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Background We investigated the effect of unexpected N2 on survival in stage IIIB/N2 cases. Methods We retrospectively analyzed 1803 non-small cell lung cancer patients between 2010 and 2016. There were 89 patients (4.9%) with unexpected N2 (pathological (p) IIIB/N2 group), whereas 49 patients (2.7%) with cN2 (clinical (c) IIIB/N2 group). Although pIIIB/N2 group underwent surgery followed by adjuvant therapy, the cIIIB/N2 group of patients had multimodality treatment including induction chemotherapy ± radiotherapy followed by surgery. Results The five-year overall survival (OS) for all patients was 36.0% [median survival time (MST) 27.9 months], and disease-free survival (DFS) was 28.9% (MST, 18.2 months). The OS was 39.6% (MST: 34.4 months) and the median DFS time was 31.1% (Median: 23.1 months) in the pIIIB/N2 group, whereas it was 29.2% (MST: 23.0 months) for OS and 22% (median: 12.4 months) for DFS in the cIIIB/N2 group. There were no significant OS and DFS differences between the pIIIB/N2 group and the cIIIB/N2 group ( p = 0.124 and p = 0.168, respectively). Conclusions In stage IIIB/N2 cases, the fact that N2 could not be detected preoperatively with minimally invasive or invasive methods and was detected in the pathological examination after surgery does not provide a survival advantage.

This study examined the effect of metastatic mediastinal lymph node involvement on the prognosis of patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or extended pleurectomy (E/P) and also to assess the effect of metastatic mediastinal lymph node involvement on the prognosis of patients with MPM in these group of patients.This retrospective study included 84 patients with MPM (66 men [78.6%] and 18 women [21.4%]) who underwent EPP (In the EPP group, patients with T2-N2 status had a significantly better mean survival (17 ± 2.1 months) than patients with T3-N2 (7.3 ± 1.6 months) or T4-N2 (3.2 ± 1.1 months) status (In summary, our results suggested that mediastinal lymph node metastasis negatively influenced the prognosis of patients with T3 MPM, regardless of treatment by EPP or E/P. Under these circumstances, preoperative cervical mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration may be considered for patients with high-stage MPM who are scheduled for surgery with curative intent. In our study, N2 status was spotted as a significant factor affecting survival, nevertheless its significance in survival of pleural mesothelioma patients should be analyzed in multi-centered studies.

Background: This study aims to investigate the changes in the clinical and radiological presentations of pulmonary aspergilloma in patients undergoing surgery and to evaluate changes in the surgical outcomes over time. Methods: Between January 2000 and January 2020, a total of 88 patients (69 males, 19 females; mean age: 45.4±11.2 years; range, 17 to 70 years) who underwent surgery for pulmonary aspergilloma were retrospectively analyzed. Surgeries performed were divided into two groups based on their chronological order: first period (from 2000 to 2010, n=44) and second period (from 2010 to 2020, n=44). Results: The most frequent underlying disorder was tuberculosis (72.7%), whereas 10 patients did not have any predisposing conditions for pulmonary aspergilloma. Regarding the aspects of radiological imaging and operative findings, 22 patients had simple aspergilloma and 66 patients had complex aspergilloma. Complications and mortality rates were 33.0% and 5.7%, respectively. A statistical downward was observed in the second period compared to that in the first period regarding the rate of patients with tuberculosis history (61.4% vs. 84.1%, p=0.01). There were more patients who did not have any predisposing conditions for pulmonary aspergilloma in the second period and in the simple aspergilloma group (p=0.04 and p Conclusion: Although pulmonary aspergilloma patients who underwent surgery in the last 10 years had a lower history of tuberculosis than those who were operated in the previous 10 years, there was no change in postoperative complications and mortality rates. An increase in simple aspergilloma prevalence may reduce the rate of surgical morbidity.

Background: The aim of this study was to investigate the long-term outcomes of patients who underwent anatomic lung resection for pulmonary aspergilloma and to evaluate the prognostic factors affecting early postoperative morbidity. Methods: Between January 2007 and January 2017, we retrospectively evaluated a total of 55 patients (40 males, 15 females; mean age: 44.6 years; range, 18 to 75 years) who underwent lobectomy and pneumonectomy for pulmonary aspergilloma. All patients were evaluated for simple or complex aspergilloma based on imaging and thoracotomy findings. Results: Thirty-two (58.2%) patients presented with hemoptysis. Seven (12.7%) patients underwent emergency surgery due to massive hemoptysis. Postoperative morbidity was observed in 15 (27.3%) patients. Prognostic factors that had an effect on morbidity were resection type, Charlson Comorbidity Index >3, and massive hemoptysis (p Conclusion: The main finding of this study is the absence of mortality after surgical treatment for pulmonary aspergilloma. The success of surgical treatment depends on the management of postoperative complications.

