Systemic Immune-Inflammation Index as a Predictor of Left Atrial Thrombosis in Nonvalvular Atrial Fibrillation

Background: The systemic immune-inflammation index (SII) has recently been investigated for cardiovascular diseases. We aimed to evaluate the relationship between SII and left atrial thrombosis (LAT). Methods: This retrospective, case-control study recruited patients with nonvalvular atrial fibrillation (NVAF) who underwent transesophageal echocardiography (TEE) for LAT detection before cardioversion or catheter ablation at a tertiary hospital between 2012 and 2021. Demographic characteristics were obtained from the hospital data system. According to TEE findings, the patients were categorized into LAT (+) and (-) groups. Age, gender, history of chronic diseases, urea, creatinine, albumin, hemogram parameters, the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), SII, the CHADS₂ score, the CHA₂DS₂-VASc score, echocardiographic parameters, antiaggregant-anticoagulant use, and non-paroxysmal atrial fibrillation were included and analyzed. Results: The study population consisted of 403 patients, including 228 men (56.6%), at a mean age of 60.84±12.26 years. A high white blood cell count (WBC) (OR, 1.26; 95% CI, 1.05 to 1.51; P=0.013), a high SII (OR, 1.00, 95% CI, 1.00 to 1.00; P=0.003), and a low ejection fraction (OR, 0.95; 95% CI, 0.90 to 0.99; P=0.018) were independent predictors of LAT (+). A spontaneous echo contrast (OR, 2.43; 95% CI, 1.35 to 4.39; P=0.003) was associated with LAT (+). SII values above 693.6 predicted LAT (+) with 71.6% sensitivity and 71.7% specificity (AUC, 0.77; P<0.001). The predictiveness of SII was similar to that of NLR (0.77 vs 0.74, P=0.093) but higher than PLR (0.77 vs 0.67; P<0.001) and WBC (0.77 vs 0.69; P=0.031). Conclusion: SII is an independent predictor of LAT in patients with NVAF

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 &lt; 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 &gt; 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 &lt; 0.001) or in the groups separately. A statistically significant increase in LVEF (p &lt; 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.

Dijagnostička točnost sastojaka mlijeka kod dijagnostike gravidnosti u krava srednje i kasne laktacije

