Clustering Nuts Level 2 Regions By K-Means and trimmed K means methods according to household consumption expenditures

Mevcut çalışmada, Türkiye’de, tüketim harcamalarına göre benzer bölgelerin belirlenmesi amaçlanmıştır. Bu bağlamda, Türkiye İstatistik Kurumu’nun (TÜİK) yayınlamış olduğu Hanehalkı Tüketim Harcamasının verileri kullanılmıştır. İlgili veride gıda ve alkolsüz içecekler, alkollü içecekler, sigara ve tütün, giyim ve ayakkabı, konut ve kira, mobilya, ev aletleri ve bakım hizmetleri, sağlık, ulaştırma, haberleşme, eğlence ve kültür, eğitim hizmetleri, lokanta ve oteller, çeşitli mal ve hizmetler olmak üzere toplamda 12 harcama mevcuttur. Ayrıca veride, TÜİK’in belirlediği Türkiye İstatistiki Bölge Birimleri Sınıflandırması Düzey 2 bölgeleri yer almaktadır. Benzer bölgelerin belirlenmesi için kümeleme yöntemlerinden k-ortalamalar ve k kırpılmış ortalamalar kullanılmıştır. K-ortalamalar yönteminde küme sayısının belirlenmesi için ise Silhouette İndeksinden yararlanılmıştır. Analiz sonucunda 3 küme olduğu tespit edilmiş ve sırasıyla kümelerde 4, 4 ve 18 bölge yer almıştır. K kırpılmış ortalamalar analiz sonucuna göre 3 küme olduğu tespit edilmiş ve sırasıyla kümelerde 4, 10 ve 11 bölge yer almıştır TR10 (İstanbul) aykırı gözlem olarak belirlenmiştir.This paper attempts to determine similar regions in Turkey according to consumption expenditures. For this reason, the data used in the analysis was gathered from Turkish Statistical Instıtute, Household Consumption Expenditures research. In the data, there were 12 variables: food and non-alcoholic beverages, alcoholic beverages, cigarettes, clothing and foot wear, housing and rent, furniture, house appliances, health, transportation, communication, entertainment and culture, educational services, restaurants, food services and hotels, various goods and services. Moreover, NUTS Level 2 regions was analyzed. In order to determine similar regions, k-means and k-trimmed means from clustering methods were used. The Silhouette Index was used to determine the number of clusters in the k-means method. As a result of the analysis, it was determined that there were 3 clusters and there were 4, 4 and 18 regions in the clusters, respectively. According to the results of the trimmed k-means analysis, it was determined that there were 3 clusters and there were 4, 10 and 11 regions in the clusters, respectively. TR10 (Istanbul) was determined as outlier

Prevalence of mastocytosis and hymenoptera venom allergy in the United States

Background : Mastocytosis is a risk factor for hymenoptera venom anaphylaxis (HVA). Current guidelines recommend measuring tryptase in HVA patients and that those with mastocytosis pursue lifelong venom immunotherapy (VIT). Available data on HVA and mastocytosis largely derives from European single-center studies and the prevalence of HVA with and without mastocytosis in the United States (US) is unknown. Objective : We sought to determine the prevalence of HVA and mastocytosis in the US using an insurance claims database and evaluate the impact of mastocytosis on VIT in HVA patients in a US cohort. Methods :The IBM Watson Database, consisting of insurance claims from approximately 27 million US patients in 2018, was queried to identify patients with HVA and/or mastocytosis. Further, a retrospective study of 161 patients undergoing VIT between 2015 – 2018 at the University of Michigan (U-M) was conducted. Results :In the IBM Watson Database, the prevalence of HVA was 167 per 100,000 (0.167%) and the prevalence of mastocytosis 10 per 100,000 (0.010%) overall and 97 per 100,000 (0.097%) among those with HVA. Mastocytosis showed a 9.7-fold increase among HVA patients versus the general population. In the U-M cohort, 2.6% of VIT patients had mastocytosis. Tryptase level did not correlate with venom reaction severity but was higher in patients with systemic VIT reactions. Conclusions :We observed a lower US HVA prevalence than previously reported. Mastocytosis was more common in US HVA patients, though at lower rates than previously reported. In VIT patients there was no correlation between tryptase level and reaction severity. Key words :Tryptasevenom allergyvenom immunotherapyanaphylaxismastocytosismast cell activation syndromemast cell disease Abbreviations Hymenoptera venom allergyHVAUnited StatesUSVenom immunotherapyVITMast Cell DiseaseMCDAmerican Academy of Allergy, Asthma, and ImmunologyWOS:000717466600002Scopus - Affiliation ID: 60105072PMID: 33895259Science Citation Index ExpandedQ1ArticleUluslararası işbirliği ile yapılan - EVETKasım2021YÖK - 2021-2

