bluuebunny/crossref_metadata_2025 huggingface dataset:
A new dissection-specific hybrid stent graft for patients with DeBakey type I aortic dissection
Authors: Charchyan Eduard , Breshenkov Denis , Belov Yuriy
Published: October 2021

OBJECTIVES

We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the ‘Soft Elephant Trunk’) in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection.

METHODS

Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results.

RESULTS

The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry.

CONCLUSIONS

Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.
Can nudging only get you so far? Testing for nudge combination effects
Authors: Howley Peter , Ocean Neel
Published: October 2021

There is an emerging body of evidence to suggest that nudges can motivate behaviour change. The question as to whether using nudges in tandem ‘crowds out’ the marginal effectiveness of each one has attracted little attention. Using a randomised survey experiment consisting of 1,800 farmers, we tested the impact of two nudge interventions (injunctive norm and social signalling) when used individually in isolation and also when used in combination. Our findings are indicative of limited crowd out effects and more generally suggest that there may be scope for employing non-monetary interventions in combination when it comes to encouraging technology uptake.
The importance of including density in multiparameter asymptotic linearized direct waveform inversion: a case study from the Eastern Nankai Trough
Authors: Farshad Milad , Chauris Hervé , Noble Mark
Published: October 2021

Iterative least-squares reverse time migration (LSRTM) is the state-of-the-art linearized waveform inversion method to obtain quantitative subsurface parameters. The main drawback of such an iterative imaging scheme is the significant computational expense of many modelling/adjoint cycles through iterations. In the context of the extended domain, an interesting alternative to LSRTM is the asymptotic linearized direct waveform inversion, providing quantitative results with only a single iteration. This approach was first proposed for constant-density acoustics and recently extended to the variable-density case. The former is based on the application of the asymptotic inverse Born operator, whereas the latter has two more extra steps: building an angle-dependent response of the asymptotic inverse Born operator and then solving a weighted least-squares approach for simultaneous inversion of two acoustic parameters. To examine the importance of accounting for density variations, we compare constant- and variable-density linearized direct waveform inversion techniques applied to a marine real data set from the Eastern Nankai Trough, offshore Japan. The inversion results confirm the efficiency of the asymptotic linearized direct waveform inversion in estimating quantitative parameters within a single iteration. The variable-density direct inversion yields subsurface images that (1) exhibit a superior resolution and (2) better reconstruct the field data than does the constant-density approach, even if the data set does not contain large enough surface offset to fully decompose velocity and density perturbations.
Graph neural network based hydraulic turbine data stream prediction
Authors: Li Ning , Ren Jing , Zhou Xin , Li Jun , Xue Chen
Published: October 2021

As a kind of green energy with mature technology, hydropower energy is more and more widely used in our real life. As the core equipment of a hydropower station, hydraulic turbine units will experience varying degrees of vibration and aging during the process of power generation. Due to the complex internal structure and the interaction between different components, the analysis and prediction of the relevant operating data of the water turbine unit has important application value. This paper proposes a graph neural network framework for multivariate data stream prediction. In this method, a graph learning module is designed to automatically extract the one-way relationship between different components of the turbine unit. In addition, the mix-hop propagation layer and expansion layer are designed to capture the spatial and temporal correlations in hydraulic turbine data stream. Experiments show that the proposed method has higher accuracy comparing with the existing methods.
Vision impairment and self-reported anxiety and depression in older adults in Nigeria: evidence from a cross-sectional survey in Kogi State
Authors: Gascoyne Ben , Jolley Emma , Penzin Selben , Ogundimu Kola , Owoeye Foluso , Schmidt Elena
Published: October 2021

Background

More than 2 billion people are thought to be living with some form of vision impairment worldwide. Yet relatively little is known about the wider impacts of vision loss on individual health and well-being, particularly in low- and middle-income countries (LMICs). This study estimated the associations between all-cause vision impairment and self-reported symptoms of anxiety and depression among older adults in Kogi State, Nigeria.

Methods

Individual eyes were examined according to the standard Rapid Assessment of Avoidable Blindness methodology, and anxiety and depression were assessed using the Washington Group Short Set on Functioning–Enhanced. The associations were estimated using multivariable logistic regression models, adding two- and three-way interaction terms to test whether these differed for gender subgroups and with age.

Results

Overall, symptoms of either anxiety or depression, or both, were worse among people with severe visual impairment or blindness compared with those with no impairment (OR=2.72, 95% CI 1.86 to 3.99). Higher levels of anxiety and/or depression were observed among men with severe visual impairment and blindness compared with women, and this gender gap appeared to widen as people got older.

