E-ISSN: 1308-5263
Turkish Journal of Hematology - Turk J Hematol: 33 (2)
Volume: 33  Issue: 2 - 2016
REVIEW
1. The Role of Angiogenesis in Haemophilic Arthropathy: Where Do We Stand and Where Are We Going?
Alexandra Agapidou, Thomas Stavrakis, Efthymia Vlachaki, Panagiotis Anagnostis, Sophia Vakalopoulou
doi: 10.4274/tjh.2016.0031  Pages 88 - 93
Haemophilia is an inherited bleeding disorder that can lead to degenerative joint arthropathy due to recurrent bleeding episodes affecting the musculoskeletal system of the patient. The cause of bleeding can be either traumatic or spontaneous. The pathogenesis of haemophilic arthropathy is unclear as many factors like iron, inflammatory cytokines, and angiogenic factors contribute to this process. Blood into joints can deteriorate the bone to such an extent that the patient experiences pain, reduction of the range of movement, and deformity of the joint, conditions that could have a great impact on quality of life. Over the years, management of haemophilic arthropathy has changed. Nowadays, early diagnosis with high resolution imaging like magnetic resonance imaging along with application of prophylaxis regimens can reduce the extent of damage to the joints. However, not all haemophilia patients have access to these interventions as cost may be prohibitive for some of them. The need for new, easy, and costeffective strategies with the ability to identify early changes could be beneficial and could make a difference in the management of haemophilic arthropathy. Understanding the mechanism of processes like angiogenesis in the mechanism of developing arthropathy could be innovative for these patients and could help in the detection of new early diagnostic and therapeutic markers.

RESEARCH ARTICLE
2. Impact of JAK2V617F Mutational Status on Phenotypic Features in Essential Thrombocythemia and Primary Myelofibrosis
İpek Yonal, Aynur Dağlar Aday, Başak Akadam Teker, Ceylan Yılmaz, Meliha Nalcacı, Akif Selim Yavuz, Fatma Deniz Sargın
doi: 10.4274/tjh.2014.0136  Pages 94 - 101
INTRODUCTION: The JAK2V617F mutation is present in the majority of patients with essential thrombocythemia (ET) and primary myelofibrosis (PMF). The impact of this mutation on disease phenotype in ET and PMF is still a matter of discussion. This study aims to determine whether there are differences in clinical presentation and disease outcome between ET and PMF patients with and without the JAK2V617F mutation.
METHODS: In this single-center study, a total of 184 consecutive Philadelphia-negative chronic myeloproliferative neoplasms, 107 cases of ET and 77 cases of PMF, were genotyped for JAK2V617F mutation using the JAK2 Ipsogen MutaScreen assay, which involves allele-specific polymerase chain reaction.
RESULTS: ET patients positive for JAK2V617F mutation had higher hemoglobin (Hgb) and hematocrit (Hct) levels, lower platelet count and more prevalent splenomegaly at diagnosis compared to patients negative for the JAK2V617F mutation, but rates of major thrombotic events, arterial thrombosis and venous thrombosis were comparable between the two groups. At presentation, PMF patients with JAK2V617F mutation had significantly higher Hgb and Hct levels and leukocyte count than patients without the mutation. Similar to the findings of ET patients, thromboembolic rates were similar in PMF patients with and without the JAK2V617F mutation. For ET and PMF patients, no difference was observed in rates of death with respect to the JAK2V617F mutational status. Moreover, leukemic transformation rate was not different in our PMF patients with and without JAK2V617F mutation.
DISCUSSION AND CONCLUSION: We conclude that JAK2V617F-mutated ET patients express a polycythemia vera-like phenotype and JAK2V617F mutation in PMF patients is associated with a more pronounced myeloproliferative phenotype.

3. D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections
Gülden Yılmaz, Belgin Coşkun, Atilla Elhan, Alpay Azap, Hamdi Akan
doi: 10.4274/tjh.2014.0070  Pages 102 - 106
INTRODUCTION: Neutropenia is a critical risk factor for invasive fungal infections (IFIs). We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia.
METHODS: Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulative- D-index (c-D-index) was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI.
RESULTS: The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000- 22,000) and 5300 (range: 2300-22,200), respectively (p=0.037 and p=0.003, respectively). The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%.
DISCUSSION AND CONCLUSION: The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.

