Health Transformation Project and Defensive Medicine Practice among Neurosurgeons in Turkey

Background

The term “Defensive” medicine was coined in the early 1970′s and has been an important topic of scientific investigation and professional debate ever since.

Objective

The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey.

Methods

The present cross-sectional study on defensive medicine assessed neurosurgeons registered at the Turkish Neurosurgical Society, who are actively working in various centers and hospitals within the Turkish health care system. A 40-question survey was adapted from existing measures described in the literature and was completed by a total of 404 neurosurgeons, representing 36.7% of the neurosurgeons registered at the Turkish Neurosurgical Society.

Results

Seventy-two percent of the participants in the current study reported practicing defensive medicine. This practice was mainly reported among inexperienced neurosurgeons (74.4%). Most were younger than 40 years of age (75.2%), working in state hospitals/universities (72.7%), and living in the Marmara region (38%). Respondents reported engaging in defensive medicine by avoiding high-risk surgery (62.6%), ordering additional imaging studies (60.9%) and laboratory tests (33.7%), and referring patients to consultants (31.2%). Most participants consider every patient as a potential threat in terms of a medical lawsuit (68.3%) and do not believe the courts can distinguish malpractice from complications (89.6%).

Conclusion

Concerns and perceptions about medical liability lead neurosurgeons to practice defensive medicine. By avoiding high-risk surgery, ordering unnecessary diagnostic tests, and referring the patients to consultants, neurosurgeons try to minimize the risk of malpractice and protect themselves from legal risks, resulting in higher healthcare expenditure and longer treatment periods.     

Brassicaceae phylogeny inferred from phytochrome A and ndhF sequence data: tribes and trichomes revisited

The family Brassicaceae comprises 3710 species in 338 genera, 25 recently delimited tribes, and three major lineages based on phylogenetic results from the chloroplast gene ndhF. To assess the credibility of the lineages and newly delimited tribes, we sequenced an approximately 1.8-kb region of the nuclear phytochrome A (PHYA) gene for taxa previously sampled for the chloroplast gene ndhF. Using parsimony, likelihood, and Bayesian methods, we reconstructed the phylogeny of the gene and used the approximately unbiased (AU) test to compare phylogenetic results from PHYA with findings from ndhF. We also combined ndhF and PHYA data and used a Bayesian mixed model approach to infer phylogeny. PHYA and combined analyses recovered the same three large lineages as those recovered in ndhF trees, increasing confidence in these lineages. The combined tree confirms the monophyly of most of the recently delimited tribes (only Alysseae, Anchonieae, and Descurainieae are not monophyletic), while 13 of the 23 sampled tribes are monophyletic in PHYA trees. In addition to phylogenetic results, we documented the trichome branching morphology of species across the phylogeny and explored the evolution of different trichome morphologies using the AU test. Our results indicate that dendritic, medifixed, and stellate trichomes likely evolved independently several times in the Brassicaceae.     

Neural invasion in pancreatic cancer: a mutual tropism between neurons and cancer cells

Neural invasion by pancreatic cancer cells (PCC) worsens the prognosis and frequently limits curative resection. We established a novel in-vitro model in which T3M4-PCCs were co-cultured with either isolated myenteric plexus cells (MP) or dorsal root ganglia (DRG) of newborn rats within a three-dimensional extracellular matrix gel. The close vicinity of MP or DRG to T3M4-PCCs induced early morphologic changes on T3M4-PCCs at the migration front prior to the migration process with elongated and neurite-targeting PCCs, compared to round and non-grouping at the non-migrating front. T3M4-PCCs built cancer-cell clusters around the DRG or MP, a process which was accelerated by increasing number of T3M4-PCCs or neurons. These findings indicate that neuro-cancer interactions start prior to PCC migration and induce evident changes in cancer and nerve biology. These findings can be reproduced within the introduced 3D in-vitro migration assay which allows investigation in the early pathogenesis of neural PCC invasion.     

