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Summary: Early‐phase trials of venetoclax in children and teenagers/young adults with leukaemia have yielded promising results, but there remains a paucity of real‐world data. To address this, we report a cohort of 41 children treated with venetoclax for a range of haematological malignancies, demonstrating complete remission in 43.6%, with most achieving minimal residual disease (MRD) negativity. Venetoclax was particularly effective as a bridge to transplant, with bridging successful in 75% of patients. Patients with MRD <1% at initiation of venetoclax were more likely to achieve MRD negativity (81.8% vs. 34.5%, p = 0.007) and had improved overall survival (54.5% vs. 17.9%, p = 0.004). [ABSTRACT FROM AUTHOR]

In this research endeavor, we investigate the potential influence exerted by ESG performance on the market capitalization of non-financial corporations included within the UK FTSE All-Share Index during the eleven-year period spanning 2010 to 2021. Integrating insights from Resource-Based View and Stakeholder Theory, this research extends the literature by considering the moderating effect of governance on the ESG–market capitalization association. This study analyzes a comprehensive dataset of UK firms, employing robust econometric techniques to substantiate its conclusions. The results demonstrate a robust positive association between the overall ESG pillars and market capitalization. Environmental, social, and governance performances independently contribute to an increased market value. The analysis reveals that firms with superior internal governance structures, characterized by the presence of independent board members, board size, an independent audit committee, and the implementation of a split CEO–chair structure, experience a magnified positive impact from ESG disclosures on market capitalization. Effective governance mechanisms enhance the credibility and effectiveness of ESG initiatives, aligning them with stakeholder expectations and regulatory standards. This alignment fosters trust and cooperation, driving better financial performance and increasing market value. This research adds its voice to the increasingly compelling body of evidence that underscores the financial advantages associated with ESG integration and highlights the critical role of internal governance in amplifying these benefits. The findings have significant implications for policymakers, investors, and corporate managers. They advocate for the strategic incorporation of ESG criteria into corporate governance frameworks to achieve sustainable financial success. [ABSTRACT FROM AUTHOR]

Summary: Early‐phase trials of venetoclax in children and teenagers/young adults with leukaemia have yielded promising results, but there remains a paucity of real‐world data. To address this, we report a cohort of 41 children treated with venetoclax for a range of haematological malignancies, demonstrating complete remission in 43.6%, with most achieving minimal residual disease (MRD) negativity. Venetoclax was particularly effective as a bridge to transplant, with bridging successful in 75% of patients. Patients with MRD <1% at initiation of venetoclax were more likely to achieve MRD negativity (81.8% vs. 34.5%, p = 0.007) and had improved overall survival (54.5% vs. 17.9%, p = 0.004). [ABSTRACT FROM AUTHOR]

This study explores the influence of risk disclosure levels and types on the readability of annual reports of non-financial firms in the UK during the COVID-19 outbreak. It further investigates how the disclosure of COVID-19-related information moderates the relationship between risk disclosure and readability. The study uses a content analysis approach and CFIE software to measure the level of risk disclosure and readability in the annual reports of non-financial firms listed on the FTSE all-share from 2019 to 2021. The results show a positive and significant effect of risk disclosure level on readability, which is stronger for firms that disclosed COVID-19 information. Different types of risk disclosure have varying effects on readability, with COVID-19 risk, credit risk, and strategic risk positively affecting readability, while operational risk negatively affects it. The study contributes to the literature on information asymmetry and institutional theory by demonstrating how risk disclosure and readability are influenced by external factors like the COVID-19 outbreak and internal factors such as firm characteristics and types of risks. It introduces a new risk definition and category specific to the COVID-19 pandemic and develops new measurements for risk disclosure, including credit, liquidity, market, operational, business, strategic, and COVID-19 risks. The study provides valuable insights for managers, investors, regulators, and standard setters on the relationship between risk disclosure and readability in annual reports. It highlights the importance of disclosing COVID-19-related information to enhance the readability and understandability of financial communication. The paper contributes to the literature and practice on risk disclosure, readability, and financial communication during crises. [ABSTRACT FROM AUTHOR]

This research examines the effect of ESG disclosure on the cost of capital for non-financial firms in the UK, indexed by the FTSE All-Share Index, during the period from 2014 to 2018. Using multivariate analysis with ordinary least squares (OLS), fixed effects, robust regression, and Tobit models, this research assesses the effect of ESG reporting, governance, and the cost of capital, including robustness checks using an alternative ESG indicator, the environmental pillar score. Contrary to expectations, ESG reporting is positively associated with the cost of capital. However, corporate governance moderates this relationship, weakening the positive correlation and reversing it to a negative association for firms with strong governance practices, consistent with the hypotheses. This research also finds that firm size, liquidity, profitability, and leverage, positively affect the cost of capital, while board size, independent board composition, audit committee independence, and auditor type do not significantly influence it. Notably, non-executive directors on the audit committee have a significant negative effect on the cost of capital. These findings are valuable for investors, companies, regulators, auditors, policymakers, and the academic and research community. Specifically, for investors, this study provides insights into how ESG disclosures can influence investment risks and returns, highlighting the importance of robust corporate governance. Companies can leverage these insights to enhance their governance practices and optimize their capital costs. Regulators and policymakers can use the findings to develop guidelines that encourage transparent ESG reporting and strong governance frameworks, thereby improving market stability and investor confidence. Auditors can utilize the results to better understand the effect of non-financial reporting on financial metrics, helping to provide more accurate audits and assessments. These findings inform investors, companies, regulators, auditors, and academia, in fostering a more sustainable and transparent financial environment. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to explore North American neonatal health care professionals' (HCPs) experience, confidence, skill, and training with the laryngeal mask airway (LMA). Study Design This was a cross-sectional survey. Results The survey was completed by 2,159 HCPs from Canada and the United States. Seventy nine percent had no clinical experience with the LMA, and less than 20% considered the LMA an alternative to endotracheal intubation (EI). The majority had received LMA training; however, 28% of registered nurses, 18% of respiratory therapists, 17% of physicians, and 12% of midwives had never inserted an LMA in a mannequin. Less than a quarter of respondents agreed that the current biennial Neonatal Resuscitation Program instruction paradigm is sufficient for LMA training. All groups reported low confidence and skill with LMA insertion, and compared with all other groups, the respiratory therapists had the highest reported confidence and skill. Conclusion This survey study, which is the first of its kind to include midwives, demonstrates that neonatal HCPs lack experience, confidence, skill, and training with the LMA, rarely use the device, and in general, do not consider the LMA as an alternative to EI. These findings contribute to, and support the findings of previous smaller studies, and in conjunction with the diminishing opportunities for EI, highlight the need for programs to emphasize the importance of the LMA for neonatal airway management and prioritize regular LMA training, with focus that parallels the importance placed on the skills of EI and mask ventilation. Key Points Lack of training for laryngeal mask airway use in neonatal resuscitation. Neonatal health care professionals rarely use the laryngeal mask airway as an alternate airway device. Neonatal health care professionals lack confidence and skill with the laryngeal mask airway. [ABSTRACT FROM AUTHOR]

