Center In Turkey Research Articles

The prognostic significance of the heterologous component in uterine carcinosarcomas.

Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.

Clinical outcome of childhood immune thrombocytopenia: Experience from a single tertiary center in Turkey

Clinical outcome of childhood immune thrombocytopenia: Experience from a single tertiary center in Turkey

Sacral neuromodulation treatment for urinary voiding dysfunctions: results of treatment with the largest single-center series in a tertiary referral center in Turkey

Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Study protocol: The effect of motivational interviewing on self-management in adult kidney transplant recipients (MIAKTR).

The aim of the study is to examine the effect of motivational interview sessions on self-management that will be conducted in accordance with the post-discharge requirements of adult kidney transplant recipients. Patient-centered motivational interviews make a significant contribution to activating patients' sense of being capable of changing to realize their self-management. This study is a single-center, single-blind, prospective randomized controlled trial. The participants of the study will consist of 80 kidney transplant recipients at an organ transplant center in Turkey. The study is a randomized controlled trial compatible with SPIRIT. The CONSORT flow diagram has been used in this study protocol. The sample will consist of participants within the 3rd, 4th, 5th, and 6th months after the kidney transplant. The measurements will be performed in the first and third months after the interviews. The study continues via the collection of data from the intervention and control groups. In order to support or improve the self-management of kidney transplant recipients, new tools are required that are suitable for this population. Patient-centered motivational interviews can make a significant contribution to activating patients' sense of being capable of changing to realize their self-management. The first motivational interview program to promote a healthy lifestyle in kidney transplant recipients, prevent unwanted conditions after transplantation, and improve self-management will be used in this study. After the intervention has been developed, we expect improvements in self-management with a motivational interviews through creating their own strategies for behavioral changes and improvements in health outcomes.

Bir Zanaat Olarak Görüşme Yönetim Alanında Yazılan Doktora Tezleri Üzerine Metodolojik Bir İnceleme/ Interview as a Craft A Methodological Review on Doctoral Dissertations Written in the Management Field

Bu makale, yönetim alanında yazılan ve birincil veri toplama yöntemi olarak görüşme yöntemi kullanılan 13 doktora tezinin metodolojik incelemesini sunmaktadır. Ayrıca, görüşme araştırmalarına ilgi duyan araştırmacıların başvurabileceği detaylı bir literatür incelemesi de içermektedir. Araştırmada veri olarak, Yüksek Öğretim Kurumu Ulusal Tez Merkezi’nin web sayfasında yapılan sistematik tarama sonucunda seçilen 13 doktora tezi kullanılmıştır. Tezlerin analizinde literatür incelemesi sonucu belirlenen değerlendirme kriterleri kullanılmış ve nitel içerik analizi uygulanmıştır. İçerik analizi sürecinde ağırlıklı olarak tümdengelimsel bir yaklaşım izlendiği söylenebilir. Kriterlerin çoğu, Steinar Kvale’nin “zanaatkar görüşme yaklaşımı”nı temel almakla birlikte, nitel araştırma alanında önde gelen araştırmacıların eserlerinden de faydalanılmıştır. Araştırma bulguları, görüşme araştırmasının uygulama adımlarında bazı önemli eksikliklerin olduğunu göstermektedir. Öne çıkan eksiklikler, yöntemin felsefi altyapısının ihmal edilmiş olması, görüşme verisinin analizinde izlenen yöntemlerin kavramsal açıdan bazı tutarsızlıklar ve belirsizlikler içermesi, tek kaynaktan faydalanma, araştırmada geçerlilik ve güvenilirlik unsurlarının nasıl sağlandığı ile ilgili yeterli açıklamanın olmaması ve bazı tezlerde bu kriterlerin yalnızca literatür tanımlarının verilmiş olması, bulguların sunumunda standart bir yaklaşımın izlenmesi olarak sıralanabilir. Bu bulguların yanı sıra, değerlendirme kriterlerinin çoğunu sağlayan ve zanaatkar görüşme yaklaşımının bazı özelliklerini taşıyan doktora tezlerinin olduğu da belirlenmiştir. Bulguların sunumunda bu tezlerden alıntılara yer verilmiştir. Araştırmanın bulguları, üniversitelerde karar verici pozisyonlarda olan akademisyenler, lisansüstü öğrencileri ve görüşme yöntemini yeni uygulamaya başlayan araştırmacılar için öneriler içermektedir.

