Miracle-dz/UniFAR-FTUs huggingface dataset:
A potential selection bias in the study of early combination antibiotic therapy versus monotherapy in septic shock

To the Editor: I read a recently published article on early combination antibiotic therapy vs. monotherapy in septic shock by Kumar and colleagues (1). The authors applied propensity score analyses to adjust for confounding between the two groups and found a significant reduction in the rate of mortality within 28 days associated with early combination antibiotic therapy, which was contrary to the findings from meta-analyses (2, 3). Before accepting this contradictory finding as a plausible causal effect, a possibility of selection bias that might have occurred in their selection of study sample (even before applying propensity score matching) should be examined. In Table 1 (p 1776), I was first struck by a disproportionately high prevalence of nosocomial infection in the monotherapy group than in the combined therapy group (43.7% vs. 27.2%). This is opposite to common practice pattern, that is, physicians are more likely to choose a combined therapy for empiric treatment of nosocomial infection. I suspect that the discrepancy between the study sample and real-world clinical practice might have happened because of the definition of monotherapy and combined therapy used by the authors. The authors defined any “appropriate” antibiotic use as choosing an antibiotic agent that later identified organisms were susceptible to (pp 1774 and 1784). This definition of exposure can be problematic, because it was based on culture susceptibility data that became available after the empiric antibiotic therapy (either monotherapy or combined therapy) had been initiated. In an example in which two antibiotics were given empirically to treat a nosocomial infection (before culture data became available), this treatment could be later classified as monotherapy if the organism was found to be resistant to one of the two antibiotics given or as combined therapy if the organism was susceptible to both antibiotics. By applying such definition to select monotherapy and combined therapy groups included in the analysis, it is likely to result in a higher proportion of resistant organisms in the monotherapy group than in the combined therapy group. This could certainly explain at least some of the worse outcomes observed in the monotherapy group. Two alternative approaches can be considered to address this selection bias. One such approach is to redefine the monotherapy and combined therapy without considering the appropriateness based on susceptibility and to use the propensity score analysis to compare the outcomes. This mimics a real clinical situation (in which culture data are not available at the time of empiric therapy) or a randomized trial (under the assumption of unmeasured confounding) that would provide a more valid causal estimate of combined therapy vs. monotherapy. Another approach is to adjust for the difference in the proportion of infection by resistant organisms (which should be available in the data set) either in the propensity score model or in the outcome model. The author has not disclosed any potential conflicts of interest.
Morphological characterization and microstructural study of Cu2ZnSnSe4 thin films with compositional variation

In second generation thin film solar cell, Cu2ZnSnSe4 (CZTSe) is used as an absorber layer due to some remarkable properties like non-toxicity and earth abundancy. In this paper we have presented the preparation of Cu2ZnSnSe4 thin films in five different elemental ratios employing the RF-DC sputtering and E-beam deposition technique. In order to study the effects of elemental compositional variation on structural and morphological properties, thin films were characterized using SEM-EDX, XRD and AFM technique. Elemental compositional variation is studied using EDX technique. Numerical analysis of the surface parameters affected by compositional variations are presented against the data processed by AFM images. Watershed based segmentation algorithm is employed to present a quantitative grain size distribution. Variation in growth exponent (β) and roughness critical exponent (α) due to compositional variation in CZTSe thin films is studied using height-height correlation function. Auto correlation length varied from 3.65 nm to 4.44 nm while Rku is found greater than three for all thin films. A critical analysis of fractal dimension and auto correlation length with surface parameters like amplitude parameters, spacing parameters and hybrid parameters is also presented. Optoelectronic properties are studied with respect to compositional variation. Sample with lowest Cu/(Zn+Sn) ratio showed the lowest value of band gap of 0.909 eV . EDX results confirmed that the atomic ratio of Cu-Zn-Sn-Se in thin films of all CZTSe samples remained controlled. Films showed tetragonal kesterite crystal structure with the space group of I −4 2 m with preferential orientation along the (105) plane.
Evaluation of the dynamic response of structures using auxetic-type base isolation