The aims of this study were to establish a cut-off point by evaluating the usability of the somatic cell count (SCC) and milk components (fat, fat-free dry matter (FFDM), protein, lactose, freezing point, electrical conductivity and pH) to observe the pregnancy status, and to determine the practical usage of these parameters as diagnostic biomarker of pregnancy status. In the present study, primiparous Holstein cows (n=133) were included in the mid and late lactation. Milk samples were collected in sterile tubes for SCC and milk components analysis. In each lactation period, SCC, milk yield and milk component parameters were analysed by Student\u27s t test according to pregnancy status. Receiver operating characteristic curves were used to determine the predictive threshold using SCC and milk component parameters to discriminate between pregnant and non-pregnant cows. SCC levels were similar for all cows in the mid and late-lactation. In the mid lactation, FFDM, protein, lactose and electrical conductivity were higher and milk yield, fat, freezing point and pH were lower in pregnant cows (p<0.05). In the late lactation, FFDM, protein, lactose and electrical conductivity were significantly higher and milk yield, fat and pH were significantly lower in pregnant cows (p<0.05). Furthermore, fat, FFDM, protein, lactose, freezing point, electrical conductivity, and pH were the best predictors for pregnancy diagnosis in mid-lactating cows with the AUC values of 0.840, 0.768, 0.780, 0.772, 0.693, 0.792, and 0.901 respectively. Furthermore, fat, FFDM, protein, lactose, electrical conductivity, and pH could be useful diagnostic tools for pregnancy determination in late lactating cows with the AUC values of 0.869, 0.684, 0.661, 0.689, 0.756, and 0.841 respectively. In conclusion, the milk components could be used as rapid, easily accessible, and inexpensive markers for the evaluation of the diagnosis of pregnancy status in primiparous Holstein cows.Ciljevi ove studije bili su utvrditi granične vrijednosti procjenom mogućnosti upotrebe broja somatskih stanica (SCC) i pojedinih fizikalno-kemijskih parametara mlijeka (udio masti, bezmasne suhe tvari (FFDM), proteina, laktoze, točke zamrzavanja, električne vodljivosti i pH) za promatranje statusa gravidnosti kao i u svrhu korištenja navedenih parametara kao bioloških markera u dijagnozi statusa gravidnosti. U ovu su studiju bile uključene prvotelke holstein pasmine (n=133) u srednjoj i kasnoj laktaciji. Uzorci mlijeka sakupljani su u sterilne epruvete za analizu SCC i fizikalno-kemijskih parametara. U svakom razdoblju laktacije, SCC, prinos mlijeka i fizikalno-kemijski parametri analizirani su Student t-testom u odnosu na status gravidnosti. Za određivanje prediktivnog praga korištene su krivulje odnosa specifičnosti i osjetljivosti klasifikatora (ROC), korištenjem SCC i fizikalno-kemijskih parametara mlijeka za razlikovanje gravidnih i negravidnih krava. Za sve krave u srednjoj i kasnoj laktaciji razine SCC bile su slične. Sredinom laktacije, FFDM, udjeli proteina i laktoze te električna vodljivost bili su viši, a prinos mlijeka, udio masti, točka ledišta i pH bili su niži u gravidnih krava (p<0,05). U kasnoj laktaciji, FFDM, udjeli proteina i laktoze te električna vodljivost bili su značajno viši, a prinos mlijeka, udio masti i pH bili su značajno niži u gravidnih krava (p<0,05). Udjeli masti, proteina i laktoze, FFDM, točka ledišta, električna vodljivost i pH bili su najbolji prediktori za dijagnozu gravidnosti kod krava u srednjoj laktaciji s vrijednostima površina ispod ROC krivulje (AUC) 0,840, 0,768, 0,780, 0,772, 0,693, 0,792 i 0,901. Udjeli masti, proteina i laktoze, FFDM, električna vodljivost i pH mogu biti korisni dijagnostički alati za određivanje gravidnosti kod krava u kasnoj laktaciji s AUC vrijednostima 0,869, 0,684, 0,661, 0,689, 0,756 i 0,841. Zaključno, komponente mlijeka mogu se koristiti kao brzi, lako dostupni i jeftini markeri za procjenu dijagnoze statusa gravidnosti kod prvotelki holstein krava

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Matüridi’de nesh problemi

ÖZETBu çalışmada Mâtürîdî’nin ilk devirlerden itibaren sıkça tartışılan nesh konusuna bakışı incelenmiştir. O’na göre nesh, bir vakte kadar geçerli olan hükmün sona erdiğini beyan etmektir. Neshin hikmetini imtihan terimiyle açıklayan Mâtürîdî, neshin bütün çeşitlerini kabul etmiştir. O, nesh meselesine ihtiyatlı bir şekilde yaklaşarak meseleleri olgu ve olaylardan kopuk bir şekilde değerlendirmeyip olgu-lafız ilişkisini gözeterek değerlendirmiştir. Nesh teorisine din-şeriat ayrımını temellendirmek için başvurmuş olup, Kur’ân’la Hz. Muhammed’e gönderilen şeriatın, daha önceki peygamberlerin dinini değil, şeriatlarını neshettiğini ve Hz. Muhammed şeriatının kıyamete kadar geçerli olduğunu vurgulamıştır. O, tarihselcilere göre indirildiği ilk muhatap kitle için bağlayıcı kabul edilip sonraki zamanlarda yaşayanlara doğrudan hitap etmeyen Kur’ân’ın bildirdiği korku namazı, hırsızlığa verilen had cezası ve zıhâr uygulaması gibi hükümleri yerel-mahallî olarak değil de evrensel olarak değerlendirmiştir. Anahtar Kavramlar: Nesh ve çeşitleri, Mâtürîdî, Tarihsellik.ABSTRACTIn this study, the view of Maturidi about the subject of nesh which has been frequently discussed as from the early ages has been analyzed. According to him, nesh is to express that a judgment that was valid until a certain time has expired. Maturidi who has explained the philosophy of nesh with the term of examination has accepted all forms of nesh. He has approached the matter of nesh temperately and evaluated the matters by observing the relation of fact and wording, not disjointedly from facts and events. Having referred to the theory of nesh in order to found the distinction of religion-sharia, he has emphasized that the shariah sent to Muhammad with Koran has overruled the sharia of former prophets, not their religions, and that the sharia of Mohammad is valid until doomsday. He has universally, not locally-endemically, evaluated the judgments such as fear salaat, limitation punishment inflicted for robbery and zihar practice which have been stated by Koran and, according to historicists, have been accepted obligatory for the first addressed audience and have not directly appealed to the ones who live in following periods.Key Terms: Nesh and its forms, Maturidi, Historicity