Background: Medical students' preparedness for clinical practice is well researched, yet little is known on the extent to which students are being prepared for a medical career. This paper reports the construction of a short medical inventory titled eXploring medical sTudents' caReer reAdiness (XTRA) to measure students' career readiness based on Super's theory of career maturity. Approach: We designed an instrument consisting of a series of 5‐point Likert‐scale to identify participants competencies regarding career exploration and planning during their undergraduate studies. The instrument was completed by 348 medical students from 41 universities in the United Kingdom. We examined the validity and reliability of the instrument through Exploratory Factor Analysis, Cronbach's coefficient α and Pearson correlation. Evaluation: Exploratory Factor Analysis revealed that 16 of the 20‐items survey were aligned with the exploration stage of Super's theory: Crystallisation (Career goals), Specification (Career pathways) and Implementation (Career accomplishments). The four items that formed two separate statistical factors were specific to a current medical career in the UK. Internal reliability for Super's factor subscales were acceptable (α = 0.71 to α = 0.81). A significant positive relationship was found between students' overall rating of career readiness and the three factors, indicating construct validity. Implications: The XTRA Inventory is a short instrument with construct and content validity specifically designed to measure career readiness of medical students. Further work on its psychometric properties will help establish this inventory to be used as a guidance and career counselling tool by medical educators and educational institutions in developing career development programmes. [ABSTRACT FROM AUTHOR]

Mitigating spill pollution in the Nile River is crucial to protecting aquatic life, water quality, and public health. Extensive studies focused on the assessment of water quality and hydrodynamics of the Nile River, but there have been relatively few studies that have applied integrated hydrodynamic and water quality modeling approaches to simulate actual accidents in the Nile Fourth Reach. The goal of this study is to develop advanced computational models to simulate accidental spills in the Nile River and track the resulting impacts on water quality. Hydrodynamic and water quality simulations were performed using Delft3D software for 144 km of the Nile River, Egypt, from El-Menia to Assuit. Once the hydrodynamic and water quality models were calibrated, two phosphate spill scenarios were modeled under maximum and minimum flow conditions. The spatial distribution of the spill plume along the studied river section was visualized every 12 h following the spill occurrence for both scenarios. The results of the research were calibrated and validated against measured field data. In addition, various error and performance indicators were calculated to thoroughly assess the rigor and reliability of the results. The results demonstrated that flow velocity was the main factor influencing the spill plume characteristics and behavior. Initially, advection force plays a significant role after a spill occurs. After that, phosphate becomes mixed and diluted through dispersion. The spill plume took less time to reach downstream areas during the period of maximum flow compared to minimum flow. Additionally, the concentration of phosphate decreased as the water flowed downstream. The spatial distribution of the spill over time can assist water treatment facilities in developing mitigation strategies to address the spill impacts. However, complex Nile River dynamics demand extensive computational power. Therefore, the model was simplified for spill events, using the modeling capabilities to analyze hypothetical spills and contaminant spread in the absence of real data. [ABSTRACT FROM AUTHOR]

This research aims to study the phenomenon of attacking the intellectual rights of creators using artificial intelligence and protecting them in jurisprudence and law through a comparative study between them, in which the researcher explains what is meant by artificial intelligence and intellectual rights, then shows images of attacks on intellectual rights using artificial intelligence and how jurisprudence and law protected these rights through a comparative study that shows the points of agreement and differences. The researcher followed the descriptive comparative approach, so he sought to clarify the scientific terms in the research, then mentioned some cases of theft of the rights of creators and studied how jurisprudence and law worked to protect them and what they agreed on and what they disagreed on, then he came out with results including the importance of protecting the intellectual rights of creators in the law and activating the moral aspect of protecting rights. He also concluded that working to protect the rights of creators should be collective, not individual, by institutions and governments, and that jurisprudence and law have done a good job of protecting intellectual rights, but with the development of images of attacks on intellectual rights, we need new formulas and intensive cooperation to curb them. [ABSTRACT FROM AUTHOR]

Tire derived aggregates (TDA) has been used successfully in numerous civil engineering projects. However, considerably few researchers investigated its performance in dynamic applications, despite the high energy absorption ability of TDA. Moreover, testing TDA samples with larger aggregate size is troublesome due to the limitation in specimen sizes available in geotechnical laboratories. Therefore, this paper provides more insights on the dynamic behavior of TDA with larger aggregate sizes. This work also investigates the extent of specimen size effect on the dynamic properties of TDA and Granulated rubber (GR). A series of undrained strain-controlled cyclic triaxial tests were performed using three specimen sizes with diameters of 70, 101 and 152 mm. TDA samples had maximum aggregate size of 19.1 and 25.4 mm, however, the GR samples had only a maximum aggregate size of 4.75 mm. All tests were performed at consolidation stress range of 25 to 100 kPa and shear strain range of 0.1 to 10%. It was found that the 70 mm specimens overestimated the shear modulus of TDA samples by a maximum of 15 to 26%. However, no significant variation was found in the shear modulus that is mobilized by the 101 and 152 mm specimens. Also, GR samples were marginally influenced by specimen size. Furthermore, regardless of the aggregate size, the damping capacity is independent of specimen size. Lastly, it is recommended to use triaxial specimen size with a diameter four times larger than the maximum aggregate size of considered TDA material. [ABSTRACT FROM AUTHOR]