Base isolation is a widely-used method used to minimise the harmful effects of earthquakes on buildings. Unlike a fixed base building, a building with a base isolation system essentially decouples the superstructure from the substructure resting on the ground. Then, during earthquakes, the superstructure’s relative displacement is significantly reduced, minimising the structural damage. Auxetics, which are materials with a negative Poisson’s ratio, are known for possessing properties such as high energy absorption. Based on the energy absorbing capabilities of auxetic materials, it is proposed that incorporating them into base isolation structures would positively impact on the performance of the system. Therefore, the article aims to investigate the response of structures under seismic loading incorporating re-entrant hexagon layers into the base isolation system. This is assessed by defining and numerically testing the system using finite element analysis. The models developed for this study represent multi-storey structural steel frames combined with fixed base, conventional lead-rubber bearing and auxetic composite base isolation. Differences in the response obtained from the mentioned systems are highlighted. Results indicate that the auxetic base isolation may improve the dynamic response of structures, although a unique performance is not recorded.
Elastofibroma Dorsi: Positron Emission Tomography/Computed Tomography Perspective

Received/Geliş Tarihi: 06.05. 2019 Accepted/Kabul Tarihi: 20.08. 2019 Address for Correspondence/Yazışma Adresi: Tamer Aksoy MD, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey Phone: +90 212 459 60 00 E-mail: drtaksoy@gmail.com ORCID ID: orcid.org/0000-0001-9341-6432 Cite this article as/Atıf: Aksoy T. Elastofibroma Dorsi: Positron Emission Tomography/Computed Tomography Perspective. İstanbul Med J 2019; 20(5): 441-5. Amaç: Elastofibroma dorsi (ED), nadir görülen ve yavaş büyüyen bir bağ dokusu tümörü olup, sıklıkla yaşlı hastalarda subskapüler bölgede gözlenmektedir. Bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme, ultrasonografi ve pozitron emisyon tomografi (PET) gibi çeşitli görüntüleme yöntemleri ile tanı konulabilmektedir. Bu retrospektif çalışmada malign veya malign olmayan sebeplerden ötürü uygulanan PET/BT incelemelerinde saptanan ED’lerin klinik özellikleri değerlendiriliştir. Yöntemler: Bu çalışmada Mayıs 2014-Aralık 2017 tarihleri arasında tek bir merkezde onkolojik veya onkolojik olmayan hastalıklar nedeniyle gerçekleştirilen PET/BT incelemeleri retrospektif olarak değerlendirilmiştir. Lezyonların anatomik boyutları BT incelemelerindeki aksiyel kesitler üzerinden değerlendirilmiştir. Lezyonların metabolik aktiviteleri veya reseptör ekspresyon durumları PET incelemesinde saptanan lezyonlar üzerine çizilen ilgi alanlarından elde edilen SUV max değerleri ile hesaplanmıştır. Bulgular: Toplamda 7300 PET raporu “ED” açısından taranmış ve ED saptanan hastaların görüntüleri tekrar değerlendirilmiştir. Yüz otuz bir hastaya ait 174 incelemede (97 kadın, 34 erkek, ortalama yaş: 62.13±8.6) ED saptandı. Prevelans %1,79 olarak saptandı. Yüz on altı hastada (%88,5) bilateral olarak ED saptanmış iken; sağda daha sık olmak üzere 15 hastada tek taraflı (%11,5) ED saptandı. Ortalama çap 2,6x4,9±1,1x1,9cm; ortalama SUV max değeri ise 2,46±0,74 olarak hesaplandı. SUV max değerleri ile ölçülen boyutlar arasında istatistiksel olarak anlamlı farklılık (p=0,001) saptandı. Sonuç: Bu çalışmada F-18 florodeoksiglikoz ve Ga-68 DOTATATE PET/BT incelemelerindeki ED’nin prevelansı ve demografik özellikleri belirtilmiştir. Çeşitli PET ajanlarının tutulum özelliklerinin ve dağılım sahalarının bilinmesi, gereksiz tetkiklerin ve girişimlerin önüne geçecektir. Anahtar Kelimeler: Elastofibroma Dorsi, PET/BT, F-18 FDG, Ga68 DOTATATE Introduction: Elastofibroma dorsi (ED) is a rare, benign and slowly growing connective tissue tumor that is frequently observed in the subscapular region in elderly people. It can be detected with various imaging modalities, such as computed tomography (CT), magnetic resonance imaging, ultrasonography and positron emission tomography (PET). In this retrospective study, the clinical features of EDs detected in PET/CT examinations performed for malignant or nonmalignant causes were evaluated.
Investigation of mathematical models based on diffusion control release for Paclitaxel from in-situ forming PLGA microspheres containing HSA microparticles

ABSTRACT Paclitaxel-loaded poly(lactic acid-co-glycolic acid) (PLGA) microspheres containing different portions of human serum albumin microparticles (mHSA) were prepared via an in situ forming method. The low solubility of Paclitaxel and presence of an external oil phase around the in situ-formed microspheres were investigated with the mathematical models based on the diffusion-control release. The release data were fitted with diffusion-based semi-empirical models including Ritger-Peppas, Weibull and Peppas-Sahlin models, and a theoretical model obtained from Fick’s second law. The release rate constants, release exponent and average drug diffusion coefficients microspheres were calculated and their variations with PLGA molecular weight and microparticles were established. Results showed good accordance between experimental and theoretical values. Besides, incorporation of mHSA within microspheres decreased the Paclitaxel diffusion. Result of docking studies showed that the binding site of mHSA sequences including HIS242 and ARG114 have more significant interaction with paclitaxel, but no significant interaction between PLGA and paclitaxel.
Pretreatment of silk for digital printing: identifying influential factors using fractional factorial experiments

Purpose The purpose of this study is to identify the most influential factors affecting the printing properties and print quality of digitally printed silk fabrics in terms of colour strength and fixation percentage. Design/methodology/approach In this study, five factors (concentration of thickener, concentration of urea, concentration of alkali, pH of pretreatment liquor and steaming duration) were investigated using a blocked 25−1 fractional factorial experiment. The type of thickeners [polyacrylic acid and polyacrylamide (PAM)] were considered as a block. Findings Linear models were obtained and statistically tested using both analysis of variance and coefficient of determination (R2), and they were found to be accurate at 90 per cent confidence level. It was revealed that concentration of alkali, concentrations of urea and pH of the pretreatment liquor had an increasing effect on colour strength, whereas concentration of thickener and steaming duration showed decreasing effect on colour strength of digitally printed silk fabrics. Furthermore, concentration of alkali, concentrations of urea had increasing effect on dye fixation percentage, whereas steaming duration showed decreasing effect on dye fixation percentage of digitally printed silk fabrics. In addition, PAM thickener based pretreatment recipe exhibited better printing properties for the digitally printing of silk fabrics. Originality/value The main influences and significant two-factor interactions were discussed in detail to gain a better understanding of the printing properties of digitally printed silk fabrics. The findings of this study are useful for further optimisation of pre- and post-treatment processes for digital printing of silk fabrics.
Longitudinal Examination of the Functional Status of Older Adults: Successful Aging Within a Representative Canadian Sample

ABSTRACT Palmore, Nowlin, and Wang (1985) posit a theoretical framework in which to predict the health status of older adults over time as a function of social, economic, physical and mental health variables. The current study provides the first independent, empirical test of this model based upon longitudinal data derived from a representative sample of older British Columbians. The results of this study support the basic structure of the Palmore model; however, various revisions were required to improve the fit of data. Findings indicate that demographic and socio-economic variables have a direct effect upon functional status at baseline. Results further suggest significant consistency in the functional status of older adults over a two-year interval. Directions for future research as well as limitations of the current study are discussed. RÉSUMÉ Palmore, Nowlin, et Wang (1985) proposent un cadre de travail permettant de prédire l'état de santé des aîné(e)s dans le temps en fonction des variables sociales, économiques, physiques et mentales. L'étude courante fournit le premier test distinct et empirique du genre basé sur des données longitudinales tirées d'un échantillonnage représentatif d'aîné(e)s de la Colombie-Britannique. Les résultats de l'étude soutiennent la structure fondamentale du modèle Palmore; cependant, il a fallu effectuer plusieurs révisions pour améliorer l'adéquation des données. Les résultats indiquent que les variables démographiques et socio-économiques ont un effet direct sur les capacités fonctionnelles de base. Ils font également ressortir une uniformité significative des capacités fonctionnelles des aîné(e)s dans un intervalle de deux ans. Le texte traite aussi de l'orientation que prendra éventuellement la recherche ainsi que les limites de l'étude en cours.
Chapter 8: Assessing risk of bias in included studies

