The performance of Khorana risk score for prediction of venous thromboembolism in patients with lung cancer: A retrospective cohort study.

Introduction: Cancer-related venous thromboembolism is one of the leading causes of mortality and morbidity in cancer patients. Lung cancer is the second most common cancer in the world and is closely related to venous thromboembolism. Venous thromboembolism affects survival in patients with cancer and it is important to be able to predict the possibility of thrombosis in patients with cancer. It was aimed to evaluate the predictive performance of the Khorana risk score in patients with lung cancer. Materials and Methods: The medical data of the patients followed up with lung cancer were analyzed retrospectively. Venous thromboembolism events in lung cancer patients were described. The relationship between the Khorana risk score and the risk of venous thromboembolism was investigated using the cumulative incidence function with compared risk models. Result: Eight hundred fourteen lung cancer patients were included in the study. Venous thromboembolism was detected in 79 (9.7%) of the patients. Sixty one (77.2%) of the patients had pulmonary embolism, 15 (19%) had peripheral deep vein thrombosis and three (3.8%) had venous thrombosis of other sites. The cumulative incidences of venous thromboembolism for high and intermediate Khorana risk scores were 10.1% and 9.7%, respectively (p= 0.09). The cumulative incidences of venous thromboembolism at 3, 6, 12, and 24 months were 4.7%, 5.8%, 6.4%, and 9.6% for the high-grade Khorana risk score; 4.6%, 5.7%, 6.3% and 7.8% for the intermediate Khorana risk score (p= 0.11). Conclusions: The Khorana risk score was not found useful in the risk stratification of venous thromboembolism (intermediate or high risk) in patients with lung cancer. New scoring systems are needed to calculate the risk of venous thromboembolism in patients with lung cancer.

[Functional parameters and affecting factors in post-COVID period]. / Post-COVID dönemde fonksiyonel parametreler ve etkileyen faktörler.

Introduction: Post-COVID period is considered to be 12 weeks after the COVID-19 infection. Patients in the post-COVID period may have prolonged or newly developed symptoms. Depending on the prolonged effects of the disease, respiratory and functional parameters may be affected. The aim of the study is to investigate the effect of COVID-19 infection on respiratory and functional parameters in the post-COVID period. Materials and Methods: A cross-sectional study was conducted to evaluate the functional parameters of patients with COVID-19 in the post-COVID period. Subjects with a history of microbiologically proven COVID-19 infection were evaluated with 6-minute walk test results, Borg, and MRC results at least 12 weeks after COVID-19 infection. The relationship between demographic characteristics, comorbidities, vaccination status, and severity of disease with 6-minute walk test results and dyspnea scales in the post-COVID period was investigated. Result: Two hundred seventeen patients were included in the study. The mean age of the patients was 48.6 ± 14.9 years and 126 (58.1%) of them were female. 142 (65.4%) of the patients were completely vaccinated against COVID-19 and 75 (34.6%) patients were incompletely vaccinated or unvaccinated. 158 (72.8%) patients had mild disease, 51 (23.5%) patients had moderate disease, and eight (3.7%) patients had severe disease. Those with a history of moderate or severe disease had significantly worsened functional parameters in the postCOVID period compared to those with mild COVID-19. The Borg scale and MRC dyspnea scale values were significantly higher in women (p= 0.008, p= 0.002, respectively). Functional parameters of those who were completely vaccinated against COVID-19 and those who were incompletely or unvaccinated individuals in the post-COVID period were similar. Conclusions: The functional parameters of people with moderate or severe COVID-19 disease were found to be significantly impaired in the post-COVID period. While the effect of smoking and vaccination status on functional parameters in the post-COVID period could not be demonstrated, disease severity and accompanying comorbidity were found to be effective.

Analysing the effect of robotic gait on lower extremity muscles and classification by using deep learning.

Robotic gait training helps the nervous system recover and strengthen weak muscle groups. Many studies in the literature show that applying robotic gait rehabilitation to patients with neurological disorders such as Multiple Sclerosis (MS), Stroke and Spinal Cord Injection (SCI) effectively restores gait ability. In contrast to the studies in the literature that included only healthy individuals, both the control and patient groups were formed and detailed analyses were carried out for both groups. In this study, EMG signals in GMA, GME, ILP, BF, VM, MG, TA muscles were recorded simultaneously with a different electrode placement during robotic gait for the first time in literature and then a location that prevents a phase shift was presented. The classification performance has also been increased by removing 26 different attribute parameters like time, frequency and statistics from the signals instead of gait studies with a maximum of 12-16 traits extraction. The extracted features were classified with the approaches Multilayer Perceptron Neural Networks (MLP), Support Vector Machines (SVM), K-Nearest Neighbourhood algorithm (KNN), Random Forest Classification Algorithm (RF) and Deep Learning and then a detailed performance comparison have been realized. Among the approaches compared the Stochastic Gradient Optimization Algorithm-based deep learning structure produced the best performance with 98.5714% accuracy. It was also seen that it is essential to plan the exoskeleton and the robotic gait pattern suitable for patients' disease state and muscle activation.

Patient-specific tumor and respiratory monitoring phantom design for quality controls of stereotactic ablative body radiotherapy in lung cancer cases.