4. Gap-PCR Screening for Common Large Deletional Mutations of β-Globin Gene Cluster Revealed a Higher Prevalence of the Turkish Inversion/Deletion (δβ)0 Mutation in Antalya
Türker Bilgen, Özden Altıok Clark, Zeynep Öztürk, M. Akif Yeşilipek, İbrahim Keser
doi: 10.4274/tjh.2014.0242  Pages 107 - 111
INTRODUCTION: Although the calculated carrier frequency for point mutations of the β-globin gene is around 10% for Antalya Province, nothing is known about the profile of large deletional mutations involving the β-globin gene. In this study, we aimed to screen common deletional mutations in the β-globin gene cluster in patients for whom direct DNA sequencing was not able to demonstrate the mutation(s) responsible for the disease phenotype.
METHODS: Thirty-one index cases selected with a series of selection events among 60 cases without detected β-globin gene mutation from 580 thalassemia-related cases tested by direct sequencing over the last 4 years in our diagnostic center were screened for the most common 8 different large deletional mutations of the β-globin gene cluster by gap-PCR.
RESULTS: We detected 1 homozygous and 9 heterozygous novel unrelated cases for the Turkish inversion/deletion (δβ)0 mutation in our series of 31 cases. Our study showed that the Turkish inversion/ deletion (δβ)0 mutation per se accounts for 16.6% of the unidentified causative alleles and also accounts for 1.5% of all detected mutations over the last 4 years in our laboratory.
DISCUSSION AND CONCLUSION: Since molecular diagnosis of deletional mutations in the β-globin gene cluster warrants different approaches, it deserves special attention in order to provide prenatal diagnosis and prevention opportunities to the families involved. We conclude that the Turkish inversion/deletion (δβ)0, as the most prevalent deletional mutation detected so far, has to be routinely tested for in Antalya, and the gap- PCR approach has valuable diagnostic potential in the patients at risk.

5. The Levels of Tissue Factor Pathway Inhibitor in Sepsis Patients Receiving Prophylactic Enoxaparin
Hadil A Al Otair, Abdel Galil M Abdel Gader, Syed M Khurshid, Abdulaziz H. Alzeer, Abdulkareem Almomen, Mashael Alshaikh, Farja Al Gahtani, Zohair A. Alaseri, Hossam A.H.abdelrazik
doi: 10.4274/tjh.2014.0312  Pages 112 - 118
INTRODUCTION: Sepsis syndrome is usually accompanied by activation of blood coagulation mechanisms. Earlier studies found deficiencies of the 3 main natural anticoagulants, antithrombin, protein C, and protein S. However, none of these inhibitors block tissue factor, the prime trigger of coagulation during sepsis that is controlled specifically by the tissue factor pathway inhibitor (TFPI). The aim of this study was to characterize the fluctuations in the levels of natural anticoagulants, particularly TFPI, in the course of sepsis and to find out their association with the anticoagulant action of the lowmolecular- weight heparin enoxaparin.
METHODS: We studied 51 consecutive patients with sepsis. Blood samples were collected from patients at baseline (0 h) and at 4, 12, and 24 h after enoxaparin administration. The following assays were undertaken using commercial kits: activated partial thromboplastin time, prothrombin time, thrombin time, total and free TFPI, protein C and protein S, antithrombin, fibrinogen, and anti-factor Xa.
RESULTS: Before enoxaparin administration, there was significant prolongation of the prothrombin time and activated partial thromboplastin time, and this remained the case in the 3 subsequent samples. There was marked reduction in the levels of antithrombin, protein C, and total and free protein S to below control values throughout the study. In contrast, plasma levels of both total and free TFPI were markedly elevated and increased after enoxaparin therapy. Anti-factor Xa levels were within the therapeutic range throughout. There was no difference in TFPI levels between those patients who died and those who survived.
DISCUSSION AND CONCLUSION: Sepsis triggered marked release of TFPI from endothelial cells. This persisted and was increased further following the administration of enoxaparin. In contrast, there was marked consumption of the natural coagulation inhibitors antithrombin, protein C, and protein S. These results go some way towards explaining why the therapeutic use of recombinant TFPI fails to correct sepsisassociated coagulopathy.

