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 < 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

Amasya’da yapılı çevrenin geç Osmanlı döneminden erken cumhuriyet dönemine dönüşümü.

This study focuses on the transformation of the built environment in the northern Anatolian town of Amasya from the late period of the Ottoman Empire to the early period of the Turkish Republic. The aim is to evaluate the settlement history of Amasya as a city with distinctive geographical characteristics, by analyzing the transformation of its built environment in relation to the changing socio-cultural, economic and political contexts. The analysis starts by focusing on the essential urban nodes formed by public buildings and places in the city center and the neighborhoods as the newly emerged defining elements in the Ottoman and Republican urban contexts. Then, the focus is widened to understand the determining urban routes experienced along the waterfront as the main element of city form, in the landscapes of public use, and through the transportation network provided in the city during the chronological frame of the study. Examining the transformation of the built environment in Amasya via the urban nodes and routes of the city from the late Ottoman to the early Republican periods, the study analyses the changing layers of the city in order to evaluate what was preserved, re-used and lost in the process of change.Thesis (Ph.D.) -- Graduate School of Natural and Applied Sciences. History of Architecture

Replication Data for: A Study for Scholarly Impacts of International Relations Academics and Departments in Turkey through Google Scholar Data

Since computers revealed the possibility to collect and evaluate large data, there has been a significant increase in studies measuring the impact of academics. This study aims to analyse International Relations scholars and departments in Turkey by using the data from Google Scholar citation counts. Through this measurement, the study will generate a new ranking list as alternative to existing measurement lists. To control outcomes, Google-generated ranking lists will be compared with data generated from Social Science Citation Index (SSCI). Thus, the study aims to make a data-based contribution to the quality assessment literature, which has become increasingly popular in Turkey. Günümüzde bilgisayarlar geniş verileri toplama ve değerlendirme imkanını ortaya çıkarınca, akademisyenlerin etkisini ölçmeyi hedefleyen çalışmalarda ciddi bir artış oldu. Elinizdeki çalışma da Google Scholar (GS) atıf sayısı verileri üzerinden Türkiye’deki Uluslararası İlişkiler akademisyenlerini ve bölümlerini analiz etmeyi hedeflemektedir. Yapılacak bu analiz ile, mevcut ölçme listelerine alternatif olarak akademisyen ve bölümlerin yeni bir sıralanması ortaya konulmaktadır. GS verilerinden hareketle elde edilen sonuçlar, kontrol amacıyla Social Science Citation Index (SSCI) veri tabanından derlenen makale sayıları ve atıflar ile karşılaştırılmıştır. Böylelikle çalışma Türkiye özelinde gittikçe kapsamlı bir hale gelen nitelik değerlendirme literatürüne verilere dayalı bir katkı yapmayı hedeflemektedi

Polynomial surface fitting and artificial neural networks-based analysis of the storage days and garlic extract supplementation dependent microbial growths in minced raw chicken meat

Akben, Selahaddin Batuhan/0000-0001-9894-746X; balpetek kulcu, duygu/0000-0001-7108-2654WOS: 000461897400009In this study, effects of garlic extract on microbial growth occurred in minced chicken were measured. Microbial growths modeled were the yeast-mold, Staphylococcus aureus, total coliform group bacteria, total mesophilic aerobic bacteria and total psychrophilic bacteria (TPB). Garlic extracts were added in concentrations of 0.5, 1, 1.5, and 2% and measurements were done at 1st, 3rd, 5th, 7th and 10th days of storage for each garlic extract. The polynomial surface fitting (PSF) and artificial neural networks (ANN) were used as modeling methods. It was found that the garlic extract has modelable effects to inhibit the microbial growth occurs in minced raw chicken meat. The fits of models were between 97 and 99%. Although the ANN provided better fit about 1-1.5%, the use of both models together was suggested due to some disadvantages of ANN. Finally, the garlic extract concentration that promises the best microbial growth inhibition was suggested using ANN and PSF models. Practical applications Garlic extract supplementation can completely prevent along first storage day all microbial growths in minced chicken meat stored at refrigerator temperature. The microbial growth can also be inhibited in later days, under same conditions. Thus, the shelf life of minced chicken meat stored at refrigerator temperature can be extended up to 1 day by means of garlic supplementation. In addition, the proposed models provide the possibility to calculate the microbial growth values as the function of storage day and garlic extract concentration.Giresun University Scientific Research Projects UnitGiresun UniversityGiresun University Scientific Research Projects Uni

