Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study

Background: Chronic increased afterload due to severe aortic stenosis (AS) results in com­pensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function. Methods: The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E’) and late (A’) diastolic annular velocities, E’/A’ ratio and E/E’ ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE. Results: Compared with baseline, the mean mitral E, septal E’ and E’/A’ ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p < 0.001). Conclusions: TAVI improves LV diastolic function and LA performance immediately

Impact of transcatheter aortic valve implantation in patients with reduced ejection fraction

Background: Aortic stenosis increases with age. According to guidelines, left ventricular systolic dysfunction is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement. We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF. Methods and results: The study included 104 patients who underwent transfemoral TAVI in our clinic. The patients were divided into two groups: LVEF ≤ 45% (REF group, n = 28) and LVEF > 45% (preserved ejection fraction [PEF] group, n = 76). Follow-up measure­ments were performed at baseline, discharge, 1st, 6th and 12th months. No statistical difference was found between the groups with respect to complications and mortality rates. A statistically significant difference was detected in LVEF after TAVI, either in all patients (53.9 ± 14.6, 57.0 ± 11.4, 59.4 ± 8.4, 60.4 ± 6.8, 63.2 ± 3.9, respectively, at baseline, discharge, 1st, 6th and 12th months, p < 0.001) or in the groups separately. A statistically significant increase in LVEF (p < 0.001) was determined at discharge, 1st, 6th and 12th months, whereas LVEF increased in all follow-ups of the PEF group, however this elevation reached a statistical significance only at the 1st month (p = 0.04). Conclusions: Our study has shown the positive effect of TAVI on LVEF and its effective and safe applicability in patients with REF.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted kappa values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders

ENDÜSTRİ 4.0 UYGULAMALARININ ÜRETİM SÜREÇLERİNE ETKİSİ: TORUN BAKIR ALAŞIMLARI VE TİC. A.Ş. ÖRNEĞİ

Günümüzde yaşanan teknolojik gelişmeler ve uzun yıllardır devam eden küreselleşme hareketi üretim modellerine bağlı olarak hem de ülkeler arasındaki sınırların kalkmasıyla birlikte her alanda meydana gelen beklenen ya da beklenmeyen ani değişimler, üretim biçimlerine yansıdığı gibi tüketici istek ve beklentilerine de yansımaktadır. Dolayısıyla, firmalar tüketici istek ve ihtiyaçlarına anında cevap verebilmek için teknolojinin sunmuş olduğu imkânları en iyi şekilde kullanarak yaşanan değişimlere uyum sağlayabilmelidir ve bu da firmaların esnek ve çevik olması gerektiği gerçeğini ortaya çıkarmaktadır. Bu araştırmanın çıkış noktası firmaların yoğun rekabet ortamında karşılaştıkları güçlükler karşısında maliyetlerinin minimum seviyelere inmesinde ve kaliteli hizmet sunumunun sağlanmasında önemli olan Endüstri 4.0 ve Yalın Üretim, Altı Sigma gibi kavramların öneminin vurgulanmasıdır. Çalışmanın amacına uygun şekilde imalat sektörü çalışmanın evreni olarak belirlenmiştir; örneklem olarak ise imalat sanayinde faaliyet gösteren Türkiye’nin en büyük 500 Sanayi Kuruluşu ve İhracatçılar Birliği sıralamasında ilk 250 firma arasında yer alan Torun Bakır Alaşımları ve Ticaret Anonim Şirketi belirlenmiştir. Çalışmada, sosyal bilimlerde araştırma tekniklerinden nitel araştırma tekniği, nitel araştırma tekniklerinden yarı yapılandırılmış görüşme tekniği kullanılarak çalışmanın bulgularına ulaşılmıştır. Çalışma kapsamında tercih edilen yönteme uygun olarak yarı yapılandırılmış görüşme tekniği firmanın üst düzey yöneticileriyle yapılmıştır. Araştırma sonucunda firmanın Endüstri 4.0 ve Yalın üretim yaklaşımları ile ilgili olarak değişime ve yeniliğe açık bir firma olarak faaliyetlerini sürdürdüğü ve değişim odaklı hareket ettiği yönünde bulgulara ulaşılmıştır. Çalışmadan elde edilen bulgular literatürle uyumludur

