Management of Biliary Complications in Liver Transplant Recipients with Duct-To-Duct Anastomosis: A Single-Center Experience.

BACKGROUND: The aims of this study were to investigate biliary complications in liver transplant recipients with choledochocholedocho stomy anastomosis, to identify the risk factors for the development of such complications, and to evaluate the success of endoscopic approaches in liver transplant recipients. METHODS: Between January 2013 and May 2021, a total of 238 patients with liver diseases underwent liver transplantation: 174 recipients undergoing choledochocholedochostomy anastomosis were included in the analysis. RESULTS: Their median age was 54.0 years. The median posttransplant follow-up period was 29 months. Hepatitis B virus infection (33%) was the most common indication for liver transplantation. Most patients (87%) received living donor liver transplantation. The overall prevalence of posttransplant biliary complications was 31%. Anastomotic biliary strictures were the most common biliary complications (72%), followed by biliary leakage (13%). The median time between endoscopic retrograde cholangiography and liver transplantation was 4 months, with a mean of 3 ± 1.6 sessions. Endoscopic retrograde cholangiography-guided drainage and balloon dilation with or without stent placement was the most common treatment modalities for recipients with biliary strictures. The overall success rate of endoscopic treatment modalities was 83.3%, with 65% of the recipients exhibiting complete biochemical and endoscopic responses. The response did not differ significantly between living donor liver transplantation and cadaveric donor liver transplant recipients (P > .05). Three recipients required revision surgery for biliary complication repair. Six patients died due to biliary sepsis. CONCLUSION: Biliary stricture and leakages were the most common biliary complications after liver transplantation. Endoscopic treatment was successful in most recipients.

Investigation of the presence of Capnophilic bacteria in routine urine cultures.

Capnophilic Escherichia coli (CEC) strains are rarely isolated from urinary tract infections (UTIs). The purpose of this research was to look into the incidence and traits of the CEC strains that cause UTIs. Nine (0.11%) epidemiologically unrelated CEC isolates with varying antibiotic susceptibility patterns were identified from patients with various co-morbidities after the evaluation of 8500 urine samples. Three of these strains belonged to the O25b-ST131 clone, and none of them possessed the yadF gene. Due to adverse incubation conditions, CEC isolation is difficult. Although rare, capnophilic incubation of urine cultures may be considered particularly for patients with underlying predisposing conditions.

Non-invasive fibrosis markers for assessment of liver fibrosis in chronic hepatitis delta.

Assessment of liver fibrosis by non-invasive means is clinically important. Studies in chronic hepatitis delta (CHD) are scarce. We evaluated the performance of eight serum fibrosis markers [fibrosis-4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), AST-to platelet-ratio-index (APRI), Goteborg University Cirrhosis Index (GUCI), Lok index, cirrhosis discriminant score (CDS) and Hui score] in CHD and chronic hepatitis B (CHB). Liver stiffness was assessed by transient elastography (TE) in CHD. The ability of fibrosis markers to detect significant fibrosis and cirrhosis were evaluated in 202 CHB and 108 CHD patients using published and new cut-offs through receiver operating characteristics (ROC) analysis. The latter was also applied to obtain cut-offs for TE. APRI, Fib-4, API and Hui score were assessed for significant fibrosis, and APRI, GUCI, Lok index, CDS and AAR for cirrhosis determination. Fibrosis markers displayed weak performance in CHB for significant fibrosis with area under ROC (AUROC) curves between 0.62 and 0.71. They did slightly better for CHD. TE displayed an AUROC of 0.92 and performed better than serum fibrosis markers (p < 0.05 for fibrosis markers). For cirrhosis determination, CDS and Lok Index displayed an AUROC of 088 and 0.89 in CHB and GUCI, Lok index and APRI displayed AUROCs around 0.90 in CHD. TE displayed the best AUROC (0.95). Hence TE is superior to serum fibrosis markers for diagnosing significant liver fibrosis and cirrhosis. GUCI, Lok index and APRI displayed a reasonable performance in CHD, which needs further confirmation.