Objective The aim of this study was to evaluate the prognostic factors affecting morbidity and mortality among patients who underwent surgery for giant pulmonary hydatid cysts in our center. Methods Data from 283 patients who underwent surgery in our center for pulmonary hydatid cyst between 2008 and 2018 were retrospectively analyzed. Cysts 10 cm in diameter or larger were considered giant hydatid cysts. Results There were 145 women (51.2%) and 138 men (48.8%). Giant cyst (≥10 cm) was present in 57 patients (20.1%), while the other 226 patients (79.9%) had cysts smaller than 10 cm. Operations were performed using videothoracoscopic approach in 68 patients (24%) and with thoracotomy in 215 patients (76%). Hydatid cysts were on the left side in 129 patients (45.6%), on the right side in 143 patients (50.5%), and bilateral in 11 patients (3.9%). Postoperative morbidity occurred in 29 patients (10.2%). Use of videothoracoscopic surgical approach did not affect morbidity. The mortality rate within the first 90 days was 0.35% (n = 1). Conclusion Giant cysts are more common in the young age group than in older adults. Regardless of cyst size, surgery should be performed as soon as possible after diagnosis to avoid potential complications.

Bu yazımızda tüm vena cava süperioru (VCS) invaze eden akciğer kanserinde torakotomi ile akciğer ve sonrasında parsiyel VCS rezeksiyonu, greft yerleştirilmesi postoperatif dönemde trombüs gelişmesi ile revizyona alınan hasta literatür eşliğinde değerlendirilecektir. Olgu: 50 yaşında erkek hasta öksürük kilo kaybı şikayetleri ile hastaneye başvurmuştur. Hastanın görüntülemelerinde sağ üst lobta mediastene invaze kitle saptanan hastanın bronkospisinde alınan biyopsisinde skuamöz hücreli karsinom olarak raporlanmıştır. Torakotomi ile operasyona alınan hastanın VCS invazyonu saptanması üzerine sağ üst lobektomi ile birlikte VCS rezeksiyonu ve greft ile rekonstrüksiyon uygulanmıştır. Postoperatif erken dönem greftte tromboz gelişmesi üzerine revizyona alınan hastaya greft değişimi uygulanmıştır. Sonuç: Özellikle santral sağ üst lob tümörlerinde mediasten invazyonu mevcut ise komşu vasküler yapılar iyi değerlendirilmeli, SVC invazyonun %50 ve üzerinde bir tutulum saptandığında parsiyel rezeksiyonu planlanmalı ve uygun greft seçimi gerekmektedir. Anahtar sözcükler: Cerrahi Anastomoz, Akciğer Kanseri, Rezeksiyon, Vena Cava Superior, Greft, Tromboz

Amaç Bu çalışmadaki amacımız, küçük hücreli dışı akciğer kanseri (KHDAK) nedeniyle rezeksiyon uygulanmış hastalarda prognostik faktörlerin cinsiyete bağlı olarak etkilerinin ve kadınlarda sağkalıma etki eden faktörlerin literatür eşliğinde değerlendirilmesidir. Gereç ve Yöntem Çalışmaya Ocak 2007-Aralık 2018 yılları arasında hastanemizde KHDAK nedeniyle akciğer rezeksiyonu uygulanmış hastalar dahil edilmiştir.1491 hasta çalışmaya dahil edilmiştir. Bulgular Hastaların ortalama yaşı 60,0±8,41 (aralık:26-84) yıl idi. 1324 (%88,8) erkek hasta, 167 (%11,2) kadın hasta çalışmada mevcuttu. 406 (%27,2) hastaya pnömonektomi, 1077 (%72,2) hastaya lobektomi ve 8 hastaya (%0,5) segmentektomi yapılmıştır. Ortalama 5 yıllık sağkalım süresi % 57.5 idi. Çalışmada kadın hastaların 5 yıllık sağkalım oranı %66,8 iken erkeklerde %56,4 idi (p=0.005). pN2 durumu değerlendirildiğinde 5 yıllık sağkalım oranı %34,3 iken, pN0 olan hastalarda sağkalım oranı %64,1 olarak saptanmıştır( p

OBJECTIVES In this study, we aimed to establish risk factors for primary spontaneous pneumomediastinum associated with Coronavirus disease 2019 (COVID-19) and reveal those which are significant. METHODS The study included 62 patients with primary spontaneous pneumomediastinum who presented to our hospital between 11 March 2020, the date of the first-reported COVID-19 case in our country, and 3 January 2021. Of these, 14 patients (22.6%) had COVID-19 and 48 patients (77.4%) did not have COVID-19. RESULTS Of the 62 patients included in the study, 41 (66.1%) were male and 21 (33.9%) were female. The mean age was 28.90 ± 16.86 (range, 16–84) years. The most common symptom at admission was chest pain (54.8%). The mean age of the patients with COVID-19 was 39.35 ± 23.04 years and that of the patients without COVID-19 was 25.85 ± 13.45 years (P < 0.001). In receiver-operating characteristic curve analysis, the area under the curve for age was 0.785 (95% confidence interval: 0.648–0.922) and the optimal cut-off value was 24 years for COVID-19-positive patients. The highest sensitivity and specificity values were 0.857 and 0.729. Twelve (85.79%) of the COVID-19-positive primary spontaneous pneumomediastinum patients were aged 24 years or older (P < 0.001). Five patients (8.1%) had positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test but no abnormal findings on computed tomography. CONCLUSIONS Having an age of more than 24 years was associated with a higher prevalence of pneumomediastinum in COVID-19 patients and emerged as an important risk factor. Multicentre studies with more cases are needed to determine whether pneumomediastinum is associated with additional other risk factors related to COVID-19., Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in Turkey on 11 March 2020.

