Search

Abstract Purpose Planning intraoperative fluid therapy in patients undergoing major abdominal surgery is important. It was aimed to define the difference between fluid therapy protocols for renal function, bleeding and postoperative service follow-ups. Materials and methods This is an observational case-controlled prospective study. Sixty patients aged 18–65 years who had undergone pancreatic surgery between December 2023– February 2023 were included in the study. Liberal (Group 1; n = 30) and targeted fluid therapies (Group 2; n = 30) were administered to the patients. Liberal fluid therapy was planned with 8–10 ml/kg/h crystalloid infusion. The targeted fluid therapy (TFT) group (Group 2; n = 30) began with a 2 ml/kg/h crystalloid infusion at the baseline. Additional fluid boluses were given in 250 ml of colloid infused over 10 min if PVI was > 13% for at least five minutes. The patients were staged using the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The amount of bleeding during surgery was recorded for both groups. Results No significant difference was observed in postoperative renal function. A significant difference was observed in the amount of intraoperative bleeding. The amount of bleeding was greater in patients managed with liberal fluid therapy. No significant difference was observed between the groups in the oral intake (hour), drain withdrawal (hour) mobilization (hour) and discharge (day) times and there isn’t any statistically significant differance between groups in cost effectivity (p>0.05). Conclusion Kidney function was preserved during individualized targeted fluid therapy using non-invasive haemodynamic monitoring parameters.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a significant public health concern, affecting one-third of the global population and posing a risk for progressive liver disease. MAFLD is characterized by hepatic steatosis and impaired metabolic status, which not only impact the liver but also other systems of the human body, making it a multisystemic disorder. Emerging evidence suggests that MAFLD and its associated pathological pathways may contribute to cognitive impairment, potentially through neuroinflammation and neurodegeneration. Studies have detected cognitive impairment in patients with MAFLD using magnetic resonance imaging, which revealed decreased brain volume and cerebral perfusion, in addition to self-reported cognitive tests. While numerous studies have demonstrated an association between MAFLD and cognitive impairment, the relationship between MAFLD and all-cause dementia remains controversial. However, the shared pathological pathways between MAFLD and dementia, such as systemic inflammation, insulin resistance, gut dysbiosis, hyperammonemia, and vascular dysfunction, indicate the possibility of a common prevention strategy for both diseases. In this review, we provide a summary of the current evidence regarding the association between cognitive impairment, all-cause dementia, and MAFLD.

Study objectives: Patients with carpal tunnel syndrome (CTS) show manifestations of arterial abnormalities, including carotid intimal thickening and increased vascular stiffness. As carpal tunnel syndrome is associated with amyloidosis, we hypothesized that previously observed abnormalities can largely be related with concomitant amyloidosis rather than CTS itself. Design: Prospective observational study. Setting: Medeniyet University Goztepe Hospital Participants: 61 patients with CTS (of whom 32 had biopsy-proven amyloidosis) and 36 healthy controls. Interventions: Subjects underwent ultrasound examinations for the measurement of coronary flow velocity reserve (CFVR), flow-mediated vasodilatation (FMD) and carotid intimal-media thickness (CIMT). Main outcome measures: Comparison of CFVR, FMD and CIMT in CTS patients with or without amyloidosis. Results: Patients with either CTS or CTS with concomitant amyloidosis (CTS-A) had significantly lower FMD (9.7 % ± 4.0 % in CTS and 10.3 % ± 4.6 % in CTS-A groups, p

Mantı is a type of ravioli with a unique taste, which has been appreciated by many people in Turkey for years. In this study, two common types of mantı samples (traditional Kayseri mantı produced by wrapping dough sheets into small bags and triangular mantı) were dried to make them microbiologically safe by lowering their water activities to a desired level of less than 0.6. Drying process was carried out in a conventional dryer at 60, 70 and 80 °C and the drying kinetics of mantı samples was determined by the Page, Henderson and Pabis, Modified Page, Logarithmic and Newton models. The best-fit model for the drying characteristics of triangular mantı was the Newton model at 60 and 70 °C while the Page and Modified Page models were the best at 80 °C. Moreover, Page/Modified Page, Newton and Page/Modified Page models were the best-fit models for traditional Kayseri mantı at 60 °C, 70 °C and 80 °C, respectively. Faster drying rates were obtained for triangular mantı, and the desired water activity value for this mantı was reached at drying temperatures of 70 °C and 80 °C, and only at 80 °C for the traditional Kayseri mantı. Drying rates increased by increasing temperature levels.

Objective: Acute decompensated heart failure (ADHF) is a life-threatening medical condition and more than 30% of patients hospitalized for ADHF develop acute kidney injury (AKI), which increases the rate of both mortality and morbidity. Previous research has indicated that several biomar- kers may help to predict the development of AKI. The aim of this study was to investigate the relationship between lactate level at the time of admission and AKI in ADHF patients. Methods: A total of 154 consecutive ADHF patients were prospectively enrolled from June 2018 to December 2018, and after applying the exclusion criteria, a total of 91 patients were included in the study. The patients were divided into 2 groups: those with and without AKI. Results: There were 63 patients in the group without AKI and 28 patients in the group with AKI. The AKI group had a higher percentage of a history of chronic kidney disease (CKD), a higher creatinine level, lower glomerular filtration rate level, lower bicarbonate level, higher lactate level, and a lower left ventricular ejection fraction compared with the non-AKI group (p

