bluuebunny/crossref_metadata_2025 huggingface dataset:
Privacy Protection, At What Cost? Exploring the Regulatory Resistance to Data Technology in Auto Insurance
Authors: Ben-Shahar Omri
Published: August 2023

Regulatory and sociological resistance to new market-driven technologies, particularly to those that rely on collection and analysis of personal data, is prevalent even in cases where the technology creates large social value and saves lives. This article is a case study of such tragic technology resistance, focusing on tracking devices in cars which allow auto insurers to monitor how policyholders drive and adjust the premiums accordingly. Growing empirical work reveals that such “usage-based insurance” induces safer driving, reducing fatal accidents by almost one third, and resulting in more affordable and fair premiums. Yet, California prohibits this technology and other states limit its effectiveness, largely in the interest of privacy protection. The article evaluates the justifications fueling the restrictive regulation vis-à-vis the loss of lives resulting from this regulation. It concludes that the social benefits of the tracking technology dramatically outweigh the privacy and related costs.
Two-way dynamic factor models for high-dimensional matrix-valued time series
Authors: Yuan Chaofeng , Gao Zhigen , He Xuming , Huang Wei , Guo Jianhua
Published: August 2023

In this article, we introduce a two-way dynamic factor model (2w-DFM) for high-dimensional matrix-valued time series and study some of the basic theoretical properties in terms of identifiability and estimation accuracy. The proposed model aims to capture separable and low-dimensional effects of row and column attributes and their correlations across rows, columns, and time points. Complementary to other dynamic factor models for high-dimensional data, the 2w-DFM inherits the dimension-reduction feature of factor models but assumes additive row and column factors for easier interpretability. We provide conditions to ensure model identifiability and consider a quasi-likelihood based two-step method for parameter estimation. Under an asymptotic regime where the size of the data matrices as well as the length of the time series increase, we establish that the estimators achieve the optimal rate of convergence and are asymptotically normal. The asymptotic properties are reaffirmed empirically through simulation studies. An application to air quality data in Chinese cities is given to illustrate the merit of the 2w-DFM.
Chromophobe renal cell carcinoma with sarcomatoid and heterologous osteosarcoma-like differentiation: a case report and literature review
Authors: Abuorouq Saleh , Sahawneh Firas , Halalsheh Omar , Haddad Husam K , Mekail Raed , Alzoubi Hiba , Alrjoub Mo’ath , Serhan Hashem A
Published: August 2023

Chromophobe renal cell carcinoma (CRCC) is a subtype of renal cell carcinoma (RCC) with a favorable prognosis. Sarcomatoid differentiation in RCC is assumed to be the outcome of the parent tumor’s dedifferentiation and associated with poorer prognosis. Sarcomatoid differentiation can be detected in CRCC as well as other subtypes, but the occurrence of divergent osteosarcoma-like components in sarcomatoid CRCC is extremely unusual. Only six cases have been previously reported in the literature, we reviewed them and presented the seventh case in a 71-year-old male who had a left kidney heterogeneous mass. The resected tumor showed a sarcoma-like spindle cell area with an adjacent osteosarcoma area producing lacy bone material and bony trabeculae in a hard area mixed with a typical CRCC. In conclusion, sarcomatoid CRCC with osteosarcomatous differentiation is a very rare tumor and should be kept in mind especially when dealing with small or frozen sections biopsies.
Signs of an Augustinian Original Sin in Milan? The Origin and Nature of Human Sin According to Ambrose
Authors: Dupont Anthony
Published: August 2023

Ambrose’s conception of sin is seldom studied. When it is, scholars often regard Ambrose’s thinking as an imperfect preparation for that of his best-known pupil, Augustine of Hippo. The present article redresses this oversight by investigating Ambrose’s conception of sin in its own right. The starting point for Ambrose’s hamartiology is his belief in the personal choice of the will. On several occasions, he attributes the Fall in Eden entirely to human responsibility. Because of this first sin, Adam and Eve lost their potential for perfect virtue and immortality. Adam’s sin, moreover, had consequences for all humankind: mortality, the loss of godlikeness, and the dissemination of a tendency to sin being chief among them. Ambrose’s reflections on Christian baptism provide an important litmus test for his thinking about the impact of Adamic sin. What exactly does baptism erase? According to the Milanese catechist, baptism erases primarily individual sins. Though Ambrose accepts the pernicious impact of Adam’s sin, we argue that his doctrine of (original) sin may not be accurately considered proto-Augustinian. Unlike Augustine’s view, here it is not Adam’s sin per se that humankind has inherited, but rather a general tendency to sin. Ambrose also never speaks of inherited guilt, but of a contamination. Finally, Ambrose always tries to balance the negative influence of original sin with his belief in individual choice and his programme of moral improvement for all Christians.
Phosphate starvation: response mechanisms and solutions
Authors: Madison Imani , Gillan Lydia , Peace Jasmine , Gabrieli Flavio , Van den Broeck Lisa , Jones Jacob L , Sozzani Rosangela
Published: August 2023