The Impact of COVID-19 Pandemic and Quarantine Process a Center in Turkey on Anxiety Levels of Pediatric Patients with Epilepsy

The Impact of COVID-19 Pandemic and Quarantine Process a Center in Turkey on Anxiety Levels of Pediatric Patients with Epilepsy

The Effect of Body Mass Index on Survival in Lung Cancer

The prognostic significance of body mass index in lung cancer and the direction of this relationship are not yet clear. This study aimed to evaluate the relationship between BMI and overall survival time of advanced-stage lung cancer patients treated in a center in Turkey, a developing country. In this study, the data of 225 patients diagnosed with stage III or stage IV lung cancer between 2016 and 2020 were analyzed. The effects of BMI and other variables on survival were examined by Cox regression analysis for NSCLC and SCLC. For NSCLC and SCLC, being underweight compared to the normal group, being diagnosed at a more advanced stage, and having a worse performance score were associated with a significantly higher risk of death. Other variables significantly associated with survival were gender, type of radiotherapy for NSCLC, age group, and family history for SCLC. This study showed that being underweight relative to the normal group was associated with worse survival for NSCLC and SCLC but did not support the obesity paradox. Studies that are representative of all BMI categories and free of bias are needed to understand the BMI-lung cancer survival relationship clearly.

The Safety and Tolerability of Nebivolol in Hypertensive Patients with Coronary Artery Disease and Left Ventricular Ejection Fraction ≥ 40%: A Population-Based Cohort Study (Nebivolol-TR Study).

This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction ≥ 40% in a Turkish cohort. A total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction ≥ 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded. The mean age of the study population was 60.3 ± 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 ± 23.5/-5.1 ± 13.5 mmHg, and the resting heart rate was -12.1 ± 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%. Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.

The Clinical Outcomes of COVID-19 in Patients on Warfarin: A Propensity Score Matching Study.

COVID-19 is associated with vascular thrombosis in critical patients. However, warfarin has not been adequately studied in patients with COVID-19. This study aimed to evaluate whether the use of warfarin, a potent oral anticoagulant, was of clinical benefit in patients with COVID-19. This was a retrospective cohort study of COVID-19 patients diagnosed at 3 different centers in Turkey between April 2020 and April 2021. Patients were grouped by whether they were taking warfarin or not. Propensity score matching analysis was used to compare the dif ferences between the groups in mortality, hospitalization, and admission to the intensive care unit. A propensity score analysis was performed on 128 patients in the warfarin group and 372 patients in the control group. After matching, 84 pairs of patients were compared. The patients in the control group were more likely to be admitted to the intensive care unit (33.3% vs. 14.3%, respectively; P=.007) and had longer hospital stays than the warfarin group (7.1 vs. 14.1 days; P=.005). The warfarin group had a lower death rate compared to the control group (7.1% vs. 27.4%, respectively; P=.001), and surviving patients were sig nificantly more likely to be in the warfarin group than the control group (56.1% vs. 20.7%, respectively; P=.001). In patients on warfarin, there was a lower incidence of in-hospital death (log-rank test P=.005). Warfarin therapy could provide clinical benefits in patients with COVID-19. The current data highlight the importance of potent anticoagulation in the treatment of COVID-19.

Clinical, neuroimaging and genetic findings in children with hereditary ataxia: single center study.

The genetics of hereditary ataxia (HA) are complex and multigenic. The diversity of genes that cause ataxia varies considerably between populations. We aimed to investigate the clinical, neuroimaging, and genetic findings of HA in children from a tertiary center in Turkey. The clinical and neuroimaging evaluations of patients, laboratory investigations, and molecular genetic evaluations of those with ataxia were performed at the pediatrics, pediatric neurology, and genetics outpatient clinics between October 2020 and October 2021. With repeated expansions in the ATXN 1, 2, 3, 7, and 8 genes for spinocerebellar ataxia (SCA) and FXN genes for Friedreich's ataxia (FA), whole-exome sequencing (WES) was used to analyze every patient. 25 patients from 24 families had ataxia and an unsteady gait as their main symptoms. The patients had a mean age of 8.5 ± 3.78 years, and the symptoms had begun at a mean age of 2 ± 0.62 years; five of these were males and three were females. A genetic cause of ataxia was found in 8/25 patients (32%). Seven of the eight gene mutations detected in the patients were novel mutations. Spinocerebellar ataxia was found in 16% of cases (n = 4), L-2-Hydroxyglutaric aciduria was found in 12% of cases (n = 3), and ataxia-telangiectasia was found in 4% of cases (n = 1). Our research adds to the body of knowledge by describing the clinical and genetic traits of HA patients in our area and by finding unusual gene changes linked to ataxia.

Outcomes of Pregnancies in Liver Transplant Recipients: Experience of a Single Center in Turkey.

Liver transplantation is the ultimate treatment for end-stage liver failure. As organ donation systems improve, more reproductive-age women are expected to undergo liver transplantation. Current studies indicate increased risk of some perinatal and maternal complications; however, the available data is still scarce. Therefore, we aimed to evaluate the maternal and fetal outcomes of pregnancies in liver transplant recipients. We retrospectively evaluated liver transplantations performed between 2011 and 2020 in a tertiary center. Perinatal, maternal, fetal outcomes and transplant status were assessed among pregnancies conceived after liver transplantation. Among 1137 patients, 82 (7.2%) were reproductive-age females. Ten pregnancies in nine patients were identified after liver transplantation. The mean age of patients was 29.3±6.1 at transplantation, and 32.5±5.4 at conception. The mean interval between conception and transplantation was 30.3±11.7 months. There were eight live births (80%), one miscarriage (10%) and one termination (10%). Three patients delivered<37th gestational week (37.5%). The median gestational age at birth was 38.5 (IQR: 5.21) weeks. The mean birth weight of infants was 2669.3±831 g. Two patients were diagnosed with preeclampsia (25%) and acute graft rejection episode was observed in one patient (10%) during pregnancy. Although the incidence of some perinatal complications, such as hypertensive disorders and preterm delivery, is increased in liver transplant recipients, pregnancy after liver transplantation appears to have favorable outcomes for the mother, fetus and transplant with close monitoring by a multidisciplinary team.

Retrospective Evaluation of Hematological and Clinical Factors Associated with 30-Day Mortality in 170 Patients Diagnosed with Intracerebral Hematoma in a Single Center in Turkey.

BACKGROUND This retrospective study from a single center in Turkey aimed to evaluate hematological and clinical factors related with 30-day mortality in patients diagnosed with intracerebral hematoma (ICH) between 2013 and 2021. MATERIAL AND METHODS All 170 consecutive patients (>18 years) admitted to the Intensive Care Unit (ICU) with spontaneous ICH were analyzed. Cranial computed tomography was performed in all patients. Venous blood samples were routinely obtained upon admission. Demographic characteristics, blood test results, imaging data, and survival data were retrieved from the institutional digital database. The primary goal of this study was to investigate the role of presenting demographic and clinical characteristics and blood tests in predicting 30-day mortality in patients with spontaneous ICH. RESULTS Receiver operating characteristic curve analysis showed that the Glasgow coma scale (GCS) score (≤9), hematoma volume (>13.4 cm³), hemoglobin (≤13.1 g/dL), international normalized ratio (>1.25), C-reactive protein (CRP) (>7.5 mg/L), and third-day neutrophil-to-lymphocyte ratio (>17.8) could be used to predict 30-day mortality. Patients with low GCS scores (≤9) had a 14.432-fold higher risk of death than other patients (OR: 14.432, 95% CI: 6.421-32.441, P<0.001). Patients with high CRP levels (>7.5) had a 3.323-fold higher risk of death than other patients (OR: 3.323, 95% CI: 1.491-7.405, P=0.003). CONCLUSIONS Tailoring scoring systems to include CRP may be beneficial for predicting spontaneous ICH prognosis. However, further studies assessing CRP and other inflammatory markers are necessary to assess whether inflammatory activity could be associated with worse outcomes in patients with ICH.

Results of the patch tests with European baseline series in children: Five years of experience from a single center in Turkey and a review of the literature.

