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Understanding customer journeys is key to e-commerce success. Many studies have been conducted to obtain journey maps of e-commerce visitors. To our knowledge, a complete, end-to-end and structured map of e-commerce journeys is still missing. In this research, we proposed a four-step methodology to extract and understand e-commerce visitor journeys using process mining. In order to obtain more structured process diagrams, we used techniques such as activity type enrichment, start and end node identification, and Levenshtein distance-based clustering in this methodology. For the evaluation of the resulting diagrams, we developed a model utilizing expert knowledge. As a result of this empirical study, we identified the most significant factors for process structuredness and their relationships. Using a real-life big dataset which has over 20 million rows, we defined activity-, behavior-, and process-level e-commerce visitor journeys. Exploitation and exploration were the most common journeys, and it was revealed that journeys with exploration behavior had significantly lower conversion rates. At the process level, we mapped the backbones of eight journeys and tested their qualities with the empirical structuredness measure. By using cart statuses at the beginning and end of these journeys, we obtained a high-level end-to-end e-commerce journey that can be used to improve recommendation performance. Additionally, we proposed new metrics to evaluate online user journeys and to benchmark e-commerce journey design success.

‎Machines can model and improve the human mind’s capabilities through artificial intelligence‎. ‎One of the most popular tools of artificial intelligence is fuzzy sets‎, ‎which can capture and model the vagueness and impreciseness in human thoughts‎. ‎This paper‎, ‎first of all‎, ‎introduces the recent extensions of ordinary fuzzy sets and then presents a literature review on the integration of fuzzy sets with other artificial intelligence techniques such as automated reasoning‎, ‎autonomous agents‎, ‎multi-agent systems‎, ‎machine learning‎, ‎case-based reasoning‎, ‎deep learning‎, ‎information reasoning‎, ‎information representation‎, ‎natural language processing‎, ‎symbolic reasoning‎, ‎and neural networks‎. ‎Graphical illustrations of literature review results are presented for each of these integrated artificial intelligence techniques‎. ‎The results of a patent search on fuzzy artificial intelligence are also given‎.

Intuitionistic Fuzzy Sets with Ordered Pairs (IFSOP) are the recent extension of intuitionistic fuzzy sets by incorporating functional and dysfunctional points of view into the definition of membership functions. This paper extends the Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) method to the Intuitionistic Fuzzy TOPSIS (IF TOPSIS) with ordered pairs method and applies it to a multi-criteria risk-based supplier selection problem under fuzziness. IF TOPSIS with ordered pairs involves finding a positive ideal solution and a negative ideal solution, and measuring the distance between each alternative and these solutions. The final ranking of the alternatives is obtained based on the proportion of distances between the positive and negative ideal solutions. By asking functional and dysfunctional questions in this ranking process, the developed IF TOPSIS with ordered pairs method incorporates the accuracy and consistency of expert judgments, enhancing the decision-making process. A sensitivity analysis is also presented in order to show the robustness of the rankings obtained by IF TOPSIS with ordered pairs.

The COVID-19 outbreak caused major disruptions on individuals’ out-of-home activities. Worldwide mandates to slow down the spread of the disease resulted in significant reductions in travel. This study analyzes the changes in individuals’ travel outcomes and their risk perceptions related to exposure and specific travel modes during the COVID-19 pandemic. We use data collected through an online survey with residents of Columbus, OH from April 30 to May 7, 2020. Employing multiple generalized estimating equations (GEEs) with a logit link function, we analyze the perceived risk of infection while traveling with different modes controlling for socio-demographics. The findings show that on average individuals are more likely to find shared modes (i.e., transit, ride-hailing, carsharing) riskier as compared to individual ones (i.e., walking, autos) when it comes to COVID-19 exposure. This study also suggests that the associations between perceptions related to exposure and various travel modes vary across groups with (1) different primary mode preferences (auto users vs non-auto users (e.g., transit users, bicyclists, etc.)), and (2) different socio-demographics. For example, auto users are more likely to find shared modes such as ride-hailing or transit riskier as compared to personal car. The conclusions present recommendations for future transportation policies in the post-COVID era. These include building upon the emerging positive perceptions towards non-motorized modes as an opportunity to promote sustainable transportation as well as formulating viable solutions to address the high-risk perceptions associated with transit.