Phosphorus is essential to plant growth and agricultural crop yields, yet the challenges associated with phosphorus fertilization in agriculture, such as aquatic runoff pollution and poor phosphorus bioavailability, are increasingly difficult to manage. Comprehensively understanding the dynamics of phosphorus uptake and signaling mechanisms will inform the development of strategies to address these issues. This review describes regulatory mechanisms used by specific tissues in the root apical meristem to sense and take up phosphate from the rhizosphere. The major regulatory mechanisms and related hormone crosstalk underpinning phosphate starvation responses, cellular phosphate homeostasis, and plant adaptations to phosphate starvation are also discussed, along with an overview of the major mechanism of plant systemic phosphate starvation responses. Finally, this review discusses recent promising genetic engineering strategies for improving crop phosphorus use and computational approaches that may help further design strategies for improved plant phosphate acquisition. The mechanisms and approaches presented include a wide variety of species including not only Arabidopsis but also crop species such as Oryza sativa (rice), Glycine max (soybean), and Triticum aestivum (wheat) to address both general and species-specific mechanisms and strategies. The aspects of phosphorus deficiency responses and recently employed strategies of improving phosphate acquisition that are detailed in this review may provide insights into the mechanisms or phenotypes that may be targeted in efforts to improve crop phosphorus content and plant growth in low phosphorus soils.
γ-ray detection from occasional flares in T Tauri stars of NGC 2071 – I. Observational connection
Authors: Filócomo A , Albacete-Colombo J F , Mestre E , Pellizza L J , Combi J A
Published: August 2023

NGC 2071 is a star-forming region that overlaps with three γ-ray sources detected by the Fermi Space Telescope. We propose that strong flare activity in T Tauri stars could produce γ-ray emission in a way that makes them a counterpart to some unidentified sources detected by the Large Area Telescope aboard the Fermi satellite. We have performed a spectral and temporal analysis for two Fermi data sets: the first 2 yr and the entire 14 yr of observations. We have found that the γ-ray source is detectable at 3.2σ above the background at energies above 100 GeV during the first 2 yr of observation. The analysis of the expected frequency of the highest energy flares occurring in T Tauri stars is consistent with our estimate. In addition, we have determined the minimum energy of the flare that would produce γ-ray emission, which is ∼5 × 1037 erg. This agreement becomes a hard observational constraint supporting previous hypotheses about rare flares as the origin of unidentified γ-ray sources in star-forming regions.
The Architecture of Metabolic Networks Constrains the Evolution of Microbial Resource Hierarchies
Authors: Takano Sotaro , Vila Jean C C , Miyazaki Ryo , Sánchez Álvaro , Bajić Djordje
Published: August 2023

Microbial strategies for resource use are an essential determinant of their fitness in complex habitats. When facing environments with multiple nutrients, microbes often use them sequentially according to a preference hierarchy, resulting in well-known patterns of diauxic growth. In theory, the evolutionary diversification of metabolic hierarchies could represent a mechanism supporting coexistence and biodiversity by enabling temporal segregation of niches. Despite this ecologically critical role, the extent to which substrate preference hierarchies can evolve and diversify remains largely unexplored. Here, we used genome-scale metabolic modeling to systematically explore the evolution of metabolic hierarchies across a vast space of metabolic network genotypes. We find that only a limited number of metabolic hierarchies can readily evolve, corresponding to the most commonly observed hierarchies in genome-derived models. We further show how the evolution of novel hierarchies is constrained by the architecture of central metabolism, which determines both the propensity to change ranks between pairs of substrates and the effect of specific reactions on hierarchy evolution. Our analysis sheds light on the genetic and mechanistic determinants of microbial metabolic hierarchies, opening new research avenues to understand their evolution, evolvability, and ecology.
Evaluation of the determinants for improved pluripotency induction and maintenance by engineered SOX17
Authors: Hu Haoqing , Ho Derek Hoi Hang , Tan Daisylyn Senna , MacCarthy Caitlin M , Yu Cheng-han , Weng Mingxi , Schöler Hans Robert , Jauch Ralf
Published: August 2023