Raisins have been widely consumed for many years all around the world, and different grape cultivars and drying techniques are used in their production. Recently, mechanical drying systems have been used to overcome any undesirable effects that arise from sun-drying with grape cultivars that require fewer pesticides to minimize the risk of residues. Both seeded and seedless cultivars were preferred for drying in the past; however, seedless grape cultivars have been increasingly preferred for drying purposes in addition to their use as table grapes. For the first time, an alternative processing method (using an energy-saving heat pump dryer) and important quality characteristics (total phenolics, antioxidant activity, brix, colour analyses and sensory evaluation) of disease resistant/tolerant grape cultivars of different species that can be grown in humid regions were investigated in this study. First, the fresh fruits of nine different grape (Vitis spp.) cultivars grown in a humid ecology were analysed, and then so too were the important phytochemical and quality characteristics of raisins dried with an energy-saving heat pump dryer. The water activity of the raisins ranged from 0.71 (Özer Beyazı) to 0.42 (Kay Gray). The total phenolic contents of Muscat Bleu (65.96), Philipp (64.88) and Campbell Early (64.53 g GAE/100 g db) berries were the highest (p < 0.05). The fresh berries of the Kishmish Vatkana cultivar had the lowest antioxidant activity, as determined by the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay (525.81 mmol TE/100 g) (p < 0.05). The total phenolic contents of raisins ranged from 12.76 to 13.58 g GAE/100 g fw. The highest value on a dry weight basis was 19.30 g GAE/100 g for the raisins of the Özer Beyazı cultivar (p < 0.05). The highest antioxidant activity value on a dry weight basis was found for the raisins of Özer Beyazı (991.01 mmol TE/100 g) using the DPPH assay. The raisins of the Philipp cultivar had an antioxidant activity of 7893.51 mmol TE/100 g db, as determined by the ferric reducing antioxidant potential (FRAP) assay, which was significantly higher than those of other cultivars, with the exception of Muscat Bleu (p < 0.05). The range for antioxidant activity values provided by the cupric reducing antioxidant capacity (CUPRAC) assay was high, and the highest value was found for the raisins of the Philipp cultivar (4505.21 mg Trolox/100 g fw) (p < 0.05). The results indicated that the raisins of the seedless Rhea and Kishmish Vatkana cultivars can be appreciated more than those of the other cultivars, both in terms of their bioactive content and sensory scores, and the raisins of these cultivars, which can be grown in humid regions, hold a great deal of potential for grape growers.

Background: Professionalism education is one of the major elements of surgical residency education. Aims: To evaluate the studies on core professionalism education programs in surgical professionalism education. Study Design: Systematic review. Methods: This systematic literature review was performed to analyze core professionalism programs for surgical residency education published in English with at least three of the following features: program developmental model/instructional design method, aims and competencies, methods of teaching, methods of assessment, and program evaluation model or method. A total of 27083 articles were retrieved using EBSCOHOST, PubMed, Science Direct, Web of Science, and manual search. Results: Eight articles met the selection criteria. The instructional design method was presented in only one article, which described the Analysis, Design, Development, Implementation, and Evaluation model. Six articles were based on the Accreditation Council for Graduate Medical Education criterion, although there was significant variability in content. The most common teaching method was role modeling with scenario- and case-based learning. A wide range of assessment methods for evaluating professionalism education were reported. The Kirkpatrick model was reported in one article as a method for program evaluation. Conclusion: It is suggested that for a core surgical professionalism education program, developmental/instructional design model, aims and competencies, content, teaching methods, assessment methods, and program evaluation methods/models should be well defined, and the content should be comparable.

The main purpose of this study is to determine the contents of 3 major phenolic compounds (gallic acid, catechin, and epicatechin) in 22 different grape cultivars/hybrids obtained from 2 different breeding programs. Additionally, changes in these phenolic components in the grape leaves of some resistant/tolerant species were determined in relation to powdery and downy mildew diseases in viticulture. The skin, pulp, and seeds of grape berries were analysed over two years, while changes in the phenolic contents of grape leaves were determined before and after these diseases for two years. The major phenolic contents of new hybrids/cultivars were compared with those of popular cultivars in different parts of the grapes, and significant differences in phenolic contents were found among hybrids/cultivars and different grape parts. Variations in the contents of phenolics in grape seeds, skins, and pulp were high, but seeds contained higher levels of these phenolics than pulp and skin. Analyses of the relationship between two viticultural diseases and phenolic changes in resistant/tolerant cultivars in relation with the susceptible “Italia” cultivar revealed that an increase in the content of the phenolic compounds was found after powdery mildew disease. Hybrids/cultivars with high phenolic contents are recommended to develop new superior cultivars, which are resistant to grape fungal diseases, in breeding programs.

INTRODUCTION[|]Inflammatory bowel diseases (IBD) consist of a number of chronic inflammatory diseases. Inflammatory process is known to be involved in all stages of atherosclerosis. Early atherosclerosis is reflected by increased levels of carotid artery intima media thickness (c-IMT) and high-sensitivity C-reactive protein (hs-CRP). Epicardial fat thickness (EFT) strongly influences both the formation and progression of atherosclerosis. Recent studies have demonstrated a relationship between c-IMT and hs-CRP levels and the risk of atherosclerosis in patients with IBD. However, no study has yet compared EFT between patients with IBD and the general healthy population. Hence, this study was designed to further evaluate whether patients with IBD have higher EFT values with increased c-IMT and hs-CRP levels compared to those in the healthy population.[¤]METHODS[|]A total of 110 patients with IBD and 105 healthy volunteers were enrolled into this study. EFT was evaluated by transthoracic echocardiography. c-IMT levels were measured using an ultrasound scanner with a linear probe. The plasma levels of hs-CRP were measured using a highly sensitive sandwich ELISA technique.[¤]RESULTS[|]The hs-CRP and c-IMT levels of patients with IBD were significantly higher than those of the control group. The EFT values of patients with IBD were significantly higher than those of the control group (0.54+-0.13 vs. 0.49+-0.09, p=0.002).[¤]DISCUSSION AND CONCLUSION[|]Echocardiographic EFT measurements of patients with IBD were significantly higher than those of the normal population, which may be associated with an increased subclinical atherosclerosis risk in these patients.[¤]

Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2±0.4 versus 2.7±0.4 versus 3.7±0.4, p value =0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.