Matüridi’de nesh problemi

Bu çalışmada Mâtürîdî’nin ilk devirlerden itibaren sıkça tartışılan nesh konusuna bakışı incelenmiştir. O’na göre nesh, bir vakte kadar geçerli olan hükmün sona erdiğini beyan etmektir. Neshin hikmetini imtihan terimiyle açıklayan Mâtürîdî, neshin bütün çeşitlerini kabul etmiştir. O, nesh meselesine ihtiyatlı bir şekilde yaklaşarak meseleleri olgu ve olaylardan kopuk bir şekilde değerlendirmeyip olgu-lafız ilişkisini gerek değerlendirmiştir. Nesh teorisine din-şeriat ayrımını temellendirmek için başvurmuş olup, Kur’ân’la Hz. Muhammed’e gönderilen şeriatın, daha önceki peygamberlerin dinini değil, şeriatlarını neshettiğini ve Hz. Muhammed şeriatının kıyamete kadar geçerli olduğunu vurgulamıştır. O, tarihselcilere göre indirildiği ilk muhatap kitle için bağlayıcı kabul edilip sonraki zamanlarda yaşayanlara doğrudan hitap etmeyen Kur’ân’ın bildirdiği korku namazı, hırsızlığa verilen had cezası ve zıhâr uygulaması gibi hükümleri yerel-mahallî olarak değil de evrensel olarak değerlendirmiştir. Anahtar Kavramlar: Nesh ve çeşitleri, Mâtürîdî, Tarihsellik. ABSTRACT In this study, the view of Maturidi about the subject of nesh which has been frequently discussed as from the early ages has been analyzed. According to him, nesh is to express that a judgment that was valid until a certain time has expired. Maturidi who has explained the philosophy of nesh with the term of examination has accepted all forms of nesh. He has approached the matter of nesh temperately and evaluated the matters by observing the relation of fact and wording, not disjointedly from facts and events. Having referred to the theory of nesh in order to found the distinction of religion-sharia, he has emphasized that the shariah sent to Muhammad with Koran has overruled the sharia of former prophets, not their religions, and that the sharia of Mohammad is valid until doomsday. He has universally, not locally-endemically, evaluated the judgments such as fear salaat, limitation punishment inflicted for robbery and zihar practice which have been stated by Koran and, according to historicists, have been accepted obligatory for the first addressed audience and have not directly appealed to the ones who live in following periods. Key Terms: Nesh and its forms, Maturidi, Historicity

Investigation of direct and indirect cost of constructions which completed from different constructions firms

