Histopathology image classification: highlighting the gap between manual analysis and AI automation

The field of histopathological image analysis has evolved significantly with the advent of digital pathology, leading to the development of automated models capable of classifying tissues and structures within diverse pathological images. Artificial intelligence algorithms, such as convolutional neural networks, have shown remarkable capabilities in pathology image analysis tasks, including tumor identification, metastasis detection, and patient prognosis assessment. However, traditional manual analysis methods have generally shown low accuracy in diagnosing colorectal cancer using histopathological images. This study investigates the use of AI in image classification and image analytics using histopathological images using the histogram of oriented gradients method. The study develops an AI-based architecture for image classification using histopathological images, aiming to achieve high performance with less complexity through specific parameters and layers. In this study, we investigate the complicated state of histopathological image classification, explicitly focusing on categorizing nine distinct tissue types. Our research used open-source multi-centered image datasets that included records of 100.000 non-overlapping images from 86 patients for training and 7180 non-overlapping images from 50 patients for testing. The study compares two distinct approaches, training artificial intelligence-based algorithms and manual machine learning models, to automate tissue classification. This research comprises two primary classification tasks: binary classification, distinguishing between normal and tumor tissues, and multi-classification, encompassing nine tissue types, including adipose, background, debris, stroma, lymphocytes, mucus, smooth muscle, normal colon mucosa, and tumor. Our findings show that artificial intelligence-based systems can achieve 0.91 and 0.97 accuracy in binary and multi-class classifications. In comparison, the histogram of directed gradient features and the Random Forest classifier achieved accuracy rates of 0.75 and 0.44 in binary and multi-class classifications, respectively. Our artificial intelligence-based methods are generalizable, allowing them to be integrated into histopathology diagnostics procedures and improve diagnostic accuracy and efficiency. The CNN model outperforms existing machine learning techniques, demonstrating its potential to improve the precision and effectiveness of histopathology image analysis. This research emphasizes the importance of maintaining data consistency and applying normalization methods during the data preparation stage for analysis. It particularly highlights the potential of artificial intelligence to assess histopathological images.

The level of depression, anxiety, and sleep quality in pregnancy during coronavirus disease 2019 pandemic

Aim

We aimed to evaluate the mental health and sleep quality of pregnant women in different trimesters during coronavirus disease 2019 (COVID‐19) pandemic and investigate the effect of quarantine and new lifestyle changes that come into our lives with pandemic with on this subject.

Methods

It was conducted on pregnant women (n = 149) who attended routine pregnancy prenatal visit during their pregnancy weeks. The data were collected using sociodemographic and clinical data form, Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) to evaluate maternal depression and anxiety.

Results

A significant correlation was observed between the week of gestation and depression, anxiety, and defective sleep scores (p < 0.001). A moderate positive correlation was found between the week of gestation and depression (r: 0.628). A high level of positive correlation was found between the week of gestation and defective sleep quality and anxiety scores (r: 0.858, r: 0.754). A statistically significant increase in depression, anxiety, and defective sleep quality was found in the group staying in home quarantine (p = 0.002).

Conclusion

This study showed that the COVID‐19 pandemic can cause depression, anxiety, and serious sleep disorders in pregnant women. The depression and anxiety scores of pregnant women in home quarantine were also found to be higher than the group not in quarantine. As the week of gestation progresses, mental health symptoms worsen and sleep quality deteriorates.

A bibliometric analysis of the 103 top-cited articles in endodontics

Objective: The purpose of this study was to identify the 100 top-cited articles in endodontics and analyse their bibliometric characteristics. Material and methods: The Web of Science database was reviewed to identify the relevant articles. Results: One hundred and three articles were included because the last four articles had the same number of citations. The top-cited article received 2115 citations. The articles were published in 28 different journals, with the most popular publication being the Journal of Endodontics (n = 36). The most prolific country was the United States (n = 41), followed by Sweden (n = 17) and Switzerland (n = 8). The most prolific author and institution were M. Torabinejad (n = 12) and Umeå University (n = 9), respectively. The majority of articles were of a basic science nature (n = 55), while endodontic microbiology (n = 24) was the most frequent subspecialty. The most common study design used in clinical articles was non-randomized experimental study (n = 5). Half of the clinical articles (n = 11) had a level III evidence score. Conclusions: The present citation analysis provides insights into the historical progress and current trends in endodontics.