An earlier version (version 5.0.2, 2008) of the Handbook is also published by John Wiley & Sons, Ltd under “The Cochrane Book Series” Imprint, as Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions (ISBN 978-0470057964) by John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England, Telephone (+44) 1243 779777; Email (for orders and customer service enquiries): cs-books@wiley.co.uk. Visit their Home Page on www.wiley.com.
Histological and morphometric studies on the effect of alpha-lipoic acid on postovariectomy osteoporosis induced in adult female albino rats

Introduction An imbalance between bone formation and bone resorption underlined the pathogenesis of reduced bone mass in osteoporosis associated with menopause. Aim of the study To investigate whether &agr;-lipoic acid can have any therapeutic application in treating bone loss in ovariectomized osteoporotic rats. Materials and methods Twenty-four adult female rats were divided into four groups: a sham-operated control group (group 1), a nontreated ovariectomized group (group 2), an &agr;-lipoic acid-treated ovariectomized group (group 3), and a sham-operated &agr;-lipoic acid-treated group (group 4). Histological decalcified and undecalcified distal femur specimens were prepared and histomorphometric parameters of bone resortion and bone formation were carried out. Results Assessment of bone resorption parameters of the distal femur metaphysis and diaphysis showed that ovariectomy in group 2 produced significant increase in mean resorption surface percentage, 28% loss in mean cortical bone thickness, and 48% loss in mean trabecular bone volume compared with controls. However, &agr;-lipoic acid administration to ovariectomized rats reduced the mean resorption surface percentage to control levels. Moreover, evaluation of bone formation parameters showed that both ovariectomy in group 2 and &agr;-lipoic acid administration to ovariectomized rats of group 3 caused significant increase in mean osteoid thickness and in mean osteoid surface percentage relative to control rats. Alpha-lipoic acid also completely (100%) restored mean cortical bone thickness, restored 90% of mean trabecular bone volume, and ameliorated the osteoporotic changes that accompanied ovariectomy. Conclusion and recommendation Alpha-lipoic acid improved the imbalance between bone resorption and bone formation, and therefore it is recommended to treat osteoporosis with &agr;-lipoic acid.
Pattern of squint presentations in children in a tertiary institution in Western Nigeria

Background: Strabismus is a common condition in children, but there is paucity of studies done exclusively on it in Nigeria Objective: To describe the pattern of presentation of strabismus among children presenting at the eye clinic, Olabisi Onabanjo University Teaching Hospital (OOUTH) Sagamu, Nigeria Study design:Retrospective . Results: Strabismus constituted 0.01% of paediatric ophthalmic presentations to OOUTH over a 5year period of between January 2008 and December 2012.Age range is from 0.75-16years with a mean of 4.9years. The male female ratio was 1:2. Esotropia was the most common type of squint while the predominant refractive error was astigmatism. Only 5(31.3%) of those whose onset was before 6months presented on or before 1 year There was very low uptake of treatment in these children. Conclusion: The prevalence of strabismus was low, intensive health education of parents and teachers is necessary to encourage early presentation and good uptake of treatment as this has a direct effect on visual and cosmetic outcome.
Alveolar Foamy Macrophages and Mast Cells in Bronchoalveolar Lavage of Methotrexate-induced Pneumonitis: 2 Case Reports and Review of the Literature

