An integrated spatial planning of the mountainous landscapes for ski sports in a case area at the eastern Türkiye

Mountainous regions have disadvantages in economic development because of harsh physical and climatic conditions.However,winter tourism activities are one of the key components for supporting economic development in the highlands.Establishing a ski resort area supports direct and indirect employment in a region,and it stops immigration from mountainous regions to other places.This research aimed to assess the potential ski areas using a multi criteria evaluation technique in the Van region which is located in the eastern part of Türkiye.In this context,snow cover duration,sun effect,slope,slope length,elevation,population density,distance from main roads and lake visibility were used as input factors in the decision making process.Each factor was standardized using a fuzzy technique based on existing well-known ski centers in Türkiye.The weight of inputs was defined by applying a survey to the professional skiers.The most important factors were detected as transportation opportunities and snow covers whereas,the least important factors were elevation and population density.Additionally,lake visibility was very important to make a difference from other existing facilities in the region.Therefore,it was included as constraints and lake visible areas were extracted at the final stage of the research.Potential ski areas were mapped in three levels as professional,intermediate and beginner skiers.One of the suitable areas was selected as a sample projection and for the 3D simulation of the ski investment area.Potential costs and benefits were discussed.It was found that a ski tourism area investment can be amortized in 3 years in the region.

Behaviour and perception of parents on irrational use of antibiotics in children at primary care level:A cross-sectional study from Turkey

Objective:To investigate the perception of antibiotics,the frequency of inappropriate antibiotic use,and the factors that lead to inappropriate antibiotic use by parents who apply to primary healthcare organizations.Methods:This cross-sectional study included 973 parents who applied to primary healthcare centers.We analyzed basic concepts related to antibiotics prescribed for their children,antibiotic administration,and antibiotic resistance,as well as parents'knowledge and attitudes towards antibiotic use,and their experiences,practices,and perceptions related to purchasing antibiotics without prescription.Results:In the past one year,78.9%of the parents gave antibiotics to their children at least once,and 39.1%gave antibiotics three or more times.Some of the participants(7.1%)reported having forced the physician to prescribe antibiotics and purchased antibiotics without a prescription(13.2%).The knowledge about antibiotics and awareness about antibiotic resistance were found to be more frequent;among parents who had university degrees,higher income levels,two or fewer children,social insurance and negative behaviours were lower in those who received information about antibiotics from healthcare professionals.The probability of taking antibiotics without prescription was lower in that of with higher income level(OR 0.460;95%CI 0.219-0.965),and the probability of forcing antibiotic prescription was higher in those with 3 or more children(OR 6.94;95%CI 2.37-20.26).The score obtained from the awareness of antibiotic resistance sub-dimension was found to negatively affect the behavior of forcing antibiotic prescription(OR 0.852;95%CI 0.732-0.993)but the score obtained from the behaviour sub-dimension was positively affect this behaviour(OR 1.136;95%CI 1.011-1.276).Conclusions:Inappropriate antibiotic use appears to be a problem with negative perception,lack of knowledge and socioeconomic dimension.Studies should be conducted to increase antibiotic knowledge in parents and to expand the scope of social insurance.

Seronegative autoimmune hepatitis in childhood

Comprehensive guidelines on seropositive autoimmune hepatitis have been published for both adults and children,although these guidelines comprise only limited knowledge about seronegative autoimmune hepatitis.Autoimmune hepatitis presents as an acute or chronic progressive disease and poor outcomes are inevitable if left untreated.The absence of autoantibody positivity,hypergammaglobulinemia and lack of comprehensive algorithms makes seronegative autoimmune hepatitis a mysterious disease.In general,seronegative autoimmune hepatitis often presents with acute hepatitis,and its treatment and prognosis similar to seropositive autoimmune hepatitis.The present review focuses on the known characteristics of seronegative autoimmune hepatitis in childhood,and those of which current knowledge is vague.

Eco-Friendly Knit Garments Washing Implementation and Its Impact

Environment pollution is one of the major threats to today’s world and researchers say most of the pollution comes from the washing industry.So,the study aims to find out an alternative way to the existing chemical wash process of the washing industry to save the environment.To conduct this study,one knit washing factory has been selected that has eco-friendly wash facilities.The eco-friendly wash process samples have been developed and finally show the comparison in respect of time,per day production and test result to the conventional chemical wash processes along with the impact of production cost on the garment.For all eco-friendly process,it has been found that water consumptions are too less in comparison with conventional process potentials which is partially related to Sustainable Development Goals 13(Climate Action).This study might help to find out a new era of doing washed knitted product business without polluting the environment.