An engineered SOX17 variant with point mutations within its DNA binding domain termed SOX17FNV is a more potent pluripotency inducer than SOX2, yet the underlying mechanism remains unclear. Although wild-type SOX17 was incapable of inducing pluripotency, SOX17FNV outperformed SOX2 in mouse and human pluripotency reprogramming. In embryonic stem cells, SOX17FNV could replace SOX2 to maintain pluripotency despite considerable sequence differences and upregulated genes expressed in cleavage-stage embryos. Mechanistically, SOX17FNV co-bound OCT4 more cooperatively than SOX2 in the context of the canonical SoxOct DNA element. SOX2, SOX17, and SOX17FNV were all able to bind nucleosome core particles in vitro, which is a prerequisite for pioneer transcription factors. Experiments using purified proteins and in cellular contexts showed that SOX17 variants phase-separated more efficiently than SOX2, suggesting an enhanced ability to self-organise. Systematic deletion analyses showed that the N-terminus of SOX17FNV was dispensable for its reprogramming activity. However, the C-terminus encodes essential domains indicating multivalent interactions that drive transactivation and reprogramming. We defined a minimal SOX17FNV (miniSOX) that can support reprogramming with high activity, reducing the payload of reprogramming cassettes. This study uncovers the mechanisms behind SOX17FNV-induced pluripotency and establishes engineered SOX factors as powerful cell engineering tools.
Circulating KIM-1 is a minimally invasive biomarker correlated with treatment response to nivolumab in patients with metastatic renal cell carcinoma
Authors: Xu Wenxin , Vemula Sai V , Niman Samuel M , Liu Xiaowen , Takakura Ayumi , Huang Zimo , Choueiri Toni K , Freedman Matthew L , Catalano Paul J , Bonventre Joseph V , Gupta Saurabh , McDermott David F , Bhatt Rupal S
Published: August 2023

Background

There are currently no circulating biomarkers used for clinical monitoring of clear cell renal cell carcinoma (ccRCC). Such a biomarker could facilitate individualized treatment decisions and minimize exposure to ineffective therapies. Prior studies have suggested that circulating KIM-1 is a potential minimally invasive biomarker for ccRCC, but the utility of KIM-1 for identifying early response to nivolumab therapy is not known.

Methods

CheckMate-009 was a prospective trial investigating nivolumab (every 3 weeks at 0.3, 2, or 10 mg/kg) in patients with metastatic clear cell RCC. We measured serum KIM-1 at baseline and after 3 weeks of treatment (prior to cycle 2) using a custom sandwich immunoassay using the R-PLEX platform. Human KIM-1 antibody (R&D systems, #AF1750) was used to prepare biotin conjugated antibodies and detection antibodies. The assay lowest limit of detection for KIM-1 was 4.88 pg/mL. We assessed the association between early changes in serum KIM-1 and treatment related clinical outcomes.

Results

Clinical data and serum KIM-1 was analyzed in 54 patients. KIM-1 was high in all patients at baseline (median serum KIM-1 5913 pg/mL, IQR 2137-25101 pg/mL). 25 patients (48%) had a decrease in KIM-1 at 3 weeks after a single dose of nivolumab. Decrease in KIM-1 at 3 weeks was associated with improved PFS (univariable HR 0.26, 95% CI 0.13-0.52; multivariable HR 0.22, 95% CI 0.097-0.50 after adjustment for sex, prior nephrectomy, nivolumab dose, and IMDC risk factors).

Conclusions

Serum KIM-1 is elevated in patients with metastatic ccRCC and is associated with clinical outcomes. Among patients treated with nivolumab in the CheckMate-009 trial, early decrease in KIM-1 from baseline to 3 weeks was predictive for PFS.

CDMRP DOD Funding: yes
Spatial proteomics enables identification of prognostic biomarkers in papillary renal cell carcinoma
Authors: Haake Scott , Brewer Jared , Nesta Alex , Vento Joseph , Beckermann Kathryn , Reddy Anupama
Published: August 2023

Background

Papillary renal cell carcinoma (PRCC) is the second most common adult kidney cancer histology, constituting 15-20% of cases. While some patients may have indolent PRCC tumors that grow slowly, other tumors rapidly metastasize. Some PRCC tumors respond to immune checkpoint inhibitors. Thus, understanding the immune tumor microenvironment and how it correlates with patient outcomes in this relatively rare disease is a critical need. Spatial interrogation of patient samples has the potential to offer novel insights into the tumor-immune axis and provide avenues for enhanced diagnosis and treatment. Addressing questions of spatial arrangement within tumors has remained a technical and biological challenge, but emerging spatial biology technologies provide molecular data at single cell resolution. We hypothesized that the spatial interaction of immune, stromal and tumor cells would be prognostic for PRCC patients.

Methods

A tissue microarray was assembled from an archive of ~100 patients presenting with PRCC. This dataset was assayed with PhenoCycler/CODEX (Akoya Biosciences) using a 31-antibody panel with immune- and cancer-related proteins. We have developed methodology and novel algorithms to perform signal normalization, cell segmentation, and cell typing. We computed neighborhoods for each of 2.5 million cells and performed network analysis to identify spatial clusters. This method allowed us to identify clusters consistently present across multiple TMA spots from the same patient and across multiple patients.

Results

Using spatial neighborhood analysis, we have identified diverse spatial clusters of potential clinical relevance, including five distinct M2 macrophage spatial clusters. We have described one of the clusters as being physically associated with helper T cells, which is visualized on a PRCC spot and shows co-occurence of M2-macrophages (CD163) and helper T cells (CD4). This pattern was replicated in additional TMA spots from the same patient. In contrast, other clusters of M2-macrophages (M2-M2 spatial cluster and M2-M1 macrophages) are visualized to show vastly different cellular neighborhoods. Clinical associations show that the patients with presence of the M2-T helper cluster have a poor cancer-associated survival (p=0.005). In comparison, the total proportion of M2 macrophages is not associated with survival (p=0.4), highlighting the importance of characterizing spatial interactions beyond cell type quantitation.

