Ankara Atatürk Eğitim ve Araştırma Hastanesi

Recycling and sustainability of geopolymer concretes are crucial for both the environment and the economy. For this purpose, the usability of recycled geopolymer concrete aggregates (RGAs) obtained by crushing geopolymer concrete produced from different aluminosilicate sources (perlite, blast furnace slag, red mud, volcanic ash, etc.) in the production of portland cement concrete was investigated. RGAs were used instead of normal aggregates as fine, coarse, and coarse+fine aggregates in concrete produced with CEM I cement. In the mixtures produced with CEM II cement, only coarse aggregates were replaced with RGAs. Compressive, flexural, and bond strength (pull-out test); restrained shrinkage (ring test); and drying shrinkage, ultrasonic pulse velocity, water absorption, and bulk density tests were performed. Additionally, the properties of the mixtures after exposure to high temperatures (300°C and 600°C) were investigated. The results showed that, with the incorporation of RGAs into concrete, regardless of the size of the RGA grains, compressive, flexural, and bond strength decreased. However, this decrease was more visible in compressive strength (14%–32% for 28 days). Drying shrinkage, water absorption, and permeable void volume increased, but cracking potential decreased. At high temperature (300°C), strength loss was 26% in reference mixture with CEM I cement (RCI) and 14% in reference mixture with CEM II cement (RCII), while RGA mixtures showed 12%–18% (CEM I) and 4%–5% (CEM II) loss. Although fine RGAs had lower compressive and flexural strength than coarse RGAs, drying shrinkage, water absorption, and permeability were lower. Mixtures of CEM II exhibited higher drying shrinkage than mixtures of CEM I. However, there was no significant difference between them in other properties.

Objective: This study analyzed demographic, clinical, and pathological features, treatment responses, and survival outcomes in non-metastatic esophageal SCC patients. Methods: A retrospective review of 74 patients was conducted. Performance status was assessed using ECOG, treatment response via RECIST 1.1, and staging via AJCC 7th edition TNM. Results: The male-to-female ratio was 0.95, with a mean age of 50.6. Tumors were mainly distal (58%), and most patients (68.7%) presented at stage 2 (25%) or 3 (43.7%). Surgery was performed in 64.9% (47.3% surgery only, 35.1% CRT only, 17.6% CRT + surgery). Median overall and disease-free survival were 38 and 24 months, respectively. Female gender, middle/lower tumor location, fewer metastatic lymph nodes, and CRT + surgery correlated with better survival (p < 0.05). Conclusion: Surgery was the most common treatment, but CRT + surgery yielded superior survival. Local recurrence was more frequent than distant metastasis. A combined approach is crucial for optimal outcomes.

The aim of this study was to investigate the factors affecting the development of pulmonary hypertension (PH) in patients with progressive massive fibrosis (PMF) and to determine the relationship between PH development and life expectancy. In this retrospective study, 181 patients with PMF were recruited over a 9-year period and 96 were eligible for analysis. We used echocardiography (ECHO) findings to estimate the likelihood of developing PH. We used Bernoulli's equation with tricuspid regurgitation velocity measurement and calculated systolic pulmonary artery pressure (sPAP) by adding the estimated right atrial pressure. We accepted sPAP values of 37 and 50 mm Hg as criteria for moderate and high probability PH. The prevalence of moderate or high probability PH (PH group) was 29.1% in patients with PMF. Older age (OR:1.059, p=0.036) and presence of C opacity (OR:4.607, p=0.024) were found to be risk factors for PH in patients with PMF. The survival rate (39.2%) and mean survival time (65.20±9.94 months) were significantly lower in the PH group compared to the non-PH group (p=0.002). PH development was primarily associated with fibrotic disease burden rather than coexisting airflow obstruction. The development of PH and the increase in the degree of PH have a negative effect on the mean survival time. Preventing the development of PMF, which has a poor prognosis, by taking necessary precautions is the most effective option in treatment.