Objective: Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) are the leading causes of hepatocellular carcinoma (HCC). This study aimed to explore the impact of baseline MASLD on the risk of HCC development in patients with CHB receiving antiviral treatment. Methods: We consecutively recruited 535 patients with CHB who initiated antiviral treatment between January 2007 and January 2023. The exclusion criteria included coexisting HDV, HCV, or HIV infection; other chronic liver diseases; extrahepatic malignancies; prior HCC; and HCC development within one year. A baseline liver biopsy was performed in 467 patients (87 %). MASLD was defined as hepatic steatosis diagnosed histologically or by imaging, combined with one cardiometabolic risk factor. The cumulative incidence of HCC and its associated factors was analyzed in patients with CHB, with and without MASLD. Results: In total, 535 treatment-naïve patients with CHB were included, with a median follow-up of 6.05 years. MASLD was not associated with an increased incidence of HCC in patients with CHB (HR: 1.17; 95 % CI: 0.77–1.79; p = 0.466). The cumulative incidence of HCC increased with the number of fulfilled cardiometabolic criteria (0–2 criteria vs. ≥ 3 criteria) (HR: 3.93; 95 % CI: 1.89–8.19; p

Non-alcoholic fatty liver disease (NAFLD), characterized by the excessive accumulation of fat within the cytoplasm of hepatocytes (exceeding 5% of liver weight) in individuals without significant alcohol consumption, has rapidly evolved into a pressing global health issue, affecting approximately 25% of the world population. This condition, closely associated with obesity, type 2 diabetes, and the metabolic syndrome, encompasses a spectrum of liver disorders ranging from simple steatosis without inflammation to non-alcoholic steatohepatitis (NASH) and cirrhotic liver disease. Recent research has illuminated the complex interplay between metabolic and immune responses in the pathogenesis of NASH, underscoring the critical role played by T and B lymphocytes. These immune cells not only contribute to necroinflammatory changes in hepatic lobules but may also drive the onset and progression of liver fibrosis. This narrative review aims to provide a comprehensive exploration of the effector mechanisms employed by T cells, B cells, and their respective subpopulations in the pathogenesis of NASH. Understanding the immunological complexity of NASH holds profound implications for the development of targeted immunotherapeutic strategies to combat this increasingly prevalent and burdensome metabolic liver disease.

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global epidemic in Türkiye and worldwide. The aim of this study was to evaluate the prevalence and predictors of MASLD and steatohepatitis among adults who died of unnatural causes including sudden death and non-burn trauma. Method: We conducted a prospective review of all consecutive adult forensic autopsies for natural (sudden unexpected) and non-natural (Suicidal, homicidal and accidental) suspicious deaths carried out at the Istanbul Council of Forensic Medicine from February to May 2022. Four wedge biopsies were extracted from sagittal sectioned liver specimens. A liver pathologist with 20 years of experience examined each case for steatosis, ballooning, inflammation, and fibrosis. Results: Among 1797 autopsies, 62 met inclusion criteria. Overall, 43.3 % (n = 26) of autopsies showed evidence of steatotic liver disease, with a distribution of steatosis severity as: Grade I (28.3 %), Grade II (6.6 %), and Grade III (8.3 %). All these cases met at least one cardiometabolic criteria and diagnosed with MASLD. Ballooning was observed in 20.0 % of cases (5 cases grades 1 and 7 cases grade 2), and Inflammation was present in 51.7 % (9 cases with grade 0–1, 12 with 1–2, 7 with 2–3, and 3 with 5–6). Notably, 46.1 % (n = 12) of MASLD cases and 20.0 % (n = 12) of all cases were diagnosed with steatohepatitis, with three cases exhibiting delicate perisinusoidal fibrosis and one case showing portal fibrosis. Conclusion: The histopathological findings from this autopsy study confirmed the markedly high prevalence of MASLD and steatohepatitis within the general adult population, highlighting the concerning burden of steatotic liver disease in Türkiye.

Background & Aims: Patients with nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) face a multifaceted disease burden which includes impaired health-related quality of life (HRQL) and potential stigmatization. We aimed to assess the burden of liver disease in patients with NAFLD and the relationship between experience of stigma and HRQL. Methods: Members of the Global NASH Council created a survey about disease burden in NAFLD. Participants completed a 35-item questionnaire to assess liver disease burden (LDB) (seven domains), the 36-item CLDQ-NASH (six domains) survey to assess HRQL and reported their experience with stigmatization and discrimination. Results: A total of 2,117 patients with NAFLD from 24 countries completed the LDB survey (48% Middle East and North Africa, 18% Europe, 16% USA, 18% Asia) and 778 competed CLDQ-NASH. Of the study group, 9% reported stigma due to NAFLD and 26% due to obesity. Participants who reported stigmatization due to NAFLD had substantially lower CLDQ-NASH scores (all p

Babesiosis, a very important vector disease, has also been detected in humans and animals. This study was carried out on 120 whole blood samples taken from Cankiri Municipality Animal Care and Rehabilitation Center (Türkiye) between December 2021 and 2022 in Cankiri. In this study, venous blood samples taken by a veterinarian were used for diagnosis. The 18S rRNA gene region was examined with conventional PCR analysis and the positive results were subjected to sequence analysis. As a result of sequence analysis, these positive cases were determined to be Babesia bigemina. Additionally, as a result of statistical analysis, it was found that dogs detected positive for B. bigemina did not give significant results according to age, gender or symptoms. B. bigemina detected in this study were registered in the NCBI database with 7 (Acc no: OQ186727), 12 (Acc no: OQ186720), 19 (Acc no: OQ186721), 21 (Acc no: OQ186722), 23 (Acc no: OQ18723), 28 (Acc no: OQ186724), 30 (Acc no: OQ186725), and 70 (Acc no: OQ186726) numbers. The B. bigemina species detected in dogs in this study is actually seen in farm animals. This study is the first detection report of B. bigemina in dogs in Turkey. As a result, Babesia species seen in dogs need to be reconsidered and investigated with the development of molecular techniques.

The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms “nonalcoholic” and “fatty” were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction–associated steatotic liver disease. There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction–associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction–associated steatotic liver disease, who consume greater amounts of alcohol per week (140–350 g/wk and 210–420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and nonstigmatising, and can improve awareness and patient identification.

Abstract. Background:. Liver biopsy for the diagnosis of non-alcoholic steatohepatitis (NASH) is limited by its inherent invasiveness and possible sampling errors. Some studies have shown that cytokeratin-18 (CK-18) concentrations may be useful in diagnosing NASH, but results across studies have been inconsistent. We aimed to identify the utility of CK-18 M30 concentrations as an alternative to liver biopsy for non-invasive identification of NASH. Methods:. Individual data were collected from 14 registry centers on patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), and in all patients, circulating CK-18 M30 levels were measured. Individuals with a NAFLD activity score (NAS) ≥5 with a score of ≥1 for each of steatosis, ballooning, and lobular inflammation were diagnosed as having definite NASH; individuals with a NAS ≤2 and no fibrosis were diagnosed as having non-alcoholic fatty liver (NAFL). Results:. A total of 2571 participants were screened, and 1008 (153 with NAFL and 855 with NASH) were finally enrolled. Median CK-18 M30 levels were higher in patients with NASH than in those with NAFL (mean difference 177 U/L; standardized mean difference [SMD]: 0.87 [0.69–1.04]). There was an interaction between CK-18 M30 levels and serum alanine aminotransferase, body mass index (BMI), and hypertension (P

In this study, chia seed mucilage powder (MP) was added into ayran drinks at different ratios (0.05, 0.10 and 0.15%, w/v), and its effect on physicochemical, rheological, microbiological and sensory properties of ayran drinks was determined during 10 days of storage at 4±1 °C. MP addition did not influence their major chemical composition significantly (p>0.05). Increasing MP ratio in drinks decreased the colour L* values of drinks while increasing their colour a* and b* values. Addition of 0.05, 0.10 and 0.15% MP reduced serum separation values of drinks by 25, 67 and 83%, respectively. The apparent viscosity value of control samples was 103.20 cP and increased to 134.25, 185.35 and 223.38 cP in ayran drinks with 0.05, 0.10 and 0.15% MP, respectively. The obtained results indicated that chia seed MP up to 0.05% can be used in ayran drink production to reduce serum separation and improve viscosity without any adverse effect on sensory liking scores.

Abstract Patients with preexisting chronic liver disease (CLD) may experience a substantial burden from both coronavirus 2019 (COVID‐19) infection and pandemic‐related life disruption. We assessed the impact of the COVID‐19 pandemic on patients with CLD. Patients enrolled in our Global Liver Registry were invited to complete a COVID‐19 survey. As of June 2021, 2500 patients (mean age ± SD, 49 ± 13 years; 53% men) from seven countries completed the survey. Of all survey completers, 9.3% had COVID‐19. Of these patients, 19% were hospitalized, 13% needed oxygen support, but none required mechanical ventilation. Of all patients including those not infected with COVID‐19, 11.3% reported that the pandemic had an impact on their liver disease, with 73% of those reporting delays in follow‐up care. The Life Disruption Event Perception questionnaire confirmed worsening in at least one area (food/nutrition, exercise, social life, vocation/education, financial situation, housing, or health care) in 81% and 69% of patients with and without a history of COVID‐19, respectively (p = 0.0001). On a self‐assessed Likert health score scale (range, 1–10; 10 indicates perfect health), patients with a COVID‐19 history scored lower (mean ± SD, 6.7 ± 2.2 vs. 7.4 ± 2.2, respectively; p

Aim: This study aims to evaluate the association between prognostic nutritional index (PNI) and contrast-induced nephropathy (CIN). Material and methods: A total of 251 patients who were at high risk for contrast nephropathy were included in the study. The patients were grouped according to their PNI score (PNI score Results: Two groups were assigned according to the PNI score. The first group consists of 111 patients (PNI Conclusion: Our study demonstrated that the PNI score was an independent risk factor for the development of CIN.

Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is the most common chronic liver disease worldwide – with an estimated global prevalence of 37%. Different from nonalcoholic fatty liver disease (NAFLD), which is an exclusion diagnosis, MAFLD is defined by a set of positive criteria. This recent change in terminology is challenging because MAFLD and NAFLD denote two similar, albeit not identical, clinical populations. When the diagnostic criteria for MAFLD are applied, liver histology appears more severe and clinical outcomes are less favorable. However, the clinical management of MAFLD and NAFLD remains similar. While liver biopsy is still the reference standard for achieving a final diagnosis, noninvasive imaging- or biomarker-based diagnostic modalities are currently gaining momentum. However, liver biopsy should be recommended when diagnostic challenges exist. In this review, we compared the epidemiology, natural history, and diagnosis of MAFLD with respect to the traditional NAFLD definition.

BackgroundFree open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown. ObjectiveThis study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework. MethodsThe authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework. ResultsThe authors identified 109 emergency medicine and critical care websites, which comprised 45.9% (n=50) blogs, 22.9% (n=25) podcasts, and 31.2% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5% (n=30) sold products, 18.3% (n=20) used advertisements, 44.0% (n=48) had institutional funding, and 27.5% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9%) to ≥5 (n=60, 55%) individuals. ConclusionsThere was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education.

Objective Left atrial (LA) function is an important predictor of adverse cardiovascular outcomes in patients with hypertension (HT). Therefore, recognition of subtle LA dysfunction in the early stages of HT is essential for controlling modifiable variables. Several electrocardiographic and echocardiographic parameters have been studied to show early LA dysfunction. The goal of this study was to investigate the relationship between newly defined morphology‐voltage‐P wave duration electrocardiography (MVP ECG) score and early LA dysfunction in hypertensive patients. Materials and methods Eighty-nine hypertensive patients were included in this study. Based on speckle tracking echocardiography results, the patients were divided into two groups: 67 patients with normal LA function were included in Group 1, and 22 patients with abnormal LA function in Group 2. Results Age, diabetes mellitus history, duration of HT history, left ventricular mass index, E/Em, and MVP ECG score values were statistically significant between the two groups. Based on the results of the multivariate logistic regression test, duration of HT history, E/Em, and MVP ECG score were determined as independent predictive parameters for early LA dysfunction in hypertensive patients. Conclusion In conclusion, MVP ECG score assessment could be a novel approach to detect early LA dysfunction in hypertensive patients.

Abstract Background Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated. Methods The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students’ course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematically. Results Among the 16,237 unique visitors who accessed the course, only 6031 medical students from 71 medical schools registered, and about 4993 (83% of registrants) completed the course, indicating high levels of satisfaction (M = 8.17, SD = 1.49) on a 10-point scale. The mean scores of each assessment modules were > 90%. The free-text responses from 987 unique students revealed a total of 17 themes (e.g., knowing the general information on COVID-19, process management of the pandemic in public health, online platform use, and instructional design) across the elements of the RE-AIM framework. Mainly, the students characterized the MOOC as well-organized and effective. Conclusions Medical students learned about COVID-19 using a self-paced and unmonitored MOOC. MOOCs could play a vital role in the dissemination of accurate information to medical students in LMIC in future public health emergencies. The students were interested in using similar MOOCs in the future.

BACKGROUND: Social media provides an opportunity for people to connect and form communities. This community architecture can help to disseminate health-related information in the form of an awareness campaign. The European Society of Gynaecological Oncology and the European Network of Gynaecological Cancer Advocacy Groups initiated a global campaign, World Gynecologic Oncology Day, on September 20, 2020. We studied and analyzed the impact and reach of this Twitter campaign. OBJECTIVE: This study aimed to assess the impact and reach of the 2020 World Gynecologic Oncology Day Twitter campaign. STUDY DESIGN: We analyzed gynecologic oncology–specific posts (tweets) between 12 am on September 17, 2020, to 11:59 pm on September 25, 2020 (Coordinated Universal Time), covering the days immediately before and after World Gynecological Oncology Day (September 20, 2020), using Tweepy. The European Network of Gynecological Cancer Advocacy Groups suggested hashtags (#GoForPurple, #WorldGODay, and #GoForCheckup) should be used for this social media campaign. We used these hashtags for our data (tweet) collection. RESULTS: A total of 382 Twitter accounts participated in this campaign and 662 tweets, including retweets, were reported. Of those, 22% of participants were healthcare professionals. A total of 164 unique hashtags were identified, and #WorldGODay was the most frequently used among the Twitter accounts. #VaginalCancer, #CervicalCancer, and #VulvarCancer were used in relation to the campaign. We identified 5 significant communities that contributed to raising awareness. CONCLUSION: Twitter campaigns should be designed around a single, short, easy-to-spell hashtag and coordinated with previously identified influential accounts using timed tweets. #WorldGOday hashtag was relevant, easy to spell, memorable, and the most effective hashtag used in this campaign.

Ischemic stroke is a rare and serious complication of coronary angiography and percutaneous coronary intervention, which has high morbidity and mortality. To our knowledge, there is no large-scale randomized controlled trial for the management of catheter-related ischemic stroke. In this case study, we presented a 46-year-old male with peri-procedural ischemic stroke during the coronary angiography (CAG). The CAG was terminated after the stroke and the left carotid artery was selectively cannulated, and digital subtraction angiography (DSA) revealed total occlusion (Modified Thrombolysis in Cerebral Infarction, mTICI, 0) of the M1 part of the left middle cerebral artery (MCA). A stent-assisted thrombectomy was performed and the DSA revealed restoration of flow to the left MCA with mTICI 3 flow in the distal branches. The next day, the neurological exam showed no sensory, motor deficits. The patient was discharged four days later. In the setting of catheter-related stroke, mechanical thrombectomy seems to be the least time-consuming and effective approach.

