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Tarihten buyana birçok medeniyete beşiklik etmiş İstanbul her dönemde bir merkez olma özelliğine sahip olmuştur. İstanbul'un bazı bölgeleri de kendisi gibi daima önemli olmuştur. Bu bölgelerden biride Haliçtir. Haliç her zaman yerleşim ve sanayi için tercih edilmiş, önemini hiçbir zaman yitirmemiştir. İstanbul 'un farklı semtlerine ve Boğaziçi'ne açılan kapısı olması bölgenin bir cazibe ve yatırım alanı olmasını sağlamıştır. Haliç köprüler, bölgenin cazibe ve yatırım merkezi olması sonucu hayata geçirilmiştir.1900'lü yıllarda bu bölgeden Eminönü-Eyüp arası günlük 100 bin kişinin faydalanacağı tahmin edilmiştir. Bu köprüler önceleri ulaşım ihtiyacının giderilmesi için hizmet verirken daha sonra ise özellikle yeni ve modern köprüler yapıldıktan sonra gelir getirici özelliği kazanmıştır. Haliç köprüleri mimari özellikleri ve inşaat yapısı açısından önemli olduğu gibi oluşturduğu katma değer açısından da iktisadi öneme sahip olmuştur. Köprüler sadece ulaşımın sağlandığı araçlar olmamış aynı zamanda belediyenin önemli bir gelir kalemi olmuştur. Köprü gelirleri belediyenin bütçe açıklarını kapatmada yardımcı olmuş, hisse senetleri borsada işlem görmüş Osmanlı ve Cumhuriyettin ilk çeyreğinde önemli miktarda gelir elde edilmiştir., Istanbul, which has been the cradle of many civilizations throughout history, has preserved its strategic position in every period. Some regions of Istanbul have always been important like itself. One of these regions is the Golden Horn. The Golden Horn has always been preferred for settlement and industry and has never lost its importance. The fact that the Golden Horn is the gateway to different districts of Istanbul and the Bosphorus has made the region an attraction and investment area. Golden Horn bridges were realized as a result of the attraction and investment center of the region.It was estimated that 100 thousand people will benefit from this region between Eminönü and Eyüp daily in the 1900s. These bridges initially served to meet the need for transportation, and later gained income-generating characteristics, especially after new and modern bridges were built. The Golden Horn bridges are important not only in terms of their architectural features and construction structure, but also in terms of the added value they create. Bridges were not only a means of transportation, but also became an important revenue item of the municipality. The bridge revenues helped the municipality to close the budget deficits, its stocks were traded on the stock exchange, and a significant amount of revenue was generated in the first quarter of the Ottoman and Republic

Havakirliliği gerek ülkemizde, gerekse dünyada önemli bir halksağlığı riski ve sorunuolarak gündemdeki yerini korumaktadır. Her yıl meydana gelen 4,3 milyon ölüm eviçi hava kirliliğine ve 3,7 milyon ölüm dış ortam hava kirliliğineatfedilmektedir. Bu bağlamda, hava kirliliğinin önlenmesi ve azaltılması ilemilyonlarca insanın sağlığı, hatta hayatı kurtarılabilir. Bu çalışmadaamacımız; Edirne il merkezinde PM10 ve bileşimindeki elementdüzeylerinin, bu parametreler kaynaklı olası hava kirliliği ve kaynaklarınınortaya konmasıdır. Ayrıca çalışmamızda Edirne ilmerkezinde PM10 vebileşimindeki elementler kaynaklı muhtemel sağlık sorunları tespit edilerek,çözüm önerileri geliştirilip ilgili kurumlarla paylaşılacaktır. Edirne T.C.Çevreve Şehircilik Bakanlığı Hava Kalitesi İzleme İstasyonunda PM10değerleri saatlik olarak ölçülmekte ve ölçüm sırasında PM10 ’lar birfilter kağıdı üzerinde saatlik olarak toplanmaktadır. Araştırmanın evrenini buistasyonda 1 Ekim 2016-30 Eylül 2017 tarihinde ölçülen PM10değerleriyle aynı zaman aralığında toplanan PM10 filtre kağıtlarıoluşturmaktadır. Çalışmamızda saatlik PM10 değerlerinden; ortalama,aşan saat sayısı, aşan gün sayısı, günlük ortalamayı aşan gün sayısı gibideğerler elde edilmiştir. PM10 filtre kağıtları ise TÜTAGEM’ de 24element (Be, B, Na, Mg, Al, K, Ca, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Sr,Mo, Cd, Sb, Ba, Tl, Pb) için analize tabi tutulmuştur. Çalışmamızda EdirneMerkez ilçede PM10 yıllık ortalaması 44,08±19,8 µg/m3bulunmuştur. Bu değer DSÖ yıllık PM10 sınır değeri olan 20 µg/m³’tenve AB yıllık PM10 sınırdeğeriolan 40 µg/m³’ten üstünde olup,ülkemizde 2017 yılı için belirlenen PM10 yıllık sınır değeri olan 48µg/m³’ün altında kalmıştır. Ölçümyapılan 8347 saatin 2247 saati (ölçüm yapılan toplam saatin % 29.9’u) DSÖ ve ABsınır değerleri üzerinde bulunmuştur. Ölçüm yapılan 348 günün 259 günde (ölçümyapılan toplam günün % 74.4’ü) PM10 değeri DSÖ ve AB sınırdeğerlerini enaz bir kezaşmıştır. Bu verilere göre; Edirne halkı ölçüm yapılanher üç satin birinde PM10 kirliliğine maruz kalmaktadır. PM10 değerleriortalama, aşan saat sayısı, aşan gün sayısı, günlük ortalamayı aşan günbakımından kış döneminde yaz dönemine göre anlamlı olarak artmaktadır (p1 çıkmıştır (p, Air pollution is a major public health risk andproblem in our country and world. The annual 4,3 million deaths are attributedto household air pollution and 3,7 million deaths to outdoor air pollution.Inthis context, by means of prevention and reduction of air pollution, millionsof people's health and lives can be saved. Our aim in this study is to presentthe levels of PM10 and the levels of the elements in itscomposition; possible air pollution due to these parameters and their sourcesin Edirne. Also the possible health problems caused by PM10 and theelements in its composition will be determined and solution proposals will bedeveloped and shared with relevant institutions. PM10 values aremeasured on an hourly basis and PM10 s are collected on a filterpaper hourly during measurement in Edirne by Ministry of Environment andUrbanization Air Quality Monitoring Station. The research census is composed byPM10 filter papers collected at the same time interval as PM10values measured from October 1, 2016 to September 30, 2017 in this station. Ofour PM10 values per hour; the average number of hours exceeded, thenumber of days exceeding, the number of days exceeding the daily average, etc.were obtained. The PM10 filter papers are analyzed for 24 elements(Be, B, Na, Mg, Al, K, Ca, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Sr, Mo, Cd,Sb, Ba, Tl, Pb) in TÜTAGEM. In our study, the annual average of PM10 wasmeasured as 44,08 ± 19,8 μg / m3 in Edirne. This value is above 20μg / m³ which is the annual PM10 limit value of WHO and above 40 μg/ m³ which is PM10 limit value of EU. But this value is below PM10annual limit value of 48 μg / m³ determined for 2017 in our country. PM10levels measured for 2247 hours of the 8347 hours (29.9% of the total hoursmeasured) exceeded WHO and EU limit values. The PM10 values exceededthe WHO and EU limit values at least once in 259 days of 348 days ofmeasurement (74.4% of the total day of measurement).According to this, thepopulation in Edirne is exposed to pollution of PM10 once everythree hours.PM10 values were significantly higher in winter than insummer in terms of average, number of hours exceeding, number of days exceedingthe daily average(p

