Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Risk factors and clinical responses of pneumonia patients with colistin-resistant Acinetobacter baumannii-calcoaceticus

BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics available.Carbapenem resistance is common and colistin resistance is rare in our country.Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country.AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and-resistant Acinetobacter sp.Strains.METHODS During the study period,108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively.Continuous variables were compared with the Mann-Whitney U test,and categorical variables were compared using Pearson’s chi-square test or Fisher’s Exact chi-square test for two groups.A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains.RESULTS High Acute Physiology and Chronic Health Evaluation II scores(OR=1.9,95%CI:1.4-2.7;P<0.001)and prior receipt of teicoplanin(OR=8.1,95%CI:1.0-63.3;P=0.045)were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp.Different combinations of antibiotics including colistin,meropenem,ampicillin/sulbactam,amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains.Although the median duration of microbiological cure(P<0.001)was longer in the colistin-resistant group,clinical(P=0.703),laboratory(P=0.277),radiological(P=0.551),microbiological response(P=1.000)and infection related mortality rates(P=0.603)did not differ between the two groups.Among the patients with infections due to colistin-resistant strains,seven were treated with antibiotic combinations that included sulbactam.Clinical(6/7)and microbiological(5/7)response rates were quite high in these patients.CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp.infections.Although combinations with sulbactam seems to be more effective in our study patients,data supporting the usefulness of combinations with sulbactam is very limited.

The predictors of long-COVID in the cohort of Turkish Thoracic Society-TURCOVID multicenter registry:One year follow-up results

Objective:To evaluate long-term effects of COVID-19,and to determine the risk factors in long-COVID in a cohort of the Turkish Thoracic Society(TTS)-TURCOVID multicenter registry.Methods:Thirteen centers participated with 831 patients;504 patients were enrolled after exclusions.The study was designed in three-steps:(1)Phone questionnaire;(2)retrospective evaluation of the medical records;(3)face-to-face visit.Results:In the first step,93.5%of the patients were hospitalized;61.7%had a history of pneumonia at the time of diagnosis.A total of 27.1%reported clinical symptoms at the end of the first year.Dyspnea(17.00%),fatigue(6.30%),and weakness(5.00%)were the most prevalent long-term symptoms.The incidence of long-term symptoms was increased by 2.91 fold(95%CI 1.04-8.13,P=0.041)in the presence of chronic obstructive pulmonary disease and by 1.84 fold(95%CI 1.10-3.10,P=0.021)in the presence of pneumonia at initial diagnosis,3.92 fold(95%CI 2.29-6.72,P=0.001)of dyspnea and 1.69 fold(95%CI 1.02-2.80,P=0.040)fatigue persists in the early-post-treatment period and 2.88 fold(95%CI 1.52-5.46,P=0.001)in the presence of emergency service admission in the post COVID period.In step 2,retrospective analysis of 231 patients revealed that 1.4%of the chest X-rays had not significantly improved at the end of the first year,while computed tomography(CT)scan detected fibrosis in 3.4%.In step 3,138(27.4%)patients admitted to face-to-face visit at the end of first year;at least one symptom persisted in 49.27%patients.The most common symptoms were dyspnea(27.60%),psychiatric symptoms(18.10%),and fatigue(17.40%).Thorax CT revealed fibrosis in 2.4%patients.Conclusions:COVID-19 symptoms can last for extended lengths of time,and severity of the disease as well as the presence of comorbidities might contribute to increased risk.Long-term clinical issues should be regularly evaluated after COVID-19.

Physical,Anatomical,and Photochemical Analyses of Some ExoticWood Species Submitted to Heat Treatment

The objective of this study was to evaluate the effect of heat treatment on decorative properties including glossiness,color coordinates including lightness(L),blue-yellow(b^(*))and red-green(a^(*)),hardness(shore-D)morphological characterization and thermal properties of some exotic wood species.Heat treatment of anigre(Aningeria altissima),cedrorana(Cedrelinga catenaeformis),cemara(Casuarina sumatrana)and coronilla(Scutia buxifolia)wood materials were performed in an oven with a programmable controller at 210°C for 3 h.The obtained samples were conditioned in a climate cabin and the decorative properties,morphological characterization with scanning electron microscopy(SEM)and thermal properties with thermogravimetric analyzer(TGA)of the obtained samples were determined.The test results showed that color got darker with heat treatment,specifically L and b^(*)decreased,and a^(*)increased for anigre and cedrorana but a^(*)decreased for cemara and coronilla.The glossiness for all samples generally increased from 20°to 85°but heat treatment decreased the glossiness.The density generally decreased with heat treatment and decrease ratio in the density was found to be in range from 5.6%to 10.6%.According to the SEM analysis,some cracks,pit aspiration and layer decomposition in the micro level of the wood structure were detected.TGA showed that heat treatment makes thermally more stable wood.As a result,it can be said that heat treatment improved the decorative properties of the exotic wood.

Heating rate effects for the melting transition of Pt-Ag-Au nanoalloys

The classical molecular dynamics simulations in canonical NVT ensemble conditions are used to investigate the melting transition in different heating rates of Pt-Ag-Au ternary nanoalloys.In order to obtain the initial configurations used in the molecular dynamics simulations,optimizing the chemical ordering of Pt_(13)AgnAu_(42−n)(n=0-42)ternary nanoalloys was performed using the Basin-Hopping algorithm which would not allow changes in the icosahedron structure.The Gupta many-body potential was used to model interatomic interactions in both molecular dynamics simulations and optimization simulations.The melting transitions of selected Pt-Ag-Au nanoalloys were explored using caloric curves and Lindemann parameters.There have been two identified types of melting mechanisms,one includes sudden jump behavior in the caloric curve and the other is an isomerization while melting transition.The temperature range in which the isomerization takes place depends on the heating rate value.

A theoretical study on chemical ordering of 38-atom trimetallic Pd-Ag-Pt nanoalloys

In this study,truncated octahedron(TO)structure is selected for further analysis and we focus on 38-atom Pd-Pt-Ag trimetallic nanoalloys.The best chemical ordering structures of PdnAg32-nPt6 trimetallic nanoalloys are obtained at Gupta level.The structures with the lowest energy at Gupta level are then re-optimized by density functional theory(DFT)relaxations and DFT results confirm the Gupta level calculations with small shifts on bond lengths indicating TO structure is favorable for 38-atom of PdnAg32-nPt6 trimetallic nanoalloys.The DFT excess energy analysis shows that Pd8Ag24Pt6 composition has the lowest excess energy value in common with excess energy analysis at Gupta level.In Pd8Ag24Pt6 composition,eight Pd atoms are central sites of 8(111)hexagonal facets of TO,24 Ag atoms locate on surface,and 6 Pt atoms locate at the core of the structure.It is also obtained that all of the compositions except Pd18Ag14Pt6 and Pd20Ag12Pt6 exhibit a octahedral Pt core.Besides,it is observed that there is a clear tendency for Ag atoms to segregate to the surface and also Pt atoms prefer to locate at core due to order parameter(R)variations.