Conclusions

These findings suggest a substantial mental health burden among people with vision impairment in LMICs, particularly older men, underscoring the importance of targeted policies and programmes addressing the preventable causes of vision impairment and blindness.
Current and future perspectives in the treatment of multidrug-resistant Gram-negative infections
Authors: Bassetti Matteo , Garau Javier
Published: September 2021

Microbial resistance is a serious threat to human health worldwide. Among the World Health Organisation’s list of priority resistant bacteria, three are listed as critical—the highest level of concern—and all three are Gram-negative. Gram-negative resistance has spread worldwide via a variety of mechanisms, the most problematic being via AmpC enzymes, extended-spectrum β-lactamases, and carbapenemases. A combination of older drugs, many with high levels of toxicity, and newer agents are being used to combat multidrug resistance, with varying degrees of success. This review discusses the current treatments for multidrug-resistant Gram-negative bacteria, including new agents, older compounds, and new combinations of both, and some new treatment targets that are currently under investigation.
Improving natural language information extraction from cancer pathology reports using transfer learning and zero-shot string similarity
Authors: Park Briton , Altieri Nicholas , DeNero John , Odisho Anobel Y , Yu Bin
Published: October 2021

Objective

We develop natural language processing (NLP) methods capable of accurately classifying tumor attributes from pathology reports given minimal labeled examples. Our hierarchical cancer to cancer transfer (HCTC) and zero-shot string similarity (ZSS) methods are designed to exploit shared information between cancers and auxiliary class features, respectively, to boost performance using enriched annotations which give both location-based information and document level labels for each pathology report.

Materials and Methods

Our data consists of 250 pathology reports each for kidney, colon, and lung cancer from 2002 to 2019 from a single institution (UCSF). For each report, we classified 5 attributes: procedure, tumor location, histology, grade, and presence of lymphovascular invasion. We develop novel NLP techniques involving transfer learning and string similarity trained on enriched annotations. We compare HCTC and ZSS methods to the state-of-the-art including conventional machine learning methods as well as deep learning methods.

Results

For our HCTC method, we see an improvement of up to 0.1 micro-F1 score and 0.04 macro-F1 averaged across cancer and applicable attributes. For our ZSS method, we see an improvement of up to 0.26 micro-F1 and 0.23 macro-F1 averaged across cancer and applicable attributes. These comparisons are made after adjusting training data sizes to correct for the 20% increase in annotation time for enriched annotations compared to ordinary annotations.

Conclusions

Methods based on transfer learning across cancers and augmenting information methods with string similarity priors can significantly reduce the amount of labeled data needed for accurate information extraction from pathology reports.
60Co-γ Radiation Alters Developmental Stages of Zeugodacus cucurbitae (Diptera: Tephritidae) Through Apoptosis Pathways Gene Expression
Authors: Ahmad Shakil , Hussain Adil , Ullah Farman , Jamil Momana , Ali Asad , Ali Saqib , Luo Yanping
Published: October 2021

Radiation is considered as a promising insect pest control strategy for minimizing postharvest yield losses. Among various techniques, irradiation is a method of choice as it induces lethal biochemical or molecular changes that cause a downstream cascade of abrupt physiological abnormalities at the cellular level. In this study, we evaluated the effect of 60Co-γ radiation on various developmental stages of Zeugodacus cucurbitae Coquillett and subsequent carry-over effects on the progeny. For this purpose, we treated eggs with 30- and 50-Gy radiation doses of 60Co-γ. We found that radiation significantly affected cellular antioxidants, insect morphology, and gene expression profiles. Our results indicate that in response to various doses of irradiation reactive oxygen species, catalase, peroxidase, and superoxide dismutase activities were increased along with a significant increase in the malondialdehyde (MDA) content. We observed higher mortality rates during the pupal stage of the insects that hatched from irradiated eggs (50 Gy). Furthermore, the life span of the adults was reduced in response to 50 Gy radiation. The negative effects carried over to the next generation were marked by significantly lower fecundity in the F1 generation of the irradiation groups as compared to control. The radiation induced morphological abnormalities at the pupal, as well as the adult, stages. Furthermore, variations in the gene expression following irradiation are discussed. Taken together, our results signify the utility of 60Co-γ radiation for fruit fly postharvest management.
Differences in Symptomatic Presentation and Cognitive Performance Among Participants With LATE-NC Compared to FTLD-TDP
Authors: Teylan Merilee A , Mock Charles , Gauthreaux Kathryn , Culhane Jessica E , Jicha Gregory , Chen Yen-Chi , Chan Kwun C G , Kukull Walter A , Nelson Peter T , Katsumata Yuriko
Published: October 2021

