Molecular characterization of mesophilic and thermophilic sulfate reducing microbial communities in expanded granular sludge bed (EGSB) reactors

The microbial communities established in mesophilic and thermophilic expanded granular sludge bed reactors operated with sulfate as the electron acceptor were analyzed using 16S rRNA targeted molecular methods, including denaturing gradient gel electrophoresis, cloning, and phylogenetic analysis. Bacterial and archaeal communities were examined over 450 days of operation treating ethanol (thermophilic reactor) or ethanol and later a simulated semiconductor manufacturing wastewater containing citrate, isopropanol, and polyethylene glycol 300 (mesophilic reactor), with and without the addition of copper(II). Analysis, of PCR-amplified 16S rRNA gene fragments using denaturing gradient gel electrophoresis revealed a defined shift in microbial diversity in both reactors following a change in substrate composition (mesophilic reactor) and in temperature of operation from 30 degrees C to 55 degrees C (thermophilic reactor). The addition of copper(II) to the influent of both reactors did not noticeably affect the composition of the bacterial or archaeal communities, which is in agreement with the very low soluble copper concentrations (3-310 microg l(-1)) present in the reactor contents as a consequence of extensive precipitation of copper with biogenic sulfides. Furthermore, clone library analysis confirmed the phylogenetic diversity of sulfate-reducing consortia in mesophilic and thermophilic sulfidogenic reactors operated with simple substrate

Severity index for rheumatoid arthritis and its association with health care costs and biologic therapy use in Turkey

Objective: This study aimed to apply the previously validated severity index for rheumatoid arthritis (SIFRA) to prevalent rheumatoid arthritis (RA) groups in Turkey and determine the effect of RA severity on health care costs and biologic use. Methods: This retrospective study used the Turkish national health insurance database MEDULA (June 1, 2009-December 31, 2011). Prevalent RA patients were required to be age 18 to 99, have two RA diagnoses at least 60 days apart and be continuously enrolled 1 year prior to (baseline period) and post (follow-up period) index date, which was the first RA claim during the identification period (June 1, 2010-December 31, 2010). SIFRA was calculated for the baseline period. Total health care costs and biologic use were examined for the follow-up period. The chi-square test was used to determine the association between SIFRA score terciles and outcomes. Generalized linear models were applied to determine health care costs while multivariate logistic regression determined the effect of SIFRA on outcome measures for biologic use. Results: A total of 1,920 patients were identified. The mean SIFRA score was 14.21, and 7.05 (49.57%) of the mean composed of clinical and functional status variables, followed by 6.32 (44.47%) for medications, 0.48 (3.40%) for radiology and laboratory findings, and 0.32 (2.25%) for extra-articular manifestation. There was a significant variation in scores across cities. After controlling for age, gender, region, and comorbidity index, patients in the high SIFRA tercile were 5.16 times more likely to be prescribed biologics (p<0.001, confidence interval [CI]: 3.46-7.69), and incurred annual health care costs that were 2,091 higher (p<0.001, CI: 1,557 - 2,625) than those in the low SIFRA score tercile. Conclusion: RA severity varies throughout Turkey and is a significant determinant of health care costs and biologic therapy use. Therefore, future comparative effectiveness studies should include the severity measure in their analysis

Coronary Angiography Utilization and Costs for Coronary Artery Bypass Graft Surgery Patients in Turkey

INTRODUCTION: To assess excess use of coronary angiography prior to coronary artery bypass graft surgery and its association with mortality, health care costs, and hospital quality in Turkey. METHODS: Using Turkish National Health Insurance Data (2009–2011) that included patients who underwent cardiac surgery, coronary angiography utilization was identified. Propensity score matching was used to compare survival rates and annual health care costs of patients in a coronary angiography excess-use group (>1 angiogram) and in a standard-therapy group (1 angiogram). The empirical Bayesian approach was used to combine mortality and hospital volume for quality index. The relationship between hospital quality and excess use of coronary angiography was assessed using Chi-squared tests. RESULTS: Out of 20,126 patients identified, 7.27% of patients underwent excessive coronary angiography procedures (excess-use group), with an average annual cost at 9.7% higher than those who had a single angiography (standard-therapy group; P < 0.01). Operational mortality associated with excessive use was significantly higher as well (7.4% versus 5.4%, P < 0.02). There exists variation in the use of coronary angiography across cities and hospitals. Patients who underwent cardiac surgery in high-quality hospitals were less likely to have excessive angiography use than those in low-quality hospitals (7.0% versus 9.5%, P < 0.01). CONCLUSION: In Turkey, excess use of coronary angiography prior to coronary artery bypass graft surgery is associated with higher operational mortality, higher expenditures, and lower hospital quality

Retrospective analysis of total direct medical costs associated with hepatitis B patients with oral antiviral versus pegylated interferon therapy in Turkey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108669/1/jvh12206.pd

Involvement of the histaminergic system in the resuscitating effect of centrally acting leptin in haemorrhagic shock in rats