Introduction: Ear lobe crease (ELC) was first described in 1973 as a physical examination finding indicating significant coronary artery disease (CAD). Several studies have been carried out in relation to this finding, and it has been shown that it is a marker of intima-media thickness, carotid artery disease, and CAD. We aimed to investigate the relationship between earlobe crease, which is a simple physical examination finding, and GRACE score as a risk estimation index in acute coronary syndromes without ST-segment elevation (NSTE-ACS) patients. Methods: 360 patients (mean age 62.2 years, 70% male) were included in our study. Patients were divided into two groups of GRACE scores ≤ 109 and >109, 167 patients were enrolled in group 1, and193 cases in group 2. Results: The group 2 patients were older, had higher systolic blood pressure (SBP) levels, a higher rate of hypertension, higher glucose levels, lower creatinine clearance levels, higher initial and peak troponin levels, lower hemoglobin levels, lower left ventricular ejection fraction (LVEF) and higher Gensini scores than the patients in group 1. The higher GRACE score group had markedly increased frequencies of ELC compared to the lower GRACE score group (80.8% vs. 24.5%, respectively, P < 0.001). Conclusion: The presence of ELC may predict moderate to high risk group of patients with NSTEACS.

Background/Aims: Advanced fibrosis (F≥3) indicates poor outcomes in nonalcoholic fatty liver disease (NAFLD). Here, we examined the diagnostic performance of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) for detecting (or excluding) advanced fibrosis in patients with biopsy-proven NAFLD. Methods: The diagnostic performance of each noninvasive test according to previously identified cutoff points indicating low and high risk for advanced fibrosis was determined in 463 patients with NAFLD. Patients who scored 2.67 on the FIB-4 were considered at low and high risk for advanced fibrosis, respectively. Patients who scored 0.676 on the NFS were considered at low and high risk for advanced fibrosis, respectively. Results: Eighty-one patients (17.5%) had biopsy-proven advanced fibrosis (F≥3). The published FIB-4 cutoff values for low and high risk were able to exclude advanced fibrosis with negative predictive values (NPVs) of 0.907 and 0.843 and specificities of 74% and 97%, respectively. The published NFS cutoff values for low and high risk were able to exclude advanced fibrosis with NPVs of 0.913 and 0.842 and specificities of 63% and 96%, respectively. If biopsies were performed in only patients with a FIB-4 above the low cutoff point (≥1.3), 67.1% could be avoided. Conversely, if biopsies were performed in only patients with an NFS above the low cutoff point (≥–1.455), 57.0% could be avoided. Conclusions: The main clinical utility of the FIB-4 and NFS in patients with NAFLD lies in the ability to exclude, not identify, advanced fibrosis.

Tomato paste is an important industrial product of food industry, which has been also produced in the homes of tomato producing countries. Although literature on the physical and chemical composition of commercial and homemade types of tomato pastes is available, studies on their antioxidant activity (ABTS), total phenolic content (TPC) and total flavonoid content (TFC) are inexistent. The aim of this study is to compare the TPC, TFC and ABTS values of homemade and commercial types of tomato pastes, as well as their pH, brix and color values. Commercial (n = 9) and homemade (n = 6) tomato pastes were obtained from either national markets or homes that produce tomato pastes in various cities of Turkey. The TPC and TFC values of commercial tomato pastes were 209.62 ± 17.02 mg gallic acid equivalent (GAE) and 42.52 ± 4.85 mg catechin equivalent (CE), respectively, and they were significantly higher (p

BackgroundResidents receive a numeric performance rating (eg, 1-7 scoring scale) along with a narrative (ie, qualitative) feedback based on their performance in each workplace-based assessment (WBA). Aggregated qualitative data from WBA can be overwhelming to process and fairly adjudicate as part of a global decision about learner competence. Current approaches with qualitative data require a human rater to maintain attention and appropriately weigh various data inputs within the constraints of working memory before rendering a global judgment of performance. ObjectiveThis study explores natural language processing (NLP) and machine learning (ML) applications for identifying trainees at risk using a large WBA narrative comment data set associated with numerical ratings. MethodsNLP was performed retrospectively on a complete data set of narrative comments (ie, text-based feedback to residents based on their performance on a task) derived from WBAs completed by faculty members from multiple hospitals associated with a single, large, residency program at McMaster University, Canada. Narrative comments were vectorized to quantitative ratings using the bag-of-n-grams technique with 3 input types: unigram, bigrams, and trigrams. Supervised ML models using linear regression were trained with the quantitative ratings, performed binary classification, and output a prediction of whether a resident fell into the category of at risk or not at risk. Sensitivity, specificity, and accuracy metrics are reported. ResultsThe database comprised 7199 unique direct observation assessments, containing both narrative comments and a rating between 3 and 7 in imbalanced distribution (scores 3-5: 726 ratings; and scores 6-7: 4871 ratings). A total of 141 unique raters from 5 different hospitals and 45 unique residents participated over the course of 5 academic years. When comparing the 3 different input types for diagnosing if a trainee would be rated low (ie, 1-5) or high (ie, 6 or 7), our accuracy for trigrams was 87%, bigrams 86%, and unigrams 82%. We also found that all 3 input types had better prediction accuracy when using a bimodal cut (eg, lower or higher) compared with predicting performance along the full 7-point rating scale (50%-52%). ConclusionsThe ML models can accurately identify underperforming residents via narrative comments provided for WBAs. The words generated in WBAs can be a worthy data set to augment human decisions for educators tasked with processing large volumes of narrative assessments.