Triglyceride-glucose index levels in patients with congenital hypogonadotropic hypogonadism and the relationship with endothelial dysfunction and insulin resistance

Introduction: The risk of cardiometabolic diseases is increased in patients with hypogonadism. The triglyceride-glucose (TyG) index is a novel surrogate marker of insulin resistance and is associated with cardiovascular diseases. We investigated the TyG index levels and the relationship with endothelial dysfunction and insulin resistance in patients with congenital hypogonadotropic hypogonadism (CHH). Material and methods: A total of 98 patients with CHH (mean age 21.66 ± 1.99 years) and 98 healthy control subjects (mean age 21.69 ± 1.21 years) were enrolled. The demographic parameters, TyG index, asymmetric dimethylarginine (ADMA), high-sensitivity C-reactive protein (hs-CRP), and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured for all participants. Results: The patients had higher waist circumference (p < 0.001), triglycerides (p = 0.001), insulin (p = 0.003), HOMA-IR (p = 0.002), ADMA (p < 0.001), and TyG index (p < 0.001) levels and lower HDL-C (p = 0.044) and total testosterone (p < 0.001) levels compared to healthy control subjects. TyG index levels significantly correlated with the ADMA (r = 0.31, p = 0.003) and HOMA-IR (r = 0.32, p < 0.001) levels. TyG index was also determinant of HOMA-IR levels (ß = 0.20, p = 0.018). Conclusion: The results of the present study show that patients with CHH had increased TyG index levels. Also, the TyG index is independently associated with insulin resistance in patients with CHH. Long-term follow-up studies are warranted to find out the role of the TyG index in determining cardiometabolic risk in patients with hypogonadism.

Upper urinary tract deterioration and possible etiologies in intractable voiding dysfunction: Role of occult spinal malformation

Objectives: To evaluate the presence of upper urinary tract deterioration (UUTD) and accompanying pathologies in children treated with the diagnosis of non-neurogenic bladder-sphincter dysfunction (NNBSD). Patients and Methods: We retrospectively reviewed the medical records of 316 consecutive patients with NNBSD who were treated. All cohort were grouped into two: Group I (Treatment success; n=284), Group II (Treatment failure with any form of occult spinal pathology; n=32). Thirty-four children with treatment-failure and normal magnetic resonance imaging (MRI) findings were excluded. Groups were compared for pre- and posttreatment pediatric lower urinary tract symptom score (PLUTSS), presence of UUTD and urodynamic findings. Results: The mean PLUTSS was significantly less in Group I compared with Group II at pre-treatment and 3 months thereafter the initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14 and 18 ± 3.4, respectively p<0.01). The mean cystometric capacities and detrusor leak point pressure (DLPP) of Group II prior to initial treatment and after 6 months of the untethering surgery were found to be 194, 267 mL and 28, 12cm H2O, respectively (p<0.05). Presence of UUTD was significantly correlated with DLPP >20 cm H2O and presence of vesicoureteral reflux (VUR)

Association of serum and follicular fluid leptin and ghrelin levels with in vitro fertilization success