6. Comparison of Myelodysplastic Syndrome Prognostic Scoring Systems
Özlen Bektaş, Ayşegül Üner, Eylem Eliaçık, Burak Uz, Ayşe Işık, Sezgin Etgül, Süreyya Bozkurt, İbrahim Celalettin Haznedaroğlu, Hakan Göker, Nilgün Sayınalp, Salih Aksu, Haluk Demiroğlu, Osman İlhami Özcebe, Yahya Büyükaşık
doi: 10.4274/tjh.2014.0455  Pages 119 - 126
INTRODUCTION: Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disease. Patients are at risk of developing cytopenias or progression to acute myeloid leukemia. Different classifications and prognostic scoring systems have been developed. The aim of this study was to compare the different prognostic scoring systems.
METHODS: One hundred and one patients who were diagnosed with primary MDS in 2003-2011 in a tertiary care university hospital’s hematology department were included in the study.
RESULTS: As the International Prognostic Scoring System (IPSS), World Health Organization Classification-Based Prognostic Scoring System (WPSS), MD Anderson Prognostic Scoring System (MPSS), and revised IPSS (IPSS-R) risk categories increased, leukemia-free survival and overall survival decreased (p<0.001). When the IPSS, WPSS, MPSS, and IPSS-R prognostic systems were compared by Cox regression analysis, the WPSS was the best in predicting leukemia-free survival (p<0.001), and the WPSS (p<0.001) and IPSS-R (p=0.037) were better in predicting overall survival.
DISCUSSION AND CONCLUSION: All 4 prognostic systems were successful in predicting overall survival and leukemia-free survival (p<0.001). The WPSS was found to be the best predictor for leukemia-free survival, while the WPSS and IPSS-R were found to be the best predictors for overall survival.

7. Platelet Dysfunction in Patients with Chronic Myeloid Leukemia: Does Imatinib Mesylate Improve It?
Olga Meltem Akay, Fezan Şahin Mutlu, Zafer Gülbaş
doi: 10.4274/tjh.2014.0213  Pages 127 - 130
INTRODUCTION: The aim of this study was to investigate the effects of imatinib mesylate on platelet aggregation and adenosine triphosphate (ATP) release in chronic myeloid leukemia patients.
METHODS: Platelet aggregation and ATP release induced by 5.0 mM adenosine diphosphate, 0.5 mM arachidonic acid, 1.0 mg/ mL ristocetin, and 2 μg/mL collagen were studied by whole blood platelet lumi-aggregometer in 20 newly diagnosed chronic myeloid leukemia patients before and after imatinib mesylate treatment.
RESULTS: At the time of diagnosis, 17/20 patients had abnormal platelet aggregation results; 8 (40%) had hypoactivity, 6 (30%) had hyperactivity, and 3 (15%) had mixed hypo- and hyperactivity. Repeat platelet aggregation studies were performed after a mean of 19 months (min: 5 months-max: 35 months) in all patients who received imatinib mesylate during this period. After therapy, 18/20 (90%) patients had abnormal laboratory results; 12 (60%) had hypoactive platelets, 4 (20%) had mixed hypo- and hyperactive platelets, and 2 (10%) had hyperactive platelets. Three of the 8 patients with initial hypoactivity remained hypoactive, while 2 developed a mixed picture, 2 became hyperactive, and 1 normalized. Of the 6 patients with initial hyperactivity, 4 became hypoactive and 2 developed a mixed pattern. All of the 3 patients with initial hypo- and hyperactivity became hypoactive. Finally, 2 of the 3 patients with initial normal platelets became hypoactive while 1 remained normal. There was a significant decrease in ristocetin-induced platelet aggregation after therapy (p<0.001), while platelet aggregation and secretion induced by other agonists showed no difference after treatment (p>0.05).
DISCUSSION AND CONCLUSION: These findings indicate that a significant proportion of chronic myeloid leukemia patients have different patterns of platelet function abnormalities and imatinib mesylate has no effect on these abnormalities, with a significant impairment in ristocetin-induced platelet aggregation.