Bu çalışmada hidrolik tahrikli aks mili test sistemi üzerinde karşılaşılacak kontrol problemi incelenmiş ve karşılaşılacak probleme göre Adaptif Bulanık PID (AB-PID) kontrol yöntemi önerilmiştir. Test sisteminde karşılaşılacak problem, test edilecek parçaların sertlik değerlerinin farklılık göstermesidir; dolayısı ile uygulanacak kontrol metodunun ölçeklendirme çarpanları test esnasında kendiliğinden ayarlanabilir olması gerekecektir. Bunu sağlamak için AB-PID kontrolcü geliştirilmiştir. AB-PID kontrolcünün performansını kıyaslamak için klasik PID ve Bulanık Mantık Kontrolcü (BMK) de aks mili testi için denenmiştir. Geliştirilen kontrolcülerin çeşitli sertlikteki test parçaları üzerinde simülasyonu yapılmıştır. Birim basamak referans girişleri için ISE ve ITSE değerleri karşılaştırılmış, ömür testi olan sinüzoidal referansta ise hata grafikleri incelenmiştir. AB-PID kontrolcünün iki tip referans girişi için de daha uygun sonuçlar verdiği gözlemlenmiştir

Background This study aimed to compare early results in patients who underwent subxiphoid wedge resection with those operated on using a multiportal approach. Methods We retrospectively evaluated 151 patients who underwent diagnostic wedge resection for suspected interstitial lung disease. Patients who underwent wedge resection via subxiphoid video-assisted thoracoscopic surgery and conventional video-assisted thoracoscopic surgery were compared. Results The study included 90 men (59.6%) and 61 women (40.4%) with a mean age of 54.8 ± 12 years. Of these, 127 patients underwent conventional video-assisted thoracoscopic surgery and 24 patients underwent subxiphoid video-assisted thoracoscopic surgery. Postoperative complications occurred in 13 patients (8.6%), with no significant difference according to surgical technique. Sex was a significant factor in the rate of complications (12.2% in men vs. 3.2% in women). There was no intraoperative mortality; the 30-day mortality rate was 4% (n = 6). Five nonsurviving patients were in the conventional video-assisted thoracoscopic surgery group and 1 was in the subxiphoid video-assisted thoracoscopic surgery group ( p = 0.95). Conclusion The results of this study indicate that the subxiphoid approach reduced procedure time and length of hospital stay in the early period, while there was no significant difference between the techniques in terms of complications or mortality. Based on these findings, we conclude that surgical outcomes were as successful with the subxiphoid approach as with conventional video-assisted thoracoscopic surgery.

Background: The aim of this study was to evaluate the effect of prognostic factors and lymph node ratio (LNR) on survival in patients with resected non-small-cell lung cancer (NSCLC).Methods: Data from 421 patients with NSCLC who underwent complete resection between 2009 and 2015 were evaluated retrospectively. LNR was defined as the ratio of positive lymph nodes to the total number of lymph nodes removed. Associations between overall survival (OS) and LNR, node (N) status, and histopathologic status were evaluated.Results: The 5-year survival rate was 42.5% among all patients and 22.3% for patients aged 65 years or older. In the multivariate analysis, age ≥65 years, advanced stage disease, non-squamous cell carcinomas, pN status, and having multiple-station pN2 and multiple station pN1 disease were found to be poor prognostic factors (p < 0.05). There was no statistical difference in survival between patients with LNR (hazard ratio: 1.04, p = 0.45).Conclusion: The results of our study indicate that pN stage, histopathologic type, pT stage, and geriatric age were the most important poor prognostic factors associated with survival after NSCLC resection. Although LNR is a factor associated with survival in gastrointestinal cancers, it did not impact survival in our study.

Background: This study aims to evaluate long-term results of induction treatment and to investigate prognostic factors affecting survival in non-small cell lung cancer patients with a pathological complete response. Methods: Between January 2010 and December 2017, a total of 39 patients (38 males, 1 female; mean age: 56.2±8.3 years; range, 38 to 77 years) having locally advanced (IIIA-IIIB) non-small cell lung cancer who were given induction treatment and underwent surgery after induction treatment and had a pathological complete response were retrospectively analyzed. Survival rates of the patients and prognostic factors of survival were analyzed. Results: Clinical staging before induction treatment revealed Stage IIB, IIIA, and IIIB disease in three (7.7%), 26 (66.7%), and 10 (25.6%) patients, respectively. The five-year overall survival rate was 61.2%, and the disease-free survival rate was 55.1%. In nine (23.1%) patients, local and distant recurrences were detected in the postoperative period. Conclusion: In patients with locally advanced non-small cell lung cancer undergoing surgery after induction treatment, the rates of pathological complete response are at considerable levels. In these patients, the five-year overall survival is quite satisfactory and the most important prognostic factor affecting overall survival is the presence of single-station N2.