Transactive response DNA-binding protein 43 kDa (TDP-43) is aberrantly aggregated and phosphorylated in frontotemporal lobar degeneration of the TDP-43 type (FTLD-TDP), and in limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). We examined data from the National Alzheimer's Coordinating Center to compare clinical features of autopsy-confirmed LATE-NC and FTLD-TDP. A total of 265 LATE-NC and 92 FTLD-TDP participants were included. Cognitive and behavioral symptoms were compared, stratified by level of impairment based on global clinical dementia rating (CDR) score. LATE-NC participants were older at death, more likely to carry APOE ε4, more likely to have Alzheimer disease neuropathology, and had lower (i.e. less severe) final CDR global scores than those with FTLD-TDP. Participants with FTLD-TDP were more likely to present with primary progressive aphasia, or behavior problems such as apathy, disinhibition, and personality changes. Among participants with final CDR score of 2–3, those with LATE-NC were more likely to have visuospatial impairment, delusions, and/or visual hallucinations. These differences were robust after sensitivity analyses excluding older (≥80 years at death), LATE-NC stage 3, or severe Alzheimer cases. Overall, FTLD-TDP was more globally severe, and affected younger participants, whereas psychoses were more common in LATE-NC.
The Particle ′Kdy in the Namārah Inscription and a New Interpretation of Line 4
Authors: Al-Jallad Ahmad
Published: October 2021

This paper edits a new Safaitic inscription that attests the particle ‘kd(y), also found in the Namārah inscription. Based on the clear context of the Safaitic attestation, we can now be certain that the particle is a conjunction meaning ‘then’, ‘thereafter’, ‘until’ although its etymology remains uncertain. The paper then moves to a discussion on the linguistic relationship between the Arabic of the Namārah inscription and Safaitic, cautioning against the practice of labelling any pre-Islamic text attesting the ’l-definite article as Classical Arabic. Finally, a new interpretation of line 4 of the Namārah inscription is offered in an attempt to remedy the problem of double vassalage.
Conducting mass gathering events during the COVID-19 pandemic: a case study of Kumbh Mela 2021 as a potential ‘super spreader event’
Authors: Shukla Saurabh , Khan Ramsha , Ahmed Yusuf , Memish Ziad A
Published: October 2021

Background

With the emergence of novel pathogens, there is a worldwide debate on the cancellation or conduction of mass gathering events.

Methods

In the current coronavirus disease-2019 (COVID-19) pandemic situation, this study assesses the challenges in the conduction of the recently held Kumbh Mela mass gathering (MG), which took place from 14th January 2021 to 29th April 2021 at Haridwar, the capital city of the state of Uttarakhand, India. The correlation between increased cases of COVID-19 and the Kumbh Mela MG has been highlighted through statistical analysis and growth curves using the available data.

Results

The Kumbh Mela-2021 emerged as a potential super spreader event with an increase of 37 cases per day to 144 cases per day (276%) in the COVID-19 cases in Haridwar. An increase from 138 to 480 cases per day (236%) and from 45 600 to 92 754 cases per day (92%) was noted in Uttarakhand and India respectively during this MG. A very strong correlation of ‘more than 0.99’ was seen between the number of cumulative cases of COVID-19 in Uttarakhand and Haridwar, and Haridwar and India during the Kumbh Mela in the third wave of the pandemic.

Conclusions

The direct influence of Kumbh Mela on the increase in the overall number of COVID-19 cases is observed. Although, the socio-cultural, psychological and economical advantages of MGs are considerable in a developing nation like India, but organization of such events can be a huge health hazard. The lack of efficient implementation and observance of COVID-19 guidelines elevates the necessity of cancellation of such MGs to prevent the outbreak of diseases. Thus, a well-conducted risk assessment prior to the hosting of a MG event during a pandemic is required with strict application of precautionary measures towards prevention of super-spreader events.
Firming up your tomato: a natural promoter variation in a MADS-box gene is causing all-flesh tomatoes
Authors: Trubanová Nina , Shi Jiaqi , Schilling Susanne
Published: September 2021

This article comments on:

Liu L, Zhang K, Bai JR, Lu J, Lu X, Hu J, Pan C, He S, Yuan J, Zhang Y, Zhang M, Guo Y, Wang X, Huang Z, Du Y, Cheng F, Li J. 2022. All-flesh fruit in tomato is controlled by reduced expression dosage of AFF through a structural variant mutation in the promoter. Journal of Experimental Botany 73, 123–138.
Potential use of arbuscular mycorrhizal fungi for simultaneous mitigation of arsenic and cadmium accumulation in rice
Authors: Li Hui , Gao Meng Ying , Mo Ce Hui , Wong Ming Hung , Chen Xun Wen , Wang Jun-Jian
Published: October 2021

Rice polluted by metal(loid)s, especially arsenic (As) and cadmium (Cd), imposes serious health risks. Numerous studies have demonstrated that the obligate plant symbionts arbuscular mycorrhizal fungi (AMF) can reduce As and Cd concentrations in rice. The behaviours of metal(loid)s in the soil–rice–AMF system are of significant interest for scientists in the fields of plant biology, microbiology, agriculture, and environmental science. We review the mechanisms of As and Cd accumulation in rice with and without the involvement of AMF. In the context of the soil–rice–AMF system, we assess and discuss the role of AMF in affecting soil ion mobility, chemical forms, transport pathways (including the symplast and apoplast), and genotype variation. A potential strategy for AMF application in rice fields is considered, followed by future research directions to improve theoretical understanding and encourage field application.
The Neighborhood of the Spike Gene Is a Hotspot for Modular Intertypic Homologous and Nonhomologous Recombination in Coronavirus Genomes
Authors: Nikolaidis Marios , Markoulatos Panayotis , Van de Peer Yves , Oliver Stephen G , Amoutzias Grigorios D
Published: October 2021