Comparison of plasma leptin and zinc levels in elite athletes and sedentary people

In consideration of leptin effects such as reducing food intake and increasing energy consumption, many researchers have sought to examine the relation between leptin and exercise. The presence of reports arguing that zinc, can be a mediator in leptin production indicates a possible relation between zinc and leptin. The present study aims to determine plasma leptin levels in elite weightlifters and examine their relation with zinc. The study enrolled 30 healthy volunteers in the 18-27 age range. The subjects were allocated to groups in equal numbers: Group 1, Control Group: the group included subjects who did not exercise regularly. Group 2, Elite Weightlifter Group: the group included elite weight lifters who were selected to the national team in their weight classes, who exercised regularly and whose values were measured during rest in the training period. Levels of plasma leptin and zinc were determined in the blood samples collected from the subjects included in the study. Comparison of serum leptin and zinc values between groups showed that leptin and zinc levels in the control group were significantly higher than those in the weightlifters and that leptin levels decreased significantly in parallel with the low zinc levels. It can be concluded that physical activity brings about changes in leptin secretion, which in turn, can be significantly related with zinc (p < 0.01).     

Evaluation of antiprotozoal and antimycobacterial activities of the resin glycosides and the other metabolites of Scrophularia cryptophila

Resin glycosides are secondary metabolites exclusive to the convolvulaceous plants. In this study, crypthophilic acids A–C (1–3), the first resin glycosides occurring in another family (Scrophulariaceae), and the other constituents of Scrophularia cryptophila were examined for in vitro antiprotozoal and antimycobacterial potentials. Except for crypthophilic acid B (2), all tested compounds exhibited growth-inhibitory effect against Trypanosoma brucei rhodesiense, with l-tryptophan (6) and buddlejasaponin III (7) being the most potent ones (IC₅₀'s 4.1 and 9.7 μg/ml). In contrast, the activity towards Trypanosoma cruzi was poor, and only crypthophilic acid C (3), 6 and 7 were trypanocidal at concentrations above 40 μg/ml. With the exception of 2 and 6, all compounds were active against Leishmania donovani. Harpagide (4) and 3 emerged as the best leishmanicidal agents (IC₅₀'s 2.0 and 5.8 μg/ml). Only compounds 3, 6 and 7 showed antimalarial activity against Plasmodium falciparum with IC₅₀ values of 4.2, 16.6 and 22.4 μg/ml. Overall the best and broadest spectrum activity was presented by compounds 3 and 7, as they inhibited all four parasitic protozoa. None of the isolates had significant activity against Mycobacterium tuberculosis (MICs >100 μg/ml) or were toxic towards mammalian (L6) cells. This is the first report of antiprotozoal activity for natural resin glycosides, as well as for harpagide (4), acetylharpagide (5), tryptophan (6) and buddlejasaponin III (7).     

Impact of SPR biosensor assay configuration on antibody: Neonatal Fc receptor binding data

Binding interactions with the neonatal Fc receptor (FcRn) are one determinant of pharmacokinetic properties of recombinant human monoclonal antibody (rhumAb) therapeutics, and a conserved binding motif in the crystallizable fragment (Fc) region of IgG molecules interacts with FcRn. Surface plasmon resonance (SPR) biosensor assays are often used to characterize interactions between FcRn and rhumAb therapeutics. In such assays, generally either the rhumAb (format 1) or the FcRn protein (format 2) is immobilized on a biosensor chip. However, because evidence suggests that, in some cases, the variable domains of a rhumAb may also affect FcRn binding, we evaluated the effect of SPR assay configuration on binding data. We sought to assess FcRn binding properties of 2 rhumAbs (rhumAb1 and rhumAb2) to FcRn proteins using these 2 biosensor assay formats. The two rhumAbs have greater than 99% sequence identity in the Fc domain but differ in their Fab regions. rhumAb2 contains a positively charged patch in the variable domain that is absent in rhumAb1. Our results showed that binding of rhumAb1 to FcRn was independent of biosensor assay configuration, while binding of rhumAb2 to FcRn was highly SPR assay configuration dependent. Further investigations revealed that the format dependency of rhumAb2-FcRn binding is linked to the basic residues that form a positively charged patch in the variable domain of rhumAb2. Our work highlights the importance of analyzing rhumAb-FcRn binding interactions using 2 alternate SPR biosensor assay configurations. This approach may also provide a simple way to identify the potential for non-Fc-driven FcRn binding interactions in otherwise typical IgGs.     

