Environmental quality and health expenditures efficiency in Türkiye: the role of natural resources.

The environmental pollution caused by climate change and global warming pose significant risks to health. This raises the question how environmental disturbances can affect health expenditures. Based on this, this study examines the asymmetric effect of environmental quality on health expenditures in Türkiye using the non-linear ARDL (NARDL) model for the 1975-2019 period. In addition to environmental quality, natural resources, economic growth, and trade openness variables are also included in the health expenditure model. The findings support the existence of an asymmetric cointegration relationship between the series. The findings also indicate that positive environmental pollution shocks affect health expenditures positively in the long run, while negative environmental pollution shocks do not have a statistically significant effect on health expenditures. Positive and negative natural resource shocks affect health expenditures negatively in the long run. Despite the effect of positive economic growth shocks on health expenditures is positive but statistically insignificant, the effect of negative economic growth shocks is positive and significant. Besides, positive trade openness shocks have a negative effect on health expenditures and negative trade openness shocks have a positive effect. The findings prove that the steps to be taken to protect the environment in the current period will increase the effectiveness of health expenditures in the future. This situation has a guiding feature for policy-makers in terms of policy decisions.

Therapy from my point of view: A case illustration of routine outcome monitoring and feedback in psychotherapeutic interventions.

Lately, the use of patient-reported outcome measures (PROM) to adapt and improve ongoing psychotherapeutic treatments has become more widespread. Their main purpose is to support data-informed, collaborative treatment decisions which include the patient's point of view on their progress. In case of nonresponse or deterioration, these systems are able to warn clinicians and guide the process "back on track" in treatment. In this case illustration, the Greifswald Psychotherapy Navigator System (GPNS) detected the deterioration of 19-year-old Sarah during the first eight sessions of cognitive-behavioral therapy for social anxiety and depression. Here, the GPNS helped the therapist gain insight as to how Sarah's social anxiety affected their treatment and adjust her strategy accordingly. Using the symptom curves and progress scales of the GPNS, the therapist was able to then address her patient's struggles in detail during their sessions and with her supervisor. After adapting her therapeutic approach, the patient's deterioration could be averted while simultaneously strengthening their communication in the process. Clinical implications and the benefits of using PROM systems for evidence-based personalization of psychotherapy are presented.

Production, properties and some applications of protease from alkaliphilic Bacillus sp. EBTA6.

Extracellular protease production by a novel strain, Bacillus sp. EBTA6, has been optimized by using central composite design of response surface methodology and properties and industrial applications of crude enzyme have been investigated. Three independent variables (temperature, pH and yeast extract concentration) chosen in the experimental design were significant terms and reduced cubic model fit with the design at p < 0.0001 level. The recommended temperature, pH and yeast extract concentration were 30 °C, 8, and 15 g/L, respectively. Crude enzyme displayed activity over a wide pH and temperature ranges having the optimum at 50-60 °C and pH 8. It was quite stable at high pH values and at 50 °C. Amongst the metal ions (Mg+, Cu2+, Ca2+, Zn2+, K2+, and Sn2+), Ca2+ enhanced the activity and the others either decreased or did not change it. The enzyme activity was reduced by phenyl-methyl-sulfonyl fluoride (PMSF), and ethylene diamine tetra acetic acid (EDTA). The results revealed that the protease was serine alkaline type. Tween 20 and Tween 80 did not inhibit the enzyme, however, sodium dodecyl sulfate (SDS), reduced it by 39%. It completely removed blood stain in 20 min and coagulated milk in the presence of CaCl2.

Microcalcified Hepatic Metastases Incidentally Detected on F-18 NaF PET/CT in a Patient with Prostate Cancer.

F-18 NaF PET/CT evaluation has gained importance in recent years. Achievements from F-18 NaF PET/CT are: higher sensitivity of positron imaging, higher target background ratio with higher tracer accumulation in bone hydroxyapatite and higher specificity through CT correlation. These properties have also given directions to new research fields based on imaging microcalcifications, very recently. A limited number of cases have reported the F-18 NaF uptake in macrocalcified soft tissue metastases. Although the presence of microcalcification was not proved; accumulation of F-18 NaF in the metastatic brain lesion with no visible calcification on the CT, in a patient with ductal breast carcinoma has also been reported. Herein we present a patient with microcalcified hepatic metastasis of prostate cancer incidentally detected on F-18 NaF PET/CT which was confirmed with histochemical staining.

Primary Pulmonary Lymphoepithelioma-like Carcinoma on FDG PET/CT.