Conclusions

In summary, we highlight the utility of spatial biology to explain the heterogeneity in patients’ tumors and to uncover novel correlates of clinical phenotypes, establishing a platform for future discovery in this field and the identification of additional spatial correlates of patient outcome and clinical response.

CDMRP DOD Funding: yes
A High-δ18O Mantle Source for the 2.06 Ga Phalaborwa Igneous Complex, South Africa?
Authors: Munro Joshua , Harris Chris
Published: August 2023

The 2060 ± 2 Ma Phalaborwa Complex is a pipe-like, ultramafic to carbonatite intrusion formed from multiple magma pulses. The complex is made up of a main pipe consisting of clinopyroxenites, ultramafic pegmatoids, carbonatites and foskorite (olivine-apatite-magnetite-calcite assemblage), surrounded by many smaller syenite plugs. The range in mineral δ18O values for all rock types and minerals analysed in the Phalaborwa Complex is 2.24 to 18.3‰. However, 24 analyses of the most abundant and robust mineral, diopside, all have δ18O values between 6.5 and 8.1‰. The δ18O values of baddeleyite, olivine, diopside, magnetite, apatite and aegirine are thought to be magmatic. Most mineral pairs have differences in δ18O values that are consistent with magmatic equilibrium at high temperatures down to closure temperature. Alkali feldspar and phlogopite have more variable δ18O values, and both minerals may have undergone subsolidus O exchange. The δD values for petrographically fresh Phalaborwa Complex phlogopite range from −79 to −48‰ with a mean of −64 ± 9‰ (1σ, n = 19). The phlogopite δD values are consistent with subduction-related magmatic water. Despite petrographic evidence for fluid–rock interaction in the carbonatite–foskorite rocks, the carbonatite δ13C and δ18O range (δ18O, 8.13 to 12.00‰; δ13C, −3.19 to −5.60‰) overlaps with the unaltered, primary igneous carbonatite field.

Magma δ18O values estimated from silicate and oxide minerals are mostly higher than normal mantle magmas (pyroxenites, ~7.6‰; foskorite, 7.2‰). The δ18O value of syenite magma estimated from aegirine is 7.8 ± 0.9‰ (1σ, n = 8), in equilibrium with whole-rock syenite δ18O values (8.7 ± 0.4‰, 1σ, n = 5). Local basement rocks have average bulk δ18O values of 8.6‰, and realistic proportions of assimilation by a mantle-derived magma (δ18O, 5.7‰) could not have produced the δ18O values in the pyroxenites or foskorites. Instead, it is proposed that the high-δ18O values of Phalaborwa Complex magmas reflect that of the mantle source. High δ18O values are also a feature of the Rustenburg Layered Suite of the Bushveld Complex (2060 to 2055 Ma), which may have had a similar high-δ18O mantle source. The higher δ18O values of the satellite syenites are consistent with an origin by partial melting of metasomatised country rock.
Efficient parthenogenesis via egg cell expression of maize BABY BOOM 1: a step toward synthetic apomixis
Authors: Skinner Debra J , Mallari Michelle D , Zafar Kashaf , Cho Myeong-Je , Sundaresan Venkatesan
Published: August 2023

The maize BABY BOOM 1 gene, when ectopically expressed in egg cells, induces parthenogenetic haploid progeny at high frequency, suggesting a promising route for producing clonal hybrid seeds in maize.
Ultrasonographic Evaluation of Diaphragmatic Thickness versus Excursion as a Predictor of Weaning in Mechanically Ventilated Patients
Authors: Elsharnouby Noha Mohamed , Ali Rania Mahrous , Eldeeb Abdallah Omar Abdelrazeg
Published: August 2023

Background

Best predictor of successful extubation after mechanical ventilation is a matter of debate.

Objective

The aim of this study was to assess the efficiency of diaphragm thickness and/or diaphragm excursion as measured by means of ultrasound as a predictor of extubation in mechanically ventilated patients in ICU.

Methods

We performed a prospective study on fifty patients who successfully passed spontaneous breathing trial (SBT). During T-tube spontaneous breathing trial (SBT) we evaluated the right hemidiaphragm excursion by using the M mode and diaphragmatic thickness fraction (DTF%) using B mode, and they were classified in to the successful extubation group and the failure group. Primary outcome: defined as weaning failure and requirement of either noninvasive ventilation or mechanical ventilation. Secondary outcome: To investigate possible factors related to weaning failure

Results

Of the 50 patients in the study, 35 patients were successfully weaned and 15 failed weaning. The mean diaphragmatic thickness fraction with respect to cut-off value was higher in the failure group during SBT whereas the diaphragmatic excursion with respect to cut off value was less in the failure group during SBT while there was increase in both DTF and diaphragmatic excursion with respect to cut off value in the success group. The diaphragmatic excursion cut-off value predictive of weaning was 10 mm with a specificity 78% and sensitivity 82% respectively and the diaphragmatic thickness cut-off value predictive of weaning was 21.5% with a specificity of 71% and sensitivity of 76% respectively. There was negative correlation between diaphragmatic function and duration of mechanical ventilation.