Evaluation of the Performance of Vasoactive Ventilation Renal Score in Predicting the Duration of Mechanical Ventilation and Intensive Care Hospitalization After Pediatric Cardiac Surgery.

Various methods have been used to evaluate the predictivity of some markers during the recovery process after cardiac surgery in children. The aim herein was to evaluate the vasoactive ventilation renal (VVR) score in predicting the clinical outcomes of children who underwent congenital cardiac surgery within the early period in the pediatric intensive care unit (PICU). Patients who underwent congenital heart surgery (CHS) between November 2016 and March 2020 were enrolled and evaluated prospectively. The VVR score was calculated as follows: vasoactive inotrope score (VIS) + ventilation index + (change in serum creatinine level based on the baseline value × 10). The relationship between the duration of mechanical ventilation and the length of stay (LOS) in the PICU was evaluated via receiver operating characteristic (ROC) curve analysis and the cut-off values were calculated. At all of the time points identified in the study, the VVR score had a higher area under the ROC curve (AUC) when compared to the VIS and serum lactate levels, and the 48-h VVR score had the highest AUC (AUC 0.851, 95% confidence interval (CI) 0.761-0.942/LOS in the PICU; AUC 0.946, 95% CI 0.885-1.000/duration of mechanical ventilation). The 48-h VVR score for the LOS in the PICU was 6.7 (sensitivity 70%, specificity 92%) and that for the duration of mechanical ventilation was 9.1 (sensitivity 87%, specificity 97%). As a result, in our study, it was found that the VVR score is a new and effective predictor of the duration of mechanical ventilation and LOS in the PICU in postoperative CHS patients.

Imputation of missing values within WHODAS 2.0 data collected from low back pain patients using the response function approach.

PURPOSE: To investigate the impact of missing data and imputation with the response function (RF) approach on bias and precision of disability estimates as well as reliability of scale of WHO Disability Assessment Schedule 2.0. MATERIAL AND METHODS: Data were collected by face-to-face interviews and self-report surveys from 284 respondents with low back pain. Hypothetical datasets were created by using person and item parameters of real data. A simulation study was devised to assess the ability parameters and reliability measures on incomplete and imputed datasets. Rasch model was used to evaluate latent trait levels. Imputation was carried out using the response function method. RESULTS: Almost the same level of bias and MSE was reached. While the missing rate increases, the Person separation index slightly reduced, still exceeded 0.94 and Cronbach alpha values have similar mean values of 0.99 with larger variations. After deletion of four items of "work or school activities" in domain 5, reliability measures reduced the lowest. CONCLUSION: Construct validity is preserved. Problems regarding the compliance of the items with the target group still persist. When researchers encounter missingness in data collected with WHODAS 2.0, the response function can be usefully implemented to impute missing values to improve the reliability of disability level estimates.Implications for rehabilitationThe Turkish version of the 36-item WHODAS is reliable and valid for assessing health and disability status in patients with low back pain.A critical issue is a systematic nonresponse was highly observed in items related to "work/school life activities" which are allowed to be skipped and excluded from the scoring according to WHODAS 2.0 training manual.Imputation of missing values within four items of "work or school activities" in domain 5 using the response function approach showed satisfactory reliability for the estimation of disability in adults with low back pain.This study showed missing data imputations with response function can be implemented by a statistician as contribute to a missing data management process better tailored to clinicians' interpretations.

Genetic Profiling of Pediatric Patients with B-Cell Precursor Acute Lymphoblastic Leukemia.