Can Laws Be a Potential PET Image Texture Analysis Approach for Evaluation of Tumor Heterogeneity and Histopathological Characteristics in NSCLC?

We investigated the association between the textural features obtained from ¹⁸F-FDG images, metabolic parameters (SUVmax_, SUVmean, MTV, TLG), and tumor histopathological characteristics (stage and Ki-67 proliferation index) in non-small cell lung cancer (NSCLC). The FDG-PET images of 67 patients with NSCLC were evaluated. MATLAB technical computing language was employed in the extraction of 137 features by using first order statistics (FOS), gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), and Laws' texture filters. Textural features and metabolic parameters were statistically analyzed in terms of good discrimination power between tumor stages, and selected features/parameters were used in the automatic classification by k-nearest neighbors (k-NN) and support vector machines (SVM). We showed that one textural feature (gray-level nonuniformity, GLN) obtained using GLRLM approach and nine textural features using Laws' approach were successful in discriminating all tumor stages, unlike metabolic parameters. There were significant correlations between Ki-67 index and some of the textural features computed using Laws' method (r = 0.6, p = 0.013). In terms of automatic classification of tumor stage, the accuracy was approximately 84% with k-NN classifier (k = 3) and SVM, using selected five features. Texture analysis of FDG-PET images has a potential to be an objective tool to assess tumor histopathological characteristics. The textural features obtained using Laws' approach could be useful in the discrimination of tumor stage.

Epidemiologic features of ınflammatory bowel disease in Western Blacksea region of Turkey for the last 10 years: retrospective cohort study

BACKGROUND/AIMS

There are only a few epidemiological study about inflammatory bowel disease in the last 10 years in Turkey, especially in Western Blacksea region. In our study, we aimed to identify the changes in the incidence and the prevalence of inflammatory bowel disease in Western Blacksea region at the last 10 years.

METHODS

Totally 223 patients with inf lammatory bowel disease (160 ulcerative colitis, 63 Crohn's disease) were enrolled in the study followed up between 2004 to 2013 years. The epidemiological characteristics of patients were recorded.

RESULTS

The prevalences were 12.53/105 and 31.83/105 for Crohn's disease and ulcerative colitis respectively. Mean annual incidences increased from 0.99/105 and 0.45/105 for ulcerative colitis and Crohn's disease (2004 to 2005 years) to 4.87/105 and 2.09/105 for ulcerative colitis and Crohn's disease respectively (2011 to 2013 years). While the prevalence was higher in urban areas in Crohn's disease (12.60/105 ), it was higher in rural areas in ulcerative colitis (36.17/105 ). In ulcerative colitis, mean annual incidences were 2.91/105 and 2.86/105 for urban and rural areas respectively. In Crohn's disease, they were 1.37/105 and 1.08/105 for urban and rural areas respectively.

CONCLUSION

The incidence of inflammatory bowel disease seems to increase in Western Blacksea region at the last 10 years. This increment is more prevalent in rural areas.

The effect of oxytocin and Kisspeptin-10 in ovary and uterus of ischemia-reperfusion injured rats

OBJECTIVE

Ischemia/reperfusion (I/R) injuries result in damage to endothelial and parenchymal cells. Oxytocin (OXY) stimulates uterine contraction during parturition and myoepithelial cells during suckling. OXY has been used as a protective antioxidant. Kisspeptin plays a key role in the central control of reproductive functions and onset of puberty. Recent studies show that these reproductive hormones have protective potential as antioxidant. The aim of this study is to investigate the potential protective effects of Kisspeptin and OXY as antioxidants on I/R injured ovary and uterus of female rats.

