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Objective: In this work, a gastro-retentive floating microsphere delivery system composed of Drug/Glyceryl mono-oleate (GMO) embedded in a Ca-alginate gas-generated matrix was designed to improve the bioavailability of a slightly-soluble model drug Famotidine. Methods: The water/Oil emulsion method was used to prepare Famotidine floatable microspheres, and formulation variables such as Alginate: GMO ratio, gas-generated bicarbonates concentration, and loading drug concentration were investigated. Conventional techniques, including DSC, XRD and FTIR were performed to confirm Famotidine compatibility with GMO and Alginate polymers. Real-Time X-ray Radiography was used for in vivo imaging of Famotidine floatable microspheres using rabbits as an animal model. HPLC spectroscopic technique was used to determine Famotidine plasma concentration after oral administration of Alginate-GMO loaded microspheres. Results: Floating Famotidine Alginate-GMO microspheres (0.75:1:0.25) w/w/w showed a remarkable entrapment efficiency (>98%), good buoyancy (>84) and prolonged in vitro drug release properties (>24 hours). DSC, XRD, and FTIR techniques showed no evidence of interaction between Famotidine and Alginate or GMO. In vivo Imaging of Famotidine floatable microspheres showed that capsules containing Famotidine-Alginate microspheres were not detected after 3 h of administration, while capsules containing Famotidine-GMO-Alginate microspheres can be detected for more than 12 h, indicating superior gastric retention properties. The pharmacokinetic parameters were calculated for Famotidine: GMO-Alginate, and Famotidine: alginate and compared with the plain drug over 24 h period. Famotidine: GMO-Alginate microspheres exhibited controlled and prolonged absorption Tmax of 6.0 vs. 3.0 and 2.0 h; Cmax of 124.9±0.9 vs. 323.7±0.4and 458.6±0.5 ng/ml; AUC0-24 of 2153.025±6.7 vs. 1650.4±1.9 and 1110.725±2.1 ng/ml for Famotidine: alginate and plain drug, respectively, reflecting the increase in the bioavailability of the drug in the floating formulations compared to the free drug. Conclusion: Prolonged gastric retention time and sustained release properties of floating GMO-alginate microsphere suggest that it could provide a valuable sustained release dosage form of slightly-soluble drugs.

The use of fat grafting is being widely used for different indications one of which is wound healing. In this study we compare the use of autologous fat grafting (AFG) as a novel indication in acute burn wounds healing and burn scarring to the conventional methods of burn wound management both clinically and histologically. Several small observational studies demonstrated the effect of the AFG in healing of chronic wounds, different vascular ulcers or effect on scars yet no randomized controlled trial is available to compare its role with conventional methods.The study was a prospective, open-label single center, randomized control clinical trial included 100 patients with superficial and deep dermal burns from March 2019 to March 2020 randomized to AFG protocol consisted of a single injection of autologous fat grafting then dressed with nano fat (Group A) or conventional methods of serial dressings with 1% silver sulphadiazine or other topical agents (Group B). Inclusion criteria included newly admitted burn patients with affected total body surface area (TBSA) (10%-25%) while exclusion criteria included burns patients with affected TBSA of 10% or 25%, or loss of subcutaneous fat, fascia, muscles and bones, inhalational burn, and burns in genitalia, perineum and peri-anal areas and co-morbidity(ies) that might affect wound healing or eligibility for anaesthesia and surgery. Also, results were confirmed by histological analysis for samples from both groups by light microscopic examination, and the nano-fat was subjected to flow cytometric analysis of the cluster of differentiation (CD) markers of mesenchymal stem cells markers CD 90, CD44, CD45, CD 73, and CD 34. (ClinicalTrials.gov Identifier: NCT03791710) RESULTS: We found a significant reduction in total hospital stay days (p = 0.001), less further skin grafting (p = 0.003), less contracture formation (p = 0.002) while scar texture improved (p = 0.001) in group A compared to group B. Flow cytometric analysis documented that the nano-fat was positive to CD 90, 73, 44, 45 and 34.In a comparison between AFG protocol to the conventional methods in the treatment of acute burn wounds, AFG protocol was associated with significant clinical improvement in the form of lower hospital stay time, lower incidence of scaring or contracture and lower skin grafting use which was confirmed by serial photographic and histological assessment.