Coronaviruses (CoVs) have very large RNA viral genomes with a distinct genomic architecture of core and accessory open reading frames (ORFs). It is of utmost importance to understand their patterns and limits of homologous and nonhomologous recombination, because such events may affect the emergence of novel CoV strains, alter their host range, infection rate, tissue tropism pathogenicity, and their ability to escape vaccination programs. Intratypic recombination among closely related CoVs of the same subgenus has often been reported; however, the patterns and limits of genomic exchange between more distantly related CoV lineages (intertypic recombination) need further investigation. Here, we report computational/evolutionary analyses that clearly demonstrate a substantial ability for CoVs of different subgenera to recombine. Furthermore, we show that CoVs can obtain—through nonhomologous recombination—accessory ORFs from core ORFs, exchange accessory ORFs with different CoV genera, with other viruses (i.e., toroviruses, influenza C/D, reoviruses, rotaviruses, astroviruses) and even with hosts. Intriguingly, most of these radical events result from double crossovers surrounding the Spike ORF, thus highlighting both the instability and mobile nature of this genomic region. Although many such events have often occurred during the evolution of various CoVs, the genomic architecture of the relatively young SARS-CoV/SARS-CoV-2 lineage so far appears to be stable.
Osteocrin, a bone-derived humoral factor, exerts a renoprotective role in ischemia–reperfusion injury in mice
Authors: Nishiguchi Yoshihiko , Hata Yusuke , Date Ryosuke , Fujimoto Daisuke , Umemoto Shuro , Kanki Tomoko , Yokoi Hideki , Mori Keita P , Handa Takaya , Watanabe-Takano Haruko , Kanai Yugo , Yasoda Akihiro , Izumi Yuichiro , Kakizoe Yutaka , Mochizuki Naoki , Mukoyama Masashi , Kuwabara Takashige
Published: October 2021

Background

Osteocrin (OSTN), a bone-derived humoral factor, was reported to act on heart and bone by potentiating the natriuretic peptide (NP) system. Ostn gene polymorphisms have been associated with renal function decline, but its pathophysiological role in the kidney remains unclear.

Methods

The role of endogenous OSTN was investigated using systemic Ostn-knockout (KO) mice. As a model for OSTN administration, liver-specific Ostn-overexpressing mice crossed with KO (KO-Tg) were generated. These mice were subjected to unilateral ischemia–reperfusion injury (IRI) and renal lesions after 21 days of insult were evaluated. A comprehensive analysis of the Wnt/β-catenin pathway was performed using a polymerase chain reaction (PCR) array. Reporter plasmid-transfected proximal tubular cells (NRK52E) were used to investigate the mechanism by which OSTN affects the pathway.

Results

After injury, KO mice showed marginal worsening of renal fibrosis compared with wild-type mice, with comparable renal atrophy. KO-Tg mice showed significantly ameliorated renal atrophy, fibrosis and tubular injury, together with reduced expressions of fibrosis- and inflammation-related genes. The PCR array showed that the activation of the Wnt/β-catenin pathway was attenuated in KO-Tg mice. The downstream targets Mmp7, Myc and Axin2 showed similar results. MMP7 and Wnt2 were induced in corticomedullary proximal tubules after injury, but not in KO-Tg. In NRK52E, OSTN significantly potentiated the inhibitory effects of NP on transforming growth factor β1–induced activation of the Wnt/β-catenin pathway, which was reproduced by a cyclic guanosine monophosphate analog.

Conclusions

Ectopic Ostn overexpression ameliorated subsequent renal injury following ischemia–reperfusion. OSTN could represent possible renoprotection in acute to chronic kidney disease transition, thus serving as a potential therapeutic strategy.
An Investigation of Maximal Strength of the Upper Limb Bilaterally in Individuals With Lateral Elbow Tendinopathy: A Systematic Review With Meta-Analysis
Authors: Heales Luke J , Bout Nicola , Dines Brandon , Parker Tegan , Reddiex Kent , Kean Crystal O , Obst Steven J
Published: October 2021

Objective

The aim of this study was to investigate whether there is evidence of bilateral upper limb strength deficits in individuals with unilateral lateral elbow tendinopathy (LET).

Methods

The electronic databases Medline via Ovid, PubMed, and Scopus were searched from inception to March 2020. Included studies encompassed maximal strength outcomes of any upper limb and appendicular musculature in individuals with LET and an asymptomatic comparator. Study quality was rated using a modified version of the Epidemiological Appraisal Instrument. Hedges g effect sizes (ES) and 95% CIs were calculated for comparisons of maximal strength in the LET group and an asymptomatic control group. Meta-analysis using a random-effects model was performed when possible.