Hava kirliliği önemli bir halk sağlığı riski ve sorunudur. Her yıl 4,3 milyon ölüm ev içi hava kirliliğine ve 3.7 milyon ölüm dış ortam hava kirliliğine atfedilmektedir. Ayrıca DSÖ tarafından 2012 yılında hava kirliliğine bağlı yaklaşık 7 milyon prematüre ölüm olduğu bildirilmiştir. Bu çalışmada amacımız; Edirne il merkezindeki hava kirliliği ölçüm istasyonlarından elde ettiğimiz PM10, PM2.5 ve SO2 değerlerinin 2014, 2015 ve 2016 yılları arasındaki farklarını, yaz-kış ve 24 saat içindeki değişimlerini incelemektir. Edirne’de SO2’nin 2014, 2015 ve 2016 yılları için ortalama değerleri sırasıyla; 33,15 μg/m3 (min. 0-max. 596), 24,57 (min. 0- max. 530) ve 27,79μg/m3 (min. 0- max. 365) olarak ve aynı yıllar için PM10 ortalamaları sırasıyla; 54,66 μg/m3 (min. 4-max. 877), 54,03 μg/m3 (min. 3-max. 728) ve 46,27 μg/m3 (min. 0-max. 402) olarak hesaplanmıştır.Her 2 parametre için de yıllar arasında anlamlı fark saptanmıştır (p

War and migration is a traumatic situation that affects human life. Many Syrians had to migrate to our country due to the negativities experienced in Syria. Children are among the most affected by migrations. In this study, the problems encountered by Syrian students in the education process are discussed. The case study method was used in this qualitative research. The study group of the research consists of school administrators, teachers and Syrian students from public schools in Altındağ district, Ankara. A triple comparison was made in order to reveal the problem of the study exactly. Semi-structured interview form was used in the research. Descriptive and content analysis methods were used to analyze the collected data. According to the findings obtained from the research, According to the findings obtained from the research, it was stated that Syrian students experienced absenteeism, communication, violence and adaptation problems, various complaints came from families, and the curriculum did not meet the needs of students. Most of these problems were mentioned repeatedly by teachers and students. Administrators and teachers have developed some suggestions for solving the problems. Özet Savaş ve göç, insan hayatını etkileyen travmatik bir durumdur. Suriye’de yaşanan olumsuzluklar nedeniyle ülkemize birçok Suriyeli göç etmek zorunda kalmıştır. Göçten en çok etkilenenler arasında çocuklar yer almaktadır. Bu çalışmada Suriyeli öğrencilerin eğitim sürecinde karşılaştıkları sorunlar ele alınmıştır. Nitel bir çalışma olan bu araştırmada durum çalışması yöntemi kullanılmıştır. Araştırmanın çalışma grubunu Ankara ili Altındağ ilçesinde kamu okullarında çalışan okul yöneticileri, öğretmenler ve Suriyeli öğrenciler oluşturmaktadır. Araştırmanın sorununu doğru bir şekilde ortaya koymak için üçlü bir karşılaştırma yapılmıştır. Araştırmada yarı yapılandırılmış görüşme formu kullanılmıştır. Elde edilen verilerin çözümlenmesinde betimsel ve içerik analizi yöntemlerinden yararlanılmıştır. Aratırmadan elde edilen bulgulara göre, Suriyeli öğrencilerin devamsızlık, iletişim, şiddet ve uyum sorunları yaşandığı, ailelerden çeşitli şikayetler geldiği, müfredat programının öğrencilerin ihtiyaçlarına cevap vermediği dile getirilmiştir. Bu sorunların çoğunluğu öğretmen ve öğrenciler tarafından tekrarlanarak dile getirilmiştir. Yönetici ve öğretmenler sorunların çözümüne yönelik bazı öneriler geliştirmişlerdir.

