The morphological investigations on the heart and some vessels of bovine foetus between the 15th and 25th weeks of gestation

Background: The aim of this study was to define the morphological and morphometric development of the foetus heart obtained from the domestic cattle in the gestation period of 15–25 weeks. Materials and methods: For this purpose, a total of 30 hearts belonging to cattle foetuses (15 males, 15 females) were used. The ages of foetuses were calculated according to the forehead-to-tail length and examined in three different groups. After dissection; biometric, macroanatomic, morphometric and histological findings were obtained from the foetal hearts according to the groups. In addition, mean values of the morphometric findings were determined. Results: As a result of the study, it was found that with the advancing age the convexity of margo ventricularis dexter increased and margo ventricularis sinister transformed from a convex-concave shape to a flat shape. The heart-to-body weight ratio was determined as 0.08% for Group II female foetuses and 0.09% for all other groups. The heart heights for Groups I, II, and III females were identified as 26.21, 41.00, and 46.27 mm, respectively, and for the males 26.45, 34.89, and 47.15 mm, respectively. In the statistical analysis, it was determined that all the morphometric values measured from the heart correlated significantly with the forehead-to-tail length. Conclusions: The data obtained as a result of the study is thought to help understand the morphological and morphometrical development of the heart, pioneer the attempts to create a foetal cattle heart model, and thus help in the diagnosis of the foetal heart pathologies.acieleck

Turner syndrome and associated problems in turkish children: A multicenter study

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosi) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto’s thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan. © Journal of Clinical Research in Pediatric Endocrinology

Preparation and thermal properties of mineral-supported polyethylene glycol as form-stable composite phase change materials (CPCMs) used in asphalt pavements

Tis work was supported by the National Natural Science Foundation of China (51704040, 51778071, 51608058), the Scientifc Research Project of Hunan Provincial Department of Education for Excellent Young Scholars (16B007), Open Fund of Key Laboratory of Special Environment Road Engineering of Hunan Province (Changsha University of Science & Technology, kf160501), and Open Fund of Key Laboratory of Biohydrometallurgy, Ministry of Education (Central South University, MOEKLB1708)

Specifying and Validating Probabilistic Inputs for Prescriptive Models of Decision Making over Time

Optimization models for making decisions over time in uncertain environments rely on probabilistic inputs, such as scenario trees for stochastic mathematical programs. The quality of model outputs, i.e., the solutions obtained, depends on the quality of these inputs. However, solution quality is rarely assessed in a rigorous way. The connection between validation of model inputs and quality of the resulting solution is not immediate. This chapter discusses some efforts to formulate realistic probabilistic inputs and subsequently validate them in terms of the quality of solutions they produce. These include formulating probabilistic models based on statistical descriptions understandable to decision makers; conducting statistical tests to assess the validity of stochastic process models and their discretization; and conducting re-enactments to assess the quality of the formulation in terms of solution performance against observational data. Studies of long-term capacity expansion in service industries, including electric power, and short-term scheduling of thermal electricity generating units provide motivation and illustrations. The chapter concludes with directions for future research

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries