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Background: The studies that generally investigate the effectiveness of pharmacological and non-pharmacological methods in reducing chest tube removal related pain are remarkable. However, new studies need to expand the use of virtual reality glasses and evaluate its effectiveness. Aim: This study aims to determine the effect of distraction with virtual reality glasses on pain during chest tube removal in patients undergoing tube thoracostomy. Material and methods: This quasi-experimental study with a pre-test post-test control group design was performed with the participation of 40 patients. The patients in the intervention group (n=20) watched the video with virtual reality glasses throughout procedure. Pain measurements were evaluated before, during, and after chest tube removal. The patients in the control group (n=20) received standard care. Results: In the intervention group, it was revealed that the pre-procedure pain score decreased compared to the pain score obtained during the procedure (p=0.002). After the chest tube removal procedure, a statistically significant decrease was observed in pain score in favor of the intervention group. In the intervention group, the pre-procedure pain score was found to decrease statistically significantly in the measurement at the 10th min of the procedure (p=0.000). The pain score of the intervention group 10 min after the chest tube removal procedure was lower than that of the control group (1.80 vs 2.95 and p=0.028). Conclusion: The virtual reality glasses assisted chest tube removal procedure can help reduce pain. Surgical nurses should benefit from the use of virtual reality glasses for pain control.

Awake video-assisted thoracoscopic surgery (A-VATS) enables the surgeon to penetrate the tissue via a small incision and with less contact between the lung and atmospheric pressure; postoperative respiratory functions are also less affected than in open surgery. A-VATS is a safer technique than traditional VATS and non-intubated video-assisted thoracoscopic surgery (NI-VATS) because it does not require muscle relaxants and sedoanalgesics. In particular, diagnostic VATS for pleural effusions can be easily performed over a single port using only local anaesthetic. Anaesthesia-related risks increase even more for elderly patients and those with severe comorbidities. Although there are long and risky operations in thoracic surgery, general anaesthesia is not required for some thoracic surgery procedures. However, A-VATS is limited to minor procedures. Due to regional anaesthesia and sedation, NI-VATS is a safe and effective method for many indications. The results show that this method can be applied with low mortality and morbidity.

Bu çalışmanın amacı, 1980-2018 yılları arasında vergi gelirleri, doğrudan yabancı yatırımlar ve ekonomik büyüme arasındaki ilişkiyi kırılgan beşli ülke grubu için (Brezilya, Endonezya, Hindistan, Güney Afrika, Türkiye) panel eşbütünleşme ve panel nedensellik analizleri ile tespit etmektir. Panel eşbütünleşme testi sonuçları değişkenler arasındaki uzun dönemli ilişkinin varlığını göstermektedir. Panel VECM nedensellik analizi sonuçları ise, uzun dönemde vergi gelirleri ve ekonomik büyüme arasında çift yönlü nedensellik ilişkisi olduğunu, kısa dönemde ise ekonomik büyümeden vergi gelirlerine doğru tek yönlü nedensellik ilişkisi olduğunu göstermektedir. Bunun yanında, panel VECM nedensellik testi sonuçları, uzun dönemde doğrudan yabancı yatırımlarından hem vergi gelirlerine hem de ekonomik büyümeye doğru tek yönlü nedensellik ilişkisi olduğunu ortaya koymaktadır. Bu sonuçlar ekonomik büyüme, doğrudan yabancı yatırımlar ve vergi gelirlerine ilişkin politikaların uzun dönemde daha etkin olduğunu göstermektedir.