WOS: 000472637800002, Objectives: In this study our first aim was to evaluate the diagnostic concordance of myocardial perfusion scintigraphy (MPS) by pharmacological stress test with adenosine (APST) with coronary angiography (CAG). The secondary aim of this study was to evaluate the correlation between CAG findings and automated analysis parameters such as left ventricular ejection fraction, summed stress score (SSS), summed rest score, summed difference score (SDS), stress MPS defect percentage ratio (extent) and transient ischemic dilation (TID) obtained by myocardial perfusion imaging single-photon emission computed tomography (SPECT). Methods: A total of 129 patients (62 male, 67 female, median age: 60.02) undergoing MPS due to suspicion of coronary ischemia who also underwent subsequent CAG in the last year were included in this study, their MPS data and CAG results were compared. Results: There was no statistically significant diagnostic concordance when visual evaluation of MPS, quantitative MPS parameters and exercise treadmill test (ETT) electrocardiography results were used alone. In fact, diagnostic concordance was higher when automated analysis parameters like TID, SSS and extent values were added to MPS SPECT visual analyses. There was diagnostic concordance in 57.9% of APST patients and 41.7% of ETT patients. There was diagnostic concordance in 75.8% of APST patients and 52.6% of ETT patients who were older than 65 years of age. Conclusion: In our study, we found that the use of APST during MPS increases diagnostic concordance with CAG. Therefore, we think that it would be appropriate to use APST in women and elderly patients with limited exercise habits. The CAG diagnostic mismatch is far above what it should be when MPS reporting is only done with visual data, and it is not supported by quantitative data such as TID, SSS, SDS and extent.

Teaching practice studies are important for candidate teachers to acquire professional skills. Teacher candidates learn to adapt to the conditions of real business life, as well as obtain theoretical knowledge of application that they have learned in college. The purpose of this study is to show whether the changes of the MEB in 2017 caused an increase in the quality of the implementation studies. Research is a qualitative study. The working group of the research is OMÜ Basic Education Department, application teaching elements (5) in Classroom Education Department and application school coordinators (6) and application teachers (17) working in primary schools affiliated to MEB. 28 people who wanted to participate in the interview voluntarily were selected by maximum diversity sampling method. Semi-structured interview form was used to collect research data. Descriptive and content analysis techniques were used in analyzing the data. According to research findings, the majority of application instructors stated that the changes made did not cause a change in the implementation studies. They pointed out that the evaluation of application school coordinators on the internet provides some benefits. Practice teachers have expressed that their work is more productive, teacher candidates are more prepared for lessons, and teacher candidates are getting more serious. Some suggestions were made based on findings. Extended English summary is in the end of Full Text PDF (TURKISH) file. ÖzetÖğretmenlik uygulaması çalışmaları, aday öğretmenlerin mesleki beceriler kazanmaları bakımından önemlidir. Öğretmen adayları, üniversitede öğrendikleri teorik bilgileri uygulama fırsatı elde etme yanında, gerçek iş hayatının koşullarına uyum sağlamayı da öğrenirler. Bu çalışmanın amacı, MEB’in 2017 yılında yapmış olduğu düzenlemelerin uygulama çalışmalarının niteliğinde bir artışa neden olup olmadığını ortaya koymaktır. Araştırma nitel bir çalışmadır. Araştırmanın çalışma grubu, OMÜ Temel Eğitim Bölümü, Sınıf Öğretmenliği Anabilim Dalı’ndaki uygulama öğretim elamanları (5) ile MEB’e bağlı ilkokullarda görev yapan uygulama okulu koordinatörleri (6) ve uygulama öğretmenleridir (17). Görüşmeye gönüllü olarak katılmak isteyen 28 kişi maksimum çeşitlilik örneklemesi yöntemiyle seçilmiştir. Araştırma verilerinin toplanmasında yarı yapılandırılmış görüşme formu kullanılmıştır. Verilerin çözümlenmesinde betimsel ve içerik analizi tekniklerinden yararlanılmıştır. Araştırma bulgularına göre, uygulama öğretim elemanlarının çoğunluğu, yapılan değişikliğin uygulama çalışmalarında bir değişikliğe neden olmadığını dile getirmişlerdir. Uygulama okulu koordinatörleri değerlendirmenin internet ortamında yapılmasının bazı yararlar sağladığını belirtmişlerdir. Uygulama öğretmenleri ise çalışmaların daha verimli olduğunu, öğretmen adaylarının derslere daha hazırlıklı geldiğini ve öğretmen adaylarının işi daha ciddiye aldıklarını dile getirmişlerdir. Bulgulara dayalı olarak bazı önerilerde bulunulmuştur.