Objective: The objective of this study is to optimize a nanosponge formulation for Loxoprofen and then incorporating it into a gel formulation offering a controlled drug release, enhanced skin permeation and thus better bioavailability. Methods: Loxoprofen nanosponges were prepared using the emulsion solvent diffusion method and formulated using Polyvinyl alcohol, Ethylcellulose and Dichloromethane. The effect of the different formulation variables like ethyl cellulose: polyvinyl alcohol ratio, drug: ethyl cellulose ratio, stirring time, stirring speed, internal phase volume and external phase volume on the particle size, entrapment efficiency, production yield, polydispersity index and Zeta potential was investigated. The optimized nanosponge formulation was incorporated into a gel. The loaded gel was evaluated by in vitro release and permeation studies and the results were compared to that of a marketed formulation (Loxonin® gel). Results: The optimized formulation showed 67.29±1.19 % entrapment efficiency, 239.8±16.95 nm particle size and-8.32±0.87 mV Zeta potential. The drug was released slowly from the nanosponge-loaded gel where the cumulative percentage of drug released was only 77.71±0.42 % in 8 h where it was incorporated in the entrapped form while it was 99.31±0.64% from Loxonin® gel where it was in the unentrapped form. The cumulative percent of drug permeated through the skin from the nanosponge-loaded gel was 98.66±0.14% for 24 h while it was only 60.38±0.18% from Loxonin® gel. Conclusion: The nanosponge-loaded gel showed more sustained drug release and a better drug permeation when compared to a marketed gel (Loxonin® gel).

Cervical spine (CS) fractures or dislocations are medical emergencies that may lead to more serious consequences, such as significant functional disability, permanent paralysis, or even death. Therefore, diagnosing CS injuries should be conducted urgently without any delay. This paper proposes an accurate computer-aided-diagnosis system based on deep learning (AlexNet and GoogleNet) for classifying CS injuries as fractures or dislocations. The proposed system aims to support physicians in diagnosing CS injuries, especially in emergency services. We trained the model on a dataset containing 2009 X-ray images (530 CS dislocation, 772 CS fractures, and 707 normal images). The results show 99.56%, 99.33%, 99.67%, and 99.33% for accuracy, sensitivity, specificity, and precision, respectively. Finally, the saliency map has been used to measure the spatial support of a specific class inside an image. This work targets both research and clinical purposes. The designed software could be installed on the imaging devices where the CS images are captured. Then, the captured CS image is used as an input image where the designed code makes a clinical decision in emergencies.

Precise assessment of water footprint to enhance water consumption and crop yields for irrigated agricultural efficiency is required in order to achieve water management sustainability. Although Penman-Monteith is more successful than others and is the most frequently used technique to calculate water footprint it requires a significant number of meteorological parameters at different spatio-temporal scales, sometimes inaccessible in many of the poor nations. Due to the greatest performance in the non-linear relations of inputs and output of the model, the complex hydrological phenomena are frequently described in machine learning models. Therefore, the objective of this research is to 1) develop and compare between the four-machine learning: Support Vector Regression (SVR), Random Forest (RF), Extreme Gradient Boost (XGB) and Artificial Neural Network (ANN) over three potato’s governorates (Al-Gharbia, Al-Dakahlia, and Al-Beheira) in Delta, Egypt and 2) select the best model in the best combination of climate input variables, which achieves high precision and low error in forecasting potato blue WF. The available variables for this study are maximum temperature (Tmax), minimum temperature (Tmin), average temperature (Tave), wind speed (WS), relative humidity (RH), precipitation (P), vapor pressure deficit (VPD), solar radiation (SR), Sown area (SA), and crop coefficient (Kc) to predict potato BWFP during (1990–2016). Six scenarios of input variables were used to test the weight of each variable in for four applied models. Different statistical indicators have been used to assess applied model performance (NSE, RMSE, MAE, MBE, A, R2, SI and MAPE). The results demonstrated that Sc5 with the XGB and ANN model is competent enough to evaluate BWF only if there are just vapor pressure deficit, precipitation, solar radiation, crop coefficient data followed by Sc1. The created models produced comparatively superior outcomes and can contribute to the decision-making process for water management and development planners.