B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is a heterogeneous leukemia subgroup. It has multiple sub-types that are likely to be classified by prognostic factors. Following a systematic literature review, this study analyzed the genes correlated with BCP-ALL prognosis ( IKZF1, PAX5, EBF1, CREBBP, CRLF2, JAK2, ERG, CXCR4, ZAP70, VLA4, NF1, NR3C1, RB1, TSLP, ZNRF1, and FOXO3A) , specifically their nucleotide variations and expression profiles in pediatric BCP-ALL samples. The study included 45 pediatric BCP-ALL patients with no cytogenetic anomaly and a control group of 10 children. The selected genes' hot-spot regions were sequenced using next-generation sequencing, while Polymorphism Phenotyping v2 and Supplemental Nutrition Assistance Program were used to identify pathogenic mutations. The expression analysis was performed using quantitative real-time polymerase chain reaction. The mutation analysis detected 328 variants (28 insertions, 47 indels, 74 nucleotide variants, 75 duplications, and 104 deletions). The most and least frequently mutated genes were IKZF1 and CREBBP , respectively. There were statistically significant differences between patients and controls for mutation distribution in eight genes ( ERG, CRLF2, CREBBP, TSLP, JAK2, ZAP70, FOXO3A, and NR3C1 ). The expression analysis revealed that JAK and ERG were significantly overexpressed in patients compared with controls (respectively, p = 0.004 and p = 0.003). This study combined genes and pathways previously analyzed in pediatric BCP-ALL into one dataset for a comprehensive analysis from the same samples to unravel candidate prognostic biomarkers. Novel mutations were identified in all of the studied genes.

Interhemispheric transfer time differs between fast and slow healthy adult readers.

The visual system forms the basis of visual word decoding processes. Reading is a left-lateralized function. The interaction between the two hemispheres via the corpus callosum is required for successful reading. It is known that callosal function and morphology are affected in reading disorders. This study investigated the differences in callosal transfer speed of verbal and nonverbal stimuli in healthy university students. We hypothesized that if the callosal transfer has a role in slow reading, transfer speed would differ between slow and fast readers. Moreover, if the difference was affected by the type of stimulus, this will provide information about the level of neural processing at which the difference is based/aroused. Fifty-one participants were grouped as slow (n = 15, 8 female) and fast (n = 36, 22 female) readers. Three types of stimuli (word, legal pseudoword, and non-verbal grating) were presented from the right or left visual field. Latencies of the evoked potentials (N1) were used to measure interhemispheric transfer time. We found that slow readers have a slower right-to-left transfer speed at the parietal site, which is related to the visual word decoding process. The finding was similar to previous studies examining individuals with dyslexia. This difference was not seen with grating stimuli; we suggest that the difference originates at the orthographic visual lexical level rather than at earlier basic visual processing. We did not observe any effect of lexical and sublexical routes on the callosal transfer time because of evaluated time windows.

Platelet-rich plasma treatment improves postoperative recovery in patients with pilonidal sinus disease: a randomized controlled clinical trial.

BACKGROUND: Pilonidal sinus is a common health problem. The current study aimed to compare the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques in terms of pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure. METHODS: Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled and randomly divided into three groups. Open surgery and moist dressings were applied to patients in group A. Open surgery followed by PRP application was performed on patients in group B. Group C underwent curettage of the sinus cavity followed by application of PRP. In this prospective randomized controlled study, patients completed questionnaires (including the Nottingham Health Profile (NHP), Short Form-36 (SF-36) and clinical information) before and after surgery. Demographics, preoperative characteristics, healing parameters, and quality-of-life scores were evaluated and calculated before and after surgery. RESULTS AND CONCLUSION: The cavity volume and wound-healing time were compared among the groups on postoperative days 0, 2, 3, 4, and 21. Each patient was followed up throughout the process of wound healing, and follow-up was continued afterward to monitor the patients for recurrence. Due to the nature of the treatment that group C received, this group achieved shorter healing times and smaller cavity volume than the other groups. In contrast, the recovery time per unit of cavity volume was significantly faster in group B than in the other groups. Overall postoperative pain scores were significantly lower for both PRP groups (open surgery, group B; minimally invasive surgery, group C) than for group A (p < 0.001) and showed different time courses among the groups. In the treatment of PS disease, PRP application improves postoperative recovery in that it speeds patients' return to daily activities, reduces their pain scores and increases their quality of life. Trial registration The current study is registered on the public website ClinicalTrials.gov (ClinicalTrials.gov identifier number: NCT04697082; date: 05/01/2021).

Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades.

INTRODUCTION: The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. METHODS: The study included a systematic search for PROMs that have been in use over the period 2000-2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. RESULTS: 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. CONCLUSION: There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.

Validity and reliability of the Turkish version of three screening tools (PYMS, STAMP, and STRONG-kids) in hospitalized children.

BACKGROUND: There are different malnutrition screening tools developed in the English language, but limited data available on the validity of their versions translated into other languages. The aim of this study is to construct a Turkish version of PYMS, STRONG-kids, and STAMP and to determine their validity and reliability in a pediatric population. METHODS: The present study was conducted at two stages. First, the process of translating PYMS, STRONG-kids, and STAMP into the Turkish language was performed. In the second stage, the validity and reliability were evaluated in the new version of the tools. The anthropometric assessment was used as the reference standard in evaluating the validity of criteria. The reliability was observed through inter-rater and intra-rater agreement. RESULTS: 202 children in total were involved in the present study, 42 of whom took part in the reliability phase. The inter-rater agreement between one dietitian and one nurse was kappa (κ) = 0.955 (95% CI 0.904-1.000) for PYMS, 0.901 (95% CI 0.828-0.974) for STRONG-kids, and 0.963 (95% CI 0.912-1.000) for STAMP (almost perfect agreement). Sensitivity of the PYMS, STRONG-kids, and STAMP were 96.8%, 87.1%, and 77.4%, respectively. Specificity of the PYMS, STRONG-kids, and STAMP was found to be 65.0%, 30%, and 60.0%, respectively. CONCLUSION: The inter-rater and intra-rater reliability of the three tools were determined to be good. While PYMS was found to be more sensitive in detecting the malnutrition risk when compared to the other tools, STRONG-kids had the lowest specificity according to the agreement between tool results and anthropometric assessment.

Development of Sensory Sensitivity Scales (SeSS): Reliability and validity analyses.

BACKGROUND: Although adults are known to have sensory sensitivity differences, existing sensitivity scales have been mostly developed for children. The limited number of adult scales measure social/emotional features and modalities together. AIMS: To develop scales for adults that evaluate visual, auditory and somatosensory sensitivities as separate domains and independent of social/emotional features. METHODS AND PROCEDURES: Two consecutive studies (visual-auditory part and somatosensory part) were conducted using the same methods. Both studies included a pilot (n1 = 405 and n2 = 294) and a main group (n1 = 425 and n2 = 603). An exploratory factor analysis produced a single-factor solution for the visual and auditory domains and a three-factor solution for the somatosensory domain (touch, pain, and itch) of Sensory Sensitivity Scales. OUTCOMES AND RESULTS: A confirmatory factor analysis revealed good construct validity in the the visual (CFI = .973, TLI = .965, and RMSEA = .075) auditory (CFI = .943, TLI = .927, and RMSEA = .074) and somatosensory (CFI = .955, TLI = .946, and RMSEA = .048) scales. The categories were internally consistent (αv = .86, αa = .79, αs = .69). As an indicator of convergent validity, higher autistic traits were related to higher sensitivity (rs-v = .17, rs-a = .25, rs-s = .14). CONCLUSIONS AND IMPLICATIONS: Sensory Sensitivity Scales (SeSS) can be used to screen sensory sensitivity variability or identify and follow up the outcome of sensory interventions in adults.

Live Donor Assessment Tool (LDAT): A Turkish validity and reliability study.