Background: Broncho-pleural fistula (BPF) can occur after pulmonary resections as a complication with high morbidity and mortality rates. Aim: In the present study, we analyzed the relation between the possible risk factors and the two major bronchial closure techniques for BPF after lung resections, and the management methods of BPF. Materials and methods: A total of 26 cases detected and managed with BPF diagnosis in our clinic between September 2005 and September 2017 were evaluated retrospectively. The cases were divided into two groups: Group 1 (n=14); bronchial closure performed manually and Group 2 (n=12) bronchial closure with stapler. We analyzed cases for age, gender, body mass index, pulmonary function tests, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, presence of bronchial stump coverage, and the mean survivals. Results: Twenty-three of the cases were males (88.5%) with a mean age of 60.03±8.7 years (range 38-73). While BPF was detected in twenty-three (88.5%) of the cases after pneumonectomy, three (11.5%) of them were after lobectomy. There was no statistically significant correlation between the two groups in gender, age, BMI, preoperative FEV1, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, and presence of bronchial stump coverage (chi-square test, p>0.05). As a result of the applied Kaplan-Meier analysis, we found no statistically significant difference in the mean survival rates between the two groups (p>0.05). Conclusions: Broncho-pleural fistulas still remains a major challenge. Although there is no statistical relationship between bronchial closure techniques and possible risk factors in our study, patients should be assessed in terms of possible risk factors. The management strategy for BPF varies according to individual patients’ clinical condition, the size of the fistula, and development time.

Tracheobronchial foreign body aspiration can be a life-threatening emergency, particularly in pediatric subjects. An aspirated solid or a semisolid object may be lodged in the larynx or trachea (1,2). If the object is large adequate to cause almost complete obstruction of the airway, asphyxia can quickly cause death. Lesser degrees of obstruction or passage of an obstructive object beyond the carina may cause fewer signs and symptoms (3). Rigid bronchoscopy is a gold standard procedure for foreign body aspiration diagnosis, management, and treatment. Rigid bronchoscopy has a relatively low complication rate and can be safely applied in experienced hands. Foreign body aspiration accounts for 0.16–0.33% of adult bronchoscopic procedures (2-4). Although many different objects have been reported in the literature which aspirated by the oral way, external penetration and aspiration into the trachea other than the oral route is an extremely rare condition. In this article, we present a case of a drill bit piece penetrating through the anterior neck region to the trachea-bronchial system. Herein we depict a very rare case of aspiration. The patient was admitted to the emergency room with a laceration in the anterior neck region. In his history drill bit piece blew up to the neck region when he was working with the drill machine. He had pain in the neck region with a 1 cm diameter laceration and blood clot (Figure 1.A). Subcutaneous emphysema was detected in the neck region. His blood pressure, heart rate, and oxygen saturation, and blood tests were normal. Posteroanterior chest radiograph and computed tomography indicated with the foreign body was seen in the anterior basal segment bronchus of the right lower lobe and there was also anterior mediastinal and cervical subcutaneous emphysema (Figure 2. A, B, C). We decided to perform rigid bronchoscopy for foreign body removal. In the bronchoscopic examination, there were no obvious pathological findings in the trachea and a drill bit piece was seen in the right anterior basal bronchi that got stuck to the mucosa. There was hemorrhage around the foreign body. After the hemorrhage is aspirated metallic piece was extracted carefully with bronchoscopic optical forceps (Figure 1.B). After the foreign body was removed, hemorrhage was controlled with Ankaferd Blood Stopper (ABS, Ankaferd Health Products Ltd, Turkey) hemostatic agent. No other complications were detected.

Pulmonary nodular lymphoid hyperplasia (PNLH) is a reactive lymphoid proliferation manifesting as multiple solitary nodules or localized infiltrates in the lungs. It is a type of benign lymphoproliferative disease that can affect the lungs. We present the case of a 41-year-old female patient with respiratory symptoms such as productive cough, left chest pain, and dyspnea. Imaging findings revealed two lesions with lobulated contour in the left upper lobe apicoposterior segment and left lower lobe superior segment. After examining the minimally invasive diagnostic methods, this rare PNLH case mimicking malignancy was both diagnosed and treated by surgery. Further studies including more patients and longer follow-ups are needed for this rare disease.

Although cystic lung lesions appear benign on radiological examination; it is known that they interfere with some lung and pleural tumors. Especially in countries like our country where the cyst hydatid disease is endemic and so, they can be confused with lung tumors, as seen in our cases. The radiological lesions which have well-circumscribed are known to may not be a part of cyst hydatid. Surgical operation appears to be a good option for both treatment and definitive diagnosis in suspected cases. In our study, we presented two cases who we can’t distinguish between tumor and cyst with the conventional methods and we decided to perform exploration.