Aim:In this study is to evaluate the preoperative risk factors and compare the complications of patients who underwent diagnostic VATS for interstitial lung diseases in our clinic and patients who started thoracoscopic and converted to thoracotomy.Methods:Patients who underwent VATS due to interstitial lung disease between January 2010 and December 2019 in our clinic were included in the study. In the study, patients were evaluated under 2 groups. There are 159 patients who underwent VATS wedge (Group-V) and 29 patients who started with VATS and converted to thoracotomy (Group-T) due to unexpected intraoperative complications.Results:There was no significant difference between VATS and thoracotomy groups in terms of demographic characteristics, except for a history of tuberculosis. The most common postoperative pathology was unusual interstitial pneumonia (n=56, 28%). Complications were observed in 17 patients (9%). Prolonged air leak in 5 patients, pneumothorax after postoperative drain removal in 3 patients, wound infection requiring revision in 3 patients, respiratory failure requiring non-invasive mechanical ventilation in 6 patients developed. Mortality occurred in 5 patients (2.7%) in the first 30 days postoperatively. Conversion from VATS to thoracotomy occurred due to a previous history of tuberculosis and widespread pleural adhesions.Conclusion:Although revealing in videothoracoscopic surgery is considered to be a failure, postoperative complication and mortality rates were found to be similar to VATS. The main risk factor for conversion to thoracotomy is tuberculous sequelae observed in preoperative thoracic CT and perioperative pleural diffuse adhesions. Therefore, VATS is a reliable and applicable method in interstitial lung disease (ILD). We think that careful patient selection in the preoperative period will reduce the probability of the thoracotomy.

In this study, vehicle body vibrations are semiactively controlled using a nonlinear adaptive controller designed to improve passenger comfort by guaranteeing closed loop system stability under variable road disturbances with parametric uncertainty. Semiactive vibration control is implemented to the system through the magnetorheological damper. The MR damper test system is established in laboratory conditions, and the required values that are measured from the test system are used in computer simulations via the hardware in the loop simulation HILS method. By this way, it is possible to avoid the financial and other difficulties of the experimental study by establishing the test system completely, and also the hesitations that may arise in terms of producing realistic results of pure simulation studies of nonlinear dynamics. A 4-degree-of-freedom half-vehicle model is developed to examine the vehicle body bounce and pitch movements, and simulations are carried out under bump and random road irregularities, and the results are presented in comparison with the performance of the conventional skyhook controller. The performances of both controllers are interpreted from the aspect of acceleration and displacement responses of the vibrations and related criteria. As a result, the vibration reduction performances of both controllers are investigated experimentally using the HILS test system and the obtained results are evaluated with some comparative figures, performance criteria, and root mean square averages of vibrations.

Background: The aim of this study was to evaluate risk factors associated with morbidity and mortality after pneumonectomy in non-small cell lung cancer patients.Methods: The study included 107 patients who underwent pneumonectomy for non-small cell lung cancer between January 2013 and December 2018. Prognostic factors affecting mortality and morbidity were investigated.Results: The patient group included 10 women (9.3%) and 97 men (90.7%) with a mean age of 59.5 ± 8.5 years. Seventy-three patients (68.2%) underwent standard pneumonectomy and 34 (31.8%) underwent extended pneumonectomy. Nine patients (8.4%) received induction chemotherapy. Complications occurred in 33 patients (30.8%). Complications were classified as surgical, cardiovascular, pulmonary, or infectious. Charlson Comorbidity Index (CCI) > 3 and right-side resection were significant risk factors for the development of complications. The most common complication was atrial fibrillation. Eleven patients developed a bronchopleural fistula. The 30-day postoperative mortality rate was 6.5% (n = 7). Mortality was not associated with any demographic and surgical characteristics other than CCI > 3 (p = .05).Conclusion: The results of this study indicate that our pneumonectomy outcomes are acceptable despite high morbidity and mortality rates. Appropriate patient selection for pneumonectomy is as important as complication management. High-comorbidity patients should undergo these procedures in experienced centers.

Süperior sulkus tümörlerinde kemoradyoterapi sonrasında ceerrahi tedavi altın standart tedavi yaklaşımıdır. Ancak torakotomi nedeniyle hastaların iyileşme süreci geçikmekte ve geç dönemde hayat kalitelerine kavuşmaktadır. Günümüzde videotorakoskopik yardımlı torasik cerrahi (VATS) ameliyatları giderek daha fazla lokal ileri evre tümörlerde uygulanmaktadır.Bizim bu vaka sunumunda VATS ile opere ettiğimiz süperior sulcus tümörlü hastamızı literatür eşliğinde değerlendirdik. Olgu:53 yaş erkek hasta göğüs ağrısı ve kol ağrısı şikayeti ile kliniğimize başvurdu.Çekilen BT’sinde sağ akciğer üst lobta yaklaşık 4 cm boyutlarında olan ve 1,2,3 kostallara invazyon gösteren spiküler uzanımlı kitle saptandı. Pozitron emmisyon tomografisinde uzak metastazı olmayan hastaya tru-cut biyopsi yapıldı. Küçük hücreli dışı akciğer kanseri saptanan hastaya öncelikle mediastinoskopi yapılarak mediastinal değerlendirmesi yapıldı. Mediastinal değerlendirmesi negatif olan hastaya konkomittan neoadjuvan kemoterapi ve radyoterapi tedavisi verildi. Neoadjuvan tedavi sonrasında hasta onkoloji konseyi tarafından değerlendirilierek VATS ile akciğer rezeksiyonu ve 1,2,3,4 kot rezeksiyonu yapıldı. Hastanın postoperatif patoloji sonucu adenokarsinom olarak raporlandı. p(T2N1M0) gelen hasta 1 yılında nüks veya metastaz saptanmadan takibine devam edilmektedir. Sonuç: Gelişen teknoloji ile minimal invaziv operasyonlar yaygınlaşmakta ve operasyon çeşitliliği artmaktadır. Süperior sulcus tümör cerrahisinde VATS ile yapılan cerrahi yaklaşımlar deneyimli merkezlerde güvenli bir şekilde yapılabilmektedir.