Expression of COX-2, PCNA, Ki-67 and p53 in gastrointestinal stromal tumors and its relationship with histopathological parameters

AIM: To investigate the expression of Cyclooxygenase-2 (COX-2), proliferating cell nuclear antigen (PCNA), Ki-67 and p53 in gastrointestinal stromal tumors (GISTs) and its relationship with histopathological parameters. METHODS: Twenty-five GISTs were examined by light microscopy and immunohistochemistry. c-kit, CD34, SMA, S-100 protein, COX-2, PCNA, Ki-67 and p53 were detected immunohistochemically and the relationship was evaluated among histopathologic parameters such as mitotic index (MI), tumor grade, tumor size, COX-2, PCNA, Ki-67 and p53. RESULTS: COX-2 protein expression was found in 19 of 25 (76%) of the tumors, and expression was noted in the cytoplasm of the tumor cells. p53 was significantly related to MI and tumor grade but no relationship was found between COX-2, proliferation markers and MI, tumor grade and tumor size. CONCLUSION: COX-2 is expressed in most GISTs and it may play an important role in the proliferation and progression of these tumors or a useful marker to identify GIST. Although immunohistochemical assessment of p53 can be used for distinguishing the risk groups of GISTs, tumor size and mitotic rate should be considered at the same time.

半胱氨酸在碳钢与硫酸界面的缓蚀行为(英文)

Interfacial behavior of cysteine (Cys) between mild steel and sulfuric acid solution as a corrosion inhibitor has been studied with electrochemical AC (alternating current) and DC (direct current) techniques at (25.0±0.1) ℃. The AC impedance results were evaluated using equivalent circuits in which a constant phase element (CPE) has been replaced with double layer capacitance (Cdl) to represent the frequency distribution of experimental data. Changes in impedance parameters (charge transfer resistance and double layer capacitance) indicated that cysteine molecules acted by accumulating at the metal/solution interface. The fractional coverage of the metal surface (θ) was determined using AC impedance results and it was found that the adsorption of cysteine on the mild steel surface followed a Langmuir isotherm model with a standard free energy of adsorption (△G0 ads) of -35.1 kJ·mol-1. To clarify the type of interaction between mild steel surface and cysteine molecules with a molecular orbital approach, electronic properties, such as, the highest occupied molecular orbital (HOMO) energy, the lowest unoccupied molecular orbital (LUMO) energy, and the frontier molecular orbital coefficients have been calculated. Energy gaps for the interaction of mild steel surface and cysteine molecules (ELUMO Fe-EHOMO Cys and ELUMO Cys-EHOMO Fe) were used to determine whether cysteine molecules acted as electron donors or electron acceptors when they interacted with the mild steel surface. The local reactivity was evaluated through the condensed Fukui indices. Theoretical calculations were carried out using the density functional theory (DFT) at B3LYP level with the 6-311++G(d,p) basis set for all atoms by Gaussian 03W program.

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients(one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

Helicobacter pylori eradication in gastric diffuse large B cell lymphoma

Diffuse large B cell lymphoma(DLBCL) of the stomach is a heterogenous disease. There are tumors without histological evidence of mucosa-associated lymphoid tissue(MALT) lymphoma, which are classified as pure or de novo DLBCL and those with evidence of MALT, which are classified as DLBCL(MALT). The association between Helicobacter pylori(H. pylori) and gastric MALT lymphoma and remission with H. pylori eradication was shown in the 1990 s. In recent years, scientists from Taiwan and others have shown that high-grade gastric lymphomas may be dependent on H. pylori and eradication of this microorganism is effective in these cases. This entity is biologically distinct from H. pylori(-) cases and has a better clinical outcome. There are sufficient data about the complete remission in some of these cases with brief treatment with antibiotics. With this strategy, it is possible to save some of these cases from the harmful effects of standard chemotherapy. It is time to treat these cases with H. pylori eradication. However, strict histopathological follow-up is crucial and histopathological response must be evaluated according to the scoring system proposed by Groupe d'Etude des Lymphomes de l'Adulte. If there is no sufficient response, chemotherapy must be given immediately. These results suggest that H. pylori dependency and high-grade transformation in gastric MALT lymphomas are distinct events.