Precise assessment of water footprint to enhance water consumption and crop yields for irrigated agricultural efficiency is required in order to achieve water management sustainability. Although Penman-Monteith is more successful than others and is the most frequently used technique to calculate water footprint it requires a significant number of meteorological parameters at different spatio-temporal scales, sometimes inaccessible in many of the poor nations. Due to the greatest performance in the non-linear relations of inputs and output of the model, the complex hydrological phenomena are frequently described in machine learning models. Therefore, the objective of this research is to 1) develop and compare between the four-machine learning: Support Vector Regression (SVR), Random Forest (RF), Extreme Gradient Boost (XGB) and Artificial Neural Network (ANN) over three potato’s governorates (Al-Gharbia, Al-Dakahlia, and Al-Beheira) in Delta, Egypt and 2) select the best model in the best combination of climate input variables, which achieves high precision and low error in forecasting potato blue WF. The available variables for this study are maximum temperature (T ), minimum temperature (T ), average temperature (T ), wind speed (WS), relative humidity (RH), precipitation (P), vapor pressure deficit (VPD), solar radiation (SR), Sown area (SA), and crop coefficient (Kc) to predict potato BWFP during (1990 -2016). Six scenarios of input variables were used to test the weight of each variable in for four applied models. Different statistical indicators have been used to assess applied model performance (NSE, RMSE, MAE, MBE, A, R2, SI and MAPE). The results demonstrated that Sc5 with the XGB and ANN model is competent enough to evaluate BWF only if there are just vapor pressure deficit, precipitation, solar radiation, crop coefficient data followed by Sc1. The created models produced comparatively superior outcomes and can contribute to the decision-making process for water management and development planners.

This study is reporting the long term clinical and radiographic results of a group of 45 patients who underwent total hip arthroplasty following acetabular fractures. The study included 39 males and 6 females. The age of the patients ranged from 32 to 61 with a mean of 46.4 years. The indication for surgery was secondary osteoarthritis in 35 patients and avascular necrosis of the femoral head in the remaining ten. The follow up period ranged from 7 to 15 years with a median of 10.3 years. Uncemented total hip prostheses were used in 37 cases while 8 cases had hybrid prostheses with cemented cups and uncemented stems. Thirty patients (66.7%) needed autogenous acetabular bone grafting. There has been a statistically significant improvement from a preoperative mean Oxford hip score of 16 to a postoperative mean score of 39.8 (p < 0.001). At the end of follow up, two cases had revision for cup loosening. The complications included one case of transient sciatic nerve palsy, and two cases of heterotopic ossification. Currently, total hip replacement remains the best option for end stage post traumatic arthritis. There are technical challenges associated with this replacement surgery which the surgeon should be aware of.

Objective. To evaluate the association of bone mineral biomarkers of calcium, phosphorus metabolism, and 25-hydroxy vitamin D with diastolic dysfunction of the left ventricle and left ventricle mass in predialysis chronic kidney children. Patients and Methods. A cross-sectional observational study was conducted on 60 children with chronic kidney disease and treated by conservative treatment from October 2018 to September 2019 in the Pediatric Nephrology and Cardiology Department at our University Hospital. Results. The most common causes of CKD were congenital renal anomalies accounted for 22 (36.67%) of the studied cases. The mean age of children was7.05±2.74 years, and 32 (53.33%) were males. The children who had a normal diastolic function were 32 (53.33%), while those who had diastolic dysfunction were 28 (46.67%). There was a statistically significant in serum phosphorus (pvalue = 0.03), serum PTH (pvalue = 0.002), and hypertension (pvalue = 0.03). There was a statistically significant positive correlation between LVMI and iPTH level (r=0.89,p≤0.0001), 25(OH) