Kocaeli University

This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The retrospective multi-centre “MF18-02” and the prospective multi-centre cohort registry trial “MF18-03” (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/− axillary lymph node dissection (ALND) post-NAC. A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.

OBJECTIVE This study aimed to develop a robotic system with autonomous functionality for holding and manipulating the endoscope in endoscopic endonasal surgery. A cost-effective prototype was created with the goal of using robotic assistance and achieving a more efficient learning curve for endoscopic surgery. METHODS A Stewart platform–based endoscope holder and positioner robotic system, developed by the Mechatronics Engineering Department of Kocaeli University, was used in conjunction with 3D Slicer and Plus Toolkit open-source health technology software. Following initial configuration on a 3D skull model, the system was applied to a fresh-frozen cadaver. RESULTS The robotic system and its registration process proved feasible, allowing the robot to autonomously reach predetermined anatomical points during the nasal step of the surgery. Compared with a previous study by the same authors, the surgery duration was successfully shortened. The experiment yielded positive outcomes in both the artificial skull model and the cadaver. The robotic system effectively performed the nasal stage of the surgery. The integration of a robotic surgical arm in the endoscopic endonasal approach holds the potential to enhance the learning curve through shared experiences. The robot offers assistance to surgeons during the learning phase of the endoscopic endonasal approach, aiding in the identification of anatomical landmarks through preoperative planning. CONCLUSIONS This system may present advantages such as improved visualization, enhanced maneuverability, and reduced user fatigue compared with conventional methods. These findings show the potential of robotic assistance in endoscopic surgical techniques.

Wheat stands as one of the few crops globally that continues to grow in strategic importance, boasting a cultivation history as ancient as humanity itself. Renowned for its essential role in the human diet, wheat grain provides not only starch and energy but also protein, gluten, and other valuable health-promoting components. This study assessed the yield and quality traits of wheat varieties in the Erzincan and Erzurum regions, conducted without irrigation over the years 2018, 2019, and 2020. The findings indicated that the Erzincan region exhibited statistically superior outcomes in terms of grain yield (25.72 kg ha⁻¹), wet gluten ratio (26.86%), and protein content (12.51%). Specifically, the Ekiz variety in Erzincan province achieved the highest grain yield (26.28 kg ha⁻¹), while the Pehlivan variety led in Erzurum with a yield of 22.94 kg ha⁻¹. Multivariate analyses highlighted significant influences of weather conditions and crop maturity on the protein and gluten contents. Consequently, the study provided critical insights into the selection of wheat varieties for cultivation in both regions and the responsiveness of these traits to varying climatic conditions.

BACKGROUND In recent years, advanced oxidation processes (AOP) have gained importance as highly effective methods in the treatment of organic substances with toxic and permanent properties. Diclofenac (DCF) and Triclosan (TCS) pollutants, which are from the endocrine disrupting chemicals (EDCs) that were encountered in various aquatic environments such as inlet and outlet waters of treatment plants, surface waters, drinking water, groundwater and sediments were reported in the literature. In this study, mineralisation of DCF and TCS pollutants, which were the EDCs, were investigated by AOPs. The applied processes were O3, O3/UV, O3/ZnO, UV/ZnO, and O3/UV/ZnO. The studies were carried out at two different initial concentrations (5 and 10 mg/L), at 5 ppm ozone dose, 2 × 8 W UVC light, 0.1 g ZnO, in the original pH, and 30 min reaction time. RESULTS The highest COD and TOC removal efficiencies were determined in O3/UV/ZnO process as 82% COD, 71% TOC at 5 mg/L concentration for DCF pollutant and as 72% COD, 75% TOC at 10 mg/L concentration for TCS pollutant. For these process conditions, the ozone consumptions were determined 0.13 mgO3/mgCODremoved, 0.31 mgO3/mgTOCremoved and 0.69 mgO3/mgCODremoved, 0.98 mgO3/mgTOCremoved, respectively. The electrical energy per order values were found in the range of 12.33–20.88 kWh/m³ for O3/UV/ZnO processes. Treatment costs of these processes were calculated in the range of 0.002 to 44.823 €/m³. CONCLUSION For the treatability of DCF and TCS pollutants, ozone‐based advanced oxidation processes, especially O3/UV/ZnO photocatalytic ozone oxidation process were determined as a feasible process. © 2024 Society of Chemical Industry (SCI).

Background In reconstructive surgeries, iliac crest bone graft harvesting is commonly preferred. The pain experienced after surgery at the anterior iliac crest (AIC) donor site might be more intense compared to the pain at the primary surgical area where the graft is placed. To address this issue, we defined a novel technique called the anterior iliac block (AIB), which can provide analgesia with lower volumes. In this study, the effect of this technique for AIC bone greft harvesting was evaluated. Methods Patients who were operated on and had AIC bone graft harvested included in this retrospective study. The study collected age, height, weight, ASA classification, and duration of surgery, information on the regional anesthesia technique, block performance, postoperative pain severity, opioid consumption, rescue analgesics used in the first postoperative 24 h. Results Data from 16 patients were analyzed. The popliteal sciatic block was performed in eight patients, infraclavicular brachial plexus block in four patients, supraclavicular brachial plexus block in one patient, PENG block in one patient, and proximal adductor canal block in two patients two provide analgesia for primary surgery. The median morphine consumption at postoperative 24th hour was 3.5 mg, median NRS score was 1 at postoperative 1st hour, and 0 at postoperative 6th, 12th and 24th hours. Conclusions The study findings indicate that the AIB provides adequate analgesia for AIC graft harvesting in the first postoperative 24-hour period. It can be used as an adjuvant to the peripheric nerve block for the primary surgical site. Trial registration NCT06295224.