Yoğunlaşma, ekonomiyi ya da belirli bir sanayi dalını oluşturan firmalar arasında çeşitli şekillerde ortaya çıkan ve haksız rekabeti ölçmede başvurulan önemli bir pazar yapısı analiz aracıdır. Pazar yoğunlaşması kavramı, ürün pazarında alıcı ve satıcıların sayı ve büyüklük bakımından dağılımı olarak ifade edilmektedir. Piyasadaki firma sayısı ile yoğunlaşma derecesi arasında ters yönlü bir ilişki vardır. Yoğunlaşma arttıkça pazardaki rekabet şansı da o ölçüde azalmaktadır. Bu çalışmada, Türkiye’de telekomünikasyon sektöründe mobil telekomünikasyon ve genişbant internet hizmetleri pazarlarının yapıları, yoğunlaşma oranları 2000 sonrası yıllar verileri incelenerek Herfindahl-Hirschman Endeksi analiz yöntemi kullanılarak karşılaştırmalı belirlenmeye çalışılmıştır

ABSTRACT CONTEXT: Neuroblastoma is the most common extracranial malignant solid tumor that occurs during childhood. It arises from primitive cells and is seen in the adrenal medulla and sympathetic ganglia of the sympathetic nervous system. CASE REPORT: We present a rare case of a 40-year-old man who was diagnosed with the onset of neuroblastoma arising in the mediastinum. He was treated by means of surgical resection in the superior mediastinum after neoadjuvant chemotherapy. The patient’s surgical outcome was satisfactory. CONCLUSION: There are still no standard treatment guidelines for adult neuroblastoma patients. Although they have a poor prognosis, the main treatment option should be complete surgery at an early stage. This situation may become clarified through biological and genetic studies in the future.

Objective: Previous reports have suggested that the incidence of spina bifida occulta (SBO) in patients with primary monosymptomatic nocturnal enuresis (PMNE) is higher than the general population. The purpose of this study was to investigate the effect of spina bifida occulta on the medical treatment outcome of PMNE. Material and Methods: Between January 2008 and December 2011, a total of 223 children (151 boys and 72 girls, aged 6-16 years; mean age: 10.1 ± 3.04 years) with PMNE were reviewed retrospectively. All of the children underwent physical examination, urine analysis, urinary tract ultrasonography and kidney ureter bladder (KUB) scout film. All patients were initially treated with a timed voiding program and were given desmopressin acetate when necessary. Results: Spina bifida occulta was detected in 75 children (33.6%). Spina bifida occulta affected L4 in 2 children, L5 in 6 children, L4-L5 in 3 children, S1 in 52 children, S2 in 7 children and S1-S2 in 2 children. Treatment was successful in 79% of the children without SBO, and in only 48% of the children with SBO. Medical treatment success rates differed significantly between the study groups. Conclusion: The presence of spina bifida occulta significantly affects the response to medical treatment in patients with PMNE. Thus, verifying spina bifida occulta status in PMNE can facilitate prognostic predictions about the response to medical treatment.

The telecommunication sector which has the characteristics of natural monopoly has transformed into a competitive structure, public operators have been privatized and independent regulatory institutions have been formed in the sector. In this study, in parallel to the methods in literature, the effect of organizing reforms and privatization in telecommunication sector on competitive performance of telecommunication sector in OECD countries were analyzed with panel data method. According to panel data results of the study, it was concluded that forming organizing activities and privatization in telecommunication sector have positive effects on the improvement of competitive structure of sector and growth dynamics of the sector.