Innate olfactory responses of female and male parasitoid Apanteles taragamae Viereck (Hymenoptera: Braconidae) toward host plant infested by the cucumber moth Diaphania indica Saunders (Lepidoptera: Crambidae)

The behavioural responses of Apanteles taragamae, a larval parasitoid of the cucumber moth Diaphania indica, to the volatiles of cucumber plants was investigated in a four-arm olfactometer. Females and males were given a choice between several odour sources that included (1) clean air, (2) uninfested, (3) host-infested, and (4) mechanically damaged cucumber plants. Females and males showed different preferences for volatiles emanating from these plants. Females responded significantly longer to the volatiles from uninfested plants than clean air, and to host-infested plants than uninfested plants. There were no significant differences in female responses to the volatiles from mechanically damaged and uninfested plants. Males responded significantly longer to clean air rather than uninfested plants. The volatiles from both uninfested and host-infested cucumber plants may play important roles in host habitat location of A. taragamae females.     

Running demands and activity profile of men’s rugby sevens: a tournament scenario

This study profiled the changes in running performances and collisions within a Rugby sevens tournament. Sixteen male players were equipped with global positioning system units while competing at the 2015 and 2016 Asia Rugby Sevens series held in Colombo and Hong Kong, respectively. Both tournaments consisted of 4 matches each, and were played over 2 days (i.e., 2 matches/day). Total distance (TD) covered increased in match 3 compared with matches 1 (19 ± 19%; p < 0.001) and 2 (16 ± 11%; p = 0.001), whilst a decrease in TD in match 4 compared with match 3 (8 ± 9%; p = 0.019) was observed. Distances covered within 6.1–12 km·h^-1 and 12.1–14 km·h^-1 speed bands were generally higher in matches 3 and/or 4 when compared with match 1 and/or 2 (p < 0.05). Frequency of entries into 14.1–18 km·h^-1 speed zone was decreased in match 4 compared with match 3 (45 ± 41%; p = 0.009), whilst incidences of heavy, very heavy and severe collisions were generally higher in matches 3 or 4 compared with matches 1 or 2 (p < 0.05). In conclusion, while some decrements in the final match were evident, running performance were generally maintained throughout despite the competitive and congested nature of Rugby Sevens tournaments     

高产木质素酶荧光假单胞杆菌L-520的筛选及其发酵工艺优化

利用苯胺蓝鉴别培养基及产酶培养基进行菌种筛选,从甘肃兴隆山分离得到的10株菌株中筛选到一株高产木质素酶活力的菌株L-520,对该菌株进行16S rDNA鉴定,确定该菌为荧光假单胞杆菌(Pseudomonas fluorescens)。分别考察了接种量、装液量,初始pH对L-520发酵产酶的影响,以及碳源、氮源对木质素酶活力的影响。结果得到最佳培养基为:蔗糖1%,NH_4Cl 0.2%,KH_2PO_4 0.1%,MgSO_4?7H_2O 0.05%。优化后的发酵条件为:初始pH 5,接种量3%,装液量50%。经发酵工艺优化后,漆酶(Lac)、木质素过氧化物酶(LiP)、锰过氧化物酶(MnP)三种酶活分别为16.43 U/L,106.32 U/L,95.89U/L,与初始酶活相比分别提高了8.7、14.74、11.09倍。本研究筛选得到的荧光假单胞杆菌有助于染料废水中偶氮染料的降解。