Purpose: Today’s manufacturing facilities are challenged by highly customized products and just in time manufacturing and delivery of these products. In this study, a batch scheduling problem is addressed to provide on-time completion of customer orders in the environment of lean manufacturing. The problem is to optimize partitioning of product components into batches and scheduling of the resulting batches where each customer order is received as a set of products made of various components. Design/methodology/approach: Three different mathematical models for minimization of total earliness and tardiness of customer orders are developed to provide on-time completion of customer orders and also, to avoid from inventory of final products. The first model is a non-linear integer programming model while the second is a linearized version of the first. Finally, to solve larger sized instances of the problem, an alternative linear integer model is presented. Findings: Computational study using a suit set of test instances showed that the alternative linear integer model is able to solve all test instances in varying sizes within quite shorter computer times comparing to the other two models. It was also showed that the alternative model can solve moderate sized real-world problems. Originality/value: The problem under study differentiates from existing batch scheduling problems in the literature since it includes new circumstances which may arise in real-world applications. This research, also, contributes the literature of batch scheduling problem by presenting new optimization models.

Nowadays, unpaid invoices and unpaid credits are becoming more and more common. Large amounts of data regarding these debts are collected and stored by debt collection agencies. Early debt collection processes aim at collecting payments from creditors or debtors before the legal procedure starts. In order to be successful and be able to collect maximum debts, collection agencies need to use their human resources efficiently and communicate with the customers via the most convenient channel that leads to minimum costs. However, achieving these goals need processing, analyzing and evaluating customer data and inferring the right actions instantaneously. In this study, fuzzy inference based intelligent systems are used to empower early debt collection processes using the principles of data science. In the paper, an early debt collection system composed of three different Fuzzy Inference Systems (FIS), one for credit debts, one for credit card debts, and one for invoices, is developed. These systems use different inputs such as amount of loan, wealth of debtor, part history of debtor, amount of other debts, active customer since, credit limit, and criticality to determine the output possibility of repaying the debt. This output is later used to determine the most convenient communication channel and communication activity profile.

Evaluation based on Distance from Average Solution (EDAS) is a new multicriteria decision making (MCDM) method, which is based on the distances of alternatives from the average scores of attributes. Classical EDAS has been already extended by using ordinary fuzzy sets in case of vague and incomplete data. In this paper, we propose an interval-valued intuitionistic fuzzy EDAS method, which is based on the data belonging to membership, nonmembership, and hesitance degrees. A sensitivity analysis is also given to show how robust decisions are obtained through the proposed intuitionistic fuzzy EDAS. The proposed intuitionistic fuzzy EDAS method is applied to the evaluation of solid waste disposal site selection alternatives. The comparative and sensitivity analyses are also included.

In some cases, the specification limits of a quality characteristic should be defined under uncertain information. In the literature, process capability analyses have been handled by using type-1 fuzzy sets under fuzziness up to now. In this paper, we develop the concept of type-2 fuzzy quality and use it in the calculation of process capability. Lower and upper specification limits are considered as type-2 fuzzy sets. We define the addition and subtraction operations for introducing interval type-2 fuzzy process capability indices. We can calculate the nonconforming percentage of the production using the developed equations. We present some numerical examples to show the applicability of the proposed equations.

Fuzzy sets have a great progress in every scientific research area. It found many application areas in both theoretical and practical studies from engineering area to arts and humanities, from computer science to health sciences, and from life sciences to physical sciences. In this paper, a comprehensive literature review on the fuzzy set theory is realized. In the recent years, ordinary fuzzy sets have been extended to new types and these extensions have been used in many areas such as energy, medicine, material, economics and pharmacology sciences. This literature review also analyzes the chronological development of these extensions. In the last section of the paper, we present our interpretations on the future of fuzzy sets.

The study presents some results of customer paths’ analysis in a shopping mall. Bluetooth-based technology is used to collect data. The event log containing spatiotemporal information is analyzed with process mining. Process mining is a technique that enables one to see the whole process contrary to data-centric methods. The use of process mining can provide a readily-understandable view of the customer paths. We installed iBeacon devices, a Bluetooth-based positioning system, in the shopping mall. During December 2017 and January and February 2018, close to 8000 customer data were captured. We aim to investigate customer behaviors regarding gender by using their paths. We can determine the gender of customers if they go to the men’s bathroom or women’s bathroom. Since the study has a comprehensive scope, we focused on male and female customers’ behaviors. This study shows that male and female customers have different behaviors. Their duration and paths, in general, are not similar. In addition, the study shows that the process mining technique is a viable way to analyze customer behavior using Bluetooth-based technology.

Multicriteria decision-making (MCDM) refers to making decisions in the presence of multiple and usually conflicting criteria. Fuzzy decision-making is used where vague and incomplete data exist for the solution. Fuzzy multicriteria decision-making is one of the most popular problems handled by the researchers in the literature. In this paper, we survey the latest status of fuzzy multicriteria decision-making methods and classify these methods dividing into two parts: fuzzy multiattribute decision-making (MADM) and fuzzy multiobjective decision-making (MODM). Most of the publications are on fuzzy MADM since there are a plenty of classical multiattribute decision-making methods in the literature. Tabular and graphical illustrations for each method are given.