Leptin, acting centrally as a neuromodulator, induces the activation of the sympathetic nervous system, which may lead to a pressor action in normotensive animals. In haemorrhagic shock, leptin administered intracerebroventricularly (icv.) evokes the resuscitating effect, with long-lasting rises in mean arterial pressure (MAP) and heart rate (HR), subsequent increase in peripheral blood flows, and a 100% survival at 2 h. Since leptin is able to activate histaminergic neurons, and centrally acting histamine also induces the resuscitating effect with the activation of the sympathetic nervous system, in the present study, we investigated an involvement of the histaminergic system in leptin-evoked cardiovascular effects in haemorrhagic shock. The model of irreversible haemorrhagic shock, with MAP decreased to and stabilised at 20 - 25 mmHg, has been used. Leptin (20 μg) given icv. at 5 min of critical hypotension evoked 181.5% increase in extracellular hypothalamic histamine concentration during the first 10 min after injection. Rises in MAP, HR and renal, mesenteric and hindquarters blood flows induced by leptin were inhibited by icv. pre-treatment with histamine H1 receptor antagonist chlorpheniramine (50 nmol). In contrast, there was no effect of H2, H3 and H4 receptor antagonists ranitidine (25 nmol), VUF 5681 (25 nmol) and JNJ 10191584 (25 nmol), respectively. In conclusion, the histaminergic system is involved in centrally-acting leptin-induced resuscitating effect in haemorrhagic shock in rats

Cancer and thrombosis: Managing the risks and approaches to thromboprophylaxis

Patients with cancer are at increased risk of venous thromboembolism (VTE) compared with patients without cancer. This results from both the prothrombotic effects of the cancer itself and iatrogenic factors, such as chemotherapy, radiotherapy, indwelling central venous devices and surgery, that further increase the risk of VTE. Although cancer-associated thrombosis remains an important cause of morbidity and mortality, it is often underdiagnosed and undertreated. However, evidence is accumulating to support the use of low-molecular-weight heparins (LMWHs) in the secondary prevention of VTE in patients with cancer. Not only have LMWHs been shown to be at least as effective as coumarin derivatives in this setting, but they have a lower incidence of complications, including bleeding, and are not associated with the practical problems of warfarin therapy. Furthermore, a growing number of studies indicate that LMWHs may improve survival among patients with cancer due to a possible antitumor effect. Current evidence suggests that LMWHs should increasingly be considered for the long-term management of VTE in patients with cancer

High energy Coulomb-scattered electrons for relativistic particle beam diagnostics

A new system used for monitoring energetic Coulomb-scattered electrons as the main diagnostic for accurately aligning the electron and ion beams in the new Relativistic Heavy Ion Collider (RHIC) electron lenses is described in detail. The theory of electron scattering from relativistic ions is developed and applied to the design and implementation of the system used to achieve and maintain the alignment. Commissioning with gold and 3He beams is then described as well as the successful utilization of the new system during the 2015 RHIC polarized proton run. Systematic errors of the new method are then estimated. Finally, some possible future applications of Coulomb-scattered electrons for beam diagnostics are briefly discussed.Comment: 16 pages, 23 figure

Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

A 13-year-old patient with a complaint of worsening lower abdominal pain during the past 4 months was admitted to the emergency department. An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos. Imperforate hymen was observed on examination of the external genitalia. MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina. Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected. Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to proceed to laparotomy. Pus with peritoneal microabscess formations was observed at laparotomy. The imperforate hymen and TVS were excised vaginally. A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach

Penile Doppler ultrasonography and elastography evaluation in patients with erectile dysfunction

Purpose: To evaluate the relationship between erection grade, erectile function score, Doppler ultrasonography (US) indexes, and elasticity score (ES) according to Doppler US diagnosis in patients with erectile dysfunction (ED). Material and methods: Real-time strain type penile elastography was performed during penile Doppler US examination for 88 patients with ED. The diagnosis according to Doppler US was determined. Erection score according to the Erection Hardness Grading Scale was evaluated. A scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM) was defined. The relationships, according to Doppler diagnosis, of ES, IIEF-5 score, SHIM scale, and erection score were evaluated. Results: Among the patients, 50 (57%) had abnormal penile Doppler US findings. According to Doppler US findings, patients were classified as normal (n = 38), borderline for arterial insufficiency (n = 4), arterial insufficiency (n = 5), and venous insufficiency (n = 41). The lowest erection hardness grades and IIEF-5 scores were detected in patients with arterial failure. When compared to the normal group, in terms of ES, the arterial failure borderline group and venous failure group had lower scores, and the arterial failure group had a higher score. However, the only significant difference was obtained in the left cavernous body of the venous failure group. Conclusions: Sonoelastography seems to add additional value for determination of stiffness of the penile cavernous body in routine evaluation of ED

Blind Image Quality Metric for Color Images Based on Human Vision System and Deep CNN

This article introduces a novel blind image quality metric (BIQM) for color images which is designed taking into account human visual system characteristics. The BIQM has a four-stage framework: RGB to YUV transformation, denoising with convolutional neural network , quality evaluation, and weighting to make it compatible with the human visual system. Experimental results, including Spearman's rank-order correlation coefficient, confirm BIQM's effectiveness, particularly in scenarios involving white noise and its compatibility with the human visual system. Furthermore, a survey involving 100 participants ranks images based on three distinct qualities, validating the method's alignment with the human visual system. The comparative analysis reveals that the proposed BIQM can compete with commonly used non-referenced quality measures and is more accurate than some of them. The MATLAB codes for the development of the BIQM are made available through the provided link: are available in the link: https://bit.ly/49MrbF