Pediatric allergic contact dermatitis (ACD) is increasingly prevalent. Patch testing is the gold-standard diagnostic method. Our study aimed to identify common contact-sensitizing allergens in Turkish children. We retrospectively analyzed the patch test results and characteristics of 191 pediatric patients [114 (59.7%) females, 77 (40.3%) males], who received the diagnosis of allergic contact dermatitis between 2015 and 2019. The mean age of the patients was 12.2 years (range 4-18 years). Thirty-six (18.8%) of the patients in the study group had positive patch test outcomes with 56 positive allergens. Girls had a significantly higher rate of total positive patch test results than boys (75%/25%; p=0.003, p < 0.05). The most frequent four allergens were nickel sulfate (n=20, 10.4%), cobalt chloride (n=6, 3.14%), p-phenylenediamine (n=5, 2.61%), Methylchloroisothiazolinone/methylisothiazolinone (n=5, 2.61%), respectively. In our study, we discovered that in addition to the frequently encountered metal allergens such as nickel and cobalt, p-phenylenediamine and Methylchloroisothiazolinone/methylisothiazolinone sensitivities were frequent in the Turkish population. p-phenylenediamine sensitization can cause serious systemic dermatitis during the lifetime of children. We suggest that in Turkey personal care and hygiene products containing Methylchloroisothiazolinone/methylisothiazolinone should be legally regulated. Since childhood contact dermatitis may have an impact on the quality of life by influencing family and social life, suspected allergens should be detected as early as possible.

Polatuzumab vedotin, rituximab, and bendamustine combination in relapsed or refractory diffuse large B-cell lymphoma: a real-world data from Turkey.

Polatuzumab vedotin (Pola) with bendamustine and rituximab (BR) is a promising option for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We analyzed the data of 71 R/R DLBCL patients who had been treated with Pola-BR in the named patient program from March 2018 to April 2021 from 32 centers in Turkey. All patients received up to six cycles of Pola 1.8mg/kg, rituximab 375mg/m2 on day 1, and bendamustine 90mg/m2 on days 1-2 of each cycle. Median age at Pola-BR initiation was 55 (19-84). The overall response rate was 47.9%, including 32.4% CR rate when a median of 3 cycles was applied. With a median follow-up of 5months, the median OS was 5months. Grade 3-4 neutropenia and thrombocytopenia were the most common hematological toxicities. The real-world data from our cohort showed the Pola-BR is an effective option with a manageable toxicity profile.

Surgical Outcomes of Regional Versus General Anesthesia in 203 Patients with Upper- and Lower-Extremity Amputation: A Retrospective Study from a Single Center in Turkey.

BACKGROUND This retrospective study from a single center in Turkey aimed to compare the surgical results of regional anesthesia and general anesthesia in 203 patients with upper- and lower-extremity amputations. MATERIAL AND METHODS The study population consisted of patients who underwent extremity amputation between 2017 and 2021. Patients' demographic data, comorbidities, American Society of Anesthesiology (ASA) scores, amputated extremities, causes and extents of amputations, length of hospital stay, associated mortality/morbidity, and postoperative 90-day mortality data were comparatively analyzed between the groups created according to the anesthesia methods used in amputations. RESULTS The study consisted of 203 patients, of whom 80.8% were male. The most commonly used anesthesia method was peripheral nerve blocks (32.5%), followed by spinal anesthesia (31.5%), general anesthesia (31.0%), epidural anesthesia (2.0%), combined spinal-epidural anesthesia (1.5%), and sedo-analgesia (1.5%). Of the amputations performed, 37.0% were upper-extremity and 63.0% were lower-extremity. Peripheral nerve blocks were used most frequently in upper-extremity amputations (71.5%), and spinal anesthesia was used most frequently in lower-extremity amputations (48.9%). The mean length of hospital stay of the patients who underwent surgery under regional anesthesia methods was shorter than that of those who underwent general anesthesia (8.7±7.4 days vs 15.0±20.6 days). The mortality rate was 0.5% in the first 24 h, 0.5% in the next 48 h, and 4.9% in total. CONCLUSIONS The study findings demonstrated that performing extremity amputations under regional anesthesia techniques, particularly peripheral nerve blocks, reduces mortality/morbidity, the need for postoperative intensive care, mean length of stay in hospital, and hospital costs.