Strategic decisions such as mergers, acquisitions and joint ventures have a strong effect on firm performance. In order to be successful in highly competitive environments firms have to make right and on time strategic decisions. However, the nature of making the right strategic decision is complex and unstructured since there are many factors affecting such decisions. Moreover these factors are usually hard and vague to evaluate numerically. This study tries to develop a multicriteria decision-making model which considers both the complexity and vagueness of strategic decisions. The weights of the factors are determined by interval type-2 Fuzzy Analytic Hierarchy Process (AHP) and then the best strategy is selected by Hesitant Fuzzy TOPSIS using the determined weights. An application to a multinational consumer electronics company is presented.

Background and Aim: The incidence of acute pancreatitis is increasing recently. The aim of this study is to investigate the effect of Ankaferd Blood Stopper (ABS) on experimental model of cerulein induced acute pancreatitis in rats., Materials and Methods: Forty Wistar Albino rats were divided into five groups. Group 1: Sham (n = 8), Group 2: Control group (n = 8), Group 3: Treatment group (n = 8), Group 4: Prophylaxis group (n = 8), Group 5: Prophylaxis treatment group (n = 8). Any practice was not administered to Group 1. Rats were treated with either 1 ml ABS or 1 ml saline via intraperitoneal route before and after inducing acute pancreatitis. Pancreatic tissues were examined histopathologically. Amylase, cytokines (tumor necrosis factor-α and interleukin-1β), and markers of apoptosis (M30 and M65) were also measured in blood samples. Immunohistochemical staining was performed with caspase 3 antibody., Results: We found a statistically significant improvement in histopathological scores in treatment group and prophylaxis group compared with controls. In treatment group, M30 and M65 levels were lower when compared with controls. In prophylaxis group, there was not a statistically significant difference in M30 levels, but M65 levels were lower when compared with controls., Conclusion: In this experimental acute pancreatitis model, we found high histopathological healing effects of ABS treatment and also prophylaxis. ABS treatment and prophylaxis reduced apoptosis.

Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC.

Background: Apoptosis plays a role in epithelial and mucosal injury, which is 1 of the mechanisms in the pathogenesis of ulcerative colitis. Apoptotic cells increase as a result of injured mucosa in ulcerative colitis and serum M 30 levels increase in epithelial cell apoptosis. In this study, we aimed to evaluate the relation between M 30 serum levels and ulcerative colitis activity., Methods: Eighty patients with ulcerative colitis and 40 healthy controls were enrolled into the study. The patient group consisted of 31 extensive colitis, 30 left-sided colitis, and 19 proctitis. The activity of ulcerative colitis was determined with clinical and endoscopic findings. Serum M 30 levels, acute phase reactants, and biochemical tests were analyzed in all subjects., Results: Serum M 30 levels in patients with active ulcerative colitis were significantly higher when compared with the healthy controls (165.6 ± 60.6 and 129.6 ± 37.4; P = 0.003). Serum M 30 levels in active left-sided colitis patients was significantly higher when compared with patients in remission phase (180.6 ± 58.5, 141.5 ± 35.4; P = 0.044). When we exclude patients with ulcerative proctitis, M 30 levels in active ulcerative colitis patients were significantly higher than that the patients in remission phase (174.0 ± 63.5, 135.0 ± 29.9; P = 0.017)., Conclusions: We found that M 30 levels increase in patients with active ulcerative colitis. Our findings support the role of apoptosis demonstrated by serum M 30 levels in the pathogenesis of active ulcerative colitis.