8. Immature Reticulocyte Fraction and Absolute Neutrophil Count as Predictor of Hemopoietic Recovery in Patients with Acute Lymphoblastic Leukemia on Remission Induction Chemotherapy
Shan.e Rauf, Saleem Ahmed Khan, Nadir Ali, Nabeel Khan Afridi, Maria Haroon, Ammara Arslan
doi: 10.4274/tjh.2014.0379  Pages 131 - 134
INTRODUCTION: Acute lymphoblastic leukemia (ALL) encompasses a group of lymphoid neoplasms that are more common in children and arise from B-and T-lineage lymphoid precursor cells. The immature reticulocyte fraction (IRF), a new routine parameter in hematology analyzers, can give an indication of hemopoietic recovery like absolute neutrophil count (ANC). The purpose of this study was to evaluate IRF in excess of 5% was considered as IRF recovery.
METHODS: In this descriptive study, 2.5 to 3 mL of EDTA blood of 45 ALL patients undergoing the remission induction phase of their treatment was sampled and analyzed with a Sysmex XE-5000 on day 1 and every second day thereafter until the day of recovery. ANC of >0.5x109/L on the day corresponding to the first of the three consecutive counts was considered as the day of ANC recovery. IRF recovery was an IRF in excess of 5%.
RESULTS: The mean age of the patients was 12.04±5.30 years; 25 patients (55.6%) were male and 20 patients (44.4%) were female. On day 1 of induction remission, the mean IRF value was 9.68±1.41, while the mean ANC value was 0.077±0.061. Mean recovery day for IRF was 11.84±7.44 and mean recovery day for ANC was 17.67±8.77 (twotailed p-value <0.0001 with 95% confidence interval). By day 28, out of 45 patients 36 (80%) showed ANC recovery, while 41 (91%) showed IRF recovery. The remaining patients who had not shown recovery by day 28 were further followed up and all of them showed recovery of both parameters by day 39.
DISCUSSION AND CONCLUSION: This study concluded that postinduction bone marrow hemopoietic recovery was earlier by IRF than ANC in children with ALL on chemotherapy.

9. The Prognostic Significance of Soluble Urokinase Plasminogen Activator Receptor in Acute Myeloid Leukemia
Nergiz Erkut, Ahmet Menteşe, Hasan Mücait Özbaş, Nilay Ermantaş, Ayşegül Sümer, Asım Örem, Mehmet Sönmez
doi: 10.4274/tjh.2014.0405  Pages 135 - 140
INTRODUCTION: The soluble urokinase plasminogen activator receptor (suPAR) is a soluble form of the urokinase plasminogen activator receptor expressed in various immune and cancer cells. The levels of suPAR have been demonstrated to correlate with prognosis in various cancers. This study was intended to investigate serum suPAR levels and their effect on prognosis in patients with acute myeloid leukemia (AML).
METHODS: Thirty newly diagnosed patients with AML and 29 healthy individuals were enrolled. Serum suPAR levels were analyzed by enzyme-linked immunosorbent assay.
RESULTS: Serum suPAR levels were significantly higher in patients with AML than in healthy individuals (9±5.9 ng/mL and 2.4±1.4 ng/mL, respectively; p<0.001). Positive correlation was determined between suPAR levels and white blood cell counts (p<0.01). Serum suPAR levels were lower in patients who achieved complete response than in patients not achieving complete response (5.5±2.2 ng/mL and 12±6.6 ng/mL, respectively; p<0.001). The median overall survival was longer in patients with serum suPAR levels below 6.71 ng/mL than in those with serum suPAR levels above 6.71 ng/mL (12.6±13.2 months and 1.71±0.6 months, respectively; p=0.02). Multivariate Cox regression analysis showed that suPAR had independent prognostic value (95% confidence interval: 1.029-6.259; p<0.05) in AML.
DISCUSSION AND CONCLUSION: Serum suPAR levels can be used as a prognostic marker in AML.