Results

Fourteen studies were included. Quality appraisal resulted in a mean Epidemiological Appraisal Instrument score of 46% (SD = 10%). Meta-analysis revealed strength deficits in shoulder abduction (pooled ES = −0.37 [95% CI = −0.62 to −0.12]) and shoulder external rotation (pooled ES = −0.55 [95% CI = −0.83 to −0.28]) of the symptomatic limb compared with an asymptomatic control group. Meta-analysis also revealed maximal strength deficits in the upper trapezius (pooled ES = −0.26 [95% CI = −0.49 to −0.02]) of the asymptomatic limb compared with an asymptomatic control group. There was also consistent evidence for strength deficits in the serratus anterior, lower trapezius, and wrist extensor muscles and deficits in grip strength of the symptomatic limb as well as strength deficits in the wrist extensor muscles of the asymptomatic limb in individuals with unilateral LET.

Conclusion

In individuals with LET, there were maximal strength deficits in shoulder abduction, shoulder external rotation, serratus anterior and lower trapezius muscles, and wrist extension, as well as deficits in grip strength of the symptomatic limb compared with an asymptomatic control group. In addition, there appeared to be strength deficits in the upper trapezius muscle, wrist extension, and metacarpophalangeal joint flexion and extension, as well as deficits in grip strength of the asymptomatic limb in individuals with LET compared with an asymptomatic control group. These results suggest bilateral strength deficits.

Impact

These findings highlight the importance of a thorough physical examination and appropriate strengthening intervention for the upper limb with a focus on shoulder and scapular stabilizers, in addition to forearm muscles, in individuals with LET.

Lay Summary

In people with tennis elbow, widespread strength deficits, including weakness of the shoulder, forearm, and wrist muscles, may exist. Interestingly, some of these weaknesses appear on both the affected and the unaffected sides in people with tennis elbow. A physical therapist can help strengthen these areas.
Comparison between Salbutamol and Salbutamol with Magnesium Sulphate by nebulization in Treatment of Acute Asthma in Asthmatic Patient
Authors: El kady Galal Adel , Elmalek Fady Adeb Abd , Shahaat Gerges Amine
Published: October 2021

Background

Asthma exacerbations are acute or subacute episodes of breathlessness, cough, wheezing, and chest tightness, or any combination of these symptoms. Exacerbations are associated with airways obstruction that should be documented and quantified by PEF or FEVI measurement. Early treatment of asthma exacerbations should be the best strategy for management.

Objective

To compare fast effectiveness between the nebulized salbutamol with normal Saline and salbutamol with magnesium sulphate by nebulizer in treatment of acute asthma. Patients and Methods: This two armed prospective randomized study included 60 patients admitted to Intensive Care Unit, Ain Shams University Hospital from July 2019 to July 2020. Patients were randomized into two equal groups: group A which included 30 patients on salbutamol nebulization and group B that included 30 patients on combination of salbutamol and magnesium sulphate.

Results

systolic blood pressure, diastolic Bl. P and FEVI were higher among salbutamol group (A) than combination group (B), meanwhile HR and 02% were significantly lower among group A than group B with statistically insignificant differences (p > 0.05). Group A had significantly higher mean of RR (20±1.33) than group B (17.2 ±1.14) (p < 0.001). Also, Group A had significantly higher mean of PEFR (217.5 ±74.72) than group B (125±78.05) (p = 0.014). There were significant differences between in group A in HR and 02% before and after TTT (p < 0.05). With treatment, the pulse rate rose significantly (p = 0.010) but there was no significant change in the systolic or diastolic blood pressure. The 02% rose significantly (p<O.001). There were significant differences between in group B in RR, HR, 02%, PEFR and FEVI before and after TTT (p < 0.05). With treatment, the respiratory rate declined significantly (p < 0.001), the pulse rate declined significantly (p = 0.013) in but there was no significant change in the systolic or diastolic blood pressure. The PEFR rose significantly (p = 0.001) and also the 02% rose significantly (p < 0.001).

Conclusion

Nebulized MgS04, either alone or combined with salbutamol, has a clinically significant bronchodilator effect in acute asthma. This suggests that a combination of MgS04 and salbutamol may be the best choice for the management of acute exacerbations of asthma.
Comparative Study between the Effect of Ultrasound Guided Pectoral Nerve Block (PEC 1) versus Serratus Anterior Plane Block (SAPB) For Postoperative Analgesia in Modified Radical Mastectomy
Authors: El-Megeed Mohamed Abd El-Rahman Abd , Hassan Alaa Eid Mohamed , Ashour Tarek Mohamed Ahmed , Youssef Ahmed Mounir Ahmed
Published: October 2021

Background

Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for earlystage breast cancers.