Aim: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder which is reported as the hepatic manifestation of metabolic syndrome with an increased risk of cardiovascular events. Patients with NAFLD are also at risk of future cardiac events independently of metabolic syndrome. The aim of this study was to examine serum concentrations of heart type fatty acid binding protein (H-FABP) in NAFLD and to investigate its correlations with metabolic parameters and subclinical atherosclerosis., Patients and Methods: A total of 34 patients with NAFLD and 35 healthy subjects were enrolled in the study. NAFLD patients had elevated liver enzymes and steatosis graded on ultrasonography. Healthy subjects had normal liver enzymes and no steatosis on ultrasonography. H-FABP levels were measured using an enzyme linked immunosorbent assay (ELISA) method and correlations with metabolic parameters and subclinical atherosclerosis were examined. Subclinical atherosclerosis was determined with carotid artery intima-media thickness (CIMT) which was measured by high resolution B mode ultrasonography., Results: H-FABP levels were elevated in patients with NAFLD (16.3 ± 4.0 ng/ml) when compared with healthy controls (13.8 ± 2.1 ng/ml; p  < 0.001). NAFLD patients had significantly higher CIMT than the controls had (0.64 ± 0.17 mm vs. 0.43 ± 0.14 mm, p = 0.009). The H-FABP concentrations were significantly positively correlated with body mass index (r = 0.255, p = 0.042), fasting blood glucose level (r = 0.300, p = 0.013), CIMT (r = 0.335, p = 0.043), and homeostasis model assessment-estimated insulin resistance (HOMA-IR; r = 0.156, p = 0.306). In multiple linear regression analysis, H-FABP levels were only independently associated with CIMT (p = 0.04), Conclusion: Serum H-FABP concentrations increase in patients with NAFLD. Our results may not only suggest that H-FABP is a marker of subclinical myocardial damage in patients with NAFLD but also of subclinical atherosclerosis, independent of metabolic syndrome and cardiac risk factors.

Vascular thrombosis and systemic hypercoagulable states are known complications of pancreatitis. Higher levels of mean platelet volume (MPV) have been associated with thrombotic diseases. However, a few studies have investigated the association between acute pancreatitis and MPV. We aimed to investigate whether there is a difference of MPV and coagulation parameters in patients with active and remission in acute pancreatitis. We included 24 consecutive patients with biliary acute pancreatitis and 24 consecutive healthy age-matched and sex-matched controls. Full blood counts and other laboratory tests were collected at onset and remission. The MPV was significantly higher in patients with acute pancreatitis at admission 8.6±1.4 fl than controls 7.6±0.7 fl (P=0.005). We detected positive correlation between, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, amylase, lipase, and glucose, BMI, D-dimer and MPV. However, there was negative correlation between progression, thrombocyte counts, hemoglobin and MPV. As a result higher MPV levels in acute pancreatitis may reflect hypercoagulation associated with pancreatitis.

Background and Aim: The aim of this study was to assess and compare the performance of a series of non-invasive tests to detect fibrosis in patients with chronic hepatitis B (CHB)., Patients and Methods: Seventy-six patients with CHB, whose blood samples were collected and biopsies were done on the same day, were included in this study. Pre-treatment calculations of aspartate aminotransferase to platelet ratio index (APRI), Forn's index, FIB-4, S-index, Shanghai Liver Fibrosis Group's index (SLFG) and Hepascore(®) were done and relations with mild and advanced fibrosis and cirrhosis were assessed. Post-treatment values of APRI, Forn's index, FIB-4, S-index with oral antiviral agents were also investigated., Results: APRI, S-index, SLFG, FIB-4, Forn's index and Hepascore(®) had 0.669, 0.669, 0.739, 0.741, 0.753, 0.780; retrospectively Area Under the Receiver Operating Characteristic Curve (AUROC) for significant fibrosis. APRI, Forn's index, S-index, FIB-4, SLFG, and Hepascore(®) had 0.681, 0.714, 0.715, 0.738, 0.747, 0.777 retrospectively AUROC for advanced fibrosis. APRI, SLFG, FIB-4, Forn's index, S-index, and Hepascore(®) had 0.741, 0.742, 0.768, 0.779, 0.792, 0.824 retrospectively AUROC for cirrhosis. APRI, Forn's index, FIB-4 and S-index were significantly lower in post-treatment group compared with pre-treatment group (P-values: <0.05, 0.001, 0.003, 0.018; respectively)., Conclusion: Hepascore(®) showed the best performance to predict significant fibrosis. Our study also suggests that the use of non-invasive test to predict fibrosis in patients with CHB may reduce the need for liver biopsy and may help to monitor the efficacy of treatment., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background & Aims: Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine., Methods: We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 ± 9.7 mo), 77 patients received entecavir (followed up for 24.0 ± 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 ± 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups., Results: Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients., Conclusions: Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection., (Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Liver fatty acid-binding protein (L-FABP) is a small molecule. The aim of this study was to examine L-FABP levels and to detect its diagnostic value in chronic hepatitis C (CHC)., Methods: We studied 22 patients with CHC and 20 healthy control subjects. Patients with persistently elevated serum aminotransferases and positive HCV RNA were included in the study. Patients with CHC underwent percutaneous liver biopsy. Serum level of L-FABP was determined by ELISA method., Results: Patients with CHC had significantly increased levels of L-FABP compared to controls. A strong correlation between serum L-FABP concentrations and aspartate aminotransferases, alanine aminotransferases, HCV RNA levels and hepatic inflammation was found. When a cut-off value was 29,000 pg/mL for L-FABP, sensitivity and specificity were 75 and 100%, respectively. Positive and negative predictive values for L-FABP were 100 and 78%, respectively., Conclusions: Serum L-FABP is used as a new diagnostic marker to detect liver injury., (Copyright © 2013 IMSS. All rights reserved.)