This research examines how ESG disclosure influences market uncertainty through carbon disclosure. It uses a 10-year dataset from 2012 to 2021 of non-financial U.K. companies in the FTSE All-Share index. This study employs four regression methods to scrutinize the interplay between ESG disclosure, carbon disclosure, and market uncertainty. The research findings uncover a notable reduction in market uncertainty associated with ESG disclosure, aligning with the Information Asymmetry Theory. Interestingly, this study also uncovers that carbon disclosure amplifies this negative relationship, a finding that resonates with the Signaling Theory. These results hold true across various measures of ESG and market uncertainty. This study enriches the sustainability reporting literature with implications for theory and practice. It extends Information Asymmetry and Signaling Theories to U.K. non-financial firms, emphasizing the need for more research on sustainability disclosure. It underscores the role of ESG and carbon disclosure in reducing cost of capital, enhancing firm value, and boosting investor confidence. It calls for transparent ESG reporting by managers, regulatory promotion of such disclosures, and stakeholder utilization of these to evaluate a firm's impact and contribution to the SDGs, fostering collaboration on sustainability. This study offers key insights for stakeholders such as managers, investors, regulators, researchers, policy makers, and educators in the realm of sustainability reporting and market dynamics. [ABSTRACT FROM AUTHOR]

Simulation is an effective training method for neonatal resuscitation (NR). However, the limitations brought about by the COVID-19 pandemic, and other resource constraints, have necessitated exploring alternatives. Virtual reality (VR), particularly 360-degree VR videos, have gained attraction in medical training due to their immersive qualities. The primary objectives of the study were to produce a high quality 360-degree virtual reality (VR) video capturing NR simulation and to determine if it could be an acceptable adjunct to teach NR. The secondary objective was to determine which aspects of NR could benefit from the incorporation of such a video in training. This was an exploratory development study. The first part consisted of producing the video using a GoPro action camera, Adobe Premiere Pro, and Unity Editor. In the second part participants were recruited, based on level of experience, to watch the video and answer questionnaires to determine acceptability (user experience and cognitive load) and aspects of NR which could benefit from the video. The video was successfully developed. Forty-six participants showed a strong general appreciation. User experience revealed high means (> 6) in the positive subscales and low means (< 4) for immersion side effect, with no difference between groups. Cognitive load was higher than anticipated. Participants indicated that this video could be effective for teaching crisis resource management principles, human and environment interactions, and procedural skills. The 360-degree VR video could be a potential new simulation adjunct for NR. Future studies are needed to evaluate learning outcomes of such videos. [ABSTRACT FROM AUTHOR]

Background: Using the sandwich osteotomy technique in the posterior mandible is delicate. This study aimed to assess the safety and the amount of bone gain using a full digital workflow versus the conventional procedure. Patients and methods: This split mouth study included 10 patients with bilateral vertically deficient posterior mandible. One side received conventional sandwich interpositional bone grafting (control group), while the other side received the same protocol using two patient‐specific guides. The first guide (cutting guide) was used to place the osteotomies safely and accurately according to the predetermined dimensions and locations, and the second guide was used to fix the mobilized bony segment, leaving the desired gap to be filled with a particulate xenogenic bone graft. Results: Full neurosensory recovery was documented at 2 months postoperative for all patients and bilaterally. After 4 months, there was a statistically significant difference in vertical bone gain between both groups (p = 0.001), measuring an average of 3.76 ± 0.72 mm in the study group and 2.69 ± 0.37 mm in the control group. No statistically significant difference was found between the planned vertical augmentation (3.85 ± 0.58 mm) and the obtained vertical bone gain (3.76 ± 0.72 mm) in the study group (p = 0.765) proving the accuracy of the guided procedure. Conclusion: Computer‐guided sandwich interpositional grafting is predictable regarding the execution of the osteotomies and the accuracy of fixation of the transport segment. [ABSTRACT FROM AUTHOR]

Urban flooding is a problem faced by most countries because of climate change. Without storm drainage systems, negative impacts may occur, such as traffic problems and increasing groundwater levels, especially in lowlands. The implementation of storm drainage networks and their fittings in poor countries is affecting their economic development. Therefore, improving the efficiency of the storm drainage network is an important issue that should be considered. This paper aims to study the most appropriate position or arrangements of grate inlets to upgrade drainage efficiency at less cost. Different arrangements of grates were studied and their efficiency was determined. A comparison between the total grate's efficiency was conducted and the best arrangement was selected. Additionally, a dimensional analysis equation was developed to determine the total efficiency of the system. Finally, the FLOW-3D program was used to simulate the laboratory results using different discharges and numbers of inlets. The error of calculation ranged between 5% and 8%. Therefore, the results indicated that this program is a powerful tool for predicting the discharge efficiency and velocity direction for large discharges. A comparison was made between this study and previous studies. The results indicated that the same trend existed. A new equation was developed to correlate discharge efficiency (E) with relative total discharge Q and number of inlets. The equation can be used by planning engineers to conduct initial planning of storm drainage layout systems and achieve cost saving. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of standardized resuscitation carts and medication trays in a Level III Neonatal Intensive Care Unit (NICU), aiming to enhance patient safety and streamline resuscitation processes. Topics discussed include the development process involving a multidisciplinary committee, the impact of the changes on clinical care and staff satisfaction, and the need for continuous training and evaluation to optimize patient care.

Over the past three decades, a notable rise in the occurrence of enteric protozoan pathogens, especially Giardia and Cryptosporidium spp., in drinking water sources has been observed. This rise could be attributed not only to an actual increase in water contamination but also to improvements in detection methods. These waterborne pathogens have played a pivotal role in disease outbreaks and the overall escalation of disease rates in both developed and developing nations worldwide. Consequently, the control of waterborne diseases has become a vital component of public health policies and a primary objective of drinking water treatment plants (DWTPs). Limited studies applied real-time PCR (qPCR) and/or immunofluorescence assay (IFA) for monitoring Giardia and Cryptosporidium spp., particularly in developing countries like Egypt. Water samples from two conventional drinking water treatment plants and two compact units (CUs) were analyzed using both IFA and qPCR methods to detect Giardia and Cryptosporidium. Using qPCR and IFA, the conventional DWTPs showed complete removal of Giardia and Cryptosporidium, whereas Mansheyat Alqanater and Niklah CUs achieved only partial removal. Specifically, Cryptosporidium gene copies removal rates were 33.33% and 60% for Mansheyat Alqanater and Niklah CUs, respectively. Niklah CU also removed 50% of Giardia gene copies, but no Giardia gene copies were removed by Mansheyat Alqanater CU. Using IFA, both Mansheyat Alqanater and Niklah CUs showed a similar removal rate of 50% for Giardia cysts. Additionally, Niklah CU achieved a 50% removal of Cryptosporidium oocysts, whereas Mansheyat Alqanater CU did not show any removal of Cryptosporidium oocysts. Conventional DWTPs were more effective than CUs in removing enteric protozoa. The contamination of drinking water by enteric pathogenic protozoa remains a significant issue globally, leading to increased disease rates. Infectious disease surveillance in drinking water is an important epidemiological tool to monitor the health of a population. [ABSTRACT FROM AUTHOR]