10. Investigation of Rho-Kinase Expressions and Polymorphisms in Mantle Cell Lymphoma Patients
Didar Yanardağ Açık, Mehmet Yılmaz, İbrahim Sarı, Serdar Öztuzcu, Zeynel A. Sayıner, Salih Subari, Abdullah T. Demiryürek
doi: 10.4274/tjh.2015.0193  Pages 141 - 147
INTRODUCTION: Mantle cell lymphoma (MCL) is a rare but aggressive form of B-cell non-Hodgkin lymphoma characterized by excessive expression of cyclin D1. Intracellular signaling enzyme Rho-kinase (ROCK) can contribute to cellular migration, proliferation, and differentiation, as well as tumor development and metastasis. However, ROCK gene and protein expressions or polymorphisms have never been investigated in MCL patients. The purpose of this study was to investigate the role of ROCK gene and protein expressions in MCL patients. We also examined ROCK2 gene polymorphisms in this study.
METHODS: A total of 60 patients with MCL and 60 healthy controls were included in this retrospective study. Hematoxylin and eosin-stained lymph node tissue slides in the entire archive were reevaluated and used for immunohistochemistry, gene expression, and polymerase chain reaction studies.
RESULTS: In immunohistochemical studies, there were significant increases in ROCK1 (p=0.0009) and ROCK2 (p<0.0001) protein expressions in MCL patients when compared with the control group. Although a marked increase in ROCK1 gene expression (p=0.0215) was noted, no significant change was observed in ROCK2 gene expression in MCL patients. Seven ROCK2 polymorphisms were studied, but the results showed no significant differences between the groups.
DISCUSSION AND CONCLUSION: This is the first study to show that ROCK1 gene and ROCK protein expressions may contribute to the development of MCL.

11. Prospective Audit of Blood Donor Selection Process in a Tertiary Care Hospital of a Developing Country
Naila Raza
doi: 10.4274/tjh.2015.0094  Pages 148 - 152
INTRODUCTION: The aim of this study was to emphasize the significance of internal audits of the blood donor selection process and documentation in a resource-limited country by assessing compliance with the established protocols, and to identify weak areas in the process.
METHODS: This audit reviewed the donor selection process at the blood bank of Liaquat National Hospital & Medical College, Karachi, over a 6-month period. Seven variables selected as performance indicators were graded as very good (%90-100%), good (80%-89%), satisfactory (70%-79%), or unacceptable (<70%). Blood bank staff was asked for feedback and suggestions.
RESULTS: Documentation of donor demographics was not within the acceptable range (documentation rates of 65.14%), donor status records were satisfactory (77.64%), and donor physical exam records were graded as good (86.34%). Five performance indicators were graded as very good (90%-100%).
DISCUSSION AND CONCLUSION: The audit proved productive in identifying major causes of irregularities in documentation and in making valuable suggestions for their rectification.

BRIEF REPORT
12. Regulatory T Cells in Patients with Idiopathic Thrombocytopenic Purpura
Alev Akyol Erikçi, Bülent Karagöz, Oğuz Bilgi
doi: 10.4274/tjh.2015.0335  Pages 153 - 155
INTRODUCTION: Immune thrombocytopenic purpura (ITP) is an immunemediated bleeding disorder in which platelets are opsonized by autoantibodies and destroyed by an Fc receptor-mediated phagocytosis by the reticuloendothelial system within the spleen. Autoimmune processes are also considered in the pathogenesis of this disorder. CD4+CD25+FoxP3+ regulatory T (Treg) cells and CD8+CD28- Treg cells have roles in autoimmune diseases. We investigated these regulatory cells in ITP patients.
METHODS: We included 22 ITP patients and 16 age-matched healthy subjects. CD4+CD25+FoxP3+ Treg cells and CD8+CD28- cells were investigated by three-color flow cytometry. The ratios of these cell populations to total lymphocytes were calculated. Statistical analysis was carried out with the Mann-Whitney U test.
RESULTS: CD4+CD25+ Treg cells were 9.69±3.70% and 12.99±5.58% in patients with ITP and controls, respectively. CD4+CD25highFoxP3+ cells were 27.72±19.74% and 27.55±23.98% in ITP patients and controls, respectively. The percentages of both of these cell types were not statistically significant when compared to the control group.
DISCUSSION AND CONCLUSION: We did not find any differences in ratios of CD4+CD25+FoxP3+ Treg cells or CD8+CD28- T cells in lymphocytes between patients and healthy subjects. We conclude that these circulatory cells are not different in ITP, but further studies are needed to explore the putative roles of these regulatory cells.