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver pathology worldwide and is strongly associated with obesity and insulin-resistance and food intake. Nesfatin-1 is a new peptide that controls appetite and food intake. The objective of this research was to examine the serum concentrations of nesfatin-1 in NAFLD., Material and Methods: Thirty NAFLD patients who had elevated liver enzymes and 40 age- and sex-matched healthy subjects were included in this study. NAFLD was diagnosed and graded with the findings of liver ultrasound scan. Nesfatin-1 concentrations were measured using an ELISA method and the relationship between nesfatin-1 and metabolic parameters were investigated. The subjects were divided into two groups according to their body mass index (≥ 30 and < 30) and nesfatin-1 concentrations were examined between both groups., Results: Serum nesfatin-1 concentrations in NAFLD patients were lower than healthy controls (0.26 ± 0.14 ng/ml, 0.38 ± 0.18 ng/ml, respectively, and p = 0.008). We found a negative correlation between nesfatin-1 and fasting glucose and body mass index. In obese subjects, serum nesfatin-1 concentrations were significantly lower when compared with non-obese subjects (0.26 ± 0.12 ng/ml, 0.37 ± 0.19 ng/ml, respectively; p = 0.014). In addition, we showed that nesfatin-1 concentrations in subjects with insulin resistance were significantly lower in comparison with insulin-sensitive ones (0.27 ± 0.17 ng/ml, 0.38 ± 0.17 ng/ml, respectively; p = 0.015)., Conclusion: Our study has shown that nesfatin-1 concentrations were reduced in NAFLD. The results of this study indicate that nesfatin-1 may have a significant role in NAFLD.

Background: Skin ageing is a continuous process, with intrinsic factors determining which extrinsic factors (chronic sun exposure and other environmental factors, particularly smoking) have the greatest effect., Aim: To investigate the effects of lifestyle and environmental factors on skin ageing in a Mediterranean population from Ankara, Turkey., Methods: In total, 574 (337 women, 237 men; age range 18-89 years) were enrolled into the study. Data were collected on age, gender, weight, height, body mass index (BMI), skin phototype, smoking status, consumption of alcohol (> 3 units/week) and coffee (> 1 cup/day), sun exposure, use of sunscreen and sunglasses, and involvement in sports and physical activities. The Daniell skin-wrinkling grading system was used as a marker of skin ageing., Results: We found that male gender, chronic sun exposure and number of pack-years of cigarette smoking significantly contributed to the formation of facial wrinkles. There was a negative correlation between facial wrinkling and the use of sunscreen and sunglasses and facial wrinkling (P < 0.001 for both). We did not find any significant association between wrinkling score and alcohol consumption, coffee consumption, sports participation or d skin phototype. Moreover, wrinkling score was significantly higher in patients with a BMI < 25 kg/m(2) than in patients with a BMI > 25 kg/m(2) (P < 0.018). Multiple logistic regression analysis was conducted after adjusting for age, gender, smoking status, alcohol consumption, skin phototype, sun exposure, and use of sunglasses and topical sun protection. We found that gender and age were significantly associated with skin ageing (P < 0.014 and < 0.001, respectively)., Conclusion: In this study, older age, male gender, low BMI, smoking and chronic sun exposure had a negative influence on skin ageing in a Turkish population., (© The Author(s). CED © 2012 British Association of Dermatologists.)

Background and Aim: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of the tumor necrosis factor super family of structurally-related cytokines. The aim of this study was to determine the diagnostic and prognostic role of serum TWEAK concentration in patients with acute pancreatitis., Methods: Twenty four patients with acute pancreatitis and 24 consecutive healthy age- and sex-matched control subjects were included in the study. The serum concentrations of TWEAK were measured at admission and then at remission. The average time between admission and remission was 7-10 days., Results: At admission, TWEAK concentration was significantly lower in patients with acute pancreatitis compared to control subjects (p < 0.001). Serum TWEAK concentrations were elevated after the remission period, however the differences were not statistically significant. In addition, serum TWEAK concentration showed a significant, inverse correlation with amylase, lipase, CRP, AST, fibrinogen, LDH and a positive correlation with calcium, albumin and platelet count., Conclusions: Patients with acute pancreatitis have lower serum TWEAK concentration than healthy subjects. These results suggest that serum TWEAK concentration could be a potential biomarker of acute pancreatitis.