BACKGROUND/AIMS: Psychosocial and psychiatric evaluations are crucial components of the assessment of a live donor candidate. The Live Donor Assessment Tool (LDAT) was developed for this purpose. This study aims to evaluate the validity and reliability of the Turkish version of LDAT. MATERIALS AND METHODS: 132 live kidney or liver donor were referred to assess their psychosocial/psychiatric appropriateness for donation and were randomized for clinical evaluation as usual or with LDAT. The internal consistency of LDAT was measured by Chronbach's alpha coefficient. Inter-rater reliability was measured by using Spearman's correlation coefficient. The potential validity of LDAT was assessed by comparing LDAT scores to clinical decisions. The Mann-Whitney U test was used to compare LDAT scores across two clinically classified groups (acceptable/declined). Logistic regression was performed using LDAT scores to predict the clinical decision. RESULTS: The Turkish version of LDAT items demonstrate good internal consistency (α=0.773). Inter-rater reliability of LDAT demonstrated strong correlation (ICC=0.72). LDAT scores differentiated the accepted/declined groups, and strongly predicted the clinical decision. With a cut-off score of 60.5, LDAT was found to have high sensitivity and specificity. CONCLUSION: The Turkish version of LDAT was found to be a valid and reliable tool. LDAT could be an appropriate tool to assess live donor candidates.

Intensive Care Psychological Assessment Tool (IPAT): Turkish validity and reliability study

Background/aim: It is of crucial importantance to be able to detect acute psychological distress in patients. The Intensive Care Psychological Assessment Tool (IPAT) was developed for this purpose in intensive care units. This study aims to evaluate the validity and reliability of the Turkish version of IPAT. Materials and methods: In total, 98 patients were included. To assess concurrent validity, the Intensive Care Experiences Scale (ICES) and the Hospital Anxiety Depression Scale were performed. Cronbach's alpha coefficient was used to estimate internal consistency. Interitem and item-total score correlations were also performed. Sensitivity and specificity were derived for concurrent anxiety and depression. Results: The internal reliability was good. Cronbach's a = 0.85. Items were well-correlated, with an average interitem correlation of 0.38. The concurrent validity of IPAT was good. Correlation between IPAT scores, anxiety, depression, ICES, and the diagnosis of delirium were as follows, respectively: r = 0.61, P < 0.01, r = 0.54, P < 0.01, r = −0.66, P < 0.01, r = 0.37, P < 0.01. With a cutoff score of ≥ 6, IPAT showed 85% sensitivity and 61% specificity to detect concurrent anxiety, and 74% sensitivity and 82% specificity to detect concurrent depression [AUC = 0.77 (95% CI, 0.68­0.87) and 0.84 (95% CI, 0.76­0.92), respectively]. Conclusion: The Turkish version of IPAT was found to be a valid and reliable tool to assess acute psychological distress among patients in intensive care units.

SLCO1B1 Polymorphisms are Associated With Drug Intolerance in Childhood Leukemia Maintenance Therapy.

BACKGROUND: Therapy discontinuations and toxicities occur because of significant interindividual variations in 6-mercaptopurine (6-MP) and methotrexate (MTX) response during maintenance therapy of childhood acute lymphoblastic leukemia (ALL). 6-MP/MTX intolerance in some of the patients cannot be explained by thiopurine S-methyl transferase (TPMT) gene variants. In this study, we aimed to investigate candidate pharmacogenetic determinants of 6-MP and MTX intolerance in Turkish ALL children. METHODS: In total, 48 children with ALL who had completed or were receiving maintenance therapy according to Children's Oncology Group (COG) protocols were enrolled. Fifteen single-nucleotide polymorphisms in 8 candidate genes that were related to drug toxicity or had a role in the 6-MP/MTX metabolism (TPMT, ITPA, MTHFR, IMPDH2, PACSIN2, SLCO1B1, ABCC4, and PYGL) were genotyped by competitive allele-specific PCR (KASP). Drug doses during maintenance therapy were modified according to the protocol. RESULTS: The median drug dose intensity was 50% (28% to 92%) for 6-MP and 58% (27% to 99%) for MTX in the first year of maintenance therapy, which were lower than that scheduled in all patients. Among the analyzed polymorphisms, variant alleles in SLCO1B1 rs4149056 and rs11045879 were found to be associated with lower 6-MP/MTX tolerance. CONCLUSIONS: SLCO1B1 rs4149056 and rs11045879 polymorphisms may be important genetic markers to individualize 6-MP/MTX doses.

Outcomes of renal replacement therapy in boys with prune belly syndrome: findings from the ESPN/ERA-EDTA Registry.