Objectives

The aim of this work is to evaluate the Effectiveness of Ultrasound Guided Pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in Modified Radical Mastectomy

Patients and Methods

After obtaining approval from the medical ethical committee in Ain Shams University This study was conducted in the operating theatres of Ain Shams University Hospitals. It included Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 15 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB).

Results

The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed.

Conclusion

SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PEC 1 block.
Propofol-dexmedetomidine Versus Propofol-ketamine for Anesthesia of Endoscopic Retrograde Cholangiopancreatography (ERCP)
Authors: Zaki Mohamed Sidky Mahmoud , Taha Sameh Salem Hanafy , Morkos Fady Adib Abd Elmalek , Salama Mohammed Ayman Abd El-Aziz
Published: October 2021

Background

The ideal method for anesthetic management during ERCP varied between deep sedation and general anesthesia with preference for general anesthesia over sedation.

Aim of the study

Primary aim: The aim of this study will to compare the effects of propofoldexmedetomidine and propofol-ketamine combinations for anesthesia in patients undergoing ERCP regarding the following outcome measures: Hemodynamic changes. Respiratory parameters changes. Propofol requirements. The recovery criteria. Post-operative pain. Secondary aim: To assess the rate of other anesthetic and procedural complications regarding the following outcome measures: Anesthetic complications: Post-procedural nausea and vomiting. Post-procedural cognitive dysfunction or hallucinations. Procedural complications: Bleeding: may occur by sphincterotomy. Duodenal perforation; it is a serious condition but it has a rare incidence and usually requires surgical intervention.

Material and methods

Patients ERCP, aged 20-50ys old, ASA І-II-III, were randomly allocated in two groups each of which was 25 by a probability method in the form of sequentially numbered, opaque, sealed envelopes (SNOSE) that will be divided in 2 groups (25 envelopes for each group) with random selection for each patient for an envelope. Group-I received dexmedetomidine loading 1µg/kg slow IV over 15min then infused at a rate of 0.5µg/kg/h by syringe pump. Group II received Ketamine 1mg/kg slow IV over 15min then infused at a rate of 0.5mg/kg/h by syringe pump. Both groups received propofol; 1-2mg/kg induction – then 5mg/kg/h IV infusion, 0.5mg/kg boluses guided by hemodynamic parameters, atracurium 0.5mg/kg intubating dose followed by 0.1mg/kg every 20min. Cuffed ETT was inserted and CMV. By the end of the procedure, patients turned supine and reversed by administration of neostigmine (0.05mg/kg) + atropine (0.01mg/kg). Extubation was performed after fulfillment of the criteria of extubation.

Conclusion

Dexmedetomidine-propofol combination was better than ketamine-propofol combination as regard; hemodynamic parameters (intra- and post-procedural), PONV, cognitive functions and recovery time. Incidence of pain had no clinical significant value between both groups. Total propofol consumption had no clinical significant difference between both groups.

Recommendation

Dexmedetomidine - propofol combination as TIVA technique for ERCP requires further studies with recommendation to include; different types of patients; geriatric, critically ill and increasing the sample size of patients.
Comparative study between intravenous versus perineural dexamethasone in prolonging the analgesic effect of supraclavicular plexus nerve block in hand surgeries
Authors: Abdelsattar Moustafa Mahmoud , Aly Naglaa Mohammad , mahran Mostafa Gamal eldin , Hamza Amr Hosny
Published: October 2021

Background

Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block.

Objective

To study the effect of dexamethasone as an adjuvant to bupivacaine either intravenous or perineural in ultrasound guided supraclavicular brachial plexus block in hand surgeries regarding the onset of the block, the duration of the block, the effect on postoperative analgesic requirements as well as anticipated complications.

Patients and Methods

In our study, 50 patients were randomly divided into 2 equal groups. perineural group received bupivacaine (0.5%) concomitant with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone were injected systemically. All patients received equal volumes of 20 milliliters.

Results

Our study showed that addition of a8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of sensory and motor blocks and significantly prolonged their durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone.

Conclusion

The use of ultrasonography in performing the supraclavicular nerve block, decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.
Comparative study of Prophylactic Intravenous Ondansetron in the Attenuation of Post Spinal Hypotension versus Dexamethasone in Parturient Undergoing Caesarean Delivery
Authors: Tewfeik Safie Ramez Tewfeik Abd El Moneim , El Hamid Hatem said Abd , Samir Ghada Mohamed
Published: October 2021

Background

Spinal anaesthesia (SA) is the preferred anaesthesia technique for Caesarean section. Hypotension and bradycardia are the most common side effects encountered and are more pronounced in pregnant patients, the incidence being as high as 52.6% and 2.5% in normal patients. The occurrence of hypotension can be dangerous as it compromises placental circulation and can have a detrimental effect on the foetus.

Objectives

The purpose of this study is to assess the efficacy of ondansetron versus dexamethasone in decreasing incidence of spinal induced hypotension in parturient undergoing cesarean surgery.