 Objectives: The aim of this study was to evaluate the relationship between in vitro fertilization (IVF) cycle outcomes, serum and follicular fluid (FF) levels of leptin and ghrelin. Material and methods: Forty-four women who underwent intracytoplasmic sperm injection cycles (ICSI) were enrolled in the study. On the third day (D3) of the menstrual cycle, venous blood samples were drawn for serum measurements of leptin and ghrelin. The follicular fluid (FF) and the corresponding oocyte were obtained from a single dominant preovulatory follicle at the time of oocyte pick-up. The FF and D3 serum leptin and ghrelin concentrations were measured by enzyme-linked immunosorbent assay. The relationship between pregnancy rate and serum, follicular fluid levels of leptin and ghrelin were analyzed. Results: Of the 44 cases included, nineteen achieved clinical pregnancy (43.18%). Follicular fluid ghrelin levels were significantly lower in the pregnant group than non-pregnant group (p &lt; 0.05) With respect to FF leptin, there was no statistically significant differences between the pregnant and non-pregnant women (p &gt; 0.05). There was no statistically significant difference in D3 serum ghrelin between pregnant and non-pregnant groups (p &gt; 0.05). However, D3 serum leptin levels were significantly lower in pregnant women than non-pregnant women (p &lt; 0.05). Conclusions: Lower ghrelin levels in the follicular fluid were associated with higher pregnancy rates. Also, D3 serum leptin levels were inversely correlated with clinical pregnancy rates. These findings support the potential role of these molecules on IVF outcomes

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The evaluation of efficiency of various Calcium Hydroxide removal techniques from root canals

Kalsiyum Hidroksit in, üstün antimikrobiyal özellikleri olmasına rağmen, kök kanalından tamamen uzaklaştırılamadığında tamamlanmış endodontik tedavilerde apikal sızıntılara neden olduğu bilinmektedir. Kök kanalından uzaklaştırılamayan Ca(OH)2 , bitmiş kanal dolgusunda apikal sızıntı yaratabilmekte, rezin esaslı kanal dolgu sistemlerinde, dentin tübüllerine penetre olarak, rezin bağlayıcı ajanın dentine adezyonunu engellemektedir. Bu çalışmanın amacı, endodontide seanslar arası pansuman materyali olarak kullanılan Ca(OH)2 in farklı irrigasyon solüsyonları ve ajitasyon metodları ile kök kanalından uzaklaştırılmasının, direkt gözlemleme ve yüksek çözünürlüklü dijital fotoğraflama metodları ile incelenip karşılaştırılmasıdır. 208 adet çekilmiş maksiller ve mandibular kanin insan dişi, 2 ana ve 13 alt grup olmak üzere toplam 26 gruba ayrıldı. Ana gruplar smear tabakasının uzaklaştırıldığı A ve uzaklaştırılmadığı B grupları olarak, alt gruplar ise irrigasyon materyali açısından: distile su,NaOCl, ısıtılmış NaOCl, NaOCl + EDTA yı, mekanik ajitasyon yöntemi açısından: şırınga irrigasyonu, canal brush ve PUI u içerecek şekilde oluşturuldu. Örnekler rotary eğe sistemleri ile biyomekanik preperasyonları yapıldıktan sonra, boylamasına ikiye ayrıldı. Kök kanalında yapay olarak oluk oluşturuldu ve kök kanalına Ca(OH)2 gönderildi. Dişler 37 C de 1 hafta süre ile bekletildi. Kök yarıları özel olarak hazırlanmış mufla sistemi yardımı ile birleştirilip Ca(OH)2 uzaklaştırma yöntemleri uygulandı. Sonuçlar oluk skorlama ve dijital fotoğraflama yöntemleri ile elde edilip veriler değerlendirildi. Ana gruplar arasında (A B) smear tabakanın uzaklaştırılıp uzaklaştırılmaması açısından istatistik olarak anlamlı bir fark bulunmadı (p>0,05). Ca(OH)2 in en iyi uzaklaştırıldığı gruplar sırasıyla PUI, kanal fırçası ve şırınga gruplarıdır. PUI grupları arasında ise PUI NaOCl EDTA grubu Ca(OH)2 in en iyi uzaklaştırıldığı grup olarak bulgulandı. Kök kanallarından Ca(OH)2 uzaklaştırılmasında PUI birinci olarak tercih edilmesi gereken yöntemdir. İrrigasyon materyali olarak NaOCl ve EDTA nın kullanılması Ca(OH)2 uzaklaştırma etkinliğini arttırabilmektedir.Calcium Hydroxide has been known by having superb antimicrobial properties, besides when it s not removed from root canal, it may cause possible apical leakage of the obturated canal system. It can also prevent adhesion of resin bonding agent to dentin and resin based canal obturation by penetrating dentinal tubules. The purpose of this study was to evaluate the removal of calcium hydroxide from root canal with different irrigation solutions and agitation methods and to compare by direct visualisation and high definition photography. 208 extracted maxiller and mandibular human canine teeth , divided into 2 main and 13 sub groups by 26 total. Main groups were smear layer positive (A) and smear layer negative (B). Sub groups were, distiled water, NaOCl, pre-heated NaOCl, NaOCl + EDTA as irrigation solution, and syringe irrigation, canal brush, PUI as agitation methods. Specimens were sectioned longitudinally along the lenght of the canals, after biomechanic preperation process with rotary system. Artificial grooves were formed at the root canal surfaces, and Ca(OH)2 placed into root canals. The teeth were stored at 37&#730;C for 1 week. Root halves placed in specially prepared metal muffle system, and Ca(OH)2 removal techniques were applied. The results were obtained with groove scoring and digital photography methods. There was no statistically significant differencies between groups A and B, in terms of smear layer existence (p>0,05). Ca(OH)2 was removed with PUI groups most effectivelly, followed with canal brush and syringe groups. Group of PUI NaOCl + EDTA was the least Ca(OH)2 coated field of percentage between PUI groups. PUI may be the first choice at removal of Ca(OH)2 from root canals. Usage of NaOCl and EDTA as irrigation materials may increase removal efficiency of Ca(OH)2