Quantitative Clinical Diagnostic Analysis of Acetone in Human Blood by HPLC: A Metabolomic Search for Acetone as Indicator

WOS: 000376913800001PubMed ID: 27298750Using high-performance liquid chromatography (HPLC) and 2,4-dinitrophenylhydrazine (2,4-DNPH) as a derivatizing reagent, an analytical method was developed for the quantitative determination of acetone in human blood. The determination was carried out at 365 nm using an ultraviolet-visible (UV-Vis) diode array detector (DAD). For acetone as its 2,4-dinitrophenylhydrazone derivative, a good separation was achieved with a ThermoAcclaim C-18 column (15 cm x 4.6mm x 3 mu m) at retention time (t(R)) 12.10 min and flowrate of 1mL min(-1) using a (methanol/acetonitrile) water elution gradient. The methodology is simple, rapid, sensitive, and of low cost, exhibits good reproducibility, and allows the analysis of acetone in biological fluids. A calibration curve was obtained for acetone using its standard solutions in acetonitrile. Quantitative analysis of acetone in human blood was successfully carried out using this calibration graph. The applied method was validated in parameters of linearity, limit of detection and quantification, accuracy, and precision. We also present acetone as a useful tool for the HPLC-based metabolomic investigation of endogenous metabolism and quantitative clinical diagnostic analysis.Canakkale Onsekiz Mart University Scientific Research Projects Commission, Canakkale/Turkey [TSA 2015-497]This study was supported by Canakkale Onsekiz Mart University Scientific Research Projects Commission, Canakkale/Turkey (Project no. TSA 2015-497), and was performed in Nanoscience and Technology Research and Application Center (NANORAC). The authors would like to thank all participants who kindly provided human blood and urine samples for the study and those who helped in the collection of samples at Canakkale Onsekiz Mart University Application and Research Hospital

Higher C-Reactive Protein to Albumin Ratio Portends Long-Term Mortality in Patients with Chronic Heart Failure and Reduced Ejection Fraction

Background and Objectives: In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods: In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results: The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6–20.4) vs. 0.6 (IQR = 0.1–2.6), p p p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions: The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker

Dual action of exosomes derived from in vitro Aβ toxicity model: The role of age for pathological response

Exosomes released from different cell types of the central nervous system play an essential role in the pathogenesis of Alzheimer's disease (AD). In this study, we aimed to create an animal model by injecting exosomes that carry AD markers into the brain to shed light on the mechanism behind Alzheimer's pathology. Exosomes obtained from mouse Neuro2A, to which Aβ toxicity model applied, were used as a mediator to build an AD phenotype. For this purpose, exosomes were administered into hippocampal CA3 region of mice with different ages. Firstly, the possible role of exosomes on brain volume was analyzed. Then, neurons and astrocytes were evaluated for survival. In addition, the progenitor cells' differentiation capacity was investigated via BrdU staining. AKT signaling pathway components were examined to detect the molecular mechanisms behind the exosomal function. We found different responses in different age groups. Expression of APP upregulated only in young animals upon delivery of Aβ-exosomes. Interestingly, young animals represented increased numbers of neurons in the hippocampus, and neurogenesis was found to be restricted after Aβ-Ex injections. However, in relation to exosome administration, the glial intensity increased in aged animals. Lastly, phosphorylation of survival kinase AKT was downregulated due to the presence of Aβ in both young and old animals. The findings reveal that the exosomes from an in vitro Aβ toxicity model may induce different responses in an age-dependent manner. This study is the first to report the relationship between exosomal function and aging by evaluating the key molecules

Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis The Multicenter HATTUSHA Study

BACKGROUND Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. OBJECTIVES This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. METHODS A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. RESULTS The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). CONCLUSIONS Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT. (J Am Coll Cardiol 2022;79:977-989) (c) 2022 by the American College of Cardiology Foundation