In this article, we present a patient who underwent right pneumonectomy due to giant hydatid cyst in the right hemithorax and discuss the relevant literature. A 42-year-old man presented with complaints of chest pain and shortness of breath. Thoracic computed tomography (CT) revealed a cystic lesion measuring 30 × 20 cm in the right hemithorax. The patient was admitted for surgery. Right posterolateral thoracotomy was performed, followed by right pneumonectomy upon observation of complete destruction of the right lung due to the cystic lesion. There were no complications and the patient was discharged on postoperative day 5. The pathology report indicated hydatid cyst. Surgery is the main treatment for pulmonary hydatid cysts. The main purpose of surgery is to preserve the lung parenchyma. Operations such as pneumonectomy that are associated with high morbidity and mortality can be performed safely in patients with giant cysts.

Background: This study aims to evaluate the factors affecting survival and mortality in patients who underwent pneumonectomy for non-small cell lung cancer.Methods: The study included 241 pneumonectomy patients. Demographic data, mortality, histopathological characteristics, tumor stages, and 5-year survival rates were analyzed.Results: The study included nine women (3.7%) and 232 men (96.3%). The patients’ mean age was 58.4±8.0 (34–81) years. Fortyfive patients (18.7%) were 65 years of age or older, and 196 patients (81.3%) were less than 65 years of age. The 30-day postoperative mortality rate was 7.9% (n=19). The only factor affecting mortality was determined as age 65 and over (p = 0.012). The median survival time was 52 months, and the 5-year survival rate was 49.4%. In multivariate analysis, advanced age, pN2 status, not receiving neoadjuvant treatment, performing sampling lymph node dissection, and not receiving adjuvant treatment were poor prognostic factors.Conclusion: Age, pN2 status, neoadjuvant and adjuvant therapy, and lymph node dissection technique were determined as the most important prognostic factors affecting survival in patients who underwent pneumonectomy for non-small cell lung cancer. Age was the most important factor affecting mortality.

Taşıt titreşimlerini bastırmakamacıyla yapılan kontrolör tasarımlarında yol girişinin ölçülmesi zor ve eksensörler gerektirdiği için maliyetlidir. Bu yüzden, manyetoreolojik damper iledonatılmış süspansiyon sistemine sahip çeyrek taşıt modeline ait düşeytitreşimleri bastırmak için yol bozucusunun önceden bilinmesine veyaölçülmesine ihtiyaç duymayan bir lineer olamayan uyarlamalı kontrolör tasarımı buçalışma ile yapılmıştır. Bu amaç doğrultusunda, yolun farklı frekans, farklıgenlik ve farklı faz değerlerine sahip bilinmeyen ve birbirinden farklısinüzoidallerin toplamından oluştuğu varsayımı yapılarak Lyapunov esasınadayalı bir yol gözlemleyicisi tasarlanmıştır. Ele alınan kontrolör, modeliçerisinde yer alabilecek parametrik belirsizliklere karşı da en iyi cevabıgaranti edecek şekilde tasarlanmıştır. Önerilen yöntemin etkinliği pasifcevaplar ile zaman ve frekans alanında karşılaştırılarak incelenmiştir., Indesigned controllers in order to suppress the vehicle vibrations, the roadinput measurement process is difficult and costly as additional sensors arerequired. Therefore, a nonlinear adaptive semi-active controller is designedwithout road disturbance measurement for quarter vehicle model with suspensionsystem equipped with magnetorheological damper in this study. For this aim, aroad observer based on the Lyapunov approach is designed by assuming that theroad consists of a sum of different frequency, different amplitude, anddifferent phases. The controller is designed to guarantee the best response tothe parametric uncertainties that may be present in the model. Effectiveness ofthe suggested method is investigated in time and frequency domain with usingnumeric simulations and some graphics.

While railway vehicles are moving, a sudden change of superstructure stiffness in crossings at the starting and ending points of tunnels or bridges leads to undesired vibrations both on the track structure and in the vehicle. In this paper, simulations are performed by using a one-dimensional train-track coupled dynamic model under the condition of a light rail vehicle passed through a slab superstructure line with different stiffness values as a transition zone of the railway. The actual conditions used in Istanbul transportation are taken into account in the modelling of the track and the light metro vehicle. The model of the track consists of an Euler-Bernoulli beam resting on discrete supported rail pads, which are connected as a viscoelastic foundation to a rigid ground. The vertical vibrations are analyzed by a model in which track and 16 DOF semi-vehicle models are combined, including a dynamic wheel-rail contact. Two different controllers are designed in parallel with secondary suspensions in order to suppress vertical vibrations of the light rail vehicle resulting from the change in the dynamic conditions of the superstructure and the rail irregularity in the transition zone to increase the comfort of the passengers. For many simulation scenarios, including unloaded and fully loaded vehicle conditions at the average and maximum operational speeds, with and without track irregularities, the superiority of the fuzzy logic controller over the commonly used PID controller is shown in the time and frequency domain.