Conclusion

The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.
Risk Factors of Postoperative Atrial Fibrillation after On-Pump CABG Surgery
Authors: Sayed Amr Mohammed Abd-Elfattah , Gomaa Gehan Abd-Elhalim Ali , Abd-Elaziz Farouk kamal Eldin , Ibrahim Ahmed Abd-Elnasser Ibrahim
Published: August 2023

Background

Atrial fibrillation is the most common arrhythmia seen following CABG

Aim of the Work

We sought to determine the preoperative and intraoperative risk factors for occurrence of postoperative atrial fibrillation (AF) following on- pump coronary artery bypass grafting surgery (CABG).

Patients and Methods

We conducted an observational prospective study on 85 patients who underwent isolated on-pump CABG divided in two groups group A POAF group and group B non AF group. Personal history, Clinical, laboratory and procedure characters were noticed and recorded.

Results

Atrial fibrillation was diagnosed in 15.3% of the population postoperatively and many factors watched were not associated with statistically significant prediction of development of postoperative AF like age, sex, body mass index (BMI), smoking, Hypertension, Diabetes mellitus, history of epilepsy and chronic kidney disease. Regarding the pathology of ischemic heart disease we classified the patients into two categories: multivessel disease and left main disease, 3 patients were emergency revascularization due to acute MI with 92% of AF patients were with multivessel disease pathology.

Conclusion

The occurrence of AF following CABG is multifactorial but defining specific risk factor for development of new onset AF postoperatively is matter of conflict among studies.
Predictive Value of Doppler Renal Resistive Index for Prediction of Acute Kidney Injury in Septic Patients in Intensive Care Unit
Authors: Saeed Abdelaziz Mohammed , Hosney Mona Refaat , Ahmed Mohamed Saleh , Abuelmajd Ahmed Abdelsattar
Published: August 2023

Background

Acute kidney injury (AKI) occurs as a serious complication in septic patients. In its severe form, AKI requires renal replacement therapy, which is applied in 5–13% of intensive care units (ICU) patients. AKI is common in patients confined in ICU and remains to be associated with poor outcomes. According to the current diagnostic criteria, serum creatinine (SCr) and urine volume are used as diagnostic and staging criteria for AKI.

Aim of the Work

To evaluate predictive value of renal resistive index in detection of acute kidney injury. Measuring flow resistance in the renal circulation, Renal Resistive Index (RRI) could become part of vital organ function assessment using Doppler ultrasound.

Patients and Methods

This was a prospective descriptive study conducted on 150 ICU patients with sepsis; to evaluate prediction value of renal resistive index in detection of acute kidney injury. Measuring flow resistance in the renal circulation, RRI could become part of vital organ function assessment using Doppler ultrasound.

Results

We found that; the mean age of all patients was (38.4 ± 13.5) years. Regarding gender of the patients, the majority (62.7%) of patients were males; while (37.3%) were females. Regarding basic clinical data; the average MAP was (57.6 ± 14.8) mmHg, the average APACHE score was (14.6 ± 3.7), and the average SOFA score was (4.2 ± 0.92). Regarding comorbidities; (24.7%) of patients had septic shock, (20%) had DM, (34%) had HTN, and (14.7%) had IHD.

Conclusion

High RRI on ICU admission was a significant predictor for development of AKI stage 2 ± 3 during the first week. High RRI can be used as an early warning signal RRI, because of its high specificity. A combined score including RRI, APACHE III and fluid balance improved AKI prediction, suggesting that vasoconstriction or poor vascular compliance, severity of disease and positive fluid balance independently contribute to AKI development.
Safety and Efficacy of Ivabradine as a Rate Control for the Heart in Sepsis
Authors: Wahba Sherif Samir , Ramzy Osama , Mohamed Marwa Mamdouh , Borham Ahmed Mohammed Ibrahim
Published: August 2023

Background

Sepsis and septic shock represent a major health problem among the critically ill patients all over the world, with associated substantial morbidity and mortality rates ranging from 18 % to 50 %. The incidence of sepsis has increased steadily over the last three decades, at least in part because of aging western population. Despite our increased understanding, improved support and more powerful antibiotic therapy, sepsis is still reported as the second leading cause of death in non-coronary intensive care units, and the tenth-mostcommon cause of death overall (the first being heart disease). Children under 12 months and elderly have the highest incidence of severe sepsis).

Objective

Evaluation of the role of heart rate control using enteral Ivabradine in the management of patients with sepsis. Assessment of the effect of enteral Ivabradine on outcome of septic patients regarding need for vasopressor therapy, mechanical ventilation, renal replacement therapy, length of ICU stay, in- hospital mortality and 30 days mortality.