BACKGROUND: As outcome data for prune belly syndrome (PBS) complicated by end-stage renal disease are scarce, we analyzed characteristics and outcomes of children with PBS using the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry data. METHODS: Data were available for 88 male PBS patients aged <20 years who started renal replacement therapy (RRT) between 1990 and 2013 in 35 European countries. Patient characteristics, survival, and transplantation outcomes were compared with those of male patients requiring RRT due to congenital obstructive uropathy (COU) and renal hypoplasia or dysplasia (RHD). RESULTS: Median age at onset of RRT in PBS was lower [7.0; interquartile range (IQR) 0.9-12.2 years] than in COU (9.6; IQR: 3.0-14.1 years) and RHD (9.4; IQR: 2.7-14.2 years). Unadjusted 10-year patient survival was 85% for PBS, 94% for COU, and 91% for RHD. After adjustment for country, period, and age, PBS mortality was similar to that of RHD but higher compared with COU [hazard ratio (HR) 1.96, 95% confidence interval (CI) 1.03-3.74]. Seventy-four PBS patients (84%) received a first kidney transplant after a median time on dialysis of 8.4 (IQR 0.0-21.1) months. Outcomes with respect to time on dialysis before transplantation, chance of receiving a first transplant within 2 years after commencing RRT, and death-censored, adjusted risk of graft loss were similar for all groups. CONCLUSIONS: This study in the largest cohort of male patients with PBS receiving RRT to date demonstrates that outcomes are comparable with other congenital anomalies of the kidney and urinary tract, except for a slightly higher mortality risk compared with patients with COU.

Integrating patient reported outcome measures and computerized adaptive test estimates on the same common metrics: an example from the assessment of activities in rheumatoid arthritis.

AIM: This study aimed to explore the potential of an inclusive and fully integrated measurement system for the Activities component of the International Classification of Functioning, Disability and Health (ICF), incorporating four classical scales, including the Health Assessment Questionnaire (HAQ), and a Computerized Adaptive Testing (CAT). METHODS: Three hundred patients with rheumatoid arthritis (RA) answered relevant questions from four questionnaires. Rasch analysis was performed to create an item bank using this item pool. A further 100 RA patients were recruited for a CAT application. Both real and simulated CATs were applied and the agreement between these CAT-based scores and 'paper-pencil' scores was evaluated with intraclass correlation coefficient (ICC). Anchoring strategies were used to obtain a direct translation from the item bank common metric to the HAQ score. RESULTS: Mean age of 300 patients was 52.3 ± 11.7 years; disease duration was 11.3 ± 8.0 years; 74.7% were women. After testing for the assumptions of Rasch analysis, a 28-item Activities item bank was created. The agreement between CAT-based scores and paper-pencil scores were high (ICC = 0.993). Using those HAQ items in the item bank as anchoring items, another Rasch analysis was performed with HAQ-8 scores as separate items together with anchoring items. Finally a conversion table of the item bank common metric to the HAQ scores was created. CONCLUSION: A fully integrated and inclusive health assessment system, illustrating the Activities component of the ICF, was built to assess RA patients. Raw score to metric conversions and vice versa were available, giving access to the metric by a simple look-up table.

A Study Examining Compliance with the Anti-Tobacco Law Nb. 4207 Inside Taxis.

OBJECTIVES: This observational study assessed compliance with the anti-tobacco Law Nb 4207 with regard to taxis in Çankaya district, Ankara. MATERIAL AND METHODS: This descriptive study was conducted in Kizilay, Kugulu, and Tandogan intersections on January 18-23, 2016 between 9.00-11.00 and 14.00-16.00 hours in Ankara. Data regarding the status of the taxi (either cruising or not), smoking inside taxis, smoking status of the taxi drivers and/or clients, location of the clients in the taxi, presence of a child in the taxi, and status of the windows (open or not) were recorded using a data-gathering form. RESULTS: Three thousand six hundred fifty-six taxis were evaluated, of which 79 (2.2%) taxi drivers were observed smoking. Clients were observed smoking in 17 taxis (1.3%). Ninety-four taxi drivers and/or clients (2.6%) were observed smoking. Taxi drivers smoked more frequently in the absence of a client. In addition, a smoking client influenced the taxi driver's smoking status (p<0.001). CONCLUSION: Violation of the anti-tobacco Law Nb 4207 was observed. In this regard, the number of inspections needs to be increased. Systematic training programs for the taxi drivers regarding the risks of tobacco should be a priority. Preventive studies concerning the hazards of passive smoking should be also conducted at a community level.