In this study, the synergistic effect of the flame-retardant additives on the properties of poly(lactic acid) (PLA) was investigated and at the same time, it was tried to increase the toughness of PLA by adding small amounts of phosphate-based additives to plasticized PLA as binary and ternary mixtures. Poly(ethylene glycol) (PEG) was used as a plasticizer. As flame retardant additives, ammonium polyphosphate (APP), tri-phenyl phosphate (TPP), and boron phosphate (BP) were used. Characterization of the composites was carried out by tensile test, impact test, differential scanning calorimetry (DSC), thermal gravimetric analyses (TGA), scanning electron microscopy (SEM), limiting oxygen index (LOI), and UL-94 horizontal burning tests. In addition, TGA-FTIR analyses were carried out to understand the thermal degradation mechanism of composites during combustion. According to the SEM micrographs of the burnt surfaces of the samples, a smooth and flat structure is observed in PLA/PEG/5TPP-5BP sample, while a porous structure and branching formations are observed in other composite samples. Among the composite samples, the best flame retardancy features were observed in the composite containing PLA/PEG/5APP-2.5TPP-2.5BP sample, and the highest impact strength and elongation at break values were obtained in the composite containing PLA/PEG/5APP-5TPP sample.

In this study, an ANN‐based Global Navigation Satellite System (GNSS) location data reduction approach was proposed. As GNSS location data becomes more common, efficient data reduction techniques are needed to reduce transmission, storage, and processing costs. This involves selecting key points from the original trajectory to maintain integrity, eliminating redundancy, and lowering transmission and storage expenses. In this study, we proposed a new method for reducing GNSS location data in both online and offline settings, utilizing an ANN trained with a mathematically generated dataset. ANN has not been used in data reduction in the literature. The approach involves training the ANN with a window size of 3 and a threshold value of 10°, followed by using the trained model for data reduction. Experimental results show that the ANN achieves a reduction rate of around 59.18% compared to the original trajectory. Notably, the ANN yields a significantly lower RMSE compared to a mathematical method, particularly in areas requiring precision. Despite the slightly slower computation times, the ANN remains suitable for real‐time applications, demonstrating its efficacy for GNSS location data reduction. Our study highlights its online capability, reasonable reduction rates, and low RMSE values, distinguishing it from existing literature. This method shows potential for scenarios where balancing reduction rates with data quality is crucial.

AC electrokinetics have been used to enhance the performance of slow diffusion-based microfluidic biosensors. Electro-osmotic flow generated by non-uniform wall surface charge overcomes this problem by producing re-circulatory flow near the sensor surface. Using such flow patterns, a two-dimensional computational model was developed and investigated for binding enhancement strategies. The effect of various design and operating parameters was studied. The parameters like concentrations of antigen, bulk flow velocity, zeta potential, reaction surface length, pitch, electrode voltage, channel geometry, length of electrode, and initial position of electrode showed a significant improvement of 360.20%, 205.23%, 84.82%, 48.93%, 28.53%, 26.97%, 17.58%, 6.80%, and 4.43%, respectively, on biosensors binding performance for the initial period of 100 s.

Universities undertake critical duties in the development of countries and increasing the level of welfare. Therefore, to achieve sustainable development goals, it is important that they focus their efforts on sustainable campus practices and contribution to society. In this work, organizational life cycle assessment was conducted to identify major environmental aspects and the most impactful processes related to the education and research activities of Kocaeli University. Life cycle impact assessment was performed by EF 3.0 method to evaluate sixteen environmental impact categories and they were comparatively assessed for the two scenarios: present situation (PS) and alternative scenario (AS—which includes increasing renewable energy rate in electricity generation). The major environmental aspects were identified as climate change and use of fossil resources. They constituted approximately 41% and 20% of overall environmental burden of the university campus for the year of 2022; respectively. Considering the processes related to the university campus activities, electricity consumption and heating with natural gas were determined as the most impactful processes which accounted for approximately 80% of the overall environmental burden. On the contrary, treatment of wastewater in the biological wastewater treatment plant located on the university campus ensured 6% environmental saving on overall environmental burden. Comparing two scenarios, it was determined that all impact categories decreased in AS compared with PS; except from the impact category for mineral and metal resource use. According to the uncertainty analysis, AS performed better than PS by 60% of the iterations for overall environmental burden.