MATERIALS AND METHODS

Rats were separated into five groups. Group 1, is control group; Group 2, rats were subjected to ischemia followed by reperfusion. Group 3, OXY administration 30 min prior to I/R applied rats; Group 4, Kisspeptin administration 30 min prior to I/R applied rats; Group 5, OXY and Kisspeptin administration 30 min prior to I/R. Ovary and uterus were removed for histopathological and biochemical observations. Malondialdehyde, glutathione levels, and superoxide dismutase activities were analyzed in order to observe antioxidant potential of OXY and Kisspeptin. Hematoxylin and Eosin staining was applied for histopathologic scoring.

RESULTS

Stromal and granulosa cells in ovary, endometrial cells in uterus were damaged in I/R group. The cellular damage of ovary and uterus were reduced in OXY and Kisspeptin administered I/R group when compared to only Kisspeptin injected I/R group and I/R group. There is no significant difference between OXY and OXY + Kisspeptin injected I/R groups. MDA levels were decreased in Kisspeptin and/or Oxytocin applied I/R group compared to I/R group. SOD activity and GSH levels were increased in Kisspeptin and/or OXY applied I/R group compared to I/R group.

CONCLUSIONS

The present results suggest that exogenous application of oxytocin and kisspeptin can have antioxidant effects on the uterus and ovary.

Pharmacokinetic, pharmacodynamic, and clinical aspects of ovulation induction agents: A review of the literature

Controlled ovarian hyperstimulation is a key step for successful outcomes of assisted reproductive technique cycle outcomes. Many medications are available, which are commonly useed solely or in combination to achieve multiple follicular development. Pharmacokinetic, pharmacodynamic, and clinical information of ovulation induction drugs deserve to be elucidated for every individual patient before commencing infertility treatment. New concepts and new treatment protocols are introduced as ovulation physiology is understood by infertility specialists. Increasing treatment success by minimizing aderse effects is a milestone of all ovarian stimulation protocols that use these novel interventions. Achievement of a satisfactory cycle outcome includes retrieval of sufficient oocytes, a single clinical pregnancy, and avoidance of ovarian hyperstimulation syndrome. In this review, we evaluate the current literature to determine the most reliable and relevant information about the most used ovulation induction drugs.

The efficacy of tyrosine kinase inhibitor dasatinib on colonic mucosal damage in murine model of colitis

BACKGROUND AND OBJECTIVE

Ulcerative colitis is an inflammatory condition of the colon in the gastrointestinal system. Currently, the most potent medications used for ulcerative colitis produce no response in 20-30% of cases. There is a need for more efficient and reliable medications. Tyrosine kinase inhibitors have shown efficacy in some inflammatory diseases. Although dasatinib, a tyrosine kinase inhibitor, suppresses proinflammatory cytokines in colonic tissue, there are a few cases of hemorrhagic colitis with dasatinib. There is no study investigating the effect of dasatinib on experimental colitis. We aimed to investigate the effect of dasatinib in a colitis model induced with acetic acid in our study.

METHODS

In the study, 24 male Sprague-Dawley rats randomly distributed into 4 groups of 6 rats each as control, dasatinib, colitis and dasatinib+colitis groups. For colitis induction, 4% acetic acid was used. Sacrificing of the rats was performed on the seventh day. Disease activity, morphologic and histological injury, superoxide dismutase, myeloperoxidase and malondialdehyde activity, TNFα and CD3 expression were assessed in colonic tissue.

RESULTS

Apart from malondialdehyde, significant difference in all parameters between the control and colitis groups was determined. Difference between the colitis and colitis+dasatinib groups was not significant in only weight loss and biochemical parameters. Though dasatinib does not fully resolve the changes in colitis, there was significant regression.

CONCLUSIONS

Dasatinib decreased the inflammation in a rodent model of colitis. It may be provide this effect by the suppression of TNFα. Dasatinib may be one of the treatment options for ulcerative colitis.

Nutritional habits in functional dyspepsia and its subgroups: a comparative study

OBJECTIVE

Research data demonstrating nutritional habits of functional dyspepsia (FD) patients are very limited. This is the first study to evaluate nutritional habits in FD subgroups according to Rome III criteria. Our aim was to evaluate nutritional habits of FD patients and determine the food items that may provoke a dyspepsia symptom.