Management processes that are included in the concept of management and described as the main functions of the manager are classified as planning, organizing, ordering, coordination and supervision by Fayol. The effectiveness of management depends on the effective use of management processes. In Turkey, there are some studies about the management processes in schools, but it seems that these are not enough numbers. The aim of this study is to develop a valid and reliable scale aimed at examining the effectiveness of management processes in schools, according to teacher opinions. The study group of the researchers constitutes 1310 teachers working in the central districts of Samsun in the academic year 2013-2014. Expert opinion is consulted for the scope validity and appearance of the scale and Indicator Factor Analysis is used to indicate the validity of the structure. According to the results of the analysis, it is understood that your scale measures a single factor. In addition, these results are verified by Confirmatory Factor Analysis. The Cronbach Alpha internal consistency coefficient is used to determine the reliability of the scale. For all of your scale, this value was found to be ,982. These results show that the scale of the efficacy of the management processes in school management is a valid and reliable scale in which the teacher's views can be used. ÖzetYönetim kavramı içinde sayılan ve yöneticinin ana işlevleri olarak nitelen yönetim süreçleri Fayol tarafından planlama, örgütleme, emir verme, eşgüdümleme ve denetleme olarak sınıflandırılmıştır. Yönetimin etkililiği, yönetim süreçlerinin etkili kullanılmasına bağlıdır. Türkiye’de, okullarda yönetim süreçleri ile ilgili bazı çalışmalar yapılmış olmakla beraber, bunların yeterli sayıda olmadığı görülmektedir. Bu çalışmanın amacı, okullarda, yönetim süreçlerinin etkililiğini, öğretmen görüşlerine göre incelemeyi amaçlayan geçerli ve güvenilir bir ölçek geliştirmektir. Araştırmanın çalışma grubunu, 2013-2014 eğitim öğretim yılında Samsun merkez ilçelerinde görev yapan 1310 öğretmen oluşturmaktadır. Ölçeğin kapsam ve görünüş geçerliğini ortaya koymak amacıyla uzman görüşüne başvurulmuş ve yapı geçerliğini belirtmek için de Açımlayıcı Faktör Analizi yapılmıştır. Analiz sonuçlarına göre ölçeğin tek faktörlü bir yapıyı ölçtüğü anlaşılmıştır. Ayrıca Doğrulayıcı Faktör Analizi ile sonuçlar doğrulanmıştır. Ölçeğin güvenirliğini tespit etmek amacıyla Cronbach Alpha iç tutarlık katsayısına bakılmıştır. Ölçeğin tamamı için bu değerin, 982 olduğu anlaşılmıştır. Bu sonuçlar, okul yönetiminde yönetim süreçlerinin etkililiği ölçeğinin, öğretmen görüşlerini belirlemede kullanılabilecek geçerli ve güvenilir bir ölçek olduğunu göstermektedir.

Objectives: There is no data about the incidence, progress and prognosis of Takotsubo Cardiomyopathy (TC) from Turkey. This study aimed to search for the progress and shortterm prognosis of TC patients and to increase the familiarity and awareness for TC in Turkey. Study design: We included 6 patients who were referred to our center with ST elevation myocardial infarction and diagnosed as TC according to the Mayo Clinic diagnostic criteria. Results: Our patients' median age was 46 years (range 17 to 64 years) and 3 of them were males. Triggering factors included emotional stress (3 patients) and physical stress (3 patients). Median troponin I level was 1.65 ng/ml (0.48-2.20), excluding the patients who underwent cardiopulmonary resuscitation. ST elevation in precordial leads was observed on the ECG of 4 patients and in inferior leads on ECG of 2 patients. Five patients' coronary arteries were normal and were diagnosed as typical, but 1 patient had non-critical stenosis on the coronary arteries and was diagnosed with reverse TC. Four patients were discharged without any complications but 2 presented with sudden cardiac death. Conclusion: This study presented the first data about TC in Turkey while attempting to increase awareness about the disease. Emergent ventricle evaluation by ventriculography or echocardiography is recommended for acute coronary syndrome patients with non-critical stenosis for the differential diagnosis.

WOS: 000414037000009, PubMed ID: 28761021, Objective: Soluble suppression of tumorigenicity-2 (sST2), a member of the interleukin 1 receptor family, is increased in mechanical stress conditions and is produced by cardiomyocytes and cardiac fibroblasts. Elevated sST2 level is associated with the prognosis of acute coronary syndrome, pulmonary arterial hypertension, and acute and chronic heart failure (HF). In this study, we aimed to investigate the relationship between sST2 levels and cardiovascular mortality in outpatients with HF. Methods: This study used a prospective observational cohort design. A total of 130 consecutive outpatients with HF were prospectively evaluated. Clinical characteristics, laboratory results, cardiovascular risk factors, comorbidities, and medication use were recorded. The patients were followed up for a mean period of 12 +/- 4 months for the development of cardiovascular death. They were classified into two groups: those who survived and those who died. Results: Mean age of patients was 67 +/- 11 years (69% males). After follow-up, 23 of 130 patients (18%) experienced cardiovascular death. sST2 levels were higher among those who died compared with among those who survived [51 (21-162) vs. 27 (9-198) ng/mL, p30 ng/mL with a sensitivity of 87% and a specificity of 67% (AUC = 0.808, 95% CI=0.730 to 0.872). sST2 levels were negatively correlated with left ventricular ejection fraction and triglyceride, total cholesterol, LDL cholesterol, and hemoglobin levels and were positively correlated with left atrium size and the presence of right ventricular dilatation. In multiple Cox regression analysis, sST2 level of >30 ng/mL (HR=6.756, p=0.002, 95% CI=1.983-23.018), hemoglobin level (HR=0.705, p