The design, production and adaptability to clinical routine of a patient-specific tumor and respiratory monitoring phantom (TRMP) was investigated using 3D printer technology. TRMP and GTV modelling were done using 4D-CT images of the inhalation phase. The model was converted to STL (Stereolithography) format and printed with STH (Strong Herbal) biopolymer with HU (Hounsfield Unit) suitable for imaging purposes. The assembly of TRMP motorized parts and mechanical equipment has been completed and made suitable for clinical use. In the first part of the study, the deviations of radio-opaque markers attached to the TRMP sternum to perform mechanical quality control tests and T1-7 costal vertebrae in CC, AP, and LAT directions were evaluated. In the second part of the study, in order to evaluate the usability of the TRMP in quality assurance (QA), point dose measurements with BeO OSL dosimetry and EBT3 gafchromic film measurements were taken in Trilogy® radiotherapy accelerator and CyberKnife® robotic radiosurgery accelerator. In this study, we present a highly flexible TMRP capable of performing independent internal and external motions. TRMP was successfully tested in different treatment accelerators, both mechanically and dosimetrically.

Comparison of different fixation techniques for periprosthetic fractures: a biomechanical study of a new implant.

INTRODUCTION: The ideal treatment method for periprosthetic fractures is controversial due to the risks of current methods. Single-cortex screw fixation in prosthesis may lead to implant failure. Therefore, we aimed to develop an implant that lowers the risk for complications. For this study, we designed and tested two new implant models. The first model was a plate with a combination of U nails and cerclage holes. The second model was a U nail plate with a screw, which combines a plate screw with U nail (staples). Our study aimed to compare the stability of two newly designed implants with classical treatment modalities. We used 27 (in 3 groups) artificial bone models and 9 different test models. METHODS: The ISO 7206-4:2010 (E) standards were used for 27 bones in nine groups tested under laboratory conditions. In our study, we examined nine different groups. In group 1, hip the prosthesis was extracted, and a revision femoral stem was embedded. In group 2, periprosthetic fractures were repaired with a plate and cable. In group 3, periprosthetic fractures were repaired with a plate and stapler. In group 4, periprosthetic fractures were repaired with a plate and stapler cable. In group 5, periprosthetic fractures were repaired with a plate stapler and screw. Groups 6 and 7 were the control groups. Group 6 was the only artificial bone group, and group 7 was the prosthesis embedded bone group. Group 8 was periprosthetic fractures treated with unicortical screw fixation with cerclage, and group 9 was periprosthetic fractures treated with unicortical screw fixation. Axial loading was applied to the bones. The yield strength of the system was determined by loading the synthetic bone models with a constant compression speed of 5 mm/min through the centre of motion using the Geratech SH 2000 testing system. During the tests, load and displacement values were recorded, and the stiffness of the models was calculated based on those values. RESULTS: According to our results, the greatest durability was found in the revision hip prosthesis group (1511 N), and the weakest performance was found in the plate with the stapler implant group (163N). When comparing the data of groups according to compression, significant differences were found in group 2 with groups 1, 4, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with 1, 5, 7, and according to breakage, significant differences were found in group2 with groups 1, 3, 5, and 7; group 3 with group 1; group 8 with groups 1 and 5; and group 9 with groups 1, 5, and 7 (p<0.001). DISCUSSION: The revision hip prosthesis treatment for periprosthetic fractures showed the best performance, followed by the plate with stapler screw. In older patients, U nail-augmented implants may be a good alternative for periprosthetic fractures. Unicortical screw and cerclage wire combination fixation results were unsatisfactory results in this study. CONCLUSION: This is an experimental study, so further studies, especially patient-specific studies, should be made to expand the findings of this study.

Augmented Reality Supported Cervical Transpedicular Fixation on 3D-Printed Vertebrae Model: An Experimental Education Study.

AIM: To investigate the use of Augmented Reality (AR) technology as it contributes to spinal surgery education with the free-hand technique, and might reduce the error ratio. MATERIAL AND METHODS: Ten candidates, with anatomy education but no surgical experience, applied 36 pedicle screws with C2-C3 posterior transpedicular fixation technique to nine vertebrae models produced via a three-dimensional (3D) printer. RESULTS: Using AR to apply pedicle screws to the experimental vertebrae model increased the safety screw ratio significantly. In comparison of Grade 0 screws to other grades: 6/18 screws (33.3%) in the free-hand technique Group (n=18), and 14/18 screws (77.8%) in the AR Group (n=18), were measured for screw insertion safety ratios. The difference was statistically significant (p=0.018). The resemblance between our results and the results of previous studies researching supportive systems indicates our 3D printed vertebra model might be a helpful educational material. CONCLUSION: AR increases the safety ratio of cervical pedicle screw fixation significantly. The parameters investigated and used for the production of vertebrae models in this study can be used for experimental material production for future studies to investigate pedicle screw positioning.

A design and construction of 4 channel biotelemetry device employing indoor.

In this study, 4 channel biotelemetry device was designed and implemented for monitoring physiological and biological signals of the patients at indoor. Body temperature, respiratory rate, heart rate, electrocardiogram (ECG) and electromyogram (EMG) signals were transmitted using 10 mW 433 MHz and 500 mW 868 MHz FM/FSK transmitter with 9.6 Kps transmission speed. At indoor, receive signal strength indicator (RSSI) levels were measured and compared with 433 and 868 MHz carrier frequency. The placement of repeater at indoor was decided as a result of RSSI measurement.

Wireless transmission of ECG signal.

In this study, the ECG signal were measured as noiseless with Ag/AgCl electrodes, then converted digital data using pulse code modulation (PCM) technique. The digital data were then sent to receiver where it is in 433 MHz FM/FSK transmitter, which has 10 mW output power and 9.6 Kps transmission speed. At the receiver, the digital data were reconverted to analog signal to monitor and record on the PC with Sonic Foundry Sound Forge 6.0 program. The power spectrum of measured ECG signal was formed using Matlab program. As a result, the medical supporting system is realized for monitoring the ECG signal on PC of human with chronic heart disease in their living surroundings.