YÖK Tez No: 394486Modern dünyada inşaat projelerinin maliyetleri: henüz "ihtiyaç" ortaya çıktığı andan itibaren önemle üzerinde çalışılması; tasarım, ölçüm, ön maliyet uygulama ve kullanım evreleri ile birlikte yıkım ve temizleme işlemlerini de içeren "yaşam boyu maliyet" döngüsü içinde irdelenmesi gereken bir konu mahiyetinde bulunmaktadır. Tarih boyunca önemli inşaat projelerinin dizayn ve yönetim uygulamaları ile hayata geçirdikleri uygulamaların içinde maliyet hesaplama ve yönetim uygulamalarının da büyük önem arz ettiği malumdur. Yapımları yüzlerce yıl süren yapıların sadece teknik yetersizlikten değil ekonomik şartlardan da zamansal olarak etkilendiği bilinmektedir. Projelendirme ve süre sınırları belirlenen bir yapım projesinin ihaleye çıkılması demek, bu projenin belirtilen kalite ve süre şartları kapsamında en uygun maliyetle nasıl ve kim tarafından vücuda getirilebileceğinin belirlenmesi anlamına gelmektedir. Her yapım projesi kendine has nitelikler içermekte ve her proje üzerinde tüm teknik, mali, ekonomik analizlerin yapılmasının yanı sıra maliyet analizlerinin de gereken doğrulukta ve nitelikte yapılarak sürekli izlenmesi; proje amaçlarının gerçekleştirilmesi yolunda en önemli uygulamalar arasında yer almaktadır. Her taahhütçü firmada bu doğrultuda hesaplamalar ve uygulamalar yaparak; geçmiş bilgilerini harmonize edip sürekli gelişen bir bilgi bankası oluşturarak hayati kıymeti olan verilerini kendi kullanımına hazır hale getirmelidir. Bu çalışmada; yurdumuzda ve dünyada yapım firmalarının maliyet belirleme ve yönetme uygulamalarına ait literatür araştırılıp, Türkiye'de faaliyet gösteren orta ve küçük ölçekli inşaat firmalarında görev yapan uzman teknik ve idari personellere yapılan bir anket yardımı ile bu firmalarca; hangi tip inşaat projeleri için hangi maliyet hesaplama yaklaşımlarının kullanıldığı, direk ve endirekt maliyetlerin ilişkilerinin nasıl gerçekleştiği ve maliyet yönetimi/kontrolü uygulamalarının nasıl yapıldığı ile ilgili veriler elde edilmiştir. Edinilen bilgiler, tablolar ve grafikler yardımı ile anlamlandırılmış, istatistiki analizler yapılmıştır. Elde edilen bulgular yardımı ile daha bilinçli ve donanımlı tercihler ve uygulamalar yapması beklenen yapım firmalarımızın; hata düzeyi en düşük derecede olan maliyet tahminleri yapabilmeleri ve ulusal ekonominin gelişimine dünya inşaat sektöründe daha fazla yer alabilmeleri için katkıda bulunulması ümit edilmektedir.The cost of construction projects in the modern world: is a subject that needs to be considered within the 'life-long cost' circle which includes destruction and clearing along with design, measurement, anticipated cost application and usage phases. It is obvious that, cost calculations and applications of practises brought to life through design and management applications of important construction projects in history have been of great importance. It is known that buildings that have taken hundreds of years to construct have been affected not only by technical insufficiency, but also economical circumstances over time. When a construction project, which has been prepared and given a deadline, is ready to be put into tendering, it means that this project is ready to be defined by who and how it is to be produced with affordability within the defined quality and time lapse. Every construction project has its own qualifications and all technical, financial, economic analysis must be done for each; a cost analysis done with necessary validity and quality and which is constantly tracked is among the most important applications of meeting the project goals. Every contractor company must prepare an appropriate pricing and practice in order to harmonise their past information and keep a record of their developing data bank for their use of this critically important data. In this study; literature about the cost and management of construction companies in the world and our country has been researched, and with the help of a survey conducted on technical specialist and administrative workers in small and intermediate scaled construction companies active in Turkey, data was obtained on which type of approach is used for which type of construction projects, how the relation between direct and indirect costs occur and how cost management/control is done in these companies. It has been given meaning and statistical analysis was produced with the help of data, charts and graphics. The aim is for construction companies which are expected to make more conscious and equipped choices and practices to make cost predictions with minimal degree of errors and to contribute to the national economical development taking more part in the world construction sector