fetal Circulatory Variation in an Acute Incident Causing Bradycardia

Umbilical artery\vein, middle cerebral artery, and ductus venosus Doppler velocimetry were performed at 33 weeks of gestation in the settings of an intrauterine growth restricted fetus during a heart rate deceleration. Interestingly, we recorded a sudden onset redistribution of fetal blood flow with fetal bradycardia. Spontaneous normalization of waveforms was observed once fetal heart rate returned to normal. Our case provides evidence to circulatory variation of a human fetus resulting from an acute incident causing bradycardia

Changing Trends and Experience with Esophageal Cancer Surgery in a Single University Hospital: Are The Results Similar or Not?

Objective: The main treatment modality for esophageal cancer remains to be surgery. Over the last decades, surgical strategies have evolved remarkably. When neoadjuvant chemoradiotherapy became standard, discussions about the role, type, and timing of surgery began. In this study, we share results we obtained after operating our patients using various surgical techniques.Material and Methods:Reliable data from 51 esophageal cancer patients were evaluated retrospectively. Of the 51 cases, 31 were operable. These operable cases were further classified according to surgical method and neoadjuvant therapy status. Median survival time in months, complications, hospital mortality, length of hospital stay, and pathology results (total lymph nodes harvested and pathologic tumor node metastasis stage [p_TNM]) were documented for the different surgical approaches.Results: Open surgical methods were performed in 21 cases, while in 10 cases the Minimally Invasive Surgery (MIS) method was used. The MIS group received neoadjuvant therapy more frequently than the open surgical methods group (p=0.013). Although more complications were observed in the MIS group, the difference to the open esophagectomy methods group was not significant. Patients in the MIS group also had longer hospital stays, but again the difference was not significant. Although a pathologic complete response was seen in 8 of the 11 (72.7%) patients in our study who received chemoradiotherapy as neoadjuvant treatment, the surgical results of patients who received chemoradiotherapy were worse, although not to a statistically significant extent.Conclusion: Despite changing trends and treatment options in esophageal cancer surgery, we have yet to see the expected improved results

Comparison of the efficacy of once- and twice-daily colchicine dosage in pediatric patients with familial Mediterranean fever - a randomized controlled noninferiority trial

Background: In this study, we examined the efficacy and safety of a once-daily dosage schema of colchicine compared with a twice-daily dosage schema in pediatric patients with familial Mediterranean fever (FMF). Methods: In this 24-week, multicenter, randomized controlled noninferiority trial, pediatric patients newly diagnosed with FMF carrying a homozygous or compound heterozygous mutation and not receiving any treatment were included. Patients were randomly assigned using a block randomization method to receive treatment with a once- or twice-daily dosage. Clinical and laboratory characteristics and medication side effects were recorded and compared between groups. The study was carried out in compliance with Good Clinical Practice and the Consolidated Standards for Reporting of Trials (CONSORT) statement. Results: A total of 92 patients were selected, and 79 patients completed the study. There were 42 patients in the once-daily dosage group and 37 in the twice-daily dosage group. The results indicated that the once-daily dosage was not inferior to the twice-daily dosage regarding decrease in attack frequency and duration as well as improvement in clinical findings and Mor severity scores. Alterations in laboratory findings indicating inflammation, such as erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A, were similar in both groups. The rates of drug side effects were similar between the once- and twice-daily dosage groups, implying comparable safety of colchicine, with the exception of diarrhea, which was slightly higher in the once-daily dosage group. Conclusions: Using colchicine with either a once- or twice-daily dosage provides similar clinical and laboratory improvements. Considering both efficacy and safety, colchicine can be prescribed with a once-daily dosage. Trial Registration ID: ClinicalTrials.gov identifier NCT02602028. Registered 5 November 2015

Brief Report: Deficiency of Complement 1r Subcomponent in Early-Onset Systemic Lupus Erythematosus: The Role of Disease-Modifying Alleles in a Monogenic Disease

Objective: To identify a genetic cause of early-onset systemic lupus erythematosus (SLE) in a large consanguineous family from Turkey and to study the mechanisms of the disease. Methods: We performed whole-exome sequencing and single-nucleotide polymorphism array genotyping in family members with and without SLE. Protein and gene expression, cytokine profile, neutrophil extracellular trap (NET) formation, and presence of low-density granulocytes were evaluated in patient primary cells and serum samples. Results: We identified a novel, homozygous, loss-of-function mutation (p.Pro445Leufs*11) in the C1R gene. Using the Sanger method of DNA sequencing in 14 family members, we confirmed the presence of the mutation in 4 patients with SLE and in an asymptomatic 9-year-old girl. Complement levels were low in sera from patients with truncated C1r protein. Two siblings with SLE who were available for detailed evaluation exhibited strong type I interferon (IFN) inflammatory signatures despite their disease being clinically inactive at the time of sampling. The type I IFN transcriptional signature in the patients’ blood correlated with disease expressivity, whereas the neutrophil signature in peripheral blood mononuclear cells was likely associated with disease severity. The female patient with SLE with the most severe phenotype presented with a stronger neutrophil signature, defined by enhanced NET formation and the presence of low-density granulocytes. Analysis of exome data for modifying alleles suggested enrichment of common SLE-associated variants in the more severely affected patients. Lupus-associated HLA alleles or HLA haplotypes were not shared among the 4 affected subjects. Conclusion: Our findings revealed a novel high-penetrance mutation in C1R as the cause of monogenic SLE. Disease expressivity in this family appears to be influenced by additional common and rare genetic variants

A novel design framework for generation and parametric modification of yacht hull surfaces

This paper proposes a new design framework for the parametric design and shape modification of a yacht hull. In this framework, the hull is divided into three regions (entrance, middle and run) and each region is represented separately. In this way, a designer has better design flexibility so that higher design variations of the hull can be achieved. Each region consists of keel line(s), deck line, chine line(s) and station lines that are represented using Bezier curves and these lines are called feature curves. A 3D surface model of a yacht hull is obtained by generating Coons patches using feature curves. Shape operators are also introduced and implemented for the modification of the given hull shape while considering some quality criteria such as hull fairness. Experiments in this study show that a variety of hull shapes can be generated using the proposed design framework with the application of the shape operators