Preparation and characterization of active polymers

Yeni bir biyobozunur karboksimetil selüloz (NaCMC) tabanlı hidrojel, çapraz bağlayıcı ajan olarak fumarik asitin (FA) kullanılması ile sentezlendi. Hidrojeller Fourier Transform İnfrared Spektroskopisi (FTIR), Termogravimetrik analiz (TGA), Diferansiyel Taramalı Kalorimetre (DSC), X-ray difraksiyonu (XRD), Taramalı Elektron Mikroskobu (SEM) ve Atomik Kuvvet Mikroskobu (AFM) kullanılarak karakterize edildi. Hidrojellerin şişme davranışları distile su, çeşitli tuz içeren su ve pH çözeltilerinde incelendi. Ayrıca sentezlenen polimerik filmin biyobozunurluğu incelendi. FTIR sonuçları FA ve NaCMC arasındaki çapraz bağlanmanın esterleşme reaksiyonu ile gerçekleştiğini göstermektedir. Çapraz bağlanma konsantrasyonunun yüzey pürüzlülüğüne, şişme kapasitesine, bozunma sıcaklığına, kristal yapısına, yüzey morfolojisine etkisi incelenmiştir. AFM incelemesi hidrojelin yüzey pürüzlülüğünün artan çapraz bağlayıcı konsantrasyonu ile azaldığını göstermektedir. CMC ve FA'nın çapraz bağlanması maksimum bozunma sıcaklıklarında bir artışa yol açmıştır. NaCMC'nin kristalliği FA ile çapraz bağlanması sonucu artmış fakat artan çapraz bağlayıcı konsantrasyonu ile minimal düşüş göstermiştir. SEM fotoğrafları hidrojelin yüzey morfolojisi hakkında çok net bilgi vermemektedir. Şişme çalışmaları hidrojelin şişme kapasitesinin artan çapraz bağlayıcı konsantrasyonu ile azaldığını göstermektedirler. Ayrıca hidrojelin farklı tuz ve pH çözeltilerindeki şişme davranışları, pH ve sıcaklık tersinirliği incelenmiştir. Şişme kapasitesi artan metal katyon yükü ile azalmıştır [Al (3+) < Ca (2+) < Na (+)]. Hidrojeller pH'a bağlı tersinir bir davranış gösterirken sıcaklığa bağlı tersinir bir şişme davranışı göstermemişlerdir. Yapılan biyobozunurluk testlerinin sonunda en fazla oranda FA içeren CMC hidrojelin en uzun biyobozunma süresine sahip olduğu ve bozunma olayının yarılanma süresinin yirmi bir saat olduğu ortaya çıkarılmıştır. A novel biodegradable sodium carboxymethyl cellulose (NaCMC)-based hydrogel was synthesized by using fumaric acid (FA) as a crosslinking agent at various ratios. Hydrogels which were crosslinked by fumaric acid as crosslinking agent (CMCF) were characterized using Fourier Transform Infrared Spectroscopy (FTIR), Thermogravimetric Analysis (TGA), Differantial Scanning Calorimetry (DSC), X-Ray Diffraction Analysis (XRD), Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM). Swelling behaviours of hydrogels were investigated in distilled water, various salt concentrations in water and pH solutions. The FTIR results indicated the crosslinking via ester formation between carboxyl groups of FA and hydroxyl group of NaCMC. The effect of FA concentration on roughness, swelling, degradation temperature, crystallinity of hydrogel structure and surface morphology of films were investigated. AFM analyses show that roughness of hydrogel surface was decreased with increasing crosslinking concentration. Crosslinking of CMC with FA leads to slightly increase in the maximum degradation temperature. Crystallinity of NaCMC was increased with crosslinking but slightly decreased with increasing crosslinker concentration. SEM images of hydrogels don?t give explicit information about surface morphology of hydrogels. Swelling studies in distilled water show that swelling degree of hydrogel was decreased with increasing crosslinking concentration. Swelling behavior of hydrogels was investigated in different salt and pH solutions as well. Besides, reversible pH-responsiveness of CMCF hydrogels were achieved but temperature not. From swelling studies in different salt solutions it was understood that the swelling capacity was decreased with an increase in charge of the metal cation [Al (3+) < Ca (2+) < Na (+)]. CMCF hydrogels containing the greatest ratio of FA exhibited the longest biodegradation time with a half life of 21 h using cellulase

The effect of the relationship between the eating attitudes of the primary school students and their mothers on the weight problems of the children