Bojiler, demiryollarinda kullanilan araclari tasimaya yarayan mekanik sistemlerdir. Tekerlek setleri, aks kutusu, fren donanimi, bolster, yatay damper, birincil ve ikincil suspansiyonlar boji sasisi uzerinde yer alir. Duz hatve kurplarda aracin dengeli sekilde ilerlemesini saglamak, arac hizla ilerlerken raydaki duzensizliklerden kaynaklanan titresimleri absorbe etmek, raylarda minimum asinmaya ve neden olmak bojinin diger gorevleri arasindadir. Rayli tasitlarda kullanilan en kritik elemanlardan birisi olan boji sasisinin son derece guvenli tasarlanmasi ve imal edilmesi onemli bir gerekliliktir. Bunun icin rayli sistemlerde guvenlik acisindan kati kurallari iceren standartlar kullanilmaktadir. TS EN 13749 standardi Turkiye tarafindan kabul edilen ve uygulanan birstandarttir. . Bu standart boji sasilerinin yapisal gerekliliklerini belirler. Iki seriden olusan bu calismanin birinci bolumunde; Y32 boji sasisinin asiri yuk durumlarindaki statik analizleri sonlu elemanlar yontemi kullanilarak (SEY) gerceklestirilmis ve TS EN 13749 standardinca uygunlugu degerlendirilmistir. Analizleri gerceklestirmek icin oncelikle Y32 Bojisinin uc boyutlu (3B) kati modeli olusturulmustur. 3B kati modelleme islemi Solidworks yazilimi kullanilarak gerceklestirilmistir. Yapisal analizler icin ise sonlu elemanlar yontemi tabanli Ansys Workbench yazilimi kullanilmistir. Olusturulan 3B kati model sonlu elemanlara hazirlik asamasi ve cozum agi olusturulmasi amaciyla Ansys Workbench yazilimina aktarilarak, gerekli gorulen geometrik duzenlemeler ve cozum agina ayirma islemi gerceklestirilmistir. Modelleme isleminde herhangi bir basitlestirmeye gidilmemis olup, gercekci bir model kurulmustur. Modelde uygun sekilde cozum agi olusturulmus, TS EN 13749 standardina uygun sekilde sinir sartlari ve kuvvetler uygulanmistir. Yapisal analizlerde kullanilan malzemelerin mekanik ozellikleri tanimlanmis ve parcalar arasi baglantilar Ansys Workbench yazilimi icerisinde kurulmustur. Yapisal analizler neticesinde elde edilen sonuclar TS EN 13749 standardinda izin verilen malzeme limit degerleri dikkate alinarak degerlendirilmis uygun olmayan kosullar icin cozum onerileri sunulmustur. Calismanin ikinci bolumunde ise, normal servis yuklemesi kosulu altinda Y32 bojisinin yorulma analizleri gerceklestirilmis olup, her dugum noktasina (node) karsilik gelen ortalama gerilme (mean stress) ve gerilme genligi (alternating stress) degerleri hesaplanmis ve yorulma sonuclari Haigh ve Goodman Diyagramlari’nda ayri ayri degerlendirilmistir.

Demiryolu tasitlarinda, yogun dinamik etkiler altinda kalmasi nedeniyle kati regulasyonlar cercevesinde tasarlanip uretilen bojiler sistemin guvenli surus sartlarini saglamasi acisindan oldukca onemli elemanlardir. Bojilerin yapisal gerekliliklerini ortaya koyan ve dunyada en cok kullanilan uluslararasi standart EN 13749 standardidir. Bu calismanin birinci bolumunde Y32 boji sasisinin asiri yuk durumlarindaki statik analizleri gerceklestirilmis ve sinir degerleri asan bolgeler icin gerekli yapisal onlemler onerilmistir. Iki seriden olusan bu calismanin bu bolumunde ise, normal servis yukleme durumundaki yorulma analizleri yapilarak EN 13749 standardinca uygunlugu arastirilmistir. Dinamik sistem elemanlarinda meydana gelen kirilmalarin %80’ninin yorulma nedeniyle oldugubilinmektedir.. Yorulma analizleri ile dinamik sistem elemanlarinin cevrim omurleri anlasilmaya calisilir. Calismanin birinci bolumunde uc boyutlu, basitlestirmeye gidilmeden gercekci bir kati modelin ve cozum agi yapisinin nasil olusturuldugundan bahsedilmistir. Kurulan modele bu bolumde yorulma analizleri icin EN 13749 standardina uygun sekilde sinir sartlari ve kuvvetler uygulanmistir. Analizlerde, Yuk Durumu 2, Yuk Durumu 5 ve Yuk Durumu 7 olmak uzere uc farkli normal servis yuklemesi ele alinmistir. Bunlardan ikisinin ayni anda sisteme etki etmesi durumlarini iceren 3 farkli durum icin yorulma analizleri gerceklestirilmistir. Her analizde bojinin iki farkli durum altinda 1 milyon adet cevrim sayisina ulasip ulasamadigina bakilmistir. Yorulma analizlerinde her dugum noktasina (node) karsilik gelen ortalama gerilme (mean stress) ve gerilme genligi (alternating stress) sonuclari cikartilmis ve bu sonuclar Haigh Diyagrami’nda degerlendirilmistir. Buna ek olarak, yorulma analizi Ansys Workbench programinda Goodman Diyagrami kullanilarak da cozdurulmustur. Boylece, literaturde kullanilan iki farkli yontemle Y32 boji sasi tasariminin normal servis yuklemesi durumlarinda EN 13749 standardinin gereklilikleri yorulma bakimindan arastirilmis ve bulgularda elde edilen degerler yorumlanmistir.

