Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Marketing strategies for boutique hotels: The case of Istanbul

With the advent of the internet, the rapid development of highly sophisticated information and communication technology (ICT) has had a paramount impact on both consumers and tourism enterprises in the 21stcentury. The fiercely competitive environment of the global tourism market has inevitably encouraged hotel operators to invest more in the latest information technologies (ITs), to give prospective tourists access to lodging information, vacation experiences, and comments about the destinations shared on Social Media (SM) or websites. As a result, hotels, and particularly Boutique Hotel (BH) operators need to closely follow rising tourism trends and harness the newest communication technologies. According to recent research, new tourist profiling shows a preference for small and medium scaled “BH” having a differentiating quality such as in its architectural design, decoration, furnishings, or quality of service. In our study, we will be primarily focusing on the effective marketing strategies that should be considered by BHs, and endeavor to put forth a coherent model for BH owners. Finally, we will perform an elaborate SWOT analysis about the marketing strategies of BHs operating in Istanbul, from which to draw some key recommendations

Exergoeconomic based multi-objective optimisation of a solid oxide fuel cell system

WOS: 000338923000001In this study, the multi-objective optimisation of a solid oxide fuel cell (SOFC) system by defining the objective functions to maximise the power output, energy efficiency and exergy efficiency, and minimise the cost under various constraints is conducted. In this regard, energy, exergy and exergoeconomic analyses are performed. Some specific cases are considered and studied parametrically by varying practical operating conditions, namely temperature, pressure, current density and stack assembly thickness. An exergoeconomic model is developed for the system and incorporated into the developed computer program MULOP (multi-objective optimiser) which is based on a genetic algorithm to investigate the system parametrically, depending on the multi-objective optimisation of the objective function ratios. The best result obtained for each objective function is 1.65 W for the power produced, 0.242 and 0.269 for both exergy and energy efficiencies, respectively, and 0.0017 $/W for the cost generated

Multi-objective optimization of a vehicular PEM fuel cell system

13th Conference on Process Integration, Modelling and Optimisation for Energy Saving and Pollution Reduction -- AUG 28-SEP 01, 2010 -- Prague, CZECH REPUBLICWOS: 000292712100015The multi-objective optimization of a vehicular fuel cell system was conducted in this study with the objective functions for maximizing the power output, both energy and exergy efficiencies, and minimizing cost generation (through exergoeconomics). The cases were investigated parametrically using varying operating conditions, such as temperature, pressure, surrounding temperature and pressure, current density, humidity and membrane thickness. A computer program was developed (MULOP-The Multi-Objective Optimizer) and a genetic algorithm based solver was applied to the program for dealing with the multi-objective problems. It was seen that the variation of the cost and work values at the same work, energy, and exergy fractions are in opposite directions. This study not only calculates the minimum result of cost and maximum results of work, energy and exergy efficiencies, but also improves the computer program for solving general multi-objective optimization problems. The selection of the optimum value depends on the requirements of the system that will be used The Pareto solution values of the multi-objective problem are 3.31 $/GW, 118 kW, 0.49 and 0.55 from the cost, work, energy efficiency and exergy efficiency points of views respectively. (C) 2011 Elsevier Ltd. All rights reserved.AIDI

Biochemical properties of partially purified polyphenol oxidase and phenolic compounds of Prunus spinosa L. subsp dasyphylla as measured by HPLC-UV

WOS: 000423507700016Polyphenol oxidase (PPO) enzyme was extracted from Prunus spinosa L. subsp. dasyphylla plum, partially purified by acetone precipitation, and its biochemical properties were investigated. Different substrates (p-coumaric acid, L-tyrosine, p-hydroxyphenyl propionic acid (PHPPA), catechol, 4-methylcatechol (4-MTC), hydrocaffeic acid, gallic acid, quercetin, catechin, and epicatechin) were analysed to determine their affinities with Prunus spinosa PPO (PsPPO). The substrate specificity was in the following order: 4-MTC > catechol > hydrocaffeic acid > catechin > epicatechin. 4-MTC was the most suitable substrate (K-m = 0.97 mM and V-max = 4753 U/mg protein). The optimal pH values were 7.0 for 4-MTC and catechol, 5.0 for catechin and epicatechin, and 4.0-6.0 for hydrocaffeic acid. Optimal temperatures were 40 degrees C for 4-MTC, 30 degrees C for catechol, and 60 degrees C for catechin, epicatechin, and hydrocaffeic acid. In the inhibition tests, the most potent inhibitor was found to be sodium metabisulphite (IC50 = 0.01 mM), followed by ascorbic acid, thiourea, benzoic acid, L-cysteine, and sodium azide. Approximately 80 and 75% of the diphenolase activity was conserved at pH 5.0 and 7.0, respectively, at 4 degrees C after 7 d incubation. Moreover, native polyacrylamide gel electrophoresis (Native-PAGE) of the enriched extract revealed the presence of at least six bands with PPO activity, suggesting the existence of different PPO isoforms. However, the oxidation of diphenol related to browning significantly, so the data obtained in this research provided a basis for the prevention of enzymatic browning of Prunus spinosa during processing. High-performance liquid chromatography (HPLC) revealed the plum extract contained protocatechuic acid, p-OH benzoic acid, vanillic acid, syringic acid, epicatechin, p-coumaric acid, and luteolin