WOS: 000316646600011, PubMed ID: 24570696, Diagnosis of patent ductus arteriosus is rare in adulthood. Closure of ductus is difficult when diagnosed at an adult age due to the development of pulmonary hypertension and pulmonary arterial disease that generally occurs. Closure of the ductus might be contraindicated, as it may lead to deterioration of the pulmonary arterial perfusion or to a pulmonary hypertensive crisis. In addition, another risk associated with percutaneous closure for these patients is the risk of embolism of the asymmetrically shaped device to the systemic circulation. We present in this manuscript a case with patent ductus arteriosus diagnosed at an adult age that underwent successful closure by the percutaneous method. During closure, an oversized Amplatzer duct occluder device was used to reduce the risk of device embolism.

The concept of servant leadership, which was initiated by Greenleaf, has been developed by other people and reached to today. The concept of servant leadership, which emphasizes the mentality of service, seems to be applicable in educational organizations. In this study, it was examined whether the school administrators had the servant leadership behaviors and the teacher opinions had significant differences in terms of some variables according to the opinions of the teachers. The population of the study consists from primary and secondary school teachers in Sinop province center. There are 426 teachers in the research universe. Of these, 302 teachers participated in the survey by random sampling. In this research, likert type instrument which was developed by Van Dierendonck and Nuijten (2011) and consisted of 26 sub-items and 7 dimensions, which was translated and adapted by Duyan (2012), was used. According to research findings; Teachers view supervisor's servant leadership behaviors partially adequate in some dimensions (accountability and responsible management), while the majority of sub-dimensions (empowerment, restraint, forgiveness, courage and humility) were viewed as insufficient. According to the results of the research, teachers view school administrators as a responsible and accountable manager rather than a servant leader. These results alsoare compatible with some previous research results conducted in Turkey. Based on the results of the research, Based on the results of the study, It is recommended that the school administrators organize educational activities in order to gain servant leadership behaviors. ÖzetGreenleaf tarafından ortaya atılan hizmetkâr liderlik kavramı, başka kişiler tarafından da geliştirilerek günümüze kadar ulaşmıştır. Hizmet etme anlayışını öne çıkaran hizmetkâr liderlik kavramı, eğitim örgütleri içinde uygun düşmektedir. Bu çalışmada öğretmen görüşlerine göre, okul yöneticilerinin hangi düzeyde hizmetkâr liderlik davranışlarına sahip olduğu ve öğretmen görüşlerinin bazı değişkenler açısından farklılık gösterip göstermediği incelenmiştir. Çalışmanın evreni, Sinop il merkezinde görev yapan öğretmenlerdir. Araştırma evreninde 426 öğretmen bulunmaktadır. Bunlardan tesadüfi örnekleme yoluyla seçilen 302 öğretmen araştırmaya katılmışlardır. Araştırmada, Van Dierendonck ve Nuijten (2011) tarafından geliştirilen ve Duyan (2012) tarafından Türkçeye uyarlanan, 26 madde ve 7 alt boyuttan oluşan likert türü ölçme aracı kullanılmıştır. Araştırma bulgularına göre, öğretmenler yöneticilerinin hizmetkâr liderlik davranışlarını “güçlendirme, geri durma, affetme, cesaretlendirme ve tevazu” alt boyutlarda yeterli düzeyde görmezken; “hesap verebilirlik ve sorumlu yöneticilik” alt boyutlarında kısmen yeterli görmüşlerdir. Araştırmanın sonuçlarına göre; öğretmenler, okul yöneticilerini hesap verebilirlik ve sorumlu yöneticilik boyutlarında yeterli görmüşlerdir. Diğer boyutlarda kısmen yeterli görmektedirler. Bu sonuçlar, Türkiye’de yapılmış bazı araştırma sonuçlarıyla da örtüşmektedir. Araştırmanın sonuçlarına dayalı olarak, okul yöneticilerinin hizmetkâr liderlik davranışlarını kazanmaları yönünde eğitim etkinlikleri düzenlemesi önerilmektedir.

Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV).Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunteers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spirometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory ECG analysis. Time domain HRV analysis performed from ambulatory ECG records. Results: 52% of patients at NYHA functional class II, 36% at class III, and 12% at class IV when they have been treated by NIMV. Groups were similar for age and sex (p>0.05 for both). Heart rates of patients were higher significantly than controls’ (p0.05). But, systolic pulmonary pressures were higher of COPD group (p

Bu yazı, akut miyokard infarktüsü sonrası ventriküler septal defekt (VSD) gelişen birhastanın klinik seyrini içermektedir. Cerrahiyi bekleme sürecinde, hastaya kardiyak koruma amacıyla levosimendan infüzyonu başlandı. İnfüzyon esnasında hastanın hemodinamisi kötüleşti. Hemodinamideki bozulmanın, levosimendan tedavisine sekonder soldan sağa şant miktarının artışına bağlı olabileceği düşünüldü., This paper reports the clinic course of a patient with postinfarction ventricular septal defect (VSD). At the period to surgery, the patient received levosimendan for cardio-protection. During the levosimendan infusion, the hemodynamics of the patient worsened. The impairment of hemodynamics and mortality of the patient might be responded to the increase of the amount of left to right shunt, which had possibly occurred due to levosimendan treatment.