Methotrexate-induced pneumonitis (MTX-P) is an unusual adverse drug reaction that typically manifests as an interstitial lung disease (ILD). Early diagnosis of this complication is desirable because discontinuation of MTX with or without steroid administration often results in a fast recovery. Conversely, a delay or a misdiagnosis may lead to death. Diagnostic workup is often problematic because underlying diseases leading to methotrexate administration, notably rheumatoid arthritis (RA), and opportunistic infections because of drug-induced immune impairment can also produce an ILD. In this clinical setting, bronchoalveolar lavage (BAL) plays a key role either in excluding infectious agents, especially in febrile presentations, or in looking for malignant cells. Unfortunately, BAL does not have specific features to allow clinicians to differentiate MTX-P from RA-associated ILD. Here, we present 2 definite cases of MTX-P in RA patients. BAL differential cell counts and alveolar CD4/CD8 values were found to be in agreement with those reported in the literature, but an increase in mast cells and the presence of foamy macrophages have never been reported among previously published cases. The presence of both mast cells and foamy macrophages could be helpful in differentiating MTX-P from many drug-unrelated ILDs, but does not assist in distinguishing MTX-P from Pneumocystis jiroveci pneumonia and RA-associated bronchiolitis obliterans organizing pneumonia.
Experimental and Numerical Investigation of Polypropylene Foam Formation through Extrusion Process

Polymeric foams appear in diverse fields from automotive to medical applications due to their unique characteristics. The morphology of the polymer foams has a huge impact on their mechanical and physical properties such as strength and density. In this thesis, nucleation and growth of bubbles in foaming of Polypropylene through the extrusion process have been investigated both experimentally and numerically. Both cell nucleation and cell growth phenomenon should be controlled through the process in order to have a customized foam. Several models have been proposed for many years and theoretical and experimental investigations have been performed on both bubble nucleation and bubble growth phenomenon. In the nucleation step, a semi-experimental model has been adopted in our studies after reconciling between the accuracy and complexity of the models. This model uses the heterogeneous nucleation mechanism, proposed by classical nucleation theory, as the main mechanism of nucleation in the foaming process and modifies it by introducing energy reduction and frequency factors. For the growth stage, a two-dimensional model that accounts for the diffusion-driven growth of bubbles in the viscoelastic fluid (PP melt) has been chosen. The two-dimensional models have a higher accuracy in predicting the final bubble radius compared to the one-dimensional models (e.g. cell model) and is capable of predicting the exact shape of non-spherical bubbles in the polymer. Using a mini-extruder, the effect of processing parameters on the final foam morphology has been studied qualitatively. Then the governing equations for the diffusion-driven bubble growth have been solved by the finite element method. The sensitivity of the growth dynamic to the processing parameters has been studied by simulating the evolution of a single bubble enclosed inside an influence volume under the assumptions of the cell model. The interactions between the bubbles, which cannot be thoroughly considered in the cell model, have been simulated by the two-dimensional model and the predictions of the bubble shapes at different processing conditions have been performed. Finally, the ability of the cell model and the two-dimensional model in predicting the final foam density have been compared with the experimental data. The results show that the accuracy of the cell model decays as the cell density and the bubble-bubble interactions increases while the 2D model has the capability of predicting foam density and the average bubble size with acceptable accuracy in nearly all experimental conditions.
Surface Recombination Concept as Applied to Determinate Silicon Solar Cell Base Optimum Thickness with Doping Level Effect

New expressions of back surface recombination of excess minority carriers in the base of silicon solar are expressed dependent on both, the thickness and the diffusion coefficient which is in relationship with the doping rate. The optimum thickness thus obtained from the base of the solar cell allows the saving of the amount of material needed in its manufacture without reducing its efficiency.
A monolayer of three-level quantum Λ-emitters: A perspective system from the viewpoint of nonlinear optical dynamics and nanophotonics

The nonlinear optical response of a monolayer of regularly spaced three-level quantum emitters with a doublet in the ground state is studied theoretically. It is found that the system demonstrates multistability, self-oscillations and dynamical chaos. In a certain frequency range, the monolayer operates as a perfect bistable mirror.