Background: Coronavirus disease 2019 (COVID-19) was first detected as a form of atypical pneumonia. COVID-19 is a highly contagious virus, and some patients may experience acute respiratory distress syndrome (ARDS) and acute respiratory failure leading to death. We aim to evaluate the clinical, imaging, and laboratory parameters according to survival time to predict mortality in fatal COVID-19 patients. Methods: Fatal 350 and survived 150 COVID-19 patients were included in the study. Fatal patients were divided into three groups according to the median value of the survival days. Demographic characteristics and in-hospital complications were obtained from medical databases. Results: Of the non-survived patients, 30% (104) died within three days, 32% (110) died within 4-10 days, and 39% (136) died within over ten days. Pneumonia on computational tomography (CT), symptom duration before hospital admission (SDBHA), intensive care unit (ICU), hypertension (HT), C-reactive protein (CRP), D-dimer, multi-organ dysfunction syndrome (MODS), cardiac and acute kidney injury, left ventricular ejection fraction (LVEF), right ventricular fractional area change (RV-FAC), and Tocilizumab/Steroid therapy were independent predictors of mortality within three days compared to between 4-10 days and over ten days mortality. A combined diagnosis model was evaluated for the age, CT score, SDBHA, hs-TnI, and D-dimer. The combined model had a higher area under the ROC curve (0.913). Conclusion: This study showed that age, pneumonia on CT, SDBHA, ICU, HT, CRP, d-dimer, cardiac injury, MODS, acute kidney injury, LVEF, and RV-FAC were independently associated with short-term mortality in non-surviving COVID-19 patients in the Turkish population. Moreover, Tocilizumab/Steroid therapy was a protective and independent predictor of mortality within three days.

Background: Canadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires the assessment of entrustable professional activities (EPAs). Dashboards could be used to track the completion of EPAs to support program evaluation. Methods: Using a design-based research process, we identified program evaluation needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. We interviewed leaders from the emergency medicine program and postgraduate medical education office at the University of Saskatchewan. Two investigators thematically analyzed interview transcripts to identify program evaluation needs that were audited by two additional investigators. Identified needs were described using quotes, analytics, and visualizations. Results: Between July 1, 2019 and April 6, 2021 we conducted 17 interviews with six participants (two program leaders and four institutional leaders). Four needs emerged as themes: tracking changes in overall assessment metrics, comparing metrics to the assessment plan, evaluating rotation performance, and engagement with the assessment metrics. We addressed these needs by presenting analytics and visualizations within a dashboard. Conclusions: We identified program evaluation needs related to EPA assessments and designed dashboard elements to meet them. This work will inform the development of other CBME assessment dashboards designed to support program evaluation.

Background: Social media is changing the modern academic landscape; this study sought to explore how organizational structures support or inhibit the harnessing of social media use in academic contexts and knowledge translation. Methods: A qualitative study was conducted using framework analysis based on the Bolman and Deal’s Four-Frame Model—structural, human resources, political and symbolic. The research team used the snowball sampling technique to recruit participants following the completion of each participant’s semi-structured interview. A member check was completed to ensure rigour. Results: 16 social media educators and experts from several countries participated in the study. Study findings showed that within the Structural Frame, participants’ organizations were reported to have with diverse hierarchical structures, ranging hospital-based (strict), education institutional-based and online only groups (malleable). The Human Resources Frame revealed that most participants’ social media organizations operated on unpaid volunteer staff. The training of these staff was primarily via role-modeling and mentorship. Regarding the Political Frame, social media helped participants accumulate scholarly currency and influence within their field of practice. The Symbolic Frame showed a wide range of traditional to non-traditional organizational supports, which interacted with both intrinsic to extrinsic motivation. Conclusions: Bolman and Deal’s Four-Frame Model framework may serve as an effective guideline for academic leaders who wish to strategically implement or enhance social media use into their organizations. The key insights that we have gained from our participants are how new emerging forms of scholarly pursuits can be more effectively enabled or hindered by the attributes of the organization within which these are occurring.

Background: There is an unmet need for non-invasive biomarkers for the diagnosis of nonalcoholic steatohepatitis (NASH) in non-specialized settings. We aimed to develop and validate a non-invasive test for diagnosing NASH in individuals with biopsy-proven nonalcoholic fatty liver disease (NAFLD). Methods: We developed a non-invasive test named the acNASH index that combines serum creatinine and aspartate aminotransferase levels in a derivation cohort of 390 Chinese NAFLD patients admitted to the hepatology center of the First Affiliated Hospital of Wenzhou Medical University (China) between December 2016 and September 2019 and subsequently validated in five external cohorts of different ethnicities of patients with biopsy-confirmed NAFLD (pooled n=1,089). Findings: The performance of the acNASH index for identifying NASH (defined as NAFLD activity score ≥5 with score of ≥1 for each steatosis, lobular inflammation and ballooning) was good in the derivation cohort with an area under receiver operating characteristics (AUROC) of 0·818 (95%CI 0·777-0·860). A cutoff of acNASH index 7·73 gave a Sp of 91%, Se of 53% and a positive predictive value (PPV) of 85% for ruling-in NASH. In the pooled validation cohort (n=1,089), the diagnostic performance of the index was also good with AUROC=0·805 (95%CI 0·780-0·830), NPV of 93% for ruling-out NASH and PPV of 73% for ruling-in NASH. Subgroup analyses showed similar performance in patients with diabetes or subjects with normal serum transaminase levels. Interpretation: The acNASH index shows promising utility as a simple non-invasive biomarker for diagnosing NASH among adults with biopsy-proven NAFLD of different ethnicities from different countries. Funding: The National Natural Science Foundation of China (82070588), High Level Creative Talents from Department of Public Health in Zhejiang Province (S2032102600032) and Project of New Century 551 Talent Nurturing in Wenzhou.