AimIMpower133 was designed with 4 cycles of chemoimmunotherapy with atezolizumab, unlike many other studies permitted 6-cycle induction. This study aimed to compare the efficacy and safety of a 4-cycle regimen with an extended 6-cycle regimen of carboplatin, etoposide, and atezolizumab in the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC).MethodsThis retrospective multicenter study was conducted across 13 oncology centers in Turkey. A total of 181 patients with ES-SCLC who received first-line treatment with chemotherapy plus atezolizumab were analyzed and grouped into those receiving 4 cycles (n = 101) and 6 cycles (n = 80) of treatment.ResultsThe median follow-up time was 20.9 months. The objective response rates were similar between the 4- and 6-cycle groups (79.2% vs 78.8%, P = .940). The disease control rates were also comparable (84.2% vs 86.3%, P = .940). The median progression-free survival (PFS) was 6.3 months in the 4-cycle and 8.1 months in the 6-cycle group (P = .357). The median overall survival (OS) was 16.6 months for the 4-cycle and 13.6 months for the 6-cycle group (P = .583). Intracranial progression was higher in the 4-cycle group (50.0% vs 25.5%, P = .007). Immune-related adverse events were similar between the groups.ConclusionThis is one of the largest real-world datasets comparing the efficacy and safety of 4 versus 6 cycles of induction chemoimmunotherapy. Although there were no significant improvements in PFS or OS, the 6-cycle regimen was associated with a lower observed rate of intracranial progression, predominantly among patients without baseline brain metastases. Further studies are needed to identify this subject in future.

Amaç: İmmatür granülositler (IG); bant nötrofil, bazofil veya eozinofil formuna immatür granülositik miyeloid hücreler olarak tanımlanmaktadır. IG’ler enfeksiyon, inflamasyon, sepsis ve diğer uyaranlar olduğunda kemik iliğinden salınan prematüre granülositlerdir (promiyelosit, miyelosit, metamiyelosit). Osteoporoz vücut immün disfonksiyonu ve sistematik inflamasyon aktivasyonu ile yakından ilişkilidir. Bu çalışmadaki amacımız osteoporoz olan ve olmayan hastalar arasında IG ve kemik mineral yoğunluğu ilişkisini değerlendirmektir.Gereç ve Yöntemler: Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’ne Kasım 2022 – Kasım 2023 tarihleri arasında postmenapozal 50-80 yaş aralığında rutin kontrol için başvuran ve kemik mineral dansitometri (KMD) çekimi yapılan, demografik verileri ve immatür granülosit sayıları olan hastalar çalışmaya dâhil edildi. Çalışmamızda hastalar; T skoru -2,5 ve altı olanlar (n=199) (Grup 1), T skoru -2,5 ve -1 arasında olanlar (n=213) (Grup 2), T skoru -1 ve üzeri olanlar (n=203) (Grup 3) olmak üzere 3 gruba ayrılmışlardır.Bulgular: Grup1’de yaş, immatür granülosit sayısı, immatür granülosit yüzdesi ve lenfosit sayısı anlamlı olarak bulunmuştur (p = 0,000*). Pearson Ki-kare testi (p = 0,000*) sonucuna göre sigara içme durumu ile KMD arasında anlamlı bir ilişki bulunmaktadır. Sigara içenlerin oranı, grup 1'de en yüksektir(%43,7). Daha düşük KMD olan bireylerde sigara içme oranı artmaktadır (p = 0,000*). Hastalık durumu baz alınarak kurulan lojistik regresyon modeline göre İmmatür granülosit sayısı 1 birim arttığında, hastalık riskinin %96,3 azalacağı tespit edilmiştir.Sonuç: Çalışmamız inflamatuar süreçlerin kemik mineral dansitesi üzerindeki etkilerini değerlendirmiş ve immatürgranülosit sayısının osteoporoz tanısında potansiyel bir biyobelirteç olarak kullanılabileceğini göstermiştir.