A 69-year-old male smoker was referred to 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) with the indication of a suspicious solitary pulmonary nodule. FDG PET/CT determined a 2.5 × 2-cm soft-tissue lesion (SUVmax, 16.2) with spiculated margins in the hilum of the right lung. A 1-cm diameter lymphadenopathy on the right hilum with an SUVmax of 3.2 was also determined. Transbronchial biopsy of the right hilar lymphadenopathy did not reveal any malignant features in histopathologic examination, and it was determined to be reactive. The patient underwent a right upper lobe segmentectomy, and the histopathologic evaluation revealed that the tumor was a primary lymphoepithelioma-like carcinoma (LELC) of the lung with negative Epstein-Barr virus (EBV) on in situ hybridization studies. In this case report, we mainly focus on the FDG avidity of this very rare kind of tumor comparatively with previous reports and possible explanations of discordancy in FDG avidity in relation to histopathologic characteristics.

Ectopic Pelvic Kidney Mimicking Sacral Metastasis on Post-Therapy Iodine-131 Scan of a Thyroid Cancer Patient.

A 25-year-old woman had total thyroidectomy and iodine-131 ablation therapy for papillary thyroid carcinoma. Whole body imaging on the 7th day of therapeutic activity demonstrated radioiodine uptake in the remnant tissue and intense heterogeneous uptake at the sacral region prominently in the posterior image. Initial interpretation was suspicious for sacral metastasis. Technetium-99m-methylene diphosphonate bone scan demonstrated normal bone uptake and the absence of left kidney. On blood-pool phase of bone scan, the absence of left renal activity and an extra area of uptake in the sacral region suggestive of pelvic kidney were noticed. Magnetic resonance imaging scan confirmed the ectopic pelvic kidney overlying the sacrum.

Diffusely Increased Splenic Fluorodeoxyglucose Uptake in Lung Cancer Patients.

OBJECTIVES: This study aimed to investigate the association of diffuse splenic F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) with tumor maximum standardized uptake value (SUVmax), presence of distant metastases, and hematological and inflammatory parameters. MATERIAL AND METHODS: Initial FDG PET/CT of 15 lung cancer patients with diffuse splenic FDG uptake were retrospectively analyzed (Group 1). Twelve patients who recently underwent FDG PET/CT for histopathologically proven lung cancer were enrolled as the control group (Group 2). All 27 patients had hematological data, including C-reactive protein (CRP) level, within 5 days before or after PET/CT. To determine SUVmax, the region of interests included the tumor, liver, spleen, and iliac crest. The possible associations between the spleen/liver (S/L) and bone marrow/liver (BM/L) ratios and tumor SUVmax, presence of metastasis, and hematological parameters were evaluated. RESULTS: The S/L ratio and hemoglobin (Hb) levels were different between the two groups (p=0.000 and 0.05, respectively). The number of patients with anemia were significantly higher in Group 1 than in Group 2 (p=0.02). Although mean Hb levels were different between the two groups, there was no correlation between Hb levels and S/L ratios. There was no significant difference between the two groups with respect to the numbers of patients who had an accompanying infection site. Only CRP levels were correlated with S/L ratios in Group 1 among various other parameters (r=0.559, p=0.05). CONCLUSION: Our results suggested that inflammation degree correlated with increased splenic FDG uptake in lung cancer patients and was enhanced by anemia. Systemic inflammation and anemia could be important causes of diffusely increased splenic FDG accumulation on PET/CT examinations of lung cancer patients.

Incidental Detection of Subcutaneous Myopericytoma of Trunk on FDG PET/CT and Bone Scintigraphy for Imaging of Colon Cancer.

Myopericytoma is a rare type of unusual soft tissue tumor with perivascular myoid differentiation. A 53-year-old man with the diagnosis of colon cancer was referred to Tc-MDP bone scan and F-FDG PET/CT for staging. A subcutaneous mass located in right lower back with heterogeneous FDG uptake was detected on PET/CT. There was increased osteoblastic activity on MDP bone scan in the same region. Mass was resected and subsequently confirmed as myopericytoma by histopathology.

Splenic infarction as a pitfall on labeled red blood cell imaging.

Patient with a history of overt gastrointestinal bleeding, diabetes mellitus, hypertension, polycythemia vera, and choledocojejunostomy was hospitalized because of hematemesis and melena. An area of Technetium-99m labeled red blood cells accumulation at the splenic flexure similar to an overt bleeding area, was observed on gastrointestinal bleeding scintigraphy (GIBS). In case of underlying malignancy, abdominal computed tomography was performed and demonstrated the infarction area placed laterally in spleen, appearing as a cold region on sctintigraphic image, separating the inferomedial and upper part of splenic uptake. Splenic variants and pathologies can complicate interpretation of GIBS.