This study examined automobile vibrations by using a half vehicle model, and its vertical and angular vibrations were suppressed by means of the nonlinear adaptive control of a magneto-rheological damper. The control method was designed in such a way that it did not need to measure the road input to suppress the vibrations by the use of adaptive road observers. Therefore, disadvantages such as measurement difficulty and cost were also eliminated. Instead of completely experimental test rigs, the hardware-in-the-loop simulation which is a hybrid method was preferred due to it being easier to set up, cheaper, and also it had a close response to the full experimental system. The experimental responses obtained by the proposed adaptive control method with adaptive road observers and the nonlinear adaptive control method in which the road disturbances were measured were compared in the time and frequency domains. Finally, the effectiveness of the proposed method was shown using some figures, root mean square values, and performance indices.

Background We investigated whether all size-based pathological T4N0–N1 non-small cell lung cancer patients with tumors at any size >7 cm had the same outcomes. Methods We reviewed non-small cell lung cancer patients with tumors >7 cm who underwent anatomical lung resection between 2010 and 2016. A total of 251 size-based T4N0–N1 patients were divided into two groups based on tumor size. Group S ( n = 192) included patients with tumors of 7.1–9.9 cm and Group L ( n = 59) as tumor size ≥10 cm. Results The mean tumor size was 8.83 ± 1.7 cm (Group S: 8.06 ± 0.6 cm, Group L: 11.3 ± 1.6 cm). There were 146 patients with pathological N0 and 105 patients with pathological N1 disease. Mean overall survival and disease-free survival were 64.2 and 51.4 months, respectively. The five-year overall survival and disease-free survival rates were 51.2% and 43.5% (five-year OS; pT4N0:52.7%, pT4N1:47.9%, DFS; pT4N0:44.3%, pT4N1: 42.3%). No significant differences were observed between T4N0 and T4N1 patients in terms of five-year OS or DFS ( p = 0.325, p = 0.505 respectively). The five-year overall survival and disease-free survival rates were 52% and 44.6% in Group S, and 48.5% and 38.9% in Group L. No significant difference was observed between the groups in terms of five-year overall survival or disease-free survival ( p = 0.699, p = 0.608, respectively). Conclusions Above 7 cm, any further increase in tumor size in non-small cell lung cancer patients had no significant effect on survival, confirming it is not necessary to further discriminate among patients with tumors in that size class.

Objective In this study, we aimed to reveal the prognostic differences between skip and non-skip metastasis mediastinal lymph node (MLN) metastasis. Methods A total of 202 patients (179 males and 23 females; mean age, 59.66 ± 9.89 years; range: 29-84 years) who had ipsilateral single-station MLN metastasis were analyzed in two groups retrospectively between January 2009 and December 2017: "skip ipsilateral MLN metastasis" group (sN2) (n = 55,27.3%) [N1(-), N2(+)], "non-skip ipsilateral MLN metastasis" group (nsN2) (n = 147,72.7%) [N1(+), N2(+)]. Results The mean follow-up was 42.63 ± 34.91 months (range: 2-117 months). Among all patients, and in the sN2 and nsN2 groups, the median overall survival times were 63.5 ± 4.56, 68.8 ± 7, and 59.3 ± 5.35 months, respectively, and the 5-year overall survival rates were 38.2%, 46.3%, and 36.4%. Conclusion Skip metastasis did not take its rightful place in TNM classification; thus, further studies will be performed. To detect micrometastasis, future studies on skip metastasis should examine non-metastatic hilar lymph nodes (LNs) through staining methods so that heterogeneity in patient groups can be avoided, that is, to ensure that only true skip metastasis cases are included. Afterwards, more accurate and elucidative studies on skip metastasis can be achieved to propound its prognostic importance in the group of N2 disease.