WOS: 000338997700001, PubMed ID: 24878253, Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5 +/- 7 and 10 male) in group 1 and 37 patients (mean age 53.1 +/- 10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p = 0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r = 0.611, p < 0.001), male sex (r = 0.266, p = 0.002) and age (r = 0.321, p = 0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080-1.313; p

WOS: 000329838600005, PubMed ID: 23796159, Objective: There is no study about hypertensive response to exercise (HRE), which is a marker of unborn hypertension (HT), and red cell distribution width (RDW) association, in diabetic normotensive patients. So, we aimed to investigate any correlation among RDW and HRE in normotensive type 2 diabetic patients. Methods: Consecutive type 2 diabetic patients without history of HT and with normal blood pressure (BP) on ambulatory BP monitoring were included to the study. We divided the patients into two groups depending on their peak systolic BP on exercise; HRE (Group 1) or normal response to exercise (Group 2). Results: Data of 75 diabetic patients (51.9 +/- 9.7) were analyzed (31 male (48%)). Their mean RDW was 13.11 +/- 0.46. Patients with HRE were significantly older than patients without HRE. Smoking was more frequent in Group 2. Gender distribution and body mass index were similar between the groups. Else hemoglobin, hematocrit, red blood cell count and RDW values were not significantly different. Office systolic BP and diastolic BP, daytime and 24-h systolic BP were significantly higher in Group 1 but heart rate was similar between the groups. Conclusions: This study revealed that RDW do not differ between diabetic normotensive patients with HRE or not.

Congress of the European-Society-of-Cardiology (ESC) -- AUG 25-29, 2012 -- Munchen, GERMANY, WOS: 000308012406383, …, European Soc Cardiol (ESC)

Amaç. Hipertansiyon aterosklerozun majör risk faktörlerindendir. Adiponektin başlıca beyaz adipoz dokudan sentez edilmekte ve endotelyal hücreler ve makrofajlar üzerinde antiaterojenik ve antiinflamatuar etkileri olduğu bilinmektedir. Yöntem. Çalışmaya 48’i hipertansif 32 tanesi normotansif 80 birey alındı. Gruplar kendi arasında obez ve nonobez olarak ayrıldı. Bulgular. Hasta grubunun kontrol grubuna göre sistolik kanbasıncı, diastolik kanbasıncı, açlık kan şekeri, total kolesterol, trigliserit, low density lipoprotein-C, hs-CRP ve mikroalbuminüri değerleri istatistiksel olarak anlamlı yüksek, high density lipoprotein-C değerleri ise anlamlı düşük bulundu (p, Aim. Hypertension is one of the major risk factors for atherosclerosis. Adiponectin is mainly synthesized by white adipose tissue; it is known to have anti-atherogenic and anti-inflammatory effects on endothelial cells and macrophages. Methods. A total of 80 individuals including 48 hypertensive and 32 normotensive individuals were included in the study. Groups were separated as obese and non-obese. Results. It was found out that the patient group had statistically higher systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, triglyceride, low density lipoprotein, high sensitive C reactive protein and microalbuminuria values than the control group while high density lipoprotein values were significantly lower (p

Amaç: Metabolik sendrom ve non -dipper kan basıncı paterni kardiyovasküler hastalıklarla ilişkilidir. Bu klinik durumların ortak patofizyolojik mekanizmalarıyla ilişkili olabilir. Metab olik sendrom ile non -dipper kan basıncı arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: 24 saatlik ambulatuar kan basıncı takibi yapılan yeni tanı almış 118 obez metabolik sendromlu hasta çalışmamıza dahil edildi. Bunlar dipper (n = 46) ve non -dipper (n = 72) olmak üzere iki gruba ayrıldı. Gece non -dipper kan basıncı, gece ortalama sistolik ve/veya diastolic kan basıncı azalması %10 dan daha az azalma oluşu olarak tanımlandı. Bulgular: Ça lışma gurubumuzun ortalama 24 saatlik kan basıncı ortalaması 146/96 mmHg idi. İki grubun temel karakteristik özellikleri benzer olmasına rağmen, non -dipper tansiyon paterni olan grupta metabolik sendrom sıklığı a nlamlı derecede daha fazla idi (p=0.038). Sonuç: Bu çalışmada non -dipper kan basıncı paterni olan hastalarda metabolik sendromun daha fazla bulunduğu saptandı . Bu durum, obez hastalarda metabolik sendrom ile non-dipper kan basıncının ortak bir patofizyolojik mekanizma içerdiğini belirtebilir., Background: Metabolic syndrome and non -dipping blood pressure pattern are related with cardiovascular disease. It is considered that there may be common pathophysiological mechanisms of these clinical entities. We aimed to investigate the association between metabolic syndrome and nondipping blood pressure pattern. Method: 118 consecutive newly diagnosed metabolic syndrome patients with obesity who underwent 24 -hour ambulatory blood pressure monitoring were included in the study. They were divided into dipper (n = 46) and non -dipper (n = 72) groups. Nocturnal non -dipping blood pressure pattern is defined as the lower than 10 % reduction in nocturnal mean systolic and/or diastolic blood pressure. Results: In the whole population, mean 24 -hour ambulatory blood pressure was 146/96 mmHg. Although, the two groups was similar in terms of basic characteristics; the frequency of metabolic syndrome was significantly greater in patients with non -dipping pattern (p=0.038). Conclusion: In this study metabolic syndrome was fou nd to be more prevalent among patients with non -dipping pattern of hypertension. This may indicate a common pathophysi ologic mechanism of metabolic syndrome and non -dipping blood pressure pattern in obese patient.