This study investigates the relationship between psychological resilience and burnout among parents of children attending special education institutions. Prolonged stress in these parents often leads to burnout and depression, adversely affecting both parental well-being and child outcomes. The research involved 155 participants (103 mothers, 52 fathers), who completed the Maslach Burnout Inventory (MBI) and the Psychological Resilience Scale (PRS). The analysis focused on how resilience subdimensions self-perception, social competence, structural style, family cohesion, future perception, and social resources predict burnout components: emotional exhaustion and depersonalization. Results revealed that psychological resilience subdimensions collectively accounted for 15% of the variance in emotional exhaustion (R² = .146, p<.01), with social resources emerging as the sole significant individual predictor (p<.01). For depersonalization, resilience subdimensions explained 30% of the variance (R² = .298, p < .001), with structural style, family cohesion, social competence, and social resources serving as significant predictors (p<.05 to p< .001). These findings underscore psychological resilience as a protective factor against burnout, particularly highlighting the role of social resources in mitigating emotional exhaustion and multiple resilience components in reducing depersonalization. The study aligns with existing literature, emphasizing that enhancing parents’ resilience especially through strengthening social networks, family cohesion, and adaptive coping strategies can buffer against burnout. Interventions targeting these resilience factors may improve parental mental health, thereby fostering more supportive environments for children with special needs. These insights advocate for integrating resilience-building programs into support systems for families in special education contexts, addressing both individual and relational dimensions of well-being.

Pembrolizumab, an immune checkpoint inhibitor used in cancer therapy, is associated with immune-related adverse effects, yet its impact on female reproductive health remains unclear. This study aimed to evaluate the effects of pembrolizumab on ovarian function and hormonal balance in a mouse model. Twenty-four Swiss albino mice were divided into acute and chronic groups, each comprising a pembrolizumab-treated and a saline-control subgroup (n=6 per subgroup). All mice underwent a superovulation protocol, and serum levels of estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) were measured using enzyme-linked immunosorbent assay kits. Ovarian tissues were evaluated histologically for follicular counts, including primordial, preantral, and secondary follicles. Estradiol levels were significantly reduced in pembrolizumab-treated mice compared with controls (p=0.007). Significantly higher levels of LH were observed in the chronic control group compared to the chronic pembrolizumab-treated group (p=0.023), while FSH and AMH levels did not differ significantly (p=0.461 and p=0.460, respectively). Primordial follicle counts were significantly higher in control groups than in pembrolizumab-treated groups (p=0.009). Pembrolizumab administration in mice led to reduced estradiol levels and diminished primordial follicle counts, indicating potential adverse effects on ovarian reserve. These findings highlight the importance of evaluating reproductive risks in female patients receiving immunotherapy.

Coconut shell, as an agricultural waste product, has emerged as a promising alternative aggregate in foam concrete (FC), contributing to both environmental sustainability and enhanced material properties. Using ceramic powder (CP) as a partial replacement for cement in FC significantly enhances sustainability by reducing CO2 emissions from cement production. This substitution not only recycles waste materials effectively but also improves thermal insulation and durability, making FC a more eco-friendly and efficient construction material. This study aims to create eco-friendly FC by examining the combined effects of CP and coconut shell aggregate (CSA) as partial substitutes for portland cement (PC) and river sand (RS), respectively. FC mixtures were produced with 0%, 10%, and 20% CP replacing PC and 0%, 25%, 50%, and 100% CSA replacing RS. A total of 12 FC mixtures were formulated, all maintaining a constant water-to-binder (w/b) ratio of 0.6. The effects of varying CP and CSA content on fresh-state, physical, and mechanical properties; sorptivity; thermal conductivity; high-temperature resistance; freeze-thaw durability; and resistance to HCl and MgSO4 were evaluated. Additionally, the microstructure of the mixtures was analyzed using scanning electron microscopy (SEM). The findings showed that mixtures with CSA enhanced thermal insulation and decreased density, but increasing CP content often decreased flowability and fresh unit weight. The mechanical performance of FC was improved by replacing RS with CSA, notably at 25% and 50% CSA levels. In contrast, CP decreased compressive strength but improved durability, especially when exposed to high temperatures and chemicals. Notably, in terms of chemical resistance and thermal stability, the mixture containing 10% CP and 50% CSA performed the best.