Role of immunotherapy in the treatment of allergic asthma

Allergen-specific immunotherapy(SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although the efficacy of SIT has been shown in terms of reducing symptoms, medication consumption and ameliorating quality of life in both allergic rhinitis and asthma, there has long been some controversies about effectiveness of SIT in the treatment of allergic asthma. The type of allergen, the dose and protocol of immunotherapy, patient selection criteria, the severity and control of asthma, all are significant contributors to the power of efficacy in allergic asthma. The initiation of SIT in allergic asthma should be considered in case of coexisting of other allergic diseases such as allergic rhinitis, unacceptable adverse effects of medications, patient's preference to avoid long-term pharmacotherapy. Steroid sparing effect of SIT in allergic asthma is also an important benefit particularly in patients who have to use these drugs in high doses for a long-time. Symptomatic asthma is a risk factor for systemic reactions and asthma should be controlled at the time of administration of SIT. Both subcutaneous immunotherapy(SCIT) and sublingual immunotherapy(SLIT) have been found to be effective in patients with allergic asthma. Although the safety profile of SLIT seems to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT may appear better and earlier than SLIT in children with allergic asthma.

硫酸溶液中1,1′-硫代羰基二咪唑在碳钢上的吸附及缓蚀影响和碘离子的增强效应(英文)

The inhibition effect of 1,1′-thiocarbonyldiimidazole (TCDI) on the corrosion behaviors of mild steel (MS) in 0.5 mol·L-1 H2SO4 solution was studied with the help of potentiodynamic polarization, electrochemical impedance spectroscopy (EIS), and linear polarization resistance (LPR) techniques. The effect of immersion time on the inhibition effect of TCDI was also investigated over 72 h. For the long-term tests, hydrogen evolution with immersion time (VH2-t) was measured in addition to the three techniques already mentioned. The thermodynamic parameters, such as adsorption equilibrium constant (Kads) and adsorption free energy (△Gads) values, were calculated and discussed. To clarify inhibition mechanism, the synergistic effect of iodide ion was also investigated. The potential of zero charge (PZC) of the MS was studied by electrochemical impedance spectroscopy method, and a mechanism of adsorption process was proposed. It was demonstrated that inhibition efficiency increased with the increase in TCDI concentration and synergistically increased in the presence of KI. The inhibition efficiency was discussed in terms of adsorption of inhibitor molecules on the metal surface and protective film formation.

Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion

AIM: To evaluate central macular thickness(CMT) and mean choroidal thickness(MCT) in eyes with branch retinal vein occlusion(BRVO), before and after ranibizumab treatment using spectral domain-optical coherence tomography(SD-OCT).·METHODS: Forty-two patients with unilateral BRVO and macular edema were included in this study. There were 25 men and 17 women. Using SD-OCT, choroidal thickness was measured at 500 μm intervals up to 1500μm temporal and nasal to the fovea. MCT was calculated based on the average of the 7 locations. All the eyes with BRVO were treated with intravitreal ranibizumab(0.5 mg/0.05 m L). Comparisons between the BRVO and fellow eyes were analyzed using Mann-Whitney U test. Preinjection and post-injection measurements were analyzed using Wilcoxon test and repeated measure analysis.· RESULTS: At baseline, there was a significant difference between the BRVO and fellow eyes in MCT[BRVO eyes 245(165-330) μm, fellow eyes 229(157-327) μm]and CMT [BRVO eyes 463(266-899) μm, fellow eyes 235(148-378) μm(P =0.041, 0.0001, respectively)]. Following treatment, CMT [295(141-558) μm] and MCT [229(157-329) μm] decreased significantly compared to the baseline measurements(P =0.001, 0.006, respectively).Also BCVA(log MAR) improved significantly(P=0.0001) in the BRVO eyes following treatment. After treatment CMT[BRVO eyes 295(141-558) μm, fellow eyes 234(157-351) μm]and MCT [BRVO eyes 229(157-329) μm, fellow eyes 233(162-286) μm] values did not reveal any significant difference in BRVO eyes and fellow eyes(P=0.051, 0.824,respectively).· CONCLUSION: In eyes with BRVO, CMT and MCT values are greater than the fellow eyes, and decrease significantly following ranibizumab injection.

