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Background: Demyelinating lesions over 20 mm in size, referred to as tumefactive demyelinating lesions, can be misdiagnosed as being either a tumor or an abscess. Although some radiological characteristics can help make a differential diagnosis easier, a cerebral biopsy may still be necessary. Objective: Our objective was to assess the clinical characteristics of tumefactive lesions, with or without a diagnosis of multiple sclerosis (MS), and present follow-up data for 54 patients with tumefactive lesions. Methods: Demographic, clinical, radiological and laboratory data were gathered and treatment responses were evaluated in a total of 54 patients from five medical centers. Result: Twenty-nine patients were diagnosed with tumefactive lesions at the onset, whereas 25 patients were diagnosed with tumefactive lesions after a diagnosis of MS. Median follow-up was 38.12 months. At final examination, 19 of the patients with a tumefactive lesion diagnosis at the onset eventually developed relapsing–remitting MS, while 10 remained with the condition as a clinically isolated syndrome. The tumefactive lesions studied were mostly focal, with closed-ring enhancement. We found that oligoclonal band positivity was less frequent in the patients with tumefactive onset. Conclusion: Although our demographic data were similar to formerly collected Turkish MS data, we found that the distribution of the patients’ clinical course differed if there was an absence of primary progressive MS and that there was a lower frequency of secondary progressive MS cases in our group of patients. We believe that less frequent oligoclonal band positivity and the difference we witnessed in the clinical course of disease in our study groups suggest that there is a need for further studies to compare all the biological and immunological differences between MS and tumefactive lesion cases, in order to reveal whether there are different pathogenetic mechanisms involved.

AimOsteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed.PurposePatients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed.MethodsA total of 518 patients’ aged 75 ± 10 (41–97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness.ResultsFive (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups (p < 0.001). Over the course of treatment, mobility improved significantly (p = 0.001), with a significantly stronger (p = 0.007) improvement in the surgically treated patients.ConclusionFracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.

Multiple sclerosis (MS) is an inflammatory disease characterized by demyelination and axonal degeneration affecting the central nervous system. Among the genetic factors suggested to be associated with this disease are polymorphisms to the vitamin D receptor (VDR) gene. We tested the hypothesis that polymorphisms in the vitamin D receptor (VDR) gene are associated with MS. The aim of the study was to investigate the relationship of MS with the VDR gene Fok-I, Bsm-I and Taq-I polymorphisms among the Turkish population. This study contains 271 MS patients and 203 healthy controls. Genomic DNA was isolated from the samples and the VDR gene Fok-I, Bsm-I and Taq-I polymorphism regions were amplified by polymerase chain reaction (PCR). The PCR products were digested, and the genotypes were determined based on size of digested PCR products. Our results demonstrate associations between MS and the distribution of the VDR gene Fok-I T/T polymorphism genotype in a dominant model, VDR gene Fok-I T allele frequency, distribution of VDR gene Taq-I C/C polymorphism genotype in a dominant model and VDR gene Taq-I C allele frequency (Pearson test, p<0.05). However, there was no association between MS and the VDR gene Bsm-I polymorphisms for the genotype distribution (Pearson test, p>0.05) or allele frequency (Pearson test, p>0.05). Fok-I and Taq-I VDR gene polymorphisms are significantly associated with MS in dominant, homozygote and heterozygote inheritance models among the Turkish population.

Dispersive soils have caused failure of many slopes and earth fills due to external and internal erosion. This study aims to investigate various factors used for identification of dispersivity and to develop some new approaches for the prediction of dispersivity of clays. To achieve this purpose, physical and index properties, as well as degree of dispersivity of 29 clay samples taken from five different locations in and around the city of Ankara were determined. Various statistical prediction models were used for prediction of new dispersivity classes obtained by weighting ranking method. It was determined that dispersivity classes obtained from physical and chemical dispersivity tests performed on the same clay samples using distilled water were different from each other. In addition, crumb and pinhole tests were performed by using test waters with varying TDS values on five selected samples to find the impact of water chemistry on dispersivity. It is concluded from all dispersivity tests that total dissolved salts (TDS) values and sodium percentage (SP) remarkably affect the degree of dispersivity, and the use of these two parameters give more reliable results for the determination of dispersivity. By considering all these facts and to predict the most reliable dispersivity class, all dispersivity classes obtained from physical and chemical dispersivity tests were reevaluated by a weighted ranking system, and new dispersivity classes were assigned. In order to estimate these new dispersivity classes, various statistical models were established by using results of chemical analysis of pore water of clay samples. For this purpose, prediction models including soft computing methods such as decision tree and logistic regression are used and most reliable prediction models having the highest prediction performance are suggested.