Patients and Methods

The study was comparative prospective case / control study conducted on 60 critically ill patients admitted with sepsis and or septic shock to the Critical Care Department at Kobry Elkoba Military complex at 12 month from 8/2019 up to 8/ 2020.

Results

Significant decrease in follow up lactate at end of Ivabradine treatment, compared to control group without Ivabradine treatment (p = 0.025). Significant decrease in follow up of crp level in group A than group B at day 2 and day 4 with (p = 0.013), (p = 0.018) respectively. Significant decrease in heart rate in group A in comparison with group B during first 48 hour with (p = 0.008). Significant difference between group A and group B regarding weaning from mechanical ventilation with (p = 0.001). There was no statistically significant difference found between group A and group B regarding rate of mortality with p-value = 0.606.

Conclusion

Use of enteral Ivabradine can reduce pathologically elevated heart rate in patients with sepsis but didn‘t affect survival, length of ICU stay, between septic patient.
Non-Invasive Positive Pressure Ventilation or Standard Oxygen Therapy as Initial Treatment of Acute Cardiogenic Pulmonary Edema in ICU Patients
Authors: Essam Amr , El Shebeiny Ahmed Ali , Fathy Reham , Elsawy Ahmed Said Mohamed
Published: August 2023

Background

Continuous positive airway pressure ventilation (CPAP) through face mask has been widely used especially in North America, Europe and Australasia to alleviate signs and symptoms of respiratory distress due to cardiogenic pulmonary edema. Continuous positive airway pressure ventilation (CPAP) is ventilatory support that is given without establishing endotracheal intubation. CPAP avoid complication of endotracheal tube and invasive mechanical ventilation, preserving the patient’s ability to speak, eat, and cough reflex, reduces the need for sedation, potential airway trauma, and the risk of ventilator associated pneumonia.

Objective: Patients and Methods

In our study, 62 patients admitted at critical care unit of the Ain Shams University Hospitals with acute cardiogenic pulmonary edema. Patients divided into two groups. Group I: included 31 patients with acute cardiogenic pulmonary edema receive CPAP with (PS 10 cm h2o, PEEP 5 cm h2o). Group II: included 31 patients with acute cardiogenic pulmonary edema receive Oxygen therapy by face mask. Both groups are compared regarding the following parameter: Pao2, Pco2, respiratory rate and Spo2 on admission, 1-hour and 2-hours, post intervention and after discontinuation of treatment. Both groups were compared regarding the rate of endotracheal intubation, ICU length of stay and hospital mortality.

Results

Our study showed that the respiratory distress was markedly improved in CPAP group compared to oxygen therapy group by face mask as shown in respiratory rate after institution of CPAP (48.31±4.29, 35.84±5.30). In our study, as regarding to ICU length of stay, there was reduction in the intensive care unit length of stay in patient received CPAP compared to length of stay in standard oxygen treatment received group (2.48 ± 0.51 vs. 4.03± 0.65). Our study show that there is reduction in rate of intubation in group I with CPAP compared with group II with oxygen therapy by face mask.

Conclusion

Continuous positive air way pressure CPAP is widely used in North America, Europe and Australasia for patients with severe ACPE. There are clear mechanistic reasons why these interventions work in acute pulmonary edema. In conclusion, patients with acute cardiogenic pulmonary edema, CPAP safely provides earlier improvement of dyspnea, respiratory distress and oxygen saturation, and decrease ICU length of stay, improved endotracheal intubation and survival rate than does oxygen therapy.
Association of Glycosylated Hemoglobin Levels with Insulin Resistance in Adolescent among Medical Students Ain Shams University
Authors: Ghobrial Bassem Boules , ElKabarity Reem Hamdy , Hassan Angie Magdy Mohammed
Published: August 2023

Background

Insulin resistance is a common pathway for the development of glucose metabolism disorders and high blood pressure, all of which are components of the metabolic syndrome. The earlier onset of obesity may cause a longer period of insulin resistance, which may explain the concomitant earlier onset of impaired glucose tolerance in young obese people and adolescents so insulin resistance has been implicated as risk factor for metabolic disorders and it is of real importance to develop simple test that can be used in routine clinical setting for identifying insulin resistant individuals in advance so HOMA-IR(Homeostatic Model Assessment for Insulin Resistance) and HbA1c (glycated haemoglobin) screening to identify young at high risk for insulin resistance and diabetes at an early stage. The study aimed to evaluate the association of HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) and HbA1c levels in overweight and nonoverweight young medical students to assess insulin resistance, a condition that can cause diabetes mellitus and metabolic syndrome in earlier life.

Subject and Methods

The study was systematic random sample was conducted between 40 overweight and 40 non-overweight students (80 in total). All cases were subjected to history taking, clinical examination and laboratory investigations included HOMA-IR and HbA1c.