13. Serum Zinc Levels in Iron Deficient Women: A Case-Control Study
Onur Özhan, Neslihan Erdem, İsmet Aydoğdu, Mehmet Ali Erkurt, İrfan Kuku
doi: 10.4274/tjh.2015.0206  Pages 156 - 158
Since similar symptoms and findings can be seen in the deficiencies of both iron and zinc, we aimed to evaluate the serum zinc levels of women with iron deficiency anemia (IDA). This study was conducted with women with iron deficiency and a healthy control group. When serum zinc levels were compared, they were found to be lower in the IDA group, which was statistically significant. With the help of these studies, iron and zinc treatment instead of only iron replacement may be considered in cases of iron deficiency.

CASE REPORT
14. Diffuse Large B-Cell Lymphoma Presenting with Bilateral Renal Masses and Hematuria: A Case Report
Şiyar Erdoğmuş, Serkan Aktürk, Zeynep Kendi Çelebi, Saba Kiremitii, Gülşah Kaygusuz, Namık Kemal Altınbaş, Evren Üstüner, Kenan Keven
doi: 10.4274/tjh.2015.0238  Pages 159 - 162
Renal involvement is most often seen in conjunction with multisystemic, disseminated lymphoma either by direct extension from a retroperitoneal mass or via hematogenous spread. Primary lymphoma of the kidney is not a common entity and it is a controversial issue on account of the absence of lymphatic tissues in the normal kidney. In this case report, we describe a 19-year-old male with hematuria, acute kidney injury, and bilateral renal masses due to massive lymphomatous infiltration of the kidneys, which was diagnosed as diffuse large B-cell non-Hodgkin lymphoma by Tru-Cut biopsy.

LETTER TO EDITOR
15. A Comparison of Healthy Infants and Adults with Respect to Indirect Microparticle Activity and the Parameters of the Thrombin Generation Test
Filiz Şimşek Orhon, Nejat Akar, Yonca Eğin, Betül Ulukol, Sevgi Başkan
doi: 10.4274/tjh.2015.0341  Pages 163 - 164
Abstract |Full Text PDF

16. Comment: In Response to “Downgraded Lymphoma: B-Chronic Lymphocytic Leukemia in a Known Case of Diffuse Large B-Cell Lymphoma - De Novo Occurrence or Transformation”
Burak Uz, Kadir Acar
doi: 10.4274/tjh.2015.0452  Pages 164 - 165
Abstract |Full Text PDF

17. Tumor Necrosis Factor and Splenectomy
İrfan Yavaşoğlu
doi: 10.4274/tjh.2016.0040  Page 166
Abstract |Full Text PDF

IMAGES IN HEMATOLOGY
18. Auer Rod in a Neutrophil in a Nonmalignant Condition
Harish Chandra, Smita Chandra, Vibha Gupta, Divyaa Mahajan
doi: 10.4274/tjh.2015.0275  Page 167
Abstract |Full Text PDF

19. Precursor B-Cell Lymphoblastic Lymphoma Presenting as a Spinal Mass at Initial Diagnosis
Oğuzhan Erol, Çiğdem Tokyol, Feyzullah Akyüz, Nuran Ahu Baysal, Mehmet Sezgin Pepeler
doi: 10.4274/tjh.2015.0294  Pages 168 - 169
Abstract |Full Text PDF

20. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Should Be Kept in Mind in Children with Febrile Neutropenia, Oral Cavity Lesions, and Skin Rash
Eda Ataseven, Şebnem Yılmaz Bengoa, Hale Ören
doi: 10.4274/tjh.2014.0470  Pages 170 - 171
Abstract |Full Text PDF