Background: Previous studies have focused on the relationship between halitosis, gastroesophageal reflux disease and Helicobacter pylori. In this study we aimed to investigate the interaction between halitosis and upper gastrointestinal endoscopic findings., Methods: Patients who previously had dyspepsia and had undergone endoscopic examination were included in the study. Symptoms of dyspepsia were investigated by means of a questionnaire that investigated halitosis. Patients who suffered from objective halitosis (confirmed by questions both to the patient and their relatives) were further investigated. Patients with known local or systemic causes of halitosis or structural disorders at endoscopy were excluded., Results: The study included 358 patients (121 men and 237 women) with dyspeptic symptoms. The patients with and without halitosis had mean ages of (39.4 ± 13.5) and (43.1 ± 14.9) years, respectively. Patients without halitosis were significantly older than those in the halitosis group (P < 0.05). Patients in the halitosis group had significantly higher frequencies of regurgitation, bloating and nausea (P < 0.05) when compared to patients without halitosis. Endoscopic findings, including esophagitis, open cardia, hiatal hernia, gastritis and duodenitis, were comparable in the two groups., Conclusions: The frequency of halitosis was high in patients with dyspepsia who underwent upper gastrointestinal endoscopy. Halitosis had a close relationship with several upper gastrointestinal symptoms, including regurgitation, nausea and bloating. There was no significant association between upper gastrointestinal endoscopic findings and halitosis.

Background: Musculoskeletal disorders are well-defined extra-intestinal manifestations of inflammatory bowel diseases (IBD). There is little data regarding the frequencies of IBD and extra-intestinal manifestations from Central and East Europe and Middle Eastern countries., Aims: To determine the prevalence of peripheral arthritis in IBD and to document the relationship to other extra-intestinal manifestations., Methods: Enrolled in the study were 357 patients who were diagnosed with IBD from December 2002 through January 2008. All of the patients underwent a detailed whole-body examination by a gastroenterologist and rheumatologist., Results: IBD-related peripheral arthritis (IBDPA) was found in 66 (18.5%) of the 357 patients (28.3% Crohn's disease, 13.5% ulcerative colitis; p=0.001 χ=11.62). IBDPA was more frequent in female patients (60.6 vs. 39.4%, p=0.000, χ=11.12). In eight (12.1%) cases, IBDPA occurred before the onset of IBD. Acute self-limiting episodes, recurrences of the attacks, and persistent symptoms of arthritis were present in 40 (60.6%), 26 (39.3%), and 29 (45.7%) patients, respectively. Arthritis was symmetrical in 33 (50%) cases. Knees (65.2%) and ankles (62.1%) were the most commonly affected joints. Erythema nodosum and pyoderma gangrenosum were more common among patients with IBDPA than patients without it (p=0.001, χ=10.49, and p=0.000 χ=25.77, respectively)., Conclusions: IBDPA is a frequent extra-intestinal complication of IBD. Those of female gender and the presence of Crohn's disease, erythema nodosum and pyoderma gangrenosum have a higher risk to develop IBDPA.

Serrated adenoma of the stomach has been very rarely reported. A 34-year-old woman underwent upper gastrointestinal endoscopy showing a serrated adenoma polyp at the posterior wall of the junction of the fundus and body of the stomach. The polyp was situated in a technically difficult area to perform a polypectomy with a snare. A banding ligation of the polyp was performed with a pneumoactivated esophageal variceal ligation device. At the follow-up, the base of the polyp was free of adenoma. Beside several other polypectomy techniques, the band ligation technique may be used in removing of the gastric polyps, which is cheap, safe and technically easy to perform.

Colorectal carcinoma, primarily a disease of adulthood, accounts for 0.2% of malignancies in adolescents and has very rarely been reported in childhood. Herein, we report a 15-year-old boy who presented with rectal bleeding, lower abdominal pain, and diarrhea. His physical examination revealed tender abdomen with hepatomegaly. A hard mass was palpated by digital rectal examination. Histologic examination revealed a mucinous rectal adenocarcinoma. He died 4 months after diagnosis. This case highlights the need for awareness of colorectal carcinomas and their invasive nature in the differential diagnosis of rectal bleeding and diarrhea in adolescents.