The results of gene expression analysis based on p-value can be extracted and sorted by their absolute statistical significance and then applied to multiple similarity scores of their gene ontology (GO) terms to promote the combination and adjustment of these scores as essential predictive tasks for understanding biological/clinical pathways. The latter allows the possibility to assess whether certain aspects of gene function may be associated with other varieties of genes, to evaluate regulation, and to link them into networks that prioritize candidate genes for classification by applying machine learning techniques. We then detect significant genetic interactions based on our algorithm to validate the results. Finally, based on specifically selected tissues according to their normalized gene expression and frequencies of occurrence from their different biological and clinical inputs, a reported classification of genes under the subject category has validated the abstract (glomerular diseases) as a case study. [ABSTRACT FROM AUTHOR]

This study examines how capital expenditure (capex) affects Environmental, Social, and Governance (ESG) reporting and how corporate governance moderates this effect. We use data from non-financial firms in the FTSE All Share index from 2012 to 2021 and measure ESG disclosure with the Bloomberg ESG Disclosure Score, capex with logarithm of the ratio of capital expenditure to total assets, and corporate governance with a composite index based on Board Size, Independent Board, Board Diversity, and Audit Committee Non-Executives. We also examine the non-linear and threshold effects of capex on ESG disclosure with spline regression models. We find that capex is positively linked to ESG disclosure and that this association is robust for firms with better corporate governance. Our findings imply that capex improves ESG performance and impact and that corporate governance enables ESG communication to stakeholders. Our research advances the existing literature by revealing the link between capex, governance, and ESG reporting in a dynamic and uncertain environment. Our study holds practical significance for companies, investors, and regulators who want to incorporate ESG factors into capex decisions and reporting. [ABSTRACT FROM AUTHOR]

Reservoirs overflow during flood season because of sedimentation cycles, which severely affects their effectiveness. Siltation is a major problem in dams constructed in waterways in arid and semi-arid areas. Therefore, the reservoirs in wadis lose their capacity due to sedimentation. This study determines an optimal design of the trapping basin on steep slope areas for Wadi Bishah in the Asir region of southwestern Saudi Arabia. The empirical design criteria of the sediment-trapping basin is used to mitigate the effects of sedimentation in the King Fahd Dam. The empirical design of the trapping basin constructed upstream of the dam located in the wadi is presented. Moreover, the annual suspended and bed sediment load (Qs and Qb) techniques for estimating the volume of sediments are used, and the relationship between the sediment trapping efficiency and size is determined. The sediment trapping in Wadi Bishah upstream sediment-trapping basins is selected to reduce the amount of sediment. One of the important results of this study tries to create a new concept to trap sediment in wadis, which are located in arid and semi-arid areas. The results obtained were evaluated using theoretical and empirical equations to determine the appropriate size of the basin. The results demonstrate that the optimal dimensions for the sediment confinement basin are Lb × Wb × hs = 3500 × 500 × 1.5 m. Also, for these dimensions, the basin efficiency was assumed to be in the range of 60–70%. The trap basin should be constructed at open check dams upstream (U/S) of the proposed basin to enhance its efficiency. Further investigation is required to understand the transport and deposition of sediments, particularly fine sediments in the basin. Additionally, the effects of sediment traps in Wadi Bishah should be assessed during the construction of these structures to aid water resource management and mitigate flood disasters. [ABSTRACT FROM AUTHOR]

This article examines the concept of qasamah (taking an oath) as a means of proof in murder cases in the absence of other physical evidence. Detailing the practice of qasamah before Islam, during the time of the Prophet Muhammad, his Companions, and those who followed them, this article analyses position of qasamah within the schools of jurisprudence. Bringing that discussion to the present day, the subsequent analysis in this article then moves on to the examples of the use of qasamah as a means of proof in murder cases in few selected jurisdictions. This research employs an analytical approach to clarify the similarities and differences within the field of qasamah and the evidentiary value that it holds. The article concludes that qasamah requires careful reconsideration by jurists to ascertain its application in contemporary times. [ABSTRACT FROM AUTHOR]

Introduction: Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. Methods: This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. Results: Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. Conclusions: TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed. [ABSTRACT FROM AUTHOR]