Introduction Abdominal wall hernias are a frequent cause of abdominal pain-related emergency department visits. Our study aimed to establish the connection between lactate levels and patient outcomes in those with abdominal pain due to abdominal wall hernias. Materials and methods Our research followed a retrospective, observational, and descriptive approach and two center. We included patients who visited the emergency department for abdominal pain and were confirmed to have abdominal wall hernias through ultrasound. Results We enrolled 493 patients meeting the criteria. Median age was 65 years, with 54% ( n  = 266) being male. Regarding outcomes, 40.5% ( n  = 200) were hospitalized, 27.7% ( n  = 137) underwent surgery, and 7.9% ( n  = 39) underwent bowel resection. Mortality rate during hernia-related hospital admission was 0.6% ( n  = 3). For hospitalized patients, there were significant differences in white blood cell count, neutrophil count and percentage, platelet count, lymphocyte count, and percentage ( p  < 0.05). Patients undergoing resection showed significant differences in neutrophil count, neutrophil percentage, lymphocyte count, and lymphocyte percentage ( p  < 0.05). Lactate levels were statistically significant in all patient groups requiring hospitalization, surgery, and resection ( p  < 0.05). Sensitivity and specificity of lactate test results indicated in patients undergoing bowel resection, lactate values ≥1.96 mmol/L had a specificity of 64%, sensitivity of 71%, and a negative predictive value of 96% ( p  < 0.05). Conclusion Low lactate levels in patients presenting to the emergency department with abdominal pain caused by abdominal wall hernias have a high negative predictive value for excluding strangulation and the need for bowel resection. Therefore, we recommend the use of lactate as an additional diagnostic tool in emergency department presentations related to abdominal wall hernias.

This study aimed to investigate the effects of magnitude, focal depth and the thickness of the overburden material on the length of the surface rupture caused by an earthquake; and to propose new empirical equations between the surface rupture length and the earthquake source parameters. To accomplish this purpose, a series of tests were carried out in the laboratory utilizing a set up simulating a strike-slip faulting mechanism. In addition to laboratory tests, a database was established from the earthquakes that have occurred in Turkey and all over the world. Consequently, new empirical equations were suggested between magnitude and surface rupture length and focal depth of an earthquake based on the data obtained from the laboratory model tests and real earthquakes.

Andesite exposed in different parts of Ankara has different weathering categories varying from fresh to residual soil. The geomechanical properties of the andesite are significantly affected by weathering. Buildings constructed especially in completely weathered and residual soil levels of the andesite have some geotechnical problems. In this study, the variation of the geomechanical properties of the andesite due to weathering is investigated in three selected sites of Ankara, through optical microscope, X-ray diffraction analyses, major element analyses, pressuremeter tests, physicomechanical tests, and seismic refraction method. The data gathered from the field and laboratory studies were used to assess the characteristics of the weathering zones. Based on the data obtained from this study, an idealized weathering profile is assessed. No bearing capacity and consolidation settlement problems exist in the area. However, care should be taken for immediate settlement of the buildings. Slopes with heights less than 8 m are not expected to cause any significant problems for buildings. There exists a ground amplification problem in the study area. The natural period of the building should not match that of the weathered rock. The ground response analyses reveal that the buildings with four to seven stories may be adversely affected from earthquakes due to resonance phenomenon. Therefore, this has to be taken into account when designing new buildings.[PUBLICATION ABSTRACT]