To investigate the rate of colchicine use in the longitudinal follow-up of familial Mediterranean fever (FMF) carriers and identify variables that could predict the necessity of colchicine treatment in this group. The study was conducted in 9 pediatric rheumatology centers. The files of children with MEFV gene carriers were retrospectively reviewed between February 2014 and May 2024. The study included 869 children with a median follow-up duration of 28 months (12–124). In most of the cases (n: 369; 43.5%), MEFV gene analysis was ordered by a pediatric rheumatologist, while in 228 children (26.2%), gene analysis was conducted at the request of a geneticist. The most common reason for ordering MEFV gene analysis was the presence of FMF-like symptoms (n: 349; 40.1%), followed by genetic screening due to a family history of FMF in relatives (n: 267; 30.7%). Colchicine therapy was initiated in 13.9% (n: 121) of the children. Variables that showed statistically significant differences in colchicine users included having a family history of amyloidosis, the MEFV gene ordered by a pediatric rheumatologist, and the presence of FMF-like symptoms. Conclusions: A small number of MEFV gene carriers develop FMF symptoms during the follow-up period, most commonly within 2–3 years. We do not recommend routine family screening for the MEFV gene after the diagnosis of an index patient unless there is a history of amyloidosis in the family or individuals having FMF-like symptoms. What is Known: • Familial Mediterranean fever (FMF) is an autosomal recessive disorder, but around 20–30% of FMF patients have only one sequence variant in the MEFV gene. • There are only a few studies that have focused on the longitudinal follow-up of MEFV gene carriers. What is New: • A minority of MEFV gene carriers require colchicine treatment, most commonly within the next 3 years. • The presence of previous FMF-like symptoms and a family history of amyloidosis are the most significant parameters for predicting colchicine use during the follow-up.

Background Studies about the evaluation of nursing care from the patient’s perspective are becoming more important. Ethic is an essential element in nursing care. Every person deserves to receive nursing care according to ethical principles, regardless of language, religion, race, or gender. In this study aimed to develop an instrument to evaluate the ethical behavior of nurses. Methods The methodological study used a mixed research method designed in accordance with the GRAMMS criteria. Qualitative data was obtained through in-depth interviews. Quantitative data were collected using the Ethical Behavior Scale in Nursing (EBSN). This study was conducted in 4 hospitals (nurses) and 3 health faculty (intern nurses/nursing students) in 2022. There are a total of 714 participants. The construct validity of the scale was evaluated with exploratory factor analyses (EFA) and confirmatory factor analyses (CFA). Cronbach’s alpha and item total analysis established the internal consistency. Pearson correlation was used for the relationship between the total scale and sub-dimensions. Results Cronbach’s alpha coefficient of the EBSN was 0.94. EBSN had 20 items and a five-factor structure which explained 70.45% of the total variance. Principal component analysis and CFA supported the theoretical construct EBSN. Fit measurements (x²/df) was 3.33. Pearson’s correlation coefficient in this data was 0.97. Conclusion The results of the analysis show the items constituting the scale have validity and reliability criteria that can measure the ethical behavior in nursing profession. It is thought that including activities that will enable nurses to gain positive individual and professional values on ethical issues such as patient rights and patient privacy during the education process will also positively affect their ethical sensitivities. Additionally, in order to increase nurses’ ethical awareness, nursing ethics issues should be included in post-graduation continuing education programs.

Purpose: Lymphadenopathies in the neck are associated with several etiological factors, such as inflammation, infection, and tumors. We diagnose some of these lymphadenopathies using serologic tests, while others are diagnosed using biopsies. The C-reactive protein/albumin ratio (CAR) has recently emerged as a crucial inflammatory marker in cardiovascular diseases and various types of cancer. Our aim in this study was to investigate the role of the CAR in the preliminary diagnosis of patients with unexplained neck lymphadenopathy. Methods: Between 2013 and 2020, 223 patients presented to our clinic with neck lymphadenopathy. Among these patients, whose cause of lymphadenopathy was not identified, 74 patients (8 children, 66 adults) who underwent neck lymphadenopathy excision were included in the study. Patients were divided into 4 groups according to pathology results: (1) patients with reactive lymphoid hyperplasia; (2) patients with granulomatous disease; (3) patients with lymphoma; and (4) patients with metastatic disease. C-reactive protein (CRP), albumin, and CAR values were compared. Results: When the CAR of the patients were compared, a significant difference was found between reactive lymphoid hyperplasia and lymphomas ( P = .006). CRP values were significantly higher in lymphomas than in lymphoid hyperplasia ( P = .007). When the albumin values of the patients were compared, it was found that the albumin value was significantly lower in patients with metastatic disease than in those with reactive lymphoid hyperplasia ( P = .032). Patients with carcinoma metastases were more common in male patients than in other groups. Conclusion: The CAR is a parameter that can be used in the preliminary diagnosis of unexplained neck lymphadenopathy. The elevation should be evaluated in favor of malignancy. It can be used as an auxiliary parameter, particularly in the diagnosis between the preliminary diagnosis of reactive lymphoid hyperplasia and lymphoma.