Sol ön inen koroner arter dışındaki arterler üzerine yerleşen anjiyografik olarak tanımlanan myokardiyal köprüleşme olguları çok nadir olarak bildirilmiştir. Ancak çokkesitli bilgisayarlı tomografi ve postmortem otopsi çalışmalarında anjiyografik olarak tanımlanandan çok daha sık olarak ve sol anterior inen arter harici diğer arterler üzerinde de myokardiyal köprüleşme olduğu bildirilmiştir. Bu yazıda koroner anjiyografide sağ koroner arterde boğulmaya yol açan çok nadir bir olguyu bildirdik. Ve bu olgu ışığında değişik görüntüleme yöntemleri ile değişik sıklıklarda myokardiyal köprüleşme izlenmesinin olası sebeplerini tartıştık., Angiographically evident myocardial bridges confined to the other arteries rather than the left anterior descending artery is very rare in the literature. Also cardiac computerized tomography studies and postmortem studies demonstrated that myocardial bridges are not as rare as the angiographic series and may be confined to the other arteries rather than the left anterior descending. We reported a very rare case with myocardial bridge on right coronary artery diagnosed by coronary angiography causing severe obstruction. We want to share this angiographically visible myocardial bridge confined to the right coronary artery and discuss the potential reasons for the frequency dilemma among different diagnostic tools.

WOS: 000311649900016, In invasive cardiology practices, the most commonly used vascular access site is the femoral artery. Atherosclerotic stenoses on the femoral and iliac arteries create difficulties in these practices. Vasospasm rarely occurs on large arteries like these. This paper reports stenosis encountered during coronary angiography on iliac arteries in 2 patients. The stenoses caused difficulties for guidewire and catheter insertion in catheterization. In the revisualization of these arteries at the next session, the stenoses had disappeared, but the arteries were tortuous. The patients did not have peripheral ischemia signs previously, nor did they appear after the procedure. These transient stenoses might have occurred due to vasospasm and the accordion effects caused by the guidewire and/or catheter.

WOS: 000302895000008, Three separate coronary arteries originating from the right or left coronary sinus of Valsalva are exceedingly rarely seen coronary anomalies. The clinical course depends on the site of origin and the anatomical trace. We report a case with all coronary arteries arising from the right sinus of Valsalva with different ostia.

WOS: 000311649900015, Endovascular treatment has become an accepted treatment modality for atrial septal defects (ASD) in adults. In multiple defects on a hypermobile atrial septum with atrial septal aneurysm (ASA), surgery used to be the treatment of choice, but transcatheter occlusion has emerged as a successful alternative in appropriate cases. We present a case with multiple ASDs treated with two ASD occluder devices.

WOS: 000295570200014, Ascending aortic pseudoaneurysms are very rare entities generally occurring after heart surgery associated with cannulation for cardiopulmonary pump or aorta-coronary artery graft implantation. The pseudoaneurysm should be treated due to the potential risk of expanding, penetrating to adjacent tissues and rupturing. We present a case with a pseudoaneurysm of the ascending aorta associated with aorta-coronary artery saphenous graft, which is a rare but an important entity.

WOS: 000295899700014, PubMed ID: 21804465, Background: Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. Material/Methods: Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological Findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. Results: Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12 2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (

WOS: 000286809300010, PubMed ID: 21145704, Background: The aim of this study was to investigate the acute effects of passive smoking on left ventricular (LV) function in healthy volunteers. Methods: Sixty-one healthy nonsmoking volunteers were enrolled in this study. LV M-mode, two-dimensional, conventional Doppler, and color tissue Doppler echocardiography were performed, and carboxyhemoglobin (COHb) levels were obtained from subjects before and immediately after exposure to passive smoking for 30 min in a smoking room. The differences between baseline and post-smoke exposure measurements of transmitral E and mitral annular Em velocities, heart rate, systolic blood pressure, diastolic blood pressure, and COHb levels were assessed. Results: Mean COHb levels were statistically higher after exposure. There were no changes in LV systolic function and volumes. LV diastolic function changed significantly immediately after passive smoking. The transmitral E wave (0.89 +/- 0.12 vs 0.70 +/- 0.14 m/sec, P =.001), the pulmonary venous D wave (0.52 +/- 0.12 vs 0.49 +/- 0.13 m/sec, P = .01), and the transmitral E/A ratio 1.79 +/- 0.48 vs 1.47 +/- 0.32, P =.001) decreased, while the transmitral A wave did not change. The mitral annular Em velocity decreased (12.5 +/- 2.1 vs 11.7 +/- 1.9 cm/sec, P =.001), the Am velocity increased (6.3 +/- 2.1 vs 6.8 +/- 1.6 cm/sec, P =.001), and the Em/Am ratio decreased (2.28 +/- 0.82 vs 1.78 +/- 0.42, P =.001). Color Doppler echocardiography determined diastolic impairment in only women, whereas color tissue Doppler echocardiography demonstrated diastolic dysfunction in both genders. Acute deleterious effects of passive smoking on color Doppler echocardiographic parameters were more prominent in women. Change in E was related to changes in heart rate and systolic blood pressure and with COHb levels, while change in Em was related only to COHb levels. Conclusions: Acute exposure to passive smoking impairs LV diastolic function in healthy volunteers. The mechanism whereby passive smoking affects diastolic function is probably complex; however, carbon monoxide exposure and an increment in COHb level may be among the causes. (J Am Soc Echocardiogr 2011; 24: 185-91.)

