GÖZ KIRPMA TESPİTİ İÇİN YENİ BİR UYARLAMALI EŞİK DEĞERİ ALGORİTMASI

Uykululuk halinin önceden tespit edilmesi, uykululuğa bağlı trafik kazalarını önlemek, fiziksel ve ekonomik kayıpların önüne geçmek açısından önemlidir. Bir kamera yardımı ile kişilerin görüntüleri üzerinde görüntü işleme teknikleri uygulanarak uykululuk halini önceden kestirmek mümkündür. Bu çalışmada, literatürdeki veri kümelerinden yararlanılarak uykululuk halinin tespit edilmesinde büyük bilgiye sahip olan göz bölgesinden gelen öznitelikler ile göz kırpma tespiti yapmak için sabit ve uyarlamalı eşik değerleri ayrı ayrı değerlendirilmiştir. Böylece, kısa süreli göz kırpma ile uzun süreli göz kapamanın daha iyi ayırt edilmesi hedeflenmiştir. Çalışmada önerilen uyarlamalı eşik değerinin sabit bir eşik değerinden çok daha başarılı göz kırpma tespiti sonuçları verdiği, iki farklı veri kümesi üzerinde yapılan deneyler ile doğrulanmıştır

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Dam failure analysis and flood disaster simulation under various scenarios

The aim of this study is to analyze the effects of a possible dam failure under various scenarios and to generate a flood hazard map for two consecutive dams located in a study area with a dense-residential region and a heavy-traffic highway. Two consecutive dams consist of Elmalı 2, a concrete-buttress dam and Elmalı 1, an earth-fill gravity dam in the upstream and downstream, respectively. Hydrologic Engineering Center-River Analysis System (HEC-RAS) was used to develop a dam failure model. Dam failure scenarios were examined regarding three main criteria: the Breach Formation Time (BFT), the Number of Failed Buttresses (NFB) of Elmalı 2, and the Reservoir Volume Ratio (RVR) of Elmalı 1. Accordingly, flood peak depth (Hp), peak flow rate (Qp), peak velocity (vp), and time to reach the peak (tp) are discussed. The results showed that BFT and NFB of Elmalı 2 were highly effective on these values, whereas RVR of Elmalı 1 had no significant effect. Moreover, the total area affected by potential floods was calculated with a comparative areal change analysis using flood inundation and flood hazard maps obtained. Estimated damage costs indicate that in the worst-case scenario, more than 500 buildings will be affected in the region. HIGHLIGHTS The effects of a possible dam failure on two consecutive dams are analyzed.; The study focuses on the dam failure analysis of a concrete-buttress dam located on a high-density residential area and a heavy-traffic highway, which is different among dam failure studies.; Flood inundation and hazard maps for the study area are generated.; The results obtained in this study serve as a guide for those living downstream of the Elmalı dam in the future.

Association of Visual-Based Signals with Electroencephalography Patterns in Enhancing the Drowsiness Detection in Drivers with Obstructive Sleep Apnea

Individuals with obstructive sleep apnea (OSA) face increased accident risks due to excessive daytime sleepiness. PERCLOS, a recognized drowsiness detection method, encounters challenges from image quality, eyewear interference, and lighting variations, impacting its performance, and requiring validation through physiological signals. We propose visual-based scoring using adaptive thresholding for eye aspect ratio with OpenCV for face detection and Dlib for eye detection from video recordings. This technique identified 453 drowsiness (PERCLOS ≥ 0.3 || CLOSDUR ≥ 2 s) and 474 wakefulness episodes (PERCLOS < 0.3 and CLOSDUR < 2 s) among fifty OSA drivers in a 50 min driving simulation while wearing six-channel EEG electrodes. Applying discrete wavelet transform, we derived ten EEG features, correlated them with visual-based episodes using various criteria, and assessed the sensitivity of brain regions and individual EEG channels. Among these features, theta–alpha-ratio exhibited robust mapping (94.7%) with visual-based scoring, followed by delta–alpha-ratio (87.2%) and delta–theta-ratio (86.7%). Frontal area (86.4%) and channel F4 (75.4%) aligned most episodes with theta–alpha-ratio, while frontal, and occipital regions, particularly channels F4 and O2, displayed superior alignment across multiple features. Adding frontal or occipital channels could correlate all episodes with EEG patterns, reducing hardware needs. Our work could potentially enhance real-time drowsiness detection reliability and assess fitness to drive in OSA drivers