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Background: In recent years the diagnosis and therapy of acute coronary syndrome (ACS) have improved markedly with a significant decrease in mortality; however, many complications still happen. The present study is designed to detect the shortterm complications of ACS and its correlation with clinical variables and treatment strategies. Methods: This is a prospective clinical study including 152 patients with ACS that was admitted to the cardiovascular department at a specialized medical hospital, Mansoura University during the period between July 2019 to October 2019. We documented the acute in-hospital complications and 1-month outcome. Results: There were 78 cases (51.3%) with no complications and 74 cases (48.7%) with complications. The most frequent complication was heart failure (HF) which was found in 51 cases (33.6%) followed by ventricular tachycardia(VT) in 19 cases (12.5%), shock in 16 cases (10.5%), sinus bradycardia in 12 cases (7.9%), pericardial effusion in 10 cases (6.6%), ventricular fibrillation(VF) in 7 cases (4.6), 1st-degree heart block(HB) in 5 cases (3.3%), right ventricular (RV) infarction and complete HB in 4 cases (2.6%), hypotension and mural thrombus in 3 cases (2%), Mobitz type-2 HB in 1 case (0.7%), left ventricular(LV) aneurysm in 2 cases (1.3%) and 6 cases (3.9%) arrested or died. Conclusions: HF was the most common complication among ACS cases and sinus bradycardia was the most common electrical abnormality. Early treatment and percutaneous coronary intervention (PCI) could improve outcomes and reduce complications. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Data on the use of single step dilatation technique during pediatric percutaneous nephrolithotomy (PCNL) in the literature is sparse. In this prospective randomized study, we aimed to compare the safety, efficacy, and perioperative complications of single step versus serial tract dilatation using Alken metal telescopic dilators during pediatric PCNL. Methods: Patients undergoing PCNL were randomized into two groups according to the dilatation technique used. In group A, Alken telescopic serial metal dilatation was utilized, and in group B, single step dilatation was performed. Inclusion criteria included children < 18 years with stone burden from 2 to 4 cm, located in the renal pelvis ± one calyx, who were candidates for PCNL. The primary outcomes were access time and complications' rate. The secondary outcomes were dilatation fluoroscopy time, operative duration, stone free rate, postoperative hospital stay, hemoglobin deficit, and need for blood transfusion. Both outcomes were evaluated and compared between both treatment groups. Results: A total of 70 patients were randomized into group A (35 patients) and group B (35 patients). Access was successfully obtained in all procedures. All the procedures were performed through a single tract. Access time and dilatation fluoroscopy time were shorter in group B (statistically significant). Patients in group A had higher rate of complications (statistically significant). Intraoperative bleeding requiring blood transfusion was less in single track dilatation than serial metal track dilatation. Conclusions: Compared to serial metal track dilatation, single step dilatation showed comparable operative time and stone free rate, with significantly reduced access time and dilatation fluoroscopy time. [ABSTRACT FROM AUTHOR]

Varicocele is the most common cause of male infertility. Alpha-glucosidase (a-GLUC) is normal constituent of human semen produced mainly in epididymis and is evaluated as a marker for seminal quality. The aim of this study was to assess seminal a-GLUC in infertile men with varicocele and post varicocelectomy. This study was conducted at Beni-Suef University Hospital. Sixty Egyptian male participants were divided into Group I: Fertile normozoospermic (n=30) as healthy control, Group II: Infertile oligoasthenoteratozoospermic (OAT) with varicocele (n=30) who underwent varicocelectomy, follow up for 3 months and were classified as Group III: Infertile OAT post varicocelectomy. Semen analysis was performed manually and seminal a-GLUC was assayed by Enzyme Linked Immunosorbent Assay (ELISA). Males with varicocele showed statistically significant decrease regarding sperm count, percentage of motile sperms and percentage of normal sperm forms when compared to healthy subjects. Semen parameters showed significant improvement after varicocelectomy. Seminal a-GLUC was statistically significantly higher among fertile normozoospermic men and post varicocelectomy when compared to infertile OAT men. Statistically significant positive correlation was found between a-GLUC level and semen parameters. Moreover, a-GLUC showed sensitivity of (100% and 85%) and specificity of (100%) at cut off values (=2.67 pg/ml and =4.3 pg/ml) between infertile OAT varicocele when compared to fertile normozoospermic and post varicocelectomy men, respectively (p<0.001). In conclusion, seminal a-GLUC could be suggested as marker for judging quality of semen in infertile men with varicocele where varicocelectomy was found to improve a-GLUC level suggesting it to have a role in fertility among men. [ABSTRACT FROM AUTHOR]

Complex by nature, infrastructure megaprojects rarely meet stakeholders' expectations. A key characteristic of such complexity is the interdependence among different project stakeholders (e.g., contractors) where disruption of one contractor's work may instigate (system-level) systemic risks, resulting in poor key performance indicators (KPIs) of the whole project. Attributed to the lack of appropriate analysis and quantification tools, managing the systemic risks resulting from such interdependence remains challenging. The current study fills this knowledge gap through proactive systemic risk management (i.e., early identification, analysis, mitigation, and continuous monitoring). The study enhanced and operationalized a previously developed conceptual framework, in which interdependence was quantified through employing complex network theoretic measures. Specifically, the current study correlated contractor interdependence to project KPIs in order to assess associated project systemic risks. Subsequently, a metaheuristic optimization technique was employed to reorganize the project's schedule—effectively managing interdependence-induced risks. To demonstrate the utility of the developed methodology, a power infrastructure project was considered. Finally, the study provides valuable insights to improve the performance of complex infrastructure projects through proactive systemic risk management, ultimately enhancing the overall project's hyper resilience (i.e., to interdependence-induced disruptions). [ABSTRACT FROM AUTHOR]

Background: Kidney stone disease contributes to a significant proportion of routine urological practice and remains a common cause of worldwide morbidity. The main aim of this clinical-pilot study was to investigate the effect of flexible ureterorenoscopy (FURS) on pre- and peri-operative clinical information, physiological observations and outcome measures.Methods: Included were 51 patients (31 males, 20 females), who underwent elective FURS, for the treatment of kidney stones. Pre-operative and peri-operative clinical information, and post-operative physiological observations and outcome measures were collected using a standard case report form. Pre-operative clinical information included age, gender, BMI, previous history of stone formation and hypertension. Pre-operative stone information included the size (mm), Hounsfield units (HU), laterality and intra-renal anatomical location. Peri-operative surgical details included surgical time in minutes; Laser use; Duration and energy of laser; and post-operative stenting. The physiological outcomes measured included systolic and diastolic blood pressure (mmHg), Likert pain score, temperature, heart rate (bpm) and respiration rate (bpm). Following initial descriptive analysis, a series of Pearson's correlation coefficient tests were performed to investigate the relationship between surgical factors other variable factors.Results: A series of significant, positive correlations were observed between; age and surgical time (p = 0.014, r = 0.373); stone size and Hounsfield unit (p = 0.029, r = 0.406); surgical time and duration of laser (p < 0.001, r = 0.702); surgical time and BMI (p = 0.035, r = 0.322); baseline heart rate and Hounsfield unit (p = 0.026, r = - 0.414); base line heart rate and BMI (p = 0.030, r = 0.307).; heart rate at 120-min post FURS and age (p = 0.038, r = - 0.308); baseline pain score and BMI (p = 0.010, r = 0.361); baseline respiration rate and BMI (p = 0.037, r = 0.296); respiration rate at 240-min post FURS and BMI (p = 0.038, r = 0.329); respiration rate at 120 min post FURS and age (p = 0.022, r = - 0.330). Four patients developed post-operative complications (3-UTIs with urinary retention, 1-urosepsis).Conclusions: We report that following FURS there is an association between various physiological, clinical and surgical parameters. Although these correlations are weak, they warrant further investigation as these may be linked with untoward complications, such as infection that can occur following FURS. This data, however, will need to be validated and reproduced in larger multi-centre studies. [ABSTRACT FROM AUTHOR]