Patients and Methods

This study was conducted at Ain Shams University Hospitals between March 2019 till September 2019. After approval is obtained from the research ethics committee of faculty of medicine, Ain Shams University & patients’ informed consents consent from each patient after full explanation of the procedure possible side effects and complications., 75 healthy parturient, (ASA)physical status I and II undergoing elective cesarean delivery under spinal anesthesia.

Results

8 mg ondansetron is more effective than 8 mg dexamethasone in the attenuation of post spinal hypotension. Also, that Dexamethasone 8 mg was as effective as ondansetron 8 mg in providing a simple, safe, cheap, and effective intra and postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden.

Conclusion

The present study demonstrated that, among patients who received spinal anesthesia with bupivacaine and fentanyl as adjuvant for elective for cesarean section, prophylactic intravenous 8 mg ondansetron compared to dexamethasone significantly decreases hypotension, HR fluctuation, yet the need for rescue doses for ephedrine were significantly higher in ondansetron.
The effect of adding Magnesium sulfate to Bupivcaine in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries
Authors: Eid Samah Medhat , Aboul ella Sahar Kamal , El-ozairy Hala Salah El-Din , Naser Thabet Aziz
Published: October 2021

Background

Brachial plexus is a bundle of nerves that arises from the neck crossing through the axilla to supply the whole upper limb with motor and sensory supply. The aim in upper limb surgeries is to block this plexus using local anesthetics.

Objective

To study the effect of magnesium sulfate as an adjuvant to bupivacaine in supraclavicular brachial plexus block.

Patients and Methods

In our study 82 adult patients (age group 18-60, ASA I-II) were randomly and evenly divided into two equal groups (41 patients each), control group received only bupivacine 0.5 % and magnesium group received 2.5ml of 10% of magnesium in addition to bupivacine 0.5%. Patients were in semisitting position 45° the block was introduced US guided.

Results

Our study showed that addition of 250 mg of magnesium to bupivacine slightly delayed the onset time of both sensory and motor block (p value >0.05) which was non significant.

Conclusion

The addition of 250 mg magnesium sulfate to bupivacaine 0.5 % solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade, the duration of postoperative analgesia and reduces the requirement of rescue analgesic without any detected side effects.
Effect of Gene Editing on Alzheimer's Disease
Authors: mohamed Noha nageh , sallam Maha mohammed , El-Khalek Marwa Ali Abd , Fouad Mohamed Mahmoud
Published: October 2021

Background

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Current estimates suggest that 44 million people live with dementia worldwide at present. This is predicted to more than triple by 2050 as the population ages. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people Treatment is currently targeted toward symptomatic therapy, although trials are underway that aim to reduce the production and overall burden of pathology within the brain. Recently, the Clustered Regular Interspaced Short Palindromic Repeats (CRISPR-cas9) has shown promise in certain neurological disorders, it provides a precise editing to human genome and reflect an efficient curative therapy.

We aimed to investigate the efficacy of knock-out of the APP gene “Amyloid precursor protein gene(APBA2)that consequently modify the expression of Amyloid protein in leucocytes cell line using CRISPR-cas9 technology.

Methods

The gene expression profile of Alzheimer's disease was downloaded from biological bioinformatics databases,and based on bioinformatics analysis, we figured out that APP gene was overexpressed in Alzheimer's disease in both brain and peripheral tissues such as plasma, fibroblast and PMNLs. We used PMNLs as the source of gene for edition in our study .We knocked out the APP gene in leucocytes cell lines using CRISPR-cas9 technology. Finally, the gene editing efficacy was evaluated by cell viability assay, the gene expression was measured by qPCR and the Amyloid protein expression was proved by Immunofluorescence.

Results

knockout of APP gene int Leucocytes Cell line resulted in reduction in cell viability that was associated with marked reduction in the amyloid protein and gene expressions.

Conclusion

knockout of APP(APBA2) gene represents a promising therapeutic strategy in Alzheimer's disease.
Effectiveness And Adherence To Hospital Infection Control Preventive Practice In Cardiac Implantable Electronic Devices
Authors: Kolta Michel Lotfy , Mohamed Khalifa Maha Mohamed , Ibrahmi Mazen Tawfik , khaled Said AbdElHaffez
Published: October 2021

Background

Cardiac implantable electronic device (CIED) have been increasingly used in the past years, There is arise in CIED related complications in the past years with the increase in the number of devices implanted, CIED associated infection is challenging in its management, including system removal (generator and leads ), antimicrobial therapy, replantation at another site.

Objectives

The aim of the study is to evaluate the adherence to the steps of infection control protocol in cardiac device implantation related infection .

Patients and Methods

One hundred patients referred for cardiac device implantation was enrolled in the study and prospectively evaluated regarding applying of infection control measures and followed up for six months to study effect of adherence to these measures in prevention of postoperative device related infection.