Abstract: Interesting properties of ionic liquids lead to their application as sub-component of membrane structures. Supported ionic liquid membranes (SILMs) are porous membranes whose pores are saturated with ionic liquids. Two ionic liquids, pr[mim]2[Tf2N]2 [1,3-di(3-methyl-imidazolium) propane bis(trifluoromethylsulfonyl) imide] and, h[mim]2 [Tf2N]2 [(1,6-di(3-methylimidazolium)hexane bis(trifluoromethylsulfonyl)imide)], were synthesized in our laboratory and stabilized on an alumina porous support. Permeability and permselectivity of carbon dioxide and methane using membranes containing these ionic liquids were then measured. The experiments were performed in the pressure range of 10–50kPa and temperature of 300–320K. Influences of temperature and pressure on the permeability and selectivity of gases have been investigated. The obtained results were compared with those of [hmim][Tf2N] (1-hexyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide) ionic liquid, which was investigated in our previous work. The results showed these two ionic liquids show smaller values for carbon dioxide and methane permeability for CO2/CH4 separation, compared with [hmim][Tf2N]. Moreover, dependence of the carbon dioxide permeability on the viscosity of ionic liquids considering investigated ionic liquids in this study and those of our previous studies on two imidazolium-based ionic liquids, [hmim][Tf2N] and [bmim][PF6] has been correlated in the range of operating temperatures. [Copyright &y& Elsevier]

Colorectal cancer (CRC) is identified as a life-threatening malignancy. Despite several efforts and proceedings available for CRC therapy, it is still a health concern. Among a vast array of novel therapeutic procedures, employing bispecific antibodies (BsAbs) is currently considered to be a promising approach for cancer therapy. BsAbs, as a large family of molecules designed to realize two distinct epitopes or antigens, can be beneficial microgadgets to target the tumor-associated antigen pairs. On the other hand, applying the immune system's capabilities to attack malignant cells has been proven as a tremendous development in cancer therapeutic projects. The current study has attempted to overview some of the approved BsAbs in CRC therapy and those under clinical trials. For this purpose, reputable scientific search engines and databases, such as PubMed, ScienceDirect, Google Scholar, Scopus, etc., were explored using the keywords 'bispecific antibodies', 'colorectal cancer', 'immunotherapy' and 'tumor markers'.

Purpose: To compare brachytherapy to external beam radiation therapy (EBRT) with respect to overall survival (OS) and disease-specific survival (DSS) among NSCLC patients undergoing limited surgical resection., Methods: All cases of T1-4 N0 M0 NSCLC undergoing limited resection and either brachytherapy or EBRT diagnosed between 2004 and 2014 were extracted from the Surveillance, Epidemiology, and End Results database. Chi-square test and Fisher's exact analysis were used to analyze categorical variables while Student's t-test was used to analyze continuous variables. Univariate analysis to assess for differences in survival with respect to covariates was performed with the log-rank test. Multivariable analysis was performed with Cox proportional hazards regression models among the entire cohort and after sub-stratification by T stage., Results: Among 543 patients, 471 underwent EBRT and 72 underwent brachytherapy. Brachytherapy demonstrated improved OS and DSS on univariate analysis as compared to EBRT (p < 0.05). Cox regression also demonstrated improved OS and DSS with brachytherapy (HR 0.604; 95% CI [0.380; 0.961] and HR 0.524; 95% CI [0.303; 0.908], respectively). Sub-cohort analysis demonstrated significant improvement in survival only among patients with T1 disease with similar survival between brachytherapy and EBRT among higher stage disease., Conclusions: Patients undergoing brachytherapy for T1-T4, N0, M0 NSCLC demonstrated at least similar survival as compared to those undergoing EBRT among patients undergoing limited resection. Improved survival was demonstrated among patients with T1 disease.