Many non-invasive tests have been studied for diagnosis and determining the activation degree of inflammatory bowel disease (IBD). Nevertheless, an ideal test has not been found yet. Mean platelet volume (MPV) is influenced by the inflammation. In a few study, decreased platelet volume have been reported in IBD. The aim of this study is to determine whether platelet volume would be useful in ulcerative colitis (UC) activity. Additionally we have analyzed overall accuracy of MPV in disease activity and compared with other inflammatory markers. A total of 61 UC patients (male/female : 41/20), and 27 healthy subjects (male/female : 18/9) were enrolled into the study. For all subjects following tests were performed; ESR, CRP, white blood cell count and mean platelet volume. A statistically significant decrease in MPV was noted in patients with UC (8.29 +/- 1.02 fL) compared with healthy controls (8.65 +/- 0.79 fL). MPV of active UC (8.06 +/- 1.19 fL) patients were significantly lower than that of inactive UC (8.45 +/- 0.87 fL). Overall accuracy of MPV in determination of active UC was 71% (with sensitivity 67%, specificity 73%). A negative correlation was found between MPV and endoscopic activity index (r : -0.358 p : 0.005). In UC, MPV did not correlate with ESR, CRP and white blood cell. Our study showed that MPV reduced in UC, particularly in patients with active UC. Decreased MPV may be an indicator for increased disease activity in patients with UC.

Background/aims: Cholangitis is one of the most morbid complications of endoscopic biliary drainage and among the commonest causes of endoscopic retrograde cholangiopancreatography-related death. The aim of this prospective study was to investigate the risk factors for the development of cholangitis after endoscopic retrograde cholangiopancreatography in a tertiary referral center., Methods: The study involved 503 consecutive patients with naive papilla who underwent endoscopic retrograde cholangiopancreatography. We included the cholangitis occurring within 72 hours after endoscopic retrograde cholangiopancreatography for all patients undergoing the procedure. All patients received antibiotic prophylaxis before endoscopic retrograde cholangiopancreatography. Factors including age, gender, presentation, nature of the papilla, therapeutic procedures, and the diagnosis were analyzed to predict post-endoscopic retrograde cholangiopancreatography cholangitis., Results: Median age was 61.2 +/- 14.8 years and there were 274 (54.5%) women and 229 (45.5%) men. Seventeen (3.3%) patients (9 F, 8 M) developed cholangitis after endoscopic retrograde cholangiopancreatography. The risk of post-endoscopic retrograde cholangiopancreatography cholangitis development was most probable in patients with hilar cholangiocarcinoma. Post-endoscopic retrograde cholangiopancreatography cholangitis risk was significantly higher in patients with biliary dilatation and biliary stent insertion, and without periampullary diverticula (odds ratio, OR: 4.8, 4.4, 1.2, respectively). Total procedure duration was significantly prolonged and common bile duct diameter was significantly increased in patients who had cholangitis. Five patients (3 F, 2 M; 0.9%) died because of post-endoscopic retrograde cholangiopancreatography complicated sepsis., Conclusions: Increased common bile duct diameter, biliary dilatation, biliary stent insertion, prolonged total procedure time, and hilar cholangiocarcinoma have higher post-endoscopic retrograde cholangiopancreatography cholangitis risk. Moreover, the presence of periampullary diverticula was found to decrease cholangitis risk.

Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by destruction and fibrosis of the bile ducts. This study aimed to demonstrate the hepatic and extrahepatic characteristic findings and prognostic outcomes of Turkish patients with PSC., Methods: The medical records of 35 consecutive patients with PSC from January 1988 to June 2007 were recorded prospectively. From the time of diagnosis, clinical features and laboratory data were collected., Results: The mean age of the 35 patients was 41.69 years (range 15-80 years) at the time of diagnosis; 14 (40%) were female, and 21 (60%) were male. The mean duration of follow-up was 58.86 months (1-180 months). Twenty (57.1%) of the patients with PSC were asymptomatic and 22 (62.9%) had inflammatory bowel disease. At the time of diagnosis, 20 (57.1%) of the patients had both intra- and extra-hepatic PSC. Twenty-one (60%) of the patients, who had undergone ERCP for stent placement, had dominant bile duct stenosis. Cholangiocarcinoma was found in 2 (5.7%) of the patients and cirrhosis was detected in 7 (20%); 5 (14.3%) underwent liver transplantation. The median follow-up time after liver transplantation was 23 months and all are still alive. Six (17.1%) patients died., Conclusions: PSC has a clinical course varied from advanced liver disease requiring liver transplantation within a short time to being asymptomatic for decades. The prognosis of Turkish patients with PSC is also disappointing as described in other studies.