Plasma levels of fetuin-a, adipocyte fatty acid-binding protein and 8-hydroxydeoxyguanosine in patients with metabolic syndrome Metabolik sendromlu hastalarda plazma fetuin-a, adiposit-yağ asidi bağlayıcı protein ve 8-hidroksideoksiguanozin düzeyleri

© 2015 by Türkiye Klinikleri.The aim of the present study was to investigate new markers for metabolic syndrome. Fetuin-A is a physiological inhibitor of insulin receptor and is associated with insulin resistance. Adipocyte fatty acid-binding protein regulates cellular lipid metabolism by carrying free fatty acids to various intracellular compartments. Recently antioxidant and insulinotropic roles of adipocyte fatty acid-binding protein were determined. 8-hydroxydeoxyguanosine is as a marker of oxidative DNA damage. In the present study, plasma levels of fetuin A, adipocyte fatty acid-binding protein and 8-hydroxydeoxyguanosine were determined in cases with metabolic syndrome. Material and Methods: A total of 60 cases with metabolic syndrome were included in the study. The control group was constituted by age-matched 20 healthy volunteers. Fasting blood samples were taken from cases, plasma levels of fetuin-A, adipocyte fatty acid-binding protein and 8-hydroxydeoxyguanosine were measured with competitive ELISA kits. Results: Plasma levels of 8- hydroxydeoxyguanosine and adipocyte fatty acid-binding protein levels were found to be significantly higher in the cases with metabolic syndrome in comparison to those in the control group. No significant difference was determined between study groups for fetuin A level. Conclusion: Plasma level of 8-hydroxydeoxyguanosine and adipocyte fatty acid-binding protein are at a high level in cases with metabolic syndrome. High 8- hydroxydeoxyguanosine level may be considered as an evidence for increased cancer risk in cases with metabolic syndrome. In addition, it was concluded that high adipocyte fatty acid-binding protein level may be related with hyperinsulinemia

False-positive 18-fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET/CT) scans mimicking malignancies

Aim 18-Fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET/CT) is an imaging modality that is often used to help differentiate benign from malignant pulmonary lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT). However, some benign lesions may also show increased metabolic activity which can lead to false-positive PET findings. We aim to illustrate false positive findings of PET scan that simulate lung cancer in a variety of diseases. Methods Patients referred to Yedikule Chest Diseases and Surgery Teaching and Research Hospital with increased FDG uptake for which histological results were available over a 2-year period (2013-2014) were reviewed. Seven patients with false-positive PET/CT findings were reported in this study. Results The majority of lesions showing increased metabolic activity were due to malignant diseases. However, increased 18 F-FDG uptake was also seen in benign lesions such as active pulmonary inflammation or infection, granulomatous processes and fibrotic lesions. Conclusion. The integration of clinical history, morphologic findings of lesions on the CT component, and metabolic activities of PET/CT scan can help reduce false interpretations. Interventional procedures

Specification of Functional Cranial Placode Derivatives from Human Pluripotent Stem Cells

Cranial placodes are embryonic structures essential for sensory and endocrine organ development. Human placode development has remained largely inaccessible despite the serious medical conditions caused by the dysfunction of placode-derived tissues. Here, we demonstrate the efficient derivation of cranial placodes from human pluripotent stem cells. Timed removal of the BMP inhibitor Noggin, a component of the dual-SMAD inhibition strategy of neural induction, triggers placode induction at the expense of CNS fates. Concomitant inhibition of fibroblast growth factor signaling disrupts placode derivation and induces surface ectoderm. Further fate specification at the preplacode stage enables the selective generation of placode-derived trigeminal ganglia capable of in vivo engraftment, mature lens fibers, and anterior pituitary hormone-producing cells that upon transplantation produce human growth hormone and adrenocorticotropic hormone in vivo. Our results establish a powerful experimental platform to study human cranial placode development and set the stage for the development of human cell-based therapies in sensory and endocrine disease