This study deals with the issue of the player's penal responsibility for acts of violence in sports; it aims at briefing the important legal issues related to this subject and clarifying the position of the UAE legislator on a player's criminal liability for sports injuries and acts of violence in sports by researching the legal framework for sports injuries and sports accidents that occur during sports competitions. The study concluded that to be exempt from criminal liability in sports competitions, the game must be one of the games recognized by sports games laws, it must have recognized rules, and the acts of violence committed during the match must not violate the game rules. Also, the UAE has included sports insurance in certain sports activities as a club obligation, so any player registered with the relevant association is not allowed to participate in sports activities managed by the union unless this player is insured under a contract of insurance that includes the risks of death, permanent or temporary disability, sports injury, and medical expenses. The study suggests that the UAE legislature should pass a sports criminal law criminalizing the use of stimulants in sports. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of female urethral and periurethral cystic vaginal swellings, with emphasis on postoperative surgical outcomes. Materials and methods: This is a retrospective analysis of females complaining of periurethral and urethral cystic swellings referred to our tertiary center, who underwent MRI for preoperative planning in the period from January 2014 till January 2021, with a total number of 57 patients. Data retrieved from the medical records included: patients' demographics, presenting symptoms and signs, preoperative radiological investigations, duration of symptoms, previous surgical intervention, detailed intraoperative data, postoperative complications, and postoperative follow-up. Results: Urethral diverticulum was the commonest cystic lesion representing (64.9%) followed by Skene gland cysts in 14%, Mullerian cysts in 7%, Gartner cysts in 3.5%, and dermoid inclusion cysts in 10.5%. MRI precisely diagnosed the various pathological entities and anatomical complex lesions prior to surgery. This was confirmed after surgery and pathology analysis. All patients were followed up with a mean duration of 35 months, without any evidence of recurrence. Conclusion: MRI as a standalone imaging technique is mandatory for diagnosis of all urethral and periurethral cystic lesions, as it offers the most accurate diagnostic modality for delineation of these lesions and hence aids in the preoperative surgical planning, aiming to avoid recurrence and improving surgical outcomes. [ABSTRACT FROM AUTHOR]

Loss‐of‐function mutations in the MEN1 tumor‐suppressor gene cause the multiple endocrine neoplasia type 1 syndrome. Menin, the MEN1 gene product, is expressed in many tissues, including bone, where its function remains elusive. We conditionally inactivated menin in mesenchymal stem cells (MSCs) using paired‐related homeobox 1 (Prx1)‐Cre and compared resultant skeletal phenotypes of Prx1‐Cre;Men1f/f menin‐knockout mice (KO) and wild‐type controls using in vivo and in vitro experimental approaches and mechanics simulation. Dual‐energy X‐ray absorptiometry demonstrated significantly reduced bone mineral density, and 3‐dimensional micro‐CT imaging revealed a decrease in trabecular bone volume, altered trabecular structure, and an increase in trabecular separation in KO mice at 6 and 9 months of age. Numbers of osteoblasts were unaltered, and dynamic histomorphometry demonstrated unaltered bone formation; however, osteoclast number and activity and receptor activator of NF‐κB ligand/osteoprotegerin (RANKL/OPG) mRNA profiles were increased, supporting increased osteoclastogenesis and bone resorption. In vitro, proliferative capabilities of bone marrow stem cells and differentiation of osteoblasts and mineralization were unaltered; however, osteoclast generation was increased. Gross femur geometrical alterations observed included significant reductions in length and in mid‐metaphyseal cross‐sectional area. Atomic force microscopy demonstrated significant decreases in elasticity of both cortical and trabecular bone at the nanoscale, whereas three‐point bending tests demonstrated a 30% reduction in bone stiffness; finite element analysis showed morphological changes of the femur microgeometry and a significantly diminished femur flexural rigidity. The biomechanical results demonstrated the detrimental outcome of the accelerated osteoclastic bone resorption. Our studies have a twofold implication; first, MEN1 deletion from MSCs can negatively regulate bone mass and bone biomechanics, and second, the experimental and computational biomechanical analyses employed in the present study should be applicable for improved phenotypic characterization of murine bone. Furthermore, our findings of critical menin function in bone may underpin the more severe skeletal phenotype found in hyperparathyroidism associated with loss‐of‐function of the MEN1 gene. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Research in education advances knowledge and improves learning, but the literature does not define how to protect residents' rights as subjects in studies or how to limit the impact of their participation on their clinical training. We aimed to develop a consensual framework on how to include residents as participants in education research, with the dual goal of protecting their rights and promoting their contributions to research. A nominal group technique approach was used to structure 3 iterative meetings held with the pre-existing residency training program committee and 7 invited experts between September 2018 and April 2019. Thematic text analysis was conducted to prepare a final report, including recommendations. Five themes, each with recommendations, were identified: (1) Freedom of participation: participation, non-participation, or withdrawal from a study should not interfere with teacher-learner relationship (recommendation: improve recruitment and consent forms); (2) Avoidance of over-solicitation (recommendation: limit the number of ongoing studies); (3) Management of time dedicated to participation in research (recommendations: schedule and proportion of time for study participation); (4) Emotional safety (recommendation: requirement for debriefing and confidential counseling); and (5) Educational safety: data collected during a study should not influence clinical assessment of the resident (recommendation: principal investigator should not be involved in the evaluation process of learners in clinical rotation). Our nominal group technique approach resulted in raising 5 specific issues about freedom of participation of residents in research in medical education, over-solicitation, time dedicated to research, emotional safety, and educational safety. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. Methods: Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). Results: Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; p < 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; p = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; p < 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. Conclusion: Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical. [ABSTRACT FROM AUTHOR]