Background: The aim of this study was to evaluate the prevalence and features of the major cutaneous manifestations (erythema nodosum [EN] and pyoderma gangrenosum [PG]) and to determine the associations between cutaneous manifestations and other extraintestinal manifestations in patients with inflammatory bowel disease (IBD)., Methods: The mucocutaneous manifestations of patients with IBD were studied between December 2002 and June 2007. All patients underwent a detailed whole body examination by a gastroenterologist and dermatologist., Results: In all, 352 patients were included in this study; 34 patients (9.3%) presented with at least 1 major cutaneous manifestation. The prevalence of EN (26 patients) and PG (8 patients) in IBD was 7.4% and 2.3%, respectively. EN was more common in Crohn's disease (16/118) than ulcerative colitis (10/234) (P = 0.002). EN was found to be related to disease activity of the bowel (P = 0.026). The prevalence of arthritis was significantly higher in the IBD patients with EN (11/26) than in IBD patients without EN (53/326) (P = 0.006). Arthritis was more common in IBD patients with PG (7/8) than in IBD patients without PG (57/344) (P = 0.00). IBD patients with PG were significantly more likely to have uveitis (1/8) compared with IBD patients without PG (5/344) (P = 0.017)., Conclusions: We found the prevalence of 2 important cutaneous manifestations to be 9.3% in IBD in Turkish patients. EN was found to be more common in Crohn's disease and is associated with an active episode of bowel disease and peripheral arthritis. In addition, PG was connected with uveitis and peripheral arthritis.

Background and Study Aims: Stent migration occurs in about 5-10% of patients undergoing biliary stenting. The aim of this study was to analyze the risk factors for stent migration in patients with benign and malignant strictures., Patients and Methods: We retrospectively analyzed records of 524 biliary plastic stent placement procedures. Details noted included the cause and localization of stricture, characteristics and number of stents, direction of stent migration, presentation of patient with migrated stent, and the methods used for retrieval of migrated stents., Results: Two hundred and four (38.9%) of the procedures were performed for benign biliary strictures (BBS) and 320 (61.1%) for malignant biliary strictures (MBS). Thirty-four patients had 45 migrated biliary stents. The rate of migration was 8.58% (proximal 4.58% and distal 4.00%). Migration frequency was higher in BBS compared with MBS (13.7% versus 5.3%, p=0.001). In BBS, the rate of stent migration was higher in cases with one (19.3%) and two stents (20.9%) when compared with cases with multiple stents (2.7%) (p=0.001; p=0.001, respectively). Migration occurred more frequently (10.9%) in cases with two stents when compared both to cases with one stent (3.0%) and those with multiple stents (0%) in MBS (p=0.008; p=0.020, respectively). In BBS, short stents migrated more frequently proximally (77%) and long stents more frequently distally (73%) (p=0.008). In BBS, migration in cases with proximal stricture occurred more frequently distally (76.9%), while in those with distal stricture, migration was more frequently proximal (73.3%) (p=0.008). All of the proximally migrated stents could be successfully retrieved endoscopically., Conclusions: The risk of stent migration is higher in BBS compared with in MBS. The cases with multiple stents had significantly lower stent migration. In BBS, long stent, proximal and postcholecystectomy strictures were associated with distal migration, while short stent, distal and non-postcholecystectomy strictures were associated with proximal migration.

Hirschsprung disease (HD) is characterized by aganglionosis, which mainly occurs in the rectum and distal sigmoid colon. Typical HD is seldom diagnosed in adulthood, and segmental involvement is very rare. A 37-year-old man suffered from refractory constipation for 20 years. He could only defecate once a week and frequently needed an enema for defecation. A barium enema showed an annular stenotic segment of the rectosigmoid colon of 8 cm in length, which started 10 cm above anal circulation and showed dilated colon above the stenotic segment. The distal rectum was normal. The narrowed segment of the rectum was resected. At one-year follow up, the patient had normal defecation without laxatives.

Background: Cancer antigen 125 (CA-125) is a tumor marker used for the diagnosis and monitoring of ovarian carcinoma. It can also be elevated in endometriosis, inflammations, and in nongynecological malignancies. Up to date, serum CA-125 levels in inflammatory bowel diseases (IBD) have not been studied before., Aim: To assess the levels of CA-125 in patients with ulcerative colitis (UC) and Crohn's disease (CD)., Methods: Serum levels of CA-125 were investigated in 68 cases with UC (male/female: 47/21), 32 CD (male/female: 21/11), and 31 healthy controls (male/female: 16/15). Levels of CA-125 were also compared among UC patients according to lesion location, severity, and activity of CD., Results: Serum CA-125 levels were 17.29+/-24.50 U/ml, 15.56+/-20.74 U/ml, and 8.85+/-2.62 U/ml in patients with UC, CD, and healthy controls, respectively. Serum CA-125 levels were significantly higher in UC compared to control group (P=0.001). Serum CA-125 levels were higher in CD patients compared to control group but there was no significance (P=0.087). Serum CA-125 levels were higher in pancolitis compared to distal type and left-sided UC., Conclusions: Our data suggest that serum CA-125 levels may be increased in patients with IBDs.