The halogen effect on the ring-opening of germacyclopropylidenoids to germaallenes

Density functional theory calculations were employed to explore the ring-opening reaction mechanisms of mono germanium analogues of cyclopropylidenoids via Doering-Moore-Skattebøl method. The theoretical findings revealed that the stepwise fashion with the intermediacy of a free germacyclopropylidene is operative for the structure with germanium atom on the carbenic position (1). Moreover, the cyclopropylidene analogue (4) of the title structures proceeds via concerted manner for the corresponding ring-opening reaction. The calculated overall energy barrier to trigger the stepwise ring-opening reaction for 1 is strongly higher than the concerted fashion for 4. Additionally, the effect of halogens (X = F, Cl, Br) on the reaction mechanism were also investigated. The energy barriers for chlorine substituted precursors are found to be lower than the fluorine and bromine substituted forms. © 2019 ACG Publications. All rights reserved

Spectroscopic, structural, aromaticity and electronic properties of isatoic anhydride - experimental and theoretical investigation

The paper compares the experimental FT-IR, H-1- and C-13-NMR spectra of isatoic anhydride (ISA) with the Hartree-Fock (HF) and Density Functional Theory (DFT) calculations using three different basis sets (6-31+G(d,p), 6-311+G(d,p), cc-pVTZ). The best compatibility between the experimental and theoretical FT-IR spectrum was observed with the use of B3LYP/6-31+G(d,p) method for ISA. Furthermore, the theoretical(1)H- and C-13-NMR spectra interpreted by GIAO method depict that the DFT formalism, particularly the B3LYP/6-311+G(d,p) theory of level, gives an accurate description of the ISA experimental chemical shifts. The calculated structural data were also compared with experimental findings. The statistical regression analyses show that the B3LYP/6-31+G(d,p) method results in a correct description of the ISA crystallographic data. Moreover, the frontier molecular orbitals (FMOs), molecular electrostatic potential (MEP) map, and NBO atomic charges of the ISA have been discussed at B3LYP/6-31+G(d,p) theory of level. The FMO analysis were used to determine the charge transfer within ISA and some chemical descriptors such as ionization potential, electron affinity, chemical hardness, softness, chemical potential and electro negativity. The Nucleus-Independent Chemical Shifts (NICS) were also computed for ISA derivatives, 2-10. In the X: O and Y: S derivative, 4, sulphur substitution increases slightly the aromaticity of ISA skeleton