Simultaneous reverse and normal initiation technique for atom transfer radical copolymerization (SR&NI ATRP) of styrene and methyl methacrylate in the presence of hexamethyldisilazane (HMDS)-modified silica aerogel nanoparticles (H-SAN) and investigating the effect of addition of H-SAN on the copolymerization and thermal properties of the products are discussed. Some unique features of the H-SAN are evaluated using nitrogen adsorption/desorption isotherm, SEM and TEM. Conversion and molecular weight determinations were carried out using GC and SEC respectively. Adding of H-SAN by 3 wt% results in decrement of conversion from 94 to 73%. In addition, molecular weight of copolymer chains decreases from 19500 to 16000 g.mol-1. However, polydispersity index values increases from 1.29 to 1.65. Linear increase of ln(M0/M) with time for all the samples shows that copolymerization proceeds in a living manner. Increasing thermal stability of the nanocomposites is demonstrated by TGA. DSC results show a decrease in glass transition temperature from 70.3 to 63.5 °C by addition of 3 wt% H-SAN.

Mesoporous diatomite platelets were employed to prepare various random poly (styrene-co-methyl methacrylate)/diatomite composites by in situ simultaneous reverse and normal initiation technique for atom transfer radical random copolymerization (SR&NI ATRP) technique. Nitrogen adsorption/desorption isotherm, SEM and TEM were employed for evaluating some inherent properties of the pristine diatomite platelets. Conversion and molecular weight determinations were carried out using GC and SEC respectively. Addition of 3 wt% diatomite platelets leads to increase of conversion from 76 to 92%. Molecular weight of poly (styrene-co-methyl methacrylate) chains increases from 12893 to 14907 g mol-1 by addition of 3 wt% mesoporous diatomite; however, polydispersity index values increases from 1.18 to 1.44. Copolymers composition was evaluated using 1H NMR spectroscopy. Increasing thermal stability of the nanocomposites is demonstrated by TGA. Differential scanning calorimetry shows an increase in glass transition temperature from 67.6 to 73.4 °C by adding 3 wt% of mesoporous diatomite platelets.

Unlabelled: Persistent pathogens, such as herpes simplex virus 1 (HSV-1), have evolved a variety of immune evasion strategies to avoid being detected and destroyed by the host's immune system. A dynamic cross talk appears to occur between the HSV-1 latency-associated transcript (LAT), the only viral gene that is abundantly transcribed during latency, and the CD8(+)T cells that reside in HSV-1 latently infected human and rabbit trigeminal ganglia (TG). The reactivation phenotype of TG that are latently infected with wild-type HSV-1 or with LAT-rescued mutant (i.e., LAT(+)TG) is significantly higher than TG latently infected with LAT-null mutant (i.e., LAT(-)TG). Whether LAT promotes virus reactivation by selectively shaping a unique repertoire of HSV-specific CD8(+)T cells in LAT(+)TG is unknown. In the present study, we assessed the frequency, function, and exhaustion status of TG-resident CD8(+)T cells specific to 40 epitopes derived from HSV-1 gB, gD, VP11/12, and VP13/14 proteins, in human leukocyte antigen (HLA-A*0201) transgenic rabbits infected ocularly with LAT(+)versus LAT(-)virus. Compared to CD8(+)T cells from LAT(-)TG, CD8(+)T cells from LAT(+)TG (i) recognized a broader selection of nonoverlapping HSV-1 epitopes, (ii) expressed higher levels of PD-1, TIM-3, and CTLA-4 markers of exhaustion, and (iii) produced less tumor necrosis factor alpha, gamma interferon, and granzyme B. These results suggest a novel immune evasion mechanism by which the HSV-1 LAT may contribute to the shaping of a broader repertoire of exhausted HSV-specific CD8(+)T cells in latently infected TG, thus allowing for increased viral reactivation., Importance: A significantly larger repertoire of dysfunctional (exhausted) HSV-specific CD8(+)T cells were found in the TG of HLA transgenic rabbits latently infected with wild-type HSV-1 or with LAT-rescued mutant (i.e., LAT(+)TG) than in a more restricted repertoire of functional HSV-specific CD8(+)T cells in the TG of HLA transgenic rabbits latently infected with LAT-null mutant (i.e., LAT(-)TG). These findings suggest that the HSV-1 LAT locus interferes with the host cellular immune response by shaping a broader repertoire of exhausted HSV-specific CD8(+)T cells within the latency/reactivation TG site., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)