Bu çalışmada, parametrik belirsizliklere sahip yüksek hızlı bir trende yolcu konforunun arttırılması gayesiyle tren gövdesinde meydana gelen düşey titreşimlerin ikinci süspansiyon sisteminde konumlandırılan parametrik belirsizliklere sahip doğrusal olmayan MR-damperler vasıtasıyla bastırılması amaçlanmıştır. Yol sürüş konforunun artırımı ve sistemin belirsizlik karşısındaki kararlılığının garanti altına alınması amacıyla uyarlamalı MR-damper tasarlanmıştır. Önerilen kontrolörün başarısı, zaman alanında kontrolsüz sistem cevapları ile yapılan karşılaştırma sonucu çeşitli performans indeksleri kullanılarak gösterilmiştir. Ayrıca, zaman alanında elde edilen cevapların PSD diyagramları ile frekans alanında da kontrolör başarısı araştırılmıştır.

OBJECTIVES The newly proposed N subclassification (new-N) was compared with the combined anatomical location and ratio of the number of metastatic lymph nodes to the total number of resected lymph nodes (anatomic-LNR) in terms of prognosis in resected lung cancer patients. METHODS Between 2005 and 2018, 961 patients who underwent lung cancer resection were catergorized into the pN1-single (N1a; n = 281), pN1-multiple (N1b; n = 182), pN2-single with skip metastasis (N2a1; n = 116), pN2-single with N1 metastasis (N2a2; n = 222) and pN2-multiple (N2b; n = 160) groups based on new-N. The optimal cut-off points for survival in pN1 and pN2 patients were determined using the best sensitivity and specificity scores, calculated using receiver operating characteristic analysis. RESULTS The difference in survival between N1a and N1b patients was statistically significant (P = 0.001), but there was no significant difference in the survival rates of N1b and N2a1 (P = 0.52). The survival curves for N2a1 and N2a2 patients almost overlapped (P = 0.143). N2a2 patients showed a better survival rate than N2b patients, with no significant difference (P = 0.132). The cut-off points for LNR were 0.10 and 0.25 for pN1 and pN2 patients, respectively, according to receiver operating characteristic analysis for survival. Based on receiver operating characteristic analysis, pN patients were categorized into the N1-lowLNR (n = 232), N1-highLNR (n = 231), N2-lowLNR (n = 266) and N2-highLNR (n = 232) groups. The 5-year survival rate was 62.9%, 49.8%, 41.1% and 27.1% for N1-lowLNR, N1-highLNR, N2-lowLNR and N2-highLNR, respectively (P CONCLUSIONS LowLNR is associated with better survival than highLNR in resected lung cancer patients. Anatomic-LNR shows a high discriminatory power for prognosis.

Degerli Meslektaslarimiz, Plevra hastaliklari, gunumuzde insidansi giderek artan ve hem gogus hastaliklari hem de gogus cerrahisi kliniklerinin pratiginde yaygin bir is yuku olusturan sorun halinde karsimiza cikmaktadir. Cok genis sebeplere dayali bir dagilim gosteren plevra patolojilerinin tani ve tedavi yontemi multidisipliner yaklasim gerekmektedir. Bu konuyla ilgili cikarilan eserler oldukca degerli teorik bilgiler icermekle birlikte pratik ve vaka noktasinda bilgi birikimini gerektigi olcude yansitmadigi gozlenmektedir. Bu dusunceden yola cikarak, plevral hastaliklari ve cerrahi tedavi yaklasimini olgu sunumlari esliginde ozetleyen alaninda bu yonuyle ilk eser olan bu kitabi degerli okuyucularimiza sunmaktan gurur duyuyoruz. Bu eserde gunumuzdeki plevra patolojilerine yaklasim, guncel tani rehberleri ve cerrahi tedavideki yenilikler, gogus hastaliklari ve gogus cerrahisi alanlarinda kursu sahibi olan degerli hocalarimiz tarafindan olgular esliginde islenmistir. Klinik tecrubelerin kanita dayali yontemlerle aktarildigi, vakalarin guncel pratigimizde rehberlik edecegi bir kaynak olarak titizlikle hazirlanmistir. Eserin tum bolumlerinin hazirlik asamasinda emegi gecen kiymetli hocalarimiza ayri ayri sukranlarimizi sunariz. Kiymetli meslektaslarimiza faydali olmasi temennisiyle…. Kizlarimiz Zulal, Elif, Defne, Gokcen ve tum saglik calisanlarinin cocuklarina armagan olmasi dilegiyle

Background: Our aim in this study was to compare the results of video-assisted thoracoscopic surgery with those of open surgery regarding efficacy, morbidity, and long-term recurrence of bronchogenic cysts in light of the literature. Methods: This study comprises the data of 51 patients whose pathological diagnosis revealed bronchogenic cyst after surgical excision between January 2010 and December 2016. There were two groups according to the type of resection: video-assisted thoracoscopic surgery (VATS) and thoracotomy. Results: Of the patients included in the study, 25 (49%) were male and 26 (51%) were female. Their average age was 41.7 ± 14.1 years. While 14 patients (27.5%) were asymptomatic in the preoperative period, 37 patients (72.5%) had symptoms. The Charlson Comorbidity Index was 0 in 35 patients (68.6%) and 1 and above in 16 patients (31.4%). While 22 (43.1%) patients underwent cyst excision via VATS, 29 (56.9%) patients underwent thoracotomy. The average length of hospital stay was 1.77 ± 0.68 days for patients who had VATS, whereas it was 3.82 ± 3.3 days for patients who had thoracotomy (p