METHODS

A total of 168 adults with FD and 135 healthy control subjects participated in the study. FD subjects were divided into epigastric pain syndrome (EP-FD), postprandial distress syndrome (PS-FD), mixed (MX-FD) subgroups according to Rome Criteria III. Subjects completed a questionnaire that included a short-form food frequency questionnaire. Furthermore, subjects were asked to list the food items that were causing a dyspepsia symptom.

RESULTS

Functional dyspepsia subjects had a slightly higher BMI (26.1 ± 4.97 kg/m(2)) than control subjects (24.6 ± 4.08 kg/m(2)). The most common symptom triggering foods among all the FD groups were fried and fatty foods (27.1%), hot spices (26.4%), and carbonated drinks (21.8%). In FD subgroups, carbonated drinks were more likely to cause a symptom in PS-FD group (37.3%) than MX-FD (25.7%) and EP-FD (22.1%) groups. There was no difference in frequency of main meals and snacks among any of the groups.

CONCLUSION

Fatty and spicy foods and carbonated drinks were the most common symptom triggering food items in FD group. In subgroups, carbonated drinks and legumes were more likely to cause a symptom in PS-FD. Removing these food items during the course of treatment might help alleviate the symptoms.

Future of public libraries

The purpose of this paper is to analyze public librarians’ perspectives on the future of public libraries in Turkey. The research is arranged under six headings as follows: the state of overall change in public libraries; services; lifelong learning and information literacy; technology; administration and collection; building, librarian, user and other elements including finance. Every aspect of the study which entails literature review, findings, discussion and conclusion were examined within the scope of these six subjects. A descriptive method of research was used; the data was collected through an online survey technique that consisted of 62 questions in the form of a three-point Likert scale. Survey questions were also constructed within the frame of the six research headings, and the questions in each group were presented in a mixed order. The questionnaire was sent to 481 librarians working in public libraries in Turkey in 2014. Of these 201 librarians responded, and 185 survey answers out of these responses were found to be valid. The response rate was 38.5%. The results show that public librarians in Turkey are optimistic about the survival and development of public libraries in the future. According to them, public libraries will undergo significant changes in the sense of structural makeup, services, technology and administration by preserving their fundamental composition and functions.

Tyrosine kinase-2 gene polymorphisms are associated with ulcerative colitis and Crohn's disease in Turkish Population

BACKGROUND AND OBJECTIVE

Inflammatory bowel disease is a group of chronic inflammatory conditions affecting gastrointestinal tract. Lots of genes have been identified resulting in susceptibility to inflammatory bowel disease. Any polymorphism leading to functional modifications in tyrosine kinase-2 may precipitate excessive immune response in the intestinal mucosa. The aim of our study is to investigate the involvement of tyrosine kinase-2 polymorphisms in the patients with inflammatory bowel disease in Turkish population.

METHODS

Four single nucleotide polymorphisms in tyrosine kinase-2 (rs280523, rs2304256, rs280519 and rs280496) were genotyped in 60 Crohn's disease, 151 ulcerative colitis patients and 89 unrelated healthy controls. These polymorphisms were detected by real-time polymerase chain reaction.

RESULTS

The presence of genotype (CC) in rs2304256 and (AA) in rs280519 were found to increase the susceptibility to ulcerative colitis (P=0.024, 0.025, respectively). rs2304256 (CA) and rs280519 (AG) have provided protection against ulcerative colitis (P=0.021, 0.012, respectively). rs280519 (AG) was protective against Crohn's disease (P=0.045). rs2304256 (CC) increased the susceptibility to inflammatory Crohn's disease (P=0.014). The presence of rs2304256 (A) increased the susceptibility to perianal Crohn's disease (P=0.03). Both rs280519 and rs2304256 polymorphisms were associated with the requirement of corticosteroid and immunosuppressive therapy in ulcerative colitis.

CONCLUSION

This study is the first demonstration of the single marker association of tyrosine kinase-2 polymorphisms with ulcerative colitis and Crohn's disease in Turkish population. They may be effective in the etiology of inflammatory bowel disease in our population. Disparity between our study and others may be related to ethnic differences.

The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury

STUDY DESIGN

Prospective single-arm study.

