The tales of two sacred buildings in urban pattern of a transportation hub : the case of Üsküdar, İstanbul

Üsküdar is one of the oldest settlements in Istanbul dating back to the early Ottoman period and the primary transportation hub of the modern city. The area is at the intersection point of bulk sea transport and underground system besides heavy motor traffic and pedestrian movement. Being by-the-sea has supported the district's function in terms of transportation and recreation facilities. There is a great square, which is defined by significant historical monuments and underground stop entrances, allows considerable pedestrian flow through the area. The aim of this study is revealing the changes in the urban form of Üsküdar throughout time and the effects of two constant sacred buildings as a significant role on users' daily lives today. For this purpose, firstly the morphological changes in the urban pattern of Üsküdar are demonstrated on the building and plot differences in the urban tissue and space syntax as a quantitative method is used to define the configuration of the urban structure in relation with the two monumental historical mosques. Secondly, the architectural structures of the two mosques examined as different systems from courtyard and surrounding of the buildings. According to this perspective, visibility graph analysis and related data sets on user behaviour are used. Moreover, the pedestrian movement pattern data in the area is collected in three different time periods during the weekday, weekend and also pray time on Friday. To conclude, this study combines different data sets, observations and analytical methods to explain the morphological character of the historic area and the influence of the Friday mosques on users' everyday life independent from their functional usage

Low Serum Triglyceride Levels as Predictors of Cardiac Death in Heart Failure Patients

Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients. From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, the mean age was 64 ± 13 years, and the mean left ventricular ejection fraction was 0.27 ±0.11. By the end of the study, both sexes had similar cardiovascular mortality rates (36% men vs 37% women, P=0.559). In Cox regression analysis, NYHA functional class, triglyceride level, and history of coronary artery disease were independent predictors of cardiovascular death for women with chronic heart failure. For men with chronic heart failure, the patient\u27s age, ejection fraction, and sodium level were independent predictors of cardiovascular death. In a modern tertiary referral heart failure clinic, decreased triglyceride levels were, upon univariate analysis, predictors of poor outcomes for both men and women. However, upon Cox regression analysis, reduced triglyceride levels were independent predictors of cardiac death only in women

Preprocedural Mean Platelet Volume Level Is a Predictor of In-Stent Restenosis of the Superficial Femoral Artery Stents in Follow-Up

Background. The mean platelet volume (MPV), the most commonly used measure of the platelet size, is a cheap and easy-to-use marker of the platelet activation. We aimed to evaluate the relationship between preprocedural MPV and other hematologic blood count parameters and in-stent restenosis in patients with superficial femoral artery (SFA) stenting. Methods and Results. The consecutive 118 patients who successfully underwent endovascular stenting of the SFA were enrolled retrospectively in the study. The mean follow-up was 23 ± 12 months. The in-stent restenosis was observed in 42 patients (35.6%). There were no statistically significant differences between the restenosis group and no-restenosis group in terms of age, gender, and smoking (p=0.116, p=0.924, and p=0.428, resp.). In the restenosis group, the MPV level was markedly higher than that in the no-restenosis group, and it was statistically significant (p<0.001). According to the ROC curve analysis, the optimal cutoff value of the MPV to determine the restenosis was >8.7 fL, and the level of the MPV >8.7 fL was a strong predictor of the restenosis (p<0.001) in logistic regression analysis. Conclusions. The measurement of the preprocedural MPV levels may help to identify high-risk patients for development of the in-stent restenosis. These patients may benefit from an aggresive antiplatelet therapy and close follow-up

A simple discharge risk model for predicting 1-year mortality in hospitalised acute decompansated heart failure patients with reduced ejection fraction

WOS: 000431104400008PubMed: 28786775Objective: The risk stratification for prognosis in heart failure is very important for optimal disease management and decision making. The aim of this study was to establish a simple discharge 1-year mortality prediction model by integrating data obtained from demographic characteristics, clinical evaluation, laboratory biomarkers and echocardiographic evaluation of hospitalised heart failure with reduced ejection fraction (HFrEF) patients with acute decompensation. Methods and results: A risk score model was developed based on beta-coefficient number of variables in a multivariable logistic regression model which was created with the use of data on clinical, laboratory, imaging and therapeutic findings of 670 patients (65.4% males, 65 +/- 11 years) who was hospitalised with acute decompensated HFrEF. The mean left ventricular ejection fraction (LVEF) was 26 +/- 9%. Independent predictors of mortality were: age >= 75 years, sodium <130 mEq/L, hepatomegaly at admission, unable to use beta-blocker at discharge and LVEF 20%. The 1-year mortality rate was 7.8% in the study population. The existence of each predictor was scored as 1 point and the discharge risk score identified patients into low (0-1 points), intermediate (2-3 points) and high (4-5 points) risk individuals with 3, 15.6 and 44.4% 1-year mortality rates, respectively. The model performance evaluated by concordance index was 0.74. Conclusions: This simple discharge risk score model for hospitalised acute decompensated HFrEF patients using easily determined demographic characteristics, clinical signs, echocardiographic and laboratory data is a valuable and an easy risk assessment tool to use at point-of-care

Elevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis

WOS: 000434357200002PubMed: 29922067Background: Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. Methods: A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. Results: Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P= 270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562-0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. Conclusion: Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality

Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved &ge;10 letters gain and &ge;10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of &ge;20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 &plusmn; 0.38, RNB: 0.61 &plusmn; 0.36, RNB to AFB: 0.61 &plusmn; 0.38), at checkpoints, or at the final visit (AFB: 0.46 &plusmn; 0.38, RNB: 0.5 &plusmn; 0.37, RNB to AFB: 0.53 &plusmn; 0.36) (p &gt; 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 &plusmn; 129.6 &mu;m) when compared to the AFB (450.5 &plusmn; 122.6 &mu;m) and RNB (442 &plusmn; 116 &mu;m) groups (p &lt; 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost &ge;10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated &ge;20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments

Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved ≥10 letters gain and ≥10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of ≥20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 ± 0.38, RNB: 0.61 ± 0.36, RNB to AFB: 0.61 ± 0.38), at checkpoints, or at the final visit (AFB: 0.46 ± 0.38, RNB: 0.5 ± 0.37, RNB to AFB: 0.53 ± 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 ± 129.6 μm) when compared to the AFB (450.5 ± 122.6 μm) and RNB (442 ± 116 μm) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost ≥10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated ≥20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments