The effects of mineralogical and petrographical features of the Lake District rocks (Isparta, Turkey) on the quality of artificial marbles

Large quantities of marble blocks are produced from many new marble quarries which were opened around Isparta (Turkey) and its surrounding region. The opened quarries are also affected negatively by weathering as a result of karstification. Therefore, block efficiency of the quarries is low which results in a lot of waste materials that can be used in cultured marble production. The production of artificial marble from marble waste materials around Isparta is the main purpose of the study. The cultured marble is an attractive, healthy and homogenous building material. It has a wide application in the building construction sector. Artificial marble which is composed of mineral dusts and polyesters has high mechanical strength and they are durable to various chemical and high temperature environmental conditions. Based on physico- mechanical properties, cultured marbles are accepted by Turkish Standards (TS). The materials used for the production of qualified cultured marble are directly related to the hardness of the minerals used as filler in the polyester resin. Physico- mechanical properties of cultured marble depend on the physical properties of the filler minerals. The compressive strength of the cultured marble material is controlled by the physical properties of the filler minerals, therefore, the hardness of the cultured marble is determined by the hardness of the filler mineral. The following analyses were carried out: wet unit volume analysis, dry unit volume analysis, compressive strength of the materials, capillary water absorption analysis, analysis of ultrasound velocity (P- wave) and the marble wastes bulk chemical analyses were investigated and the results of the data were evaluated and discussed. In addition, natural and artificial marbles were compared with respect to physico- mechanical properties

The effects of mineralogical and petrographical features of the Lake District rocks (Isparta, Turkey) on the quality of artificial marbles

Large quantities of marble blocks are produced from many new marble quarries which were opened around Isparta (Turkey) and its surrounding region. The opened quarries are also affected negatively by weathering as a result of karstification. Therefore, block efficiency of the quarries is low which results in a lot of waste materials that can be used in cultured marble production. The production of artificial marble from marble waste materials around Isparta is the main purpose of the study. The cultured marble is an attractive, healthy and homogenous building material. It has a wide application in the building construction sector. Artificial marble which is composed of mineral dusts and polyesters has high mechanical strength and they are durable to various chemical and high temperature environmental conditions. Based on physico- mechanical properties, cultured marbles are accepted by Turkish Standards (TS). The materials used for the production of qualified cultured marble are directly related to the hardness of the minerals used as filler in the polyester resin. Physico- mechanical properties of cultured marble depend on the physical properties of the filler minerals. The compressive strength of the cultured marble material is controlled by the physical properties of the filler minerals, therefore, the hardness of the cultured marble is determined by the hardness of the filler mineral. The following analyses were carried out: wet unit volume analysis, dry unit volume analysis, compressive strength of the materials, capillary water absorption analysis, analysis of ultrasound velocity (P- wave) and the marble wastes bulk chemical analyses were investigated and the results of the data were evaluated and discussed. In addition, natural and artificial marbles were compared with respect to physico- mechanical properties.Publisher's Versio

Predictive factor for lymph node metastasis in non-metastatic colorectal adenocarcinomas

Objectives: To evaluate the predictive factors of lymph node involvement in non-metastatic colorectal adenocarcinomas (nmCRC). Methods: A total of 453 patients diagnosed with nmCRC were analyzed regarding T stage, lymphovascular invasion status, tumor grade and proposed risk score (RS), determined by the combination of these three factors for lymph node metastasis. Results: The median age was 62 (25-90 years), M/F ratio was 1.4:1 and majority of the patients had tumors localized on the left colon (70.6%). The number of excised lymph nodes was ≥12 in 77% of the cases. The postoperative pathological assessments revealed that 57.2% of patie,nts had N0 disease, 29.1% had N1 disease, and 13.7% had N2 disease. The T stages (p=0.007), grade (p<0.001), lymphovascular invasion (p=0.002), RS (p<0.001), and number of excised lymph nodes (p=0.029) were significantly different between N0, N1, and N2 patients. Higher RS was associated with lymph node metastasis (p<0.001). Conclusion: The risk score may predict lymph node metastasis in patients with nmCRC and if validated may be helpful in the decision-making of adjuvant chemotherapy, especially in the elderly and patients with inadequate lymph node dissection

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

A Marchiafava-Bignami Patient with Mild Symptoms and the Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis

Marchiafava-Bignami disease (MBD) is a rare entity associated with chronic alcoholism, with the degeneration of the corpus callosum being its most important characteristic. Clinical presentations may be in various forms, but the disorder can be divided into 2 broad clinical subtypes: a more severe type presenting with disorders of consciousness, which may lead to coma; or a second subtype with milder symptoms, easily underdiagnosed due to the similarity with alcohol withdrawal symptoms. With treatment and restoration of nutrition, the symptoms may be alleviated and the patient may even recover from the disease-induced coma. We present the case of a 40-year-old woman who was diagnosed with MBD. The patient had relatively weak symptoms and the diagnosis was made primarily on cranial imaging data. Diffusion-weighted MRI (DWI) was performed using a 1.5-Tesla MR system and it was seen to be significantly more efficient in detecting the ovoid nodular lesion of 6x10 mm size in the posterior corpus callosum, compared to FLAIR- and T1- and T2-weighted sequences. The lesion was no longer visible in the follow-up imaging studies after thiamine (100 mg/day for a week) treatment. It is concluded that DWI, a commonly used technique in the diagnosis of ischemic cerebrovascular disease, also has significant diagnostic value for MBD. In diffusion-weighted sequence, the variation from low to high intensities in apparent diffusion coefficient throughout the progression can be explained by cytotoxic edema and pure demyelination, respectively. (Archives of Neuropsychiatry 2011;48: 277-80

Cognitive and anatomical correlates of anosognosia in amnestic mild cognitive impairment and early-stage Alzheimer's disease

Background: Anosognosia is a common feature in Alzheimer's disease (AD). The brain substrates of anosognosia are not fully understood, and less is known about the cognitive substrates of anosognosia in prodromal and early stages of AD