Evaluating Left-Censored Data Through Substitution, Parametric, Semi-parametric, and Nonparametric Methods: A Simulation Study.

In this study, an attempt was made to determine the degrees of bias in particular sampling sizes and methods. The aim of the study was to determine deviations from the median, the mean, and the standard deviation (SD) in different sample sizes and at different censoring rates for log-normal, exponential, and Weibull distributions in the case of full and censored data sampling. Thus, the concept of "censoring" and censoring types was handled in the first place. Then substitution, parametric (MLE), nonparametric (KM), and semi-parametric (ROS) methods were introduced for the evaluation of left-censored observations. Within the scope of the present study, the data were produced uncensored based on the different parameters of each distribution. Then the datasets were left-censored at the ratios of 5, 25, 45, and 65 %. The censored data were estimated through substitution (LOD and LOD/[Formula: see text]), parametric (MLE), semi-parametric (ROS), and nonparametric (KM) methods. In addition, evaluation was made by increasing the sample size from 20 to 300 by tens. Performance comparison was made between the uncensored dataset and the censored dataset on the basis of deviations from the median, the mean, and the SD. The results of simulation studies show that LOD/[Formula: see text] and ROS methods give better results than other methods in deviation from the mean in different sample sizes and at different censoring rates, while ROS gives better results than other methods in deviation from the median in almost all sample sizes and at almost all censoring rates.

Prognostic Importance of Bone Marrow Uptake on Baseline 18F-FDG Positron Emission Tomography in Diffuse Large B Cell Lymphoma.

AIM: To define the role of 18F-flourodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of bone marrow (BM) involvement in patients with diffuse large B cell lymphoma (DLBCL). MATERIALS AND METHODS: Fifty-four (mean age: 55.5 ± 18.3 years, 20 female and 34 male) DLBCL patients who underwent pretreatment 18F-FDG PET/CT were included to the study. Focal or diffuse BM 18F-FDG uptake that is higher than mediastinal blood pool uptake was accepted as positive. After staging of disease by CT and 18F-FDG PET/CT, all the patients received R-CHOP treatment after diagnostic blinded bone marrow biopsy (BMB). Presence of positive BM uptake in 18F-FDG PET/CT and histopathological examination results of BMBs were analyzed by Chi-square test. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 18F-FDG PET/CT in the detection of BM involvement were calculated. Prognostic importance of the presence of BM 18F-FDG uptake was analyzed by Kaplan-Meier analysis. RESULTS: BM 18F-FDG uptake was detected in 8 patients. Histopathological examination of BMB revealed BM involvement in 6 out of 8 patients. BMB was negative in all patients who have no 18F-FDG uptake in the evaluation of PET/CT images. Sensitivity, specificity, accuracy, PPV, and NPV of 18F-FDG PET/CT in the detection of BM involvement were calculated as 100%, 96%, 96%, 75%, and 100%, respectively. In the Kaplan-Meier analysis, we found that presence of pretreatment 18F-FDG uptake in BM has a prognostic importance. Whereas mean time to progression (TTP) in patients with BM uptake was 32.25 ± 10.9 months and mean TTP in those without was 51.69 ± 3.6 months (p = 0.013). CONCLUSIONS: BM uptake in pretreatment 18F-FDG PET/CT is an important prognostic factor in DLBCL patients. Moreover, in consideration of high NPV, 18F-FDG PET/CT could eliminate unnecessary BMB in FDG-negative patients.