Assesment of Patient'S Perspective on Treatment Free Remission in CML: A Turkish Multicenter Cohort

Treatment free remission (TFR) is one of the main goals of therapy in Chronic Myeloid Leukemia (CML). Patient perspective and expectations have an indicative effect on discontinuation decisions. We analyzed 116 CML patients' perspective on TFR and factors that associated with willingness for tyrosine kinaz inhibitor (TKI) discontinuation from four different center in Turkey based on a national survey. Patients in our cohort had 7.8% awareness of TFR and after brief information willingness to attempt TFR has been reached to 58.9% in all population. Shorter disease duration was associated with enhanced willingness to attempt discontinuation in multivariate analyses (p=0.031). Most common patient related limitation for TKI discontinuation decision was anxiety about disease relaps and TKI resistance. Even disease relaps in TFR means molecular and detectable with close monitoring, patients still had considerable concerns about TKI discontinuation.

Genotype of congenital adrenal hyperplasia patients with testicular adrenal rest tumor

Testicular adrenal rest tumor (TART) is one of the important complications that can cause infertility in male patients with congenital adrenal hyperplasia (CAH) and should therefore be diagnosed and treated at an early age. The factors that result in TART in CAH have not been completely understood. The aim of this study is to evaluate the genotype-phenotype correlation in CAH patients with TART. MethodAmong 230 malepatients with CAH who were followed upwith regular scrotal ultrasonography in 11 different centers in Turkey, 40 patients who developed TARTand whose CAH diagnosis was confirmed by genetic testing were included in this study. Different approaches and methods were used for genotype analysis in this multicenter study. A few centers first screened the patients for the ten most common mutations in CYP21A2 and performed Sanger sequencing for the remaining regions only if these prior results were inconclusive while the majority of the departments adopted Sanger sequencing for the whole coding regions and exon-intron boundaries as the primary molecular diagnostic approach for patients with either CYP21A2 orCYP11B1 deficiency. The age of CAH diagnosis and TART diagnosis, type of CAH, and identified mutations were recorded. ResultsTART was detected in 17.4% of the cohort [24 patients with salt-wasting (SW) type, four simple virilizing type, and one with nonclassical type with 21-hydroxylase (CYP21A2) deficiency and 11 patients with 11-beta hydroxylase (CYP11B1) deficiency]. The youngest patients with TART presenting with CYP11B1 and CYP21A2 deficiency were of 2 and 4 years, respectively. Eight different pathogenic variants in CYP21A2were identified. The most common genotypes were c.293-13C>G/c.293-13C>G (31%) followed by c.955C>T/c.955C>T(27.6%) and c.1069C>T/c.1069C>T (17.2%). Seven different pathogenic variants were identified in CYP11B1. The most common mutation in CYP11B1 in our study was c.896T>C (p.Leu299Pro). ConclusionWe found that 83% TART patients were affected with SW typeCYP21A2 deficiency,and the frequent mutations detected were c.955C>T (p.Gln319Ter), c.293-13C>G in CYP21A2 and c.896T>C (p.Leu299Pro) inCYP11B1. Patients with CYP11B1 deficiency may develop TART at an earlier age. This study that examined the genotype–phenotype correlation in TART may benefit further investigations in larger series.

The pattern of chromosomal abnormalities in recurrent miscarriages: a single center retrospective study.

Chromosomal abnormalities are more common in first trimester recurrent miscarriages (RM). Chromosomal anomalies affect approximately 2%-8% of couples with RM. Evaluate the spectrum and the frequencies of chromosomal anomalies in RM. A retrospective hospital record-based descriptive study. A tertiary care center in Turkey. We studied couples with RM between October 2020 and January 2022. Relevant family and medical history, clinical examination and the results of karyotype were statistically analyzed. Prevalence and types of chromosomal aberrations in couples with RM. SAMPLE SİZE: 362 couples with a history of RM RESULTS: Among the 362 couples, 14 cases (3.86%) had chromosome abnormalities. Eight cases (57.14%) were structural anomalies and six cases (42.86%) were numerical chromosomal aberrations. We found five balanced translocations (67.5%) and three Robertsonian translocations (37.5%). The prevalence of polymorphic variants was 51/362 (14.1%). This study supports the conclusion that clinicians should understand the importance of chromosome analysis in these couples and direct them to karyotyping after two abortions in order to exclude the possibility of a genetic cause of RM. Single-center study and retrospective. None.