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

Anecdotally, cystic vestibular schwannomas (cVSs) are regarded to have unpredictable biologic activity with poorer clinical results, and most studies showed a less favorable prognosis following surgery. While stereotactic radiosurgery (SRS) is a well-established therapeutic option for small- to medium-sized VSs, cVSs are often larger, thus making upfront SRS more complicated. The purpose of this retrospective study was to assess the efficacy and safety of upfront SRS for large cVSs. The authors reviewed the data of 54 patients who received upfront, single-session Gamma Knife radiosurgery (GKRS) with a diagnosis of large cVS (> 4 cm3). Patients with neurofibromatosis type 2, multiple VSs, or recurrent VSs and < 24 months of clinical and neuroimaging follow-up were excluded. Hearing loss (48.1%) was the primary presenting symptom. The majority of cVSs were Koos grade IV (66.7%), and the most prevalent cyst pattern was "mixed pattern of small and big cysts" (46.3%). The median time between diagnosis and GKRS was 12 months (range, 1-147 months). At GKRS, the median cVS volume was 6.95 cm(3) (range, 4.1-22 cm(3)). The median marginal dose was 12 Gy (range, 10-12 Gy). The mean radiological and clinical follow-up periods were 62.2 ± 34.04 months (range, 24-169 months) and 94.9 ± 45.41 months (range, 24-175 months), respectively. At 2, 6, and 12 years, the tumor control rates were 100%, 95.7%, and 85.0%, respectively. Tumor shrinkage occurred in 92.6% of patients (n = 50), tumor volume remained stable in 5.6% of patients (n = 3), and tumor growth occurred in 1.9% of patients (n = 1). At a median follow-up of 53.5 months, the pre-GKRS tumor volume significantly decreased to 2.35 cm(3) (p < 0.001). While Koos grade 3 patients had a greater possibility of attaining higher volume reduction, "multiple small thick-walled cyst pattern" and smaller tumor volumes decreased the likelihood of achieving higher volume reduction. Serviceable hearing (Gardner-Robertson Scale I-II) was present in 16.7% of patients prior to GKRS and it was preserved in all of these patients following GKRS. After GKRS, 1.9% of patients (n = 1) had new-onset trigeminal neuralgia. There was no new-onset facial palsy, hemifacial spasm, or hydrocephalus. Contrary to what was believed, our findings suggest that upfront GKRS seems to be a safe and effective treatment option for large cVSs

Coincidence of right adrenal vein and retroaortic left renal vein variations in a patient undergoing laparoscopic adrenalectomy

In this case, we report an interesting right adrenal vein variation with renovascular variations discovered during the laparoscopic right adrenalectomy. A Sixth eightyear-old woman was referred for treatment of a right adrenal mass. Computed tomography sections revealed 3x4.5x3.5 cm well defined right adrenal mass and retroaortic left renal vein. Conventional laparoscopic transabdominal approach was scheduled. During the laparoscopic exploration It was noted that there was no vein drainage from adrenal gland to the inferior vena cava. As this dissection completed, right adrenal vein was exposed arisen from accessory right hepatic vein. In some reports ıt has been reported that adrenal vein variations can be associated with retroaortic left renal vein, but the right adrenal vein joined with an accessory right hepatic vein and retroaortic left renal vein combination is extremely uncommon condition

Sigmoid Colon Fistula due to Mesh Infection in a Patient Operated for Incarcerated Groin Hernia with Transabdominal Pre-Peritoneal (TAPP) Technique

Although laparoscopic surgery is an accepted procedure in elective inguinal hernia repair, it is controversial for incarcerated hernias. Persistent infections due to inflammation of mesh; visceral tissue erosion and migration of mesh are rare but possible complications. In this manuscript, we report a case of laparoscopic hernia repair with transabdominal preperitoneal technique complicated with both these complications and discuss with literature. [Cukurova Med J 2015; 40(Suppl 1): 122-126

Long-term results of upfront, single-session Gamma Knife radiosurgery for large cystic vestibular schwannomas

Anecdotally, cystic vestibular schwannomas (cVSs) are regarded to have unpredictable biologic activity with poorer clinical results, and most studies showed a less favorable prognosis following surgery. While stereotactic radiosurgery (SRS) is a well-established therapeutic option for small- to medium-sized VSs, cVSs are often larger, thus making upfront SRS more complicated. The purpose of this retrospective study was to assess the efficacy and safety of upfront SRS for large cVSs. The authors reviewed the data of 54 patients who received upfront, single-session Gamma Knife radiosurgery (GKRS) with a diagnosis of large cVS (> 4 cm3). Patients with neurofibromatosis type 2, multiple VSs, or recurrent VSs and < 24 months of clinical and neuroimaging follow-up were excluded. Hearing loss (48.1%) was the primary presenting symptom. The majority of cVSs were Koos grade IV (66.7%), and the most prevalent cyst pattern was "mixed pattern of small and big cysts" (46.3%). The median time between diagnosis and GKRS was 12 months (range, 1-147 months). At GKRS, the median cVS volume was 6.95 cm3 (range, 4.1-22 cm3). The median marginal dose was 12 Gy (range, 10-12 Gy). The mean radiological and clinical follow-up periods were 62.2 ± 34.04 months (range, 24-169 months) and 94.9 ± 45.41 months (range, 24-175 months), respectively. At 2, 6, and 12 years, the tumor control rates were 100%, 95.7%, and 85.0%, respectively. Tumor shrinkage occurred in 92.6% of patients (n = 50), tumor volume remained stable in 5.6% of patients (n = 3), and tumor growth occurred in 1.9% of patients (n = 1). At a median follow-up of 53.5 months, the pre-GKRS tumor volume significantly decreased to 2.35 cm3 (p < 0.001). While Koos grade 3 patients had a greater possibility of attaining higher volume reduction, "multiple small thick-walled cyst pattern" and smaller tumor volumes decreased the likelihood of achieving higher volume reduction. Serviceable hearing (Gardner-Robertson Scale I-II) was present in 16.7% of patients prior to GKRS and it was preserved in all of these patients following GKRS. After GKRS, 1.9% of patients (n = 1) had new-onset trigeminal neuralgia. There was no new-onset facial palsy, hemifacial spasm, or hydrocephalus. Contrary to what was believed, our findings suggest that upfront GKRS seems to be a safe and effective treatment option for large cVSs