Introduction: Intubations are frequently performed procedures in neonatal intensive care units (NICU) and delivery rooms (DR). Unsuccessful first attempts are common as are tracheal intubation-associated events (TIAEs) and severe desaturations. Stylets are often used during intubation, but their association with intubation outcomes is unclear. Objective: To compare intubation success, rate of relevant TIAEs, and severe desaturations in neonates intubated with and without stylets. Methods: Tracheal intubations of neonates in the NICU or DR from 16 centers between October 2014 and December 2018, performed by neonatology or pediatric providers, were collected from the NEAR4NEOs international registry. Primary oral intubations with a laryngoscope were included in the analysis. First-attempt success, the occurrence of relevant TIAEs, and severe oxygen desaturation (≥20% saturation drop from baseline) were compared between intubations performed with versus without a stylet. Logistic regression with generalized estimate equations was used to control for covariates and clustering by sites. Results: Out of 5,292 primary oral intubations, 3,877 (73%) utilized stylets. Stylet use varied considerably across the centers with a range between 0.5 and 100%. Stylet use was not associated with first-attempt intubation success, esophageal intubation, mainstem intubation, or severe desaturations after controlling for confounders. Patient size was associated with these outcomes and much more predictive of success. Conclusions: Stylet use during neonatal intubation was not associated with higher first-attempt intubation success, fewer relevant TIAEs, or less severe desaturations. These data suggest that stylets can be used based on individual preference, but stylet use may not be associated with better intubation outcomes. [ABSTRACT FROM AUTHOR]

Objective: Describe the current practice of family presence during neonatal tracheal intubations (TIs) across neonatal intensive care units (NICUs) and examine the association with outcomes.Design: Retrospective analysis of TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS).Setting: Thirteen academic NICUs.Patients: Infants undergoing TI between October 2014 and December 2017.Main Outcome Measures: Association of family presence with TI processes and outcomes including first attempt success (primary outcome), success within two attempts, adverse TI-associated events (TIAEs) and severe oxygen desaturation ≥20% from baseline.Results: Of the 2570 TIs, 242 (9.4%) had family presence, which varied by site (median 3.6%, range 0%-33%; p<0.01). Family member was more often present for older infants and those with chronic respiratory failure. Fewer TIs were performed by residents when family was present (FP 10% vs no FP 18%, p=0.041). Among TIs with family presence versus without family presence, the first attempt success rate was 55% vs 49% (p=0.062), success within two attempts was 74% vs 66% (p=0.014), adverse TIAEs were 18% vs 20% (p=0.62) and severe oxygen desaturation was 49% vs 52%, (p=0.40). In multivariate analyses, there was no independent association between family presence and intubation success, adverse TIAEs or severe oxygen desaturation.Conclusion: Family are present in less than 10% of TIs, with variation across NICUs. Even after controlling for important patient, provider and site factors, there were no significant associations between family presence and intubation success, adverse TIAEs or severe oxygen desaturation. [ABSTRACT FROM AUTHOR]

Objectives: Stress incontinence is the most common type of urinary incontinence in females. Recently, the gold standard treatment is mid-urethral tapes, however their efficacy is questioned in intrinsic sphincter deficiency (ISD). In our study, we try to adjust the tension applied during transobturator tapes (TOT) to evaluate its effectiveness in ISD, in order to prevent obstruction or failure and persistence of stress urinary incontinence. Materials and Methods: This study was prospectively conducted on eighty female patients having ISD, presenting at the Urology Departments in Alexandria and Minia University Hospitals. The patients were randomly assigned to two groups, with Group I including forty patients, who underwent TOT using tension-free technique, and Group II including forty patients using our new tension adjustment technique under saddle anesthesia. Patients filled the International Continence Questionnaire and Urinary Distress Inventory and did pressure flow study pre- and postoperatively. Postoperatively, the patients filled Patient Global Impression of Improvement and underwent translabial ultrasound (U/S) to estimate the distance between the tape and the urethra. Results: In Group I, 70% of the patients were cured with mean Valsalva leak point pressure (VLPP) of 51.43 ± 3.39 preoperatively, 20% were not improved, and 10% were improved with a mean VLPP of 44.5 ± 3.54 preoperatively, which increased to 86 ± 4.24 postoperatively. In Group II, 95% of the patients were cured with a mean VLPP of 50.74 cmH2O ± 6.56 preoperatively and 5% improved but not cured with a mean VLPP of 31 cmH2O preoperatively, which increased to 127 cmH2O at a bladder capacity of 400 ml. All patients in both groups underwent translabial U/S 6 months postoperatively. The distance between the mid-tape and the outer urethra measured by translabial US showed no significant difference between the two studied groups. Conclusion: Performing TOT using our tensioned proposed technique in ISD seems to be effective and with low morbidity. Intraoperative adjustment of tension using Valsalva maneuver under saddle anesthesia gives better outcomes than the conventional tension-free technique. The concept of tension-free vaginal tape should be challenged. [ABSTRACT FROM AUTHOR]