The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer.

We aimed to investigate the impact of tumor necrosis in non-muscle invasive bladder cancer on patients' recurrence and progression rates and survival outcomes. This study was conducted retrospectively in a single tertiary center in Turkey. Medical records of patients who underwent transurethral resection of the bladder tumor between January 2016 and January 2021 were reviewed. Patients with pTa and pT1 non-muscle invasive bladder cancer who had undergone complete resection were included in our study. All pathological specimens were reevaluated for the presence of tumor necrosis. A total of 287 patients (244 males and 43 females) were included in our study. Of them, 33 (11.5%) patients had tumor necrosis. The rates of multiple and large tumors (>3 cm) were higher in patients with tumor necrosis (p=0.002 and p<0.001, respectively). Tumor necrosis was associated with higher rates of pT1 diseases (p<0.001), high-grade tumors (p<0.001), and the presence of lymphovascular invasion (p=0.007). The mean recurrence-free survival of patients with tumor necrosis was 42.3 (4.6) months, and the recurrence-free survival of patients without tumor necrosis was 43.5 (1.8) months (p=0.720). The mean progression-free survival of patients with tumor necrosis was 43.1 (4.6) months, and the progression-free survival of patients without tumor necrosis was 58.4 (0.9) months. In log-rank analysis, there was a statistically significant difference between patients with and without tumor necrosis in terms of progression-free survival (p<0.001). In this study, we demonstrated that patients with non-muscle invasive bladder cancer and tumor necrosis in pathological specimens have shorter progression-free survival and more adverse pathological features.

Süleymaniye (Gümüşhane) Kış Turizm Merkezi İçin Bir Uygunluk Analizi Araştırması

Turizm yatırımları yapılmadan önce doğal ve beşerî özellikler göz önüne alınarak uygunluk analizlerinin yapılması, kaynak israfını ve yanlış arazi kullanımını önleme açısından önemlidir. Bu çalışmada, Gümüşhane Şehrinde kurulması planlanan Süleymaniye Kış Turizmi Merkezi için yörenin coğrafi özellikleri doğrultusunda bir uygunluk analizi gerçekleştirilmiştir. Gümüşhane Şehri, Doğu Karadeniz’in iç kesiminde, Süleymaniye Mahallesi ise Gümüşhane şehir merkezindeki Tenceli Tepe’nin doğu yamacında yer almaktadır. Çalışma kapsamında kış turizmi faaliyetlerini etkileyen parametrelerin sahadaki durumunun belirlenmesi, bulgulardan yola çıkarak sürdürülebilir turizme yönelik öneriler sunmak amaçlanmıştır. Bu amaçla arazi çalışmaları, literatürden faydalanarak sahanın kış turizmi potansiyelini etkileyebilecek faktörler tespit edilmiş, bu parametrelerin sahadaki durumu Türkiye’deki bazı kış turizm merkezleriyle kıyaslanarak açıklanmıştır. Bunun yanı sıra belirlenen parametrelere etki ve ağırlık değerleri verilerek CBS ile uygunluk analizi yapılmıştır. Çeşitli kuruluşlardan sahayla ilgili ikincil veriler temin edilerek değerlendirilmiştir. Bulgulara göre, beş sınıftan oluşan uygunluk analizinde Süleymaniye Mahallesinde kış turizmi yatırımlarının yapılması planlanan sahanın büyük bölümü orta seviyede; az bir kısmı ise uygun sınıfında yer almaktadır. Sahanın, Gümüşhane Şehrinin merkezinde yer alması, ana yollara yakınlığı, ulaşım kolaylığı, eğim, bakı ve arazi örtüsünün kış turizmine uygunluğu en önemli avantajlardır. Ancak sahada kar kalınlığını ideal seviyede tutmak, kış turizmi süresini uzatabilmek için yapay kara ihtiyaç duyulması muhtemeldir. Sahada kurulacak tesisin kendi enerjisini kendi üretecek şekilde tasarlanması maliyetin düşürülmesinde, yöredeki diğer turistik destinasyonlarla ilişkilendirilmesi ise kış mevsimi dışında da kullanılmasına olanak tanıyacaktır.