OBJECTIVES

To investigate the effect of functional electrical stimulation (FES) cycling on late functional recovery, spasticity, gait parameters and oxygen consumption during walking in patients with chronic incomplete spinal cord injury (SCI).

SETTING

Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.

METHODS

Ten patients with chronic (duration of more than 2 years) incomplete SCI who could ambulate at least 10 m independently or with the assistance of a cane or walker, but no hip-knee-ankle-foot orthosis. The subjects underwent 1-h FES cycling sessions three times a week for 16 weeks. Outcome measures including the total motor score, the Functional Independence Measure (FIM) score, the Modified Ashworth Scale for knee spasticity, temporal spatial gait parameters and oxygen consumption rate during walking were assessed at baseline, 3 and 6 months after the baseline.

RESULTS

There were statistically significant improvements in total motor scores, the FIM scores and spasticity level at the 6-month follow-up (P<0.01). The changes in gait parameters reached no significant level (P>0.05). Oxygen consumption rate of the patients showed significant reduction at only 6 months compared with baseline (P<0.01).

CONCLUSION

The results suggest that FES cycling may provide some functional improvements in the late period of SCI.

SPONSORSHIP

The study was supported by The Scientific and Technological Research Council of Turkey (TUBITAK).

Bactericidal permeability increasing protein gene polymorphism is associated with inflammatory bowel diseases in the Turkish population

BACKGROUND/AIMS

Inflammatory bowel disease, a chronic inflammatory disease with unknown etiology, affects the small and large bowel at different levels. It is increasingly considered that innate immune system may have a central position in the pathogenesis of the disease. As a part of the innate immune system, bactericidal permeability increasing protein has an important role in the recognition and neutralization of gram-negative bacteria. The aim of our study was to investigate the involvement of bactericidal permeability increasing protein gene polymorphism (bactericidal permeability increasing protein Lys216Glu) in inflammatory bowel disease in a large group of Turkish patients.

PATIENTS AND METHODS

The present study included 528 inflammatory bowel disease patients, 224 with Crohn's disease and 304 with ulcerative colitis, and 339 healthy controls.

RESULTS

Bactericidal permeability increasing protein Lys216Glu polymorphism was found to be associated with both Crohn's disease and ulcerative colitis (P = 0.0001). The frequency of the Glu/Glu genotype was significantly lower in patients using steroids and in those with steroid dependence (P = 0.012, OR, 0.80; 95% confidence interval [CI]: 0.68-0.94; P = 0.0286, OR, 0.75; 95% CI: 0.66-0.86, respectively). There was no other association between bactericidal permeability increasing protein gene polymorphism and phenotypes of inflammatory bowel disease.

CONCLUSIONS

Bactericidal permeability increasing protein Lys216Glu polymorphism is associated with both Crohn's disease and ulcerative colitis. This is the first study reporting the association of bactericidal permeability increasing protein gene polymorphism with steroid use and dependence in Crohn's disease.

Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction

OBJECTIVES

The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction.

METHODS

Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC.

RESULTS

In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (P<0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals.

CONCLUSION

In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization.

Rectus abdominalis muscle metastasis from uterine leiomyosarcoma: An unusual case and review of the literature

Uterine leiomyosarcoma is an aggressive malignancy. Spread to the lung, thyroid, liver, brain, pancreas, heart, duodenum, breast, vagina, submandibular gland, and bone has been reported. We describe a case of metastatic uterine leiomyosarcoma to the rectus abdominalis muscle as the first case in the literature. A 39-year-old nulligravid woman presented with a history of pelvic pain. Physical examination discovered about a 6-cm mass in the suprapubic region. She had previously undergone a hysterectomy for uterine leiomyosarcoma. Operative findings had revealed a mass measuring 4×5×6 cm located in the rectus abdominalis muscle. Abnormal mitotic figures and necrosis were evident, and uterine leiomyosarcoma was diagnosed. Uterine leiomyosarcomas are malignancies of the smooth muscle arising from the myometrium. Skeletal muscle is an uncommon site of metastasis by hematogenous spread. In conclusion, we have described a case of skeletal muscle metastasis (first case of rectus abdominalis muscle metastasis) secondary to uterine leiomyosarcoma.