Introduction: As academia begins to incorporate modern communication technologies into its scholarly structures, there are both enablers and barriers which foster academics’ uptake of these innovations. Those who are early adopters of academic social media - whether it be for education, research-related networking, or knowledge translation - may therefore be best positioned to highlight both enablers and barriers within their work environments. Methods: The authors conducted a constructivist grounded theory study to discern what prominent practitioners of academic social media (e.g. Twitter) have encountered in their careers. Participants were recruited via a snowball sampling technique and invited to participate in semi-structured interviews. Three investigators engaged in constant comparative analysis of incoming transcripts. To enhance rigour, we conducted an audit of the analysis and a participant member check. Results: Seventeen emerging influencers in the field of academic social media were recruited. After axial coding, the 30 enablers and 21 barriers to academic social media use were mapped to three spheres of influence: personal, institutional, and virtual. The investigators propose a framework that organizes these enablers and barriers around a tipping point where sustainability becomes possible. Conclusions: Multiple enablers and barriers were described to influence social media users within academic medicine. By organizing these facets into a personal, institutional, and virtual framework along a spectrum, we can begin to understand the underlying structures that potentiate the academic ecosystems in which social media and similar innovations may flourish.

Background: Canadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires frequent assessments of entrustable professional activities (EPAs). Faculty struggle to provide helpful feedback and assign appropriate entrustment scores. CBME faculty development initiatives rarely incorporate teaching metrics. Dashboards could be used to visualize faculty assessment data to support faculty development. Methods: Using a design-based research process, we identified faculty development needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. Data was collected within the emergency medicine residency program at the University of Saskatchewan through interviews with program leaders, faculty development experts, and faculty participating in development sessions. Two investigators thematically analyzed interview transcripts to identify faculty needs that were audited by a third investigator. The needs were described using representative quotes and the dashboard elements designed to address them. Results: Between July 1, 2019 and December 11, 2020 we conducted 15 interviews with nine participants (two program leaders, three faculty development experts, and four faculty members). Three needs emerged as themes from the analysis: analysis of assessments, contextualization of assessments, and accessible reporting. We addressed these needs by designing an accessible dashboard to present contextualized quantitative and narrative assessment data for each faculty member. Conclusions: We identified faculty development needs related to EPA assessments and designed dashboard elements to meet them. The resulting dashboard was used for faculty development sessions. This work will inform the development of CBME assessment dashboards for faculty.

A new parabolic function for I-V curves’ analysis has been proposed. The new “analytical tool” provides a simple way to describe photophysical processes at an approximately monolayer surface of a dye-sensitized solar cell. It may now be possible to estimate factors such as hole–electron recombination, surface defects, and electron diffusion at the semiconductor layer. The theoretical approach that was previously reported by our group for predicting the photovoltaic performance of potential dye sensitizers has also been validated. The experimental photovoltaic and DFT/TD-DFT data of apigenin and those of the highly rated black dyes were used for the validation.

This paper addresses the Electric Vehicle Routing Problem with Simultaneous Pickup and Delivery (EVRP-SPD), in which electric vehicles (EVs) simultaneously deliver goods to and pick up goods from customers. Due to the limited battery capacity of EVs, their range is shorter than that of internal combustion vehicles. In the EVRP, in addition to the depot and the customers, there are also charging stations (CS) because EVs need to be charged when their battery is empty. The problem is formulated as an integer linear model, and an efficient solution is proposed to minimize the total distance traveled. To create a feasible initial solution, Clarke and Wright’s savings algorithm is used. Several variants of variable neighborhood search are tested, and the reduced-variable neighborhood search algorithm is used to find the best solution in a reasonable time. Computer experiments are performed with benchmark instances to evaluate the effectiveness of our approach in terms of solution quality and time. The obtained results show that the proposed method can achieve efficient solutions in terms of solution quality and time in all benchmark instances.

In this study, ultrasound application at two different frequencies (37 or 80 kHz) and durations (15 or 30 min) was used as a pre-treatment for raw broiler breasts, and its effect on cooling, color, textural and sensory characteristics of cooked broiler breasts during vacuum cooling process was determined. The anterior and posterior parts of broiler breast halves were carefully removed, and these parts with a 20 mm width were named as the regions A and B, respectively. Both regions were vacuum-packed and pre-treated by ultrasound, followed by oven-cooking in aluminum foils, and cooling time, weight loss and temperature distribution characteristics were determined. Besides sensory and textural properties, the effect of the ultrasound pre-treatment on the pH, dry matter and ash contents and color (CIELAB) values of cooked breasts was determined. During vacuum cooling, ultrasound pre-treatment significantly reduced cooling time required to cool cooked broiler breasts from 85 °C to 12.5 °C, and the lowest values for the regions A and B were obtained for the 30 min ultrasound pre-treatment at 37 kHz as 12.72 and 14.61 min, respectively (p 0.05). In conclusion, ultrasound pre-treatment can be successfully used for the vacuum cooling process of broiler breasts for the reduction of cooling time, and a 30 min ultrasound pre-treatment at 37 kHz can provide relatively superior cooling characteristics.