Cirrhosis and hepatopulmonary syndrome

Hepatopulmonary syndrome(HPS)is characterized as a triad:liver disease,intrapulmonary vascular dilatation and arterial hypoxemia.HPS is reported to be present in 4%to 32%of adult patients with end-stage liver disease and in 9%-20%of children.The pathogenesis of HPS has not been clearly identified.Portal hypertension causes impairment in the perfusion of the bowel and increases the enteral translocation of Gram(-)bacteria and endotoxins.This stimulates the release of vasoactive mediators,such as tumor necrosis factor-alpha,heme oxygenase-derived carbon monoxide and nitric oxide.Genetic alterations have not been associated with this syndrome yet;however,cytokines and chemokines have been suggested to play a role.Recently,it was reported that cumulated monocytes lead to the activation of vascular endothelial growth factor-dependent signaling pathways and pulmonary angiogenesis,which plays an important role in HPS pathogenesis.At present,the most effective and only radical treatment is a liver transplant(LT).Cirrhotic patients who are on the waiting list for an LT have a shorter survival period if they develop HPS.Therefore,it is suggested that all cirrhotic cases should be followed closely for HPS and they should have priority in the waiting list.

Association of CagA and VacA presence with ulcer and non-ulcer dyspepsia in a Turkish population

AIM: The mostly known genotypic virulence features, of H. pyloriare cytotoxin associated gene A (ragA) and Vacuolating cytotoxin gene A (VacA). We investigated the association of these major virulence factors with ulcer and non-ulcer dyspepsia in our region.METHODS: One hundred and forty two dyspeptic patients were studied (average age 44.8±15.9 years, range 15-87years, 64 males and 78 females). Antral and corpus biopsies were taken for detecting and genotyping of H. pylori. 107patients who were H. pylori positive by histological assessment were divided into three groups according to endoscopic findings: Duodenal ulcer (DU), gastric ulcer (GU)and non-ulcer dyspepsia (NUD). The polymerase chain reaction (PCR) was used to detect CagA and VacA genes of H.pylori using specific primers.RESULTS: H.pyloriwas isolated from 75.4 % (107/142) of the patients. Of the 107 patients, 66 (61.7 %) were cagApositive and 82 (76.6 %) were Vacl-positive. CagA gene was positively associated with DU and GU (P＜0.01, P＜0.02),but not with NUD (P＞0.05). Although VacA positivity in ulcer patients was higher than that in NUD group, the difference was not statistically significant (P＞0.05).CONCLUSION: There is a significantly positive association between CagA genes and DU and GU. The presence of VacA is not a predictive marker for DU, GU, and NUD in our patients.

Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic patient has been estimated to be 19%-34%through their lifetime.The pathophysiology of diabetic foot ulcer consist of neuropathy,trauma and,in many patients,additional peripheral arterial disease.In particular,diabetic neuropathy leads to foot deformity,callus formation,and insensitivity to trauma or pressure.The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification,surgical debridement,dressing to facilitate wound healing,offloading,vascular assessment(status and presence of a chance for interventional vascular correction),and infection and glycemic control.Although especially surgical procedures are sometimes inevitable,they are poor predictive factors for the prognosis of diabetic foot ulcer.Different novel treatment modalities such as nonsurgical debridement agents,oxygen therapies,and negative pressure wound therapy,topical drugs,cellular bioproducts,human growth factors,energy-based therapies,and systematic therapies have been available for patients with diabetic foot ulcer.However,it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials.This review aims at evaluating diabetic foot ulcer with regard to all aspects.We will also focus on conventional and novel adjunctive therapy in diabetic foot management.