Despite the recent efforts in characterizing and investigating the dynamic properties of tire-derived aggregates (TDA) and its use in civil engineering applications, the size of TDA used in most of the previous work was significantly smaller than the TDA size range mentioned in ASTM D6270 standards. There are two types of TDA, Type A and Type B, in which the maximum aggregate size of Types A and B are 200 and 450 mm, respectively. Thus, the availability of experimental data and shear modulus reduction curves for the dynamic behavior of TDA of larger sizes are deemed necessary for practical engineers to assess and investigate the behavior of such material under dynamic loads. This paper provides the results of large-scale undrained cyclic triaxial tests performed on Type A TDA at large strain amplitudes. The tests were performed under confining pressures ranging from 25 to 200 kPa and shear strain levels ranging from 0.1% to 10%. Furthermore, each test consisted of successive stages in which the number of cycles and axial strain levels varied. The shear modulus of Type A TDA has a range of 245–1,796 kPa, with a decreasing trend with increasing shear strain amplitudes. Furthermore, the dampening ratios were found to range from 11% to 23.5%. Finally, the shear modulus reduction curves were obtained through curve fitting techniques and nonlinear regression. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. Five to ten percent of patients have monogenic form of the disease, while most of sporadic PD cases are caused by the combination of genetic and environmental factors. Microtubule-associated protein tau (MAPT) has been appointed as one of the most important risk factors for several neurodegenerative diseases including PD. MAPT is characterized by an inversion in chromosome 17 resulting in two distinct haplotypes H1 and H2. Studies described a significant association of MAPT H1j subhaplotype with PD risk, while H2 haplotype was associated with Parkinsonism, particularly to its bradykinetic component. We report here an isolated case displaying an akinetic-rigid form of PD, with age of onset of 41 years and a good response to levodopa, who developed dementia gradually during the seven years of disease progression. The patient does not carry the LRRK2 G2019S mutation, copy number variations, nor pathogenic and rare variants in known genes associated with PD. MAPT subhaplotype genotyping revealed that the patient has the H1j/H2 diplotype, his mother H1j/H1j, his two healthy brothers H1j/H1v and his deceased father was by deduction H1v/H2. The H1j/H2 diplotype was shown in a total of 3 PD patients among 80, who also did not have known PD-causing mutation and in 1 out of 92 healthy individual controls. The three patients with this diplotype all have a similar clinical phenotype. Our results suggest that haplotypes H1j and H2 are strong risk factor alleles, and their combination could be responsible for early onset of PD with dementia. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. Study Design  TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. Result  In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, p  < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36–2.67, p  < 0.001). Conclusion  High team stress levels during TI were more frequently reported among TIs with adverse events. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to investigate the use of simulation in neonatal-perinatal medicine (NPM) fellowship programs. Study Design  This was a cross-sectional survey of program directors (PDs) and simulation educators in Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowship programs. Results  Responses were received from 59 PDs and 52 simulation educators, representing 60% of accredited programs. Of responding programs, 97% used simulation, which most commonly included neonatal resuscitation (94%) and procedural skills (94%) training. The time and scope of simulation use varied significantly. The majority of fellows (51%) received ≤20 hours of simulation during training. The majority of PDs (63%) wanted fellows to receive >20 hours of simulation. Barriers to simulation included lack of faculty time, experience, funding, and curriculum. Conclusion  While the majority of fellowship programs use simulation, the time and scope of fellow exposure to simulation experiences are limited. The creation of a standardized simulation curriculum may address identified barriers to simulation. [ABSTRACT FROM AUTHOR]

A critical stage of shotgun proteomics is database search, a process which attempts to match the experimental spectra to the theoretical one. Given the considerable time and effort spent in analysis, it is self-evident for a researcher to aspire for rigorous computational analysis and a more confident and accurate peptide/protein identification. Mass spectrometry (MS) has been applied across several clinical disciplines. The pathophysiology of Stress Urinary Incontinence (SUI), caused by a damaged pelvic floor, has become a boundless disease altering the quality of life worldwide. Although some studies pointed markers that can be bioindicators for SUI, these findings raise the issue of sensitivity and specificity. Therefore, it is critical to have a sensitive and specific analytical approach to identify markers that have been associated with protective and deleterious associations in disease. Here, we describe our designed and developed workflow for protein identification from tandem mass spectrometry that uses multiple search engines. We apply our workflow to an existing study addressing the pathophysiology of SUI. We demonstrate how using the combined approach together with high-performance computing techniques can surmount the challenges of complex analyses and extended computing time. We also compare the relative performance of each combination. Our results suggest that a combination of MS-GF+ and COMET represents the best sensitivity-specificity trade-off, outperforming all other tested combinations. The approach was also sensitive and accurately identified a set of protein that was shown to be markers for categories of diseases associated with the pathophysiology of SUI. This workflow was developed to encourage proteomic researchers to adopt MS-based techniques for accurate analysis and to promote MS as a routine tool to the clinical cohorts. [ABSTRACT FROM AUTHOR]

A critical stage of shotgun proteomics is database search, a process which attempts to match the experimental spectra to the theoretical one. Given the considerable time and effort spent in analysis, it is self-evident for a researcher to aspire for rigorous computational analysis and a more confident and accurate peptide/protein identification. Mass spectrometry (MS) has been applied across several clinical disciplines. The pathophysiology of Stress Urinary Incontinence (SUI), caused by a damaged pelvic floor, has become a boundless disease altering the quality of life worldwide. Although some studies pointed markers that can be bioindicators for SUI, these findings raise the issue of sensitivity and specificity. Therefore, it is critical to have a sensitive and specific analytical approach to identify markers that have been associated with protective and deleterious associations in disease. Here, we describe our designed and developed workflow for protein identification from tandem mass spectrometry that uses multiple search engines. We apply our workflow to an existing study addressing the pathophysiology of SUI. We demonstrate how using the combined approach together with high-performance computing techniques can surmount the challenges of complex analyses and extended computing time. We also compare the relative performance of each combination. Our results suggest that a combination of MS-GF+ and COMET represents the best sensitivity-specificity trade-off, outperforming all other tested combinations. The approach was also sensitive and accurately identified a set of protein that was shown to be markers for categories of diseases associated with the pathophysiology of SUI. This workflow was developed to encourage proteomic researchers to adopt MS-based techniques for accurate analysis and to promote MS as a routine tool to the clinical cohorts. [ABSTRACT FROM AUTHOR]

Background: The number of patients diagnosed and subsequently treated for kidney stones is increasing, and as such the number of post-operative complications is likely to increase. At present, little is known about the role of specific biomarkers, following flexible ureterorenoscopy (FURS) for the surgical treatment of kidney stones. The main aim of the study was to evaluate the role of kidney and infection biomarkers, in patients undergoing FURS.Methods: Included were 37 patients (24 males, 13 females), who underwent elective FURS, for the treatment of kidney stones. Venous blood samples were collected from each patient: pre-operatively, and at 30 min, 2 and 4 h post-operatively. Changes to kidney (NGAL, Cystatin-C) and infection (MPO, PCT) biomarkers was quantified by means of ELISA, Biomerieux mini-vidas and Konelab 20 analysers.Results: Four patients developed post-operative complications (3 - UTIs with urinary retention, 1 - urosepsis. NGAL concentration increased significantly following FURS (p = 0.034). Although no significant changes were seen in Cystatin C, MPO and PCT (p ≥ 0.05) some key clinical observation were noted. Limiting factors for this study were the small number of patients recruited and restriction in blood sampling beyond 4 h.Conclusions: Although not confirmative, changes seen to biomarkers such as Cystatin C, NGAL and MPO in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications which can develop following FURS. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. Methods: A retrospective analysis of our records over the last 10 years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Results: Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25 min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2 days. After a mean follow-up of 6.3 ± 3.1 years, all patients had undergone successful repair, except for one patient with complex VVF. Conclusions: Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements. [ABSTRACT FROM AUTHOR]