Like/dislike analysis using EEG: determination of most discriminative channels and frequencies

In this study, we have analyzed electroencephalography (EEG) signals to investigate the following issues, (i) which frequencies and EEG channels could be relatively better indicators of preference (like or dislike decisions) of consumer products, (ii) timing characteristic of "like" decisions during such mental processes. For this purpose, we have obtained multichannel EEG recordings from 15 subjects, during total of 16 epochs of 10 s long, while they were presented with some shoe photographs. When they liked a specific shoe, they pressed on a button and marked the time of this activity and the particular epoch was labeled as a LIKE case. No button press meant that the subject did not like the particular shoe that was displayed and corresponding epoch designated as a DISLIKE case. After preprocessing, power spectral density (PSD) of EEG data was estimated at different frequencies (4, 5, …, 40 Hz) using the Burg method, for each epoch corresponding to one shoe presentation. Each subject's data consisted of normalized PSD values (NPVs) from all LIKE and DISLIKE cases/epochs coming from all 19 EEG channels. In order to determine the most discriminative frequencies and channels, we have utilized logistic regression, where LIKE/DISLIKE status was used as a categorical (binary) response variable and corresponding NPVs were the continuously valued input variables or predictors. We observed that when all the NPVs (total of 37) are used as predictors, the regression problem was becoming ill-posed due to large number of predictors (compared to the number of samples) and high correlation among predictors. To circumvent this issue, we have divided the frequency band into low frequency (LF) 4-19 Hz and high frequency (HF) 20-40 Hz bands and analyzed the influence of the NPV in these bands separately. Then, using the p-values that indicate how significantly estimated predictor weights are different than zero, we have determined the NPVs and channels that are more influential in determining the outcome, i.e., like/dislike decision. In the LF band, 4 and 5 Hz were found to be the most discriminative frequencies (MDFs). In the HF band, none of the frequencies seemed offer significant information. When both male and female data was used, in the LF band, a frontal channel on the left (F7-A1) and a temporal channel on the right (T6-A2) were found to be the most discriminative channels (MDCs). In the HF band, MDCs were central (Cz-A1) and occipital on the left (O1-A1) channels. The results of like timings suggest that male and female behavior for this set of stimulant images were similar.

İnternet Erişim Özgürlüğünün Kısıtlanması: Türkiye Üzerine Bir Değerlendirme

Türkiye’de internet erişim engellemeleri ve sansür algısında farklılıkların bulunması, bu konudaki literatüre de yansımaktadır. Literatürde, sınırsız internet erişim özgürlüğü isteyen, 5651 Sayılı Kanun’u eleştiren ve kaldırılması gerektiğini savunan ya da tüm filtreleme ve erişim engellemelerini sansür uygulaması olarak nitelendiren birçok yayın yer almaktadır. Bu çalışmada, Türkiye’de internet erişim özgürlüğünün kısıtlanmasına neden olan uygulamaların, mevcut hukuksal düzenlemeler çerçevesinde değerlendirilmesi amaçlanmıştır. Önceki çalışmalardan farklı olarak, mevzuat, uygulama ve alınan kararlar arasındaki ilişki ayrıntılı olarak incelenmiş, zararlı içeriğe sahip olduğu gerekçesiyle internet sitelerinin erişime kapatılmasının ne kadar başarılı olduğuna yanıt aranmış ve erişim engellemelerinin amacına ulaşabilmesi için neler yapılması gerektiği konusunda önerilerde bulunulmuştur. Ayrıca, alternatif yöntemler aracılığıyla erişime kapatılan sitelere nasıl kolayca erişim sağlanabildiğine dikkat çekilmiş ve bu durumun bilgi erişim özgürlüğü kapsamında hukuksal değerlendirmesi yapılmıştır. Literatürde yer alan eleştirilerin geçerliği hukuksal düzenlemeler, alınan erişim engelleme kararları, Yargıtay kararları ve uygulama sonucunda amaçlanan hedefe ulaşılabilme durumu irdelenerek yeniden değerlendirilmiştir. Elde edilen bulgularda çocuklar için zararlı içerikle mücadele konusunda dünya genelinde ortak irade oluştuğu, ancak Türkiye’de daha kapsamlı mücadelenin saydam olmayan yöntemlerle yürütülmesinden dolayı “sansür uygulaması” algısının oluştuğu görülmektedir. Erişime kapatılan sitelere Türkiye’den erişim istatistikleri 5651 Sayılı Kanun ve uygulanan yöntemin amaçlanan hedefe ulaşmada yetersiz kaldığını göstermektedir.