Results

Regarding HOMA-IR in present study they illustrated statistically significant difference between groups with higher levels in overweighed group than for normal weight group.HOMA-IR ≥2.5 was represent (17.5%)of normal weight group and (45.0%) of overweighed group with statistically significant difference. N statistically significant difference regarding Glucose (mg/dl) level for normal and overweighed group. The relation was statistically significant regarding Insulin (mIU/ml) level as it was higher in overweighed group than normal group. Regarding HbA1c% in present study; there is no statistically significant difference between normal group compared to obese group that range within normal values with higher result in obese group. Our study found statistically significant association between HOMA-IR<2.5 and (glucose and insulin), in both groups and for HbA1c in obese group. Also statistically significant positive correlation between HOMA-IR and HbA1c% in all patients.

Conclusion

Obesity is significantly associated with higher levels of fasting insulin, and HOMA-IR values in adolescents. There is a positive correlation between HbA1c and HOMA-IR
Ultrasound Guided Quadratus Lumborum Block Compared to Caudal Bupivacaine/Neostigmine in Pediatric Lower Abdominal Surgeries: A Randomized Controlled Trial
Authors: Ashoor Tarek M , Eldeen Eman Mohamed Zain , Reyad Mostafa Kamel , Hasseb Ahmad M , Esmat Ibrahim M
Published: August 2023

Background

The postoperative analgesia in pediatric patients undergoing lower abdominal surgeries could be achieved by Quadratus lumborum block (QLB) or Caudal block (CB). The combination of neostigmine and bupivacaine shortens the onset and increases the duration of regional blocks.

Methods

80 pediatric patients undergoing lower abdominal surgeries under general anesthesia were randomized to receive either QLB using bupivacaine or CB using bupivacaine/neostigmine mixture. Time to first needed rescue analgesia was considered as a primary outcome while pain score, blood glucose level, nausea, vomiting, bradycardia, hypotension and urinary pretension were considered as secondary outcomes.

Results

The time to first rescue of analgesia was significantly longer in QLB group (p=˂ 0.001) and rate of rescue analgesia requirements was significantly lower in quadratus lumborum group (p=˂ 0.001), while time to perform the block and block failure were significantly higher in QLB group. Side effects were infrequent and non-significant among groups.

Conclusion

Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries could be safely and effectively achieved by Quadratus lumborum block and caudal bupivacaine/neostigmine mixture block with priority to caudal block.
Comparison between Levosimendan versus Beta Agonists in Preservation of Renal Function in Cardiac Surgery Patients with Low Cardiac Output Syndrome
Authors: Hassab Gamal Saad Abdelhamid , Mustafa Zakaria Abdelaziz , Elkhattab Salwa Omar , Kamal Mohamed Mohamed
Published: August 2023

Background

Acute kidney injury post cardiac surgery in patients who develop low cardiac output syndrome (LCOS) postoperatively is a serious complication. Many studies have been performed to assess the effect of inotropic agents on cardiac function when administered postoperatively, some studies performed to evaluate the nephroprotective effect of conventional inotropic agents as compared to levosimendan.

Objective

To evaluate the possible nephroprotective effect of Levosimendan as compared to betaagonists in cardiac surgery patients with LCOS.

Patients and Methods

It is a randomized prospective comparative study at Ain Shams university hospitals from December 2020 to May 2021. A total of 60 patients who have developed low cardiac output syndrome post cardiac surgery divided into two groups of 30 patients each. Group A received beta-agonists (dobutamine 2 - 20 µ/kg/min or adrenaline 0.01 to 0.5 mcg/kg/minute) and Group B received levosimendan for 24 h at a rate of 0.1 mcg/kg/min to a target dose of 12.5 mg. we assessed the incidence of renal failure in these patients. We assessed the progress of acute kidney injury in patients who developed acute renal impairment at diagnosis of LCOS in both treatment groups. Parameters assessed include hemodynamics and renal function parameters.

Results

The incidence of acute kidney injury at diagnosis of LCOS postoperative was 30% (n = 9) in each group, 44% of them in the control group (n = 4) developed renal failure at discharge from ICU and none of the study group patients developed renal failure at discharge. At time of discharge from ICU the incidence of renal failure in beta – agonist group was 13.3% while the incidence in the levosimendan group was 0%.

Conclusion

Levosimendan has a nephroprotective effect that plays a role in preservation of renal functions and decreasing the incidence of kidney failure in patients with LCOS post cardiac surgery as compared to beta – agonists.
Convalescent Plasma Transfusion for Treatment of Corona Virus Disease 2019 (COVID-19) Infection: A Systematic Review
Authors: Hakim Sameh M , Elhakim Ashraf M H , Amer Akram M , Chikhouni Ghoson M A
Published: August 2023

Background and object

The coronavirus disease 2019 (COVID-19) represents a major global challenge with more than 200 million confirmed cases and over 4.5 million deaths till now. Unfortunately, therapeutic options are still limited and under trial. Convalescent plasma (CP) has emerged as a treatment modality based on previous use in similar viral outbreaks and early clinical trials, but there is still a controversy regarding its efficacy in COVID-19 patients. The aim of this systematic review is to examine evidence on the value of CP as a potential therapy for COVID-19 patients.