Bu çalışma annelerin yeme davranışı ile çocukların yeme davranışları arasındaki ilişkiyi açıklayıp, çocukluk çağı kilo problemleri üzerine etkisini değerlendirmek amacıyla tanımlayıcı ve kesitsel tipte, Haziran 2018- Kasım 2018 tarihleri arasında Silifke İlçe Sağlık Müdürlüğü Obezite Polikliniğine başvuran ve araştırmaya katılmayı kabul eden, ilkokul 1,2,3 ve 4. sınıftaki 210 öğrenci ve anneleriyle gerçekleştirilmiştir. Sosyodemografik bilgiler, Çocuklarda Yeme Davranışı ve Hollanda Yeme Davranışı ölçeklerinden oluşan anket annelerle yüz yüze görüşülerek doldurulmuş ve öğrencilerle annelerinin boy-kilo ölçümleri alınmıştır. Öğrencilerin ölçüm sonuçları WHO Anthroplus programına girilerek normal, fazla kilolu ve obez olarak üç gruba ayrılmıştır. Çalışmamıza katılan öğrencilerin %51,9’u kız, %48,1’i erkektir. Annelerle çocuklarının beden kitle indeksi arasında pozitif ilişki saptanmıştır. Çocukların kilo durumu annelerin çocuklarının kilosunu nasıl bulduğuna bağlıdır (p<0,05). Çocuklarda gıda hevesliliği, gıdadan keyif alma, duygusal aşırı yeme, içme tutkusu ve yemek seçiliği puanları beden kitle indeksi arttıkça artarken, tokluk hevesliği, yavaş yeme puanları beden kitle indeksi arttıkça azalmaktadır (p<0,05). Annelerdeki duygusal yemenin çocuklardaki duygusal az- aşırı yeme, gıda hevesliliği, gıdadan keyif alma ve içme tutkusu davranışı üzerinde pozitif yönlü etkisi olduğu görülmüştür. Annelerde dışsal yemenin normal kilolu çocuklarda gıda hevesliliği, duygusal az-aşırı yeme davranışları; annelerde kısıtlayıcı yemenin normal kilolu çocuklarda tokluk hevesliliği davranışıyla pozitif yönlü ilişki görülmüştür. Annelerde duygusal yeme davranışıyla fazla kilolu çocuklarda içme tutkusu ve duygusal az-aşırı yeme arasında pozitif, annelerde dışsal yeme davranışıyla fazla kilolu çocuklarda tokluk hevesliliği, yavaş yeme ve duygusal az yeme arasında pozitif, yemek seçiciliğiyle negatif yönde ilişki olduğu görülmüştür. Araştırmamıza göre ilkokul öğrencileriyle annelerinin yeme davranışlarının beden kitle indeksini etkilediği ve yeme davranışları arasındaki ilişkinin çocuklarda kilo problemi üzerine etkisinin olduğu görülmüş olup bu etkiyi daha net görebilmek ve değerlendirebilmek için daha kapsamlı ve uzunlamasına çalışmalar yapılması gerekmektedir.This study explains the relationship between eating attitudes of mothers and their children, and it was conducted with a descriptive and cross-sectional method in order to evaluate the impact of this relationship on weight problems in childhood. It was done with 210 1 st , 2 nd , 3 rd and 4 th grade primary school students and their mothers who came to Silifke Health Center Obesity Polyclinic between June and November in 2018 and were willing to take part in the study. The questionnaire that contains sociodemographic information and the scales of Eating Attitude of Children and Eating Attitude of the Netherlands was completed by interviewing face to face with the mothers, and the height and the weight of both the mothers and the students were also measured. The measurement of the students were categorized into three as normal-weight, overweight and obese by entering the data in WHO Anthroplus program. 51.9 % of the students who participated in the study were female, and 48.1% of them were male. A positive correlation between the body mass index of the mothers and their children was seen. The weight of the children was dependent on what their mothers thought about their weight (p<0,05). While the points of children responsiveness to food, enjoyment of food, emotional overeating and desire drinking, and food fussiness were increasing as the body mass index was increasing, the points of satiety responsiveness and eating slowly were decreasing as the body mass index was increasing (p<0,05). In addition, it was seen that emotional eating of the mothers had a positive effect on the children’s attitudes of emotional under – over eating, responsiveness to food, enjoyment of food and desire for drinking. There was also a positive correlation between the mothers’ extrinsic eating and their normal-weight children’s responsiveness to food and emotional under-over eating. At the same time, a positive correlation between the mothers’ restrictive eating and their normal-weight children’s postprandial responsiveness was seen. Moreover, there was a positive correlation between the mothers’ attitude of emotional eating and their overweight children’s desire for drinking and emotional under-over eating. Similarly, there was a positive correlation between the mothers’ attitude of extrinsic eating and their overweight children’s satiety responsiveness, eating slowly, and emotional undereating. However, there was a negative correlation between the mothers’ attitude of extrinsic eating and their overweight children’s being choosy in eating. This research revealed that the eating attitudes of the primary school students and their mothers influenced their body mass index, and the relationship between their eating attitudes had an effect on the weight problems of the children. However, in order to be able to see and evaluate that relationship more clearly, more comprehensive and longitudinal studies have to be done

Using of activated carbon produced from spent tea leaves for the removal of malachite green from aqueous solution

Spent tea leaves, as a waste material, were used to produce active carbon (STAC) in this study. STAC was used as low-cost adsorbent to remove malachite green (MG) from aqueous solutions. Characterization of STAC was made by using Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM) and surface area measurements. The effects of contact time, pH, temperature, amount of adsorbent and ionic strength on removal of malachite green were investigated. The STAC exhibited largest adsorption capacity (256.4 mg g(-1)) at 45 degrees C. STAC removed 94% of malachite green from aqueous solution and adsorption is favorable at operation conditions studied. The amount of adsorbed malachite green increased up to pH 4 and remained constant above the pH 4. Equilibrium sorption data were analyzed. by Freundlich, Langmuir and Dubinin-Radushkevich equations. Langmuir isotherm exhibited the best fit with the experimental data. Sorption kinetics was determined by pseudo-first-order, pseudo-second-order, Elovich rate equations and intraparticle diffusion models. The adsorption of MG onto STAC followed pseudo-second-order kinetics. From the thermodynamic studies, the negative value of free energy (Delta G degrees) and positive value of enthalpy (Delta H degrees) changes indicated the spontaneous and endothermic nature of the adsorption. (C) 2012 Elsevier B.V. All rights reserved