WOS: 000283727000039, PubMed ID: 19446349, …

BACKGROUND: B-type natriuretic peptide (BNP) is secreted from the ventricles in response to volume expansion and pressure overload. We aimed to investigate plasma BNP levels in inferior myocardial infarction (MI) with and without right ventricular MI (RVMI). METHODS: We enrolled 49 patients (mean age: 60+/-10 years, 45 males) who were admitted with first acute inferior MI. Sixteen patients (mean age: 58+/-10 years, 15 males) had also RVMI. The BNP levels were measured at admission. All patients underwent echocardiographic examination in the first day of hospitalization. Receiver-operating characteristic curve was obtained for prediction of inferior MI with RVMI. RESULTS: Inferior MI with RVMI had lower RV fractional area change (36+/-14% vs. 48+/-15%, P=0.03) and right ventricle lateral annulus S velocity (10.6+/-1.9 m/s, 12.2+/-2.6 m/s, P=0.02). The BNP levels were higher in inferior MI with RVMI than isolated inferior MI (75+/-44 pg/ml vs. 32+/-24 pg/ml, P=0.001). On the basis of the receiver-operating characteristic analysis, the cutoff value of BNP concentration >46 pg/ml provided the best discrimination of patients with and without RVMI (sensitivity 76%, specificity 88%) with positive and negative predictive values of 92 and 63%, respectively. CONCLUSION: Plasma BNP levels are higher in inferior MI with RVMI than isolated inferior MI. RV involvement may be suspected when BNP levels are higher than 46 pg/ml in inferior MI.

OBJECTIVES We aimed to investigate whether there were any differences in the percentages of CD14(+) monocytes between subgroups of acute coronary syndromes (ACS). CD14(+) is a monocyte surface receptor that plays a role in the innate immune system. CD14(+) monocytes are associated with complications of atherosclerosis. METHODS In total we enrolled 115 patients with ACS: 24 with unstable angina (UA); 29 with non-ST elevation myocardial infarction (NSTEMI); and 62 with ST elevation myocardial infarction (STEMI). The levels of C-reactive protein and percentage of CD14(+) monocyte were measured on admission. RESULTS CD14(+) monocyte percentages were observed to be different between groups by analysis of variance test. The percentages of CD14(+) monocyte were 81.24+/-10.04% in the UA group; 89.40+/-5.84% in the NSTEMI group; and 87.22+/-11.75% in the STEMI group (P=0.013). The differences between the UA and the NSTEMI and between the UA and the STEMI groups with Bonferroni posthoc testing were significant (P=0.014 and P=0.049 respectively). Moreover, no significant difference was found between the NSTEMI and STEMI groups (P=1.000). The C-reactive protein levels in the UA group were detected to be significantly low with Bonferroni posthoc testing compared with both the NSTEMI and STEMI groups (for both comparisons, P

Coronary artery anomalies could be cause of confl icts for catheterization, especially, in the setting of acute coronary syndrome. We described a case of rare single coronary anomaly which the right coronary artery arisen from terminal part of left circumfl ex artery. Patient was presented with non-ST segment elevation myocardial infarction. Coronary angiography revealed subtotal stenosis of left anterior descending artery at the mid portion. Left circumfl ex artery lying in usual route and branch out the posterior descending artery. The right coronary artery arisen from terminal circumfl ex artery. Left anterior descending artery lesion was stented without any complication., Koroner arter anomalileri tanı ve tedavide zorluğa yol açabilir. Özellikle akut koroner sendrom seyrinde tanınması tanı ve tedavinin hızlı ve güvenli yapılabilmesi açısından önemlidir. Tek koroner arter anomalileri ise seyrek görülür. Biz de akut koroner sendrom seyrinde tanısı konulan sirkumfl eks arter distalinden köken alan sağ koroner arter olgusu sunduk. Hasta ST elevasyonsuz miyokart enfarktüsü kliniğiyle başvurdu. Koroner anjiyografi de sol ön inen arterinde tama yakın tıkanıklık olduğu, sirkumfl eks arterin normal anatomik pozisyonunda olduğu, ancak postero- desending arteri verdikten sonra sağ atriyoventriküler sulkustan sağ koroner arter yerleşimi boyunca uzandığı izlendi. Aynı seansta sol inen arter lezyonuna başarılı stent yerleştirme işlemi yapıldı.