An FDTD-based computer simulation platform for shock wave propagation in electrohydraulic lithotripsy

Extracorporeal Shock Wave Lithotripsy (ESWL) is based on disintegration of the kidney stone by delivering high-energy shock waves that are created outside the body and transmitted through the skin and body tissues. Nowadays high-energy shock waves are also used in orthopedic operations and investigated to be used in the treatment of myocardial infarction and cancer. Because of these new application areas novel lithotriptor designs are needed for different kinds of treatment strategies. In this study our aim was to develop a versatile computer simulation environment which would give the device designers working on various medical applications that use shock wave principle a substantial amount of flexibility while testing the effects of new parameters such as reflector size, material properties of the medium, water temperature, and different clinical scenarios. For this purpose, we created a finite-difference time-domain (FDTD)-based computational model in which most of the physical system parameters were defined as an input and/or as a variable in the simulations. We constructed a realistic computational model of a commercial electrohydraulic lithotriptor and optimized our simulation program using the results that were obtained by the manufacturer in an experimental setup. We, then, compared the simulation results with the results from an experimental setup in which oxygen level in water was varied. Finally, we studied the effects of changing the input parameters like ellipsoid size and material, temperature change in the wave propagation media, and shock wave source point misalignment. The simulation results were consistent with the experimental results and expected effects of variation in physical parameters of the system. The results of this study encourage further investigation and provide adequate evidence that the numerical modeling of a shock wave therapy system is feasible and can provide a practical means to test novel ideas in new device design procedures.

Reversible post-pregabalin peripheral edema in a spinal cord injury patient

STUDY DESIGN

Case report.

OBJECTIVES

To report a case of paraplegia with limb edema caused by pregabalin.

SETTING

Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.

CASE REPORT

A 40-year-old male patient with T11 paraplegia had the complaint of swelling in both the lower limbs. He had been given pregabalin because of the neuropathic pain in both the lower limbs. At 10 months, the patient has experienced edema in lower limbs. There was severe edema in both legs, ankles and feet, more evident on the left. Venous Doppler ultrasound was normal on both sides. Blood tests for possible etiologies were normal. No other etiology could be found. The edema was considered to be caused by pregabalin and the medicine was ceased gradually. The edema resolved completely in 2 weeks.

CONCLUSION

Pregabalin, which is one of medications used for neuropathic pain, might cause limb edema, that is, a condition needs differential diagnosis. This is particularly important for patients with spinal cord injuries (SCIs). Such adverse effect of pregabalin should be kept in mind as an etiology of limb edema in SCI management.

2004 İlköğretim Programı'nda Okuma ve Kütüphane Kullanma Alışkanlıklarına İlişkin Öğretmen Görüşleri

Bu çalışma, Türkiye’de 2005–2006 öğretim yılında uygulanmaya başlanan 2004 İlköğretim Programı’nın okuma ve kütüphane kullanma alışkanlıklarını hangi düzeyde ve nasıl bir yaklaşım içinde ele aldığını belirlemek amacıyla yapılmıştır. Çalışma, Ankara Büyükşehir Belediyesi sınırları içinde bulunan 2’si özel 7 ilköğretim okulunda görev yapan sınıf öğretmenleri üzerinde gerçekleştirilmiştir. Bu çerçevede, bu okullardaki 118 öğretmene anket uygulanmıştır. Çalışmada, öğretmenlerin, okuma ve kütüphane kullanma alışkanlıkları açısından ilköğretim programlarına ilişkin görüşleri analiz edilmiştir. Araştırma sonucunda, öğretmenlerin okuma ve kütüphane kullanma alışkanlıklarının sözü edilen programda sistematik bir yaklaşımla ele alınmadığı görüşünde oldukları anlaşılmıştır.