Sutureless amniotic membrane transplantation following excision of ocular surface neoplasia

Dear Sir,S uccess of surgical management of conjunctival neoplasias primarily depends on the complete excision of the mass and eradication of tumor cells from the ocular surface[1-3].Especially in cases that extensive resections are required,primary closure may not be feasible;so ocular surface reconstruction can be a challenging problem for the surgeons.For conjunctival tissue defects different

Umbilical cord blood serum therapy for the management of persistent corneal epithelial defects

AIM:Toevaluatetheroleofumbilical cord blood serum(CBS) therapy in cases with persistent corneal epithelial defects(PED).METHODS:Sixteen eyes of 14 patients with PED who were resistant to conventional treatment were treated with 20% umbilical cord serum eye drops. Patients were followed-up weekly until epithelization was complete.The collected data included the grade of corneal lesion(Grade I: epithelial defect +superficial vascularization,Grade II: epithelial defect +stromal edema, Grade III:corneal ulcer +stromal melting), the size of epithelial defect(pretreatment, 7th, 14 thand 21stdays of treatment),and follow-up time was evaluated retrospectively.RESULTS:The mean size of epithelial defect on two perpendicular axes was 5.2×4.6-mm2(range: 2.5-8 mm×2.2-9 mm2). Mean duration of treatment was 8.3 ±5wk.CBS therapy was effective in 12 eyes(75%) and ineffective in 4 eyes(25%). The epithelial defects in 4ineffective eyes were healed with amniotic membrane transplantation and tarsorrhaphy. The rate of complete healing was 12.5% by 7d, 25% by 14 d, and 75% by 21 d.The healing time was prolonged in Grade III eyes in comparison to eyes in Grade I or Grade II.CONCLUSION:The results of the current study indicated the safety effectiveness of CBS drops in the management of PED. The grade of disease seems have a role on the healing time.

Frailty significantly impairs the short term prognosis in elderly patients with heart failure

Background Frailty is a condition of elderly characterized by increased vulnerability to stressful events with high risk of adverse outcomes. The purpose of this study was to evaluate the association between frailty and adverse outcomes including death and hospitalization due to heart failure in elderly patients. Methods We included patients aged ≥ 65 years with the diagnosis of heart failure. The clinical and laboratory data, echocardiography and ECGs were recorded. Additionally, the frailty scores of the patients were evaluated according to Canadian Study of Health and Aging. All the patients were divided as frail or non-frail. The groups were compared for their characteristics and the occurrence of clinical outcomes. Results We included 86 eligible patients. The median follow-up time was four months. The mean age was 75 ± 6.5 years. Of these 86 patients, 17 (19.7%) patients encountered an event (death and/or hospitalization). Nine patients (10.4%) died during follow-up. Thirty patients (34.9%) were considered frail. Among the demographic, clinical and laboratory data, only total protein and albumin levels were found to be lower in frail patients (total protein level: 6.8 ± 0.6 g/dL in non-frails, 6.5 ± 0.9 g/dL in frails, P = 0.05;albumin level: 3.8 ± 0.4 g/dL in non-frails, 3.4 ± 0.6 g/dL in frails, P = 0.001). In multivariate analysis, frailty was found to be strongly associated with clinical outcomes in short term. Conclusions Being frail in an elderly heart failure patient is associated with death and/or hospitalization due to heart failure in short term. Therefore, frailty score should be evaluated for all elderly heart failure patients as a prognostic marker.

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery:A general perspective of current studies?

BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus(T2DM).Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM.There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM,but remission rates of T2DM after metabolic surgery can display great variability.AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy,adjustable gastric banding,Roux-en-Y gastric bypass,and biliopancreatic diversion with duodenal switch.METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures.RESULTS In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patient with T2DM,but further studies are needed to clarify better the rate of diabetes remission.CONCLUSION In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patients with T2DM,but further studies are needed to clarify better the rate of diabetes remission.

Analysis of Cardiotocogram Data for Fetal Distress Determination by Decision Tree Based Adaptive Boosting Approach

Cardiotocography is one of the most widely used technique for recording changes in fetal heart rate (FHR) and uterine contractions. Assessing cardiotocography is crucial in that it leads to iden- tifying fetuses which suffer from lack of oxygen, i.e. hypoxia. This situation is defined as fetal dis- tress and requires fetal intervention in order to prevent fetus death or other neurological disease caused by hypoxia. In this study a computer-based approach for analyzing cardiotocogram in- cluding diagnostic features for discriminating a pathologic fetus. In order to achieve this aim adaptive boosting ensemble of decision trees and various other machine learning algorithms are employed.