Methods

The current review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. A literature search was conducted on multiple databases including Medline/PubMed, Web of Science, Cochrane library, Wiley Online Library, Scopus and Google Scholar. Databases were searched for eligible studies using the following keywords: COVID-19, novel corona virus, SARS-COV-2, convalescent plasma, and convalescent plasma therapy (CPT). Data extraction and risk of bias assessments were performed by independent two reviewers. Clinical studies comparing CP combined with standard treatment for COVID-19 versus standard treatment only were eligible, including RCTs, non-randomized clinical trials (NRCTs) and case series. We only included studies published in English but there was no restriction on the year of publication, country where study was conducted or age or sex of patients. The primary outcome was mortality rate. Secondary outcomes were time to clinical improvement, need for mechanical ventilation, intensive care or hospital length of stay and incidence of transfusion-related adverse outcomes.

Results

Based on the selection criteria, 23 articles were eligible including 8 RCTs and 15 controlled nonrandomized studies of interventions (NRSIs). Nearly all RCTs had low risk of bias. However, the risk of bias was considered to be high in all NRSIs. Our review showed that CP reduced overall mortality significantly in only 3 RCTs and 5 NRSIs and improved clinical outcomes significantly in only one RCT and 6 NRSIs. The time to clinical improvement, ICU stay, and need for mechanical ventilations were significantly better in CP groups in limited numbers of studies. The overall incidence of severe transfusionrelated adverse outcomes was low.

Conclusions

Current evidence regarding the benefit of CP in moderate to severe COVID-19 is nonconclusive. Most evidence is derived from NRSI that suffer from significant risk of bias. Evidence from RCTs carries low risk of methodological bias but clinical benefit of CP is inconsistent across studies. CP seems to be associated with no increased risk of serious transfusion-related adverse outcome. More welldesigned RCTs are still needed to elucidate the actual role of CP in patients with COVID-19.
Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy
Authors: Hassan Bahaa Eldeen Ewais , Taha Sameh Salem Hefni , El Derh Maha Sadek Hussein , Sayed Hassan Taha Kandil Hassan
Published: August 2023

Background

Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery.

Aim of the Work

Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective.

Patients and Methods

The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline.

Results

There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p < 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p < 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A.

Conclusion

We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.
The Effect of Volume Preload versus Ephedrine Infusion for Prevention of Hypotension due to Spinal Anesthesia for Cesarean Section
Authors: El-Shaer Ahmed Nagah , El-Hamid Hadil Magdy Abd , Saleh Mohamed Abd El-Mawla , Mahmoud Ismail Farid Ibrahim
Published: August 2023

Background

Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. We hypothesized that using ephedrine to maintain maternal blood pressure during spinal anesthesia for cesarean delivery provides better hemodynamic stability with subsequent better maternal and neonatal outcomes compared to volume preload.

Aim of the Work

We compared volume preload and ephedrine infusion to guard against the hypotensive effect of spinal anesthesia during cesarean delivery.

Patients and Methods

After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent this study was conducted in the operating theaters of Ain Shams University Hospitals. This study was a randomized Controlled Clinical Trial. Adult parturients undergoing cesarean section under spinal anesthesia randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group (A) received Volume Preload, group (B) received Ephedrine Infusion.

Results

The results of the study showed that compared with volume preload, ephedrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery.

Conclusion

Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in ephedrine compared with volume preload.
Value of C-reactive Protein Level to Distinguish between Ischemic and Hemorrhagic Stroke
Authors: El-shaer Ahmed Nagah , Ibrahim Dalia Ahmed , Fouly Mohamed Abdelmoneim , Muhammed Mahmoud Abdel-Hamid
Published: August 2023

Background

Stroke is considered as a life threatening case in neurological patients. It is one of the leading causes of morbidity and mortality worldwide, as cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Spontaneous ICH accounts for approximately 20% of all strokes, and it is characterized by high rates of mortality and residual disability among survivors.

Aim of the Work

To detect the value of serum CRP level in differentiation between ischemic and hemorrhagic stroke.

Patients and Methods

We conducted a prospective cross section study which included patients who were diagnosed with acute stroke through the period Jan 2021 and July 2021, we recruited 72 patients who were admitted to stroke unit of Ain shams university, they were subsequently divided based on etiology of the stroke into 2 groups: Ischemic stroke group: 36 patients and hemorrhagic stroke group: 36 patients.

Results

We conducted a cross section analytical study to compare the CRP level among egyptian cohort of patients (n = 72) who were diagnosed with acute ischemic (n = 36) versus hemorrhagic strokes (n = 36) who were admitted to emergency of Ain shams university, aiming to detect the value of serum CRP level in differentiation between ischemic and hemorrhagic stroke. In the present study we found that there was a statistically significant difference between the studied groups and CRP on day 0, mean CRP during Hospital Stay and CRP at discharge.

Conclusion

Elevated CRP levels are associated with excessive risk of ischemic stroke but not hemorrhagic stroke. The serum CRP level can be used as a predictor for ischemic stroke in the general population.