Results

analysis of all factors of infection control protocol revealed significant correlation between postoperative device related infection and the following factors, Age ( p value = 0.010) , DM ( p value = 0.024) and number of Operators≥4.0 ( p = 0.001) as well as duration of sterilization ( p = 0.001), wearing double gloves (p = <0.001).

Conclusion

Our results proved certain factors as significant risk factors for device related infection, they are either patient related factors including and diabetes mellitus or device related factors reflecting higher incidence with CRT devices (p = 0.025), others related to applying anti septic measures namely double glove technique and duration of skin disinfect prior to the procedure.

Abbreviation list;

CIED (cardiac implantable electronic devices), DRI (device related infection), CKD (chronic kidney disease), DM (diabetes mellitus), HTN (hypertension), CRT (cardiac resynchronization therapy), DDD (dual chamber device), VVI (ventricular demand pacing), ICD (implantable cardioverter defibrillator).
Comparison Between the Incidence of Coronary No-Reflow in Patients with Acute ST-Elevation Myocardial Infarction receiving ticagrelor versus clopidogrel loading doses
Authors: Elewa Mohamad Gamaleldin , Eletriby Shehab Adel , Elserafy Ahmed Shawky
Published: October 2021

Background

Primary PCI is the preferred reperfusion strategy for ST segment elevation myocardial infarction (STEMI); because it offers prompt and complete recanalization of an occluded infarct-related artery. However, inspite of successfully restored (Thrombolysis in Myocardial Infarction [TIMI] grade 3) epicardial blood flow, myocardial reperfusion is not regained in some patients. This phenomenon is referred to as coronary no reflow. Such patients with no reflow have higher incidence of resting segmental wall motion abnormalities (SWMA), myocardial free wall rupture, and death.

Objective

To compare the effect of 180 mg ticagrelor versus 600 mg clopidogrel loading doses, on the incidence of no-reflow in acute ST segment elevation myocardial infarction (STEMI) patients.

Material and Methods

This study was carried out on 100 patients, presented with acute STEMI to Ain Shams university hospitals, in the period between November 2018 and February 2019 who underwent primary percutaneous coronary intervention (PCI). All patients were subjected to history, clinical examination, ECG recording before and after primary PCI, blood samples before primary PCI for (creatinine, CKTotal, CKMB in addition to routine laboratory investigations), and echocardiography after primary PCI. Patients were divided into two groups, where 50 patients received a 600 mg loading dose of clopidogrel and the other 50 received a 180 mg loading dose of ticagrelor prior to primary PCI. The primary endpoint was the occurrence of no reflow defined as TIMI flow grades ≤ 2 and or MBG of 0 or 1. The secondary endpoint was the occurrence of major adverse cardiac events during hospital stay.

Results

The primary endpoint of no reflow occurred in 17 (34%) patients in the clopidogrel group versus 12 (24%) patients in the ticagrelor group. This difference was not statistically significant (P-value 0.271). There was no significant statistical difference in the occurrence of major adverse cardiac events either.

Conclusion

The incidence of no reflow does not seem to be affected by the type of P2Y12 inhibitor loading received in the setting of STEMI. Further large-scale multi-center studies are required to prove or disprove the current evidence on the superiority of ticagrelor over clopidogrel in STEMI patients.
Evaluation of High-Sensitive C Reactive Protein Serum Level in Patients with Chronic Plaque Psoriasis before and After Treatment with Narrow Band Ultraviolet B Therapy or Methotrexate Comparative Study
Authors: Eldahshan Lobna Ebrahim , ElShiemy Saleh Mohammed , El Husseiny Rania Mahmoud , Saudy Wael Mohammed
Published: October 2021

Background

Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life.Highly sensitive c reactive protein ( hsCRP) could be useful as biomarker for assessing the psoriasis severity(1).

Objectives

Assess the changes in high-sensitive C-reactive protein serum level in patients with chronic plaque psoriasis before and after treatment with narrow band ultraviolet B therapy and Methotrexate.

Patients and Methods

Our Prospective clinical study included 40 patients of both sex, aged 20-60 years old with psoriasis vulgaris recruited from dermatology outpatient clinic of Ain Shams University Hospital from January 2018 to December 2018. The study was approved by Ain Shams University ethical committee. Informed consents were taken from each Patient after full description of the study aims and procedures

Results

Both methotrexate and nb-uvb showed significant decrease in serum level hscrp ,PASI score and DLQI after 12 weeks of treatment ,although there were statistically significant lower PASI , DLQI scores and serum level hscrp after 12 weeks of treatment in methotrexate group of patient compared to nb-uvb group of patients

Conclusion

Highly sensitive C reactive protein(hscrp) is a promising inflammatory marker for monitoring psoriasis severity and efficacy of treatment respectively .Methotrexate treatment showed significant effect on psoriasis severity regarding lowering hscrp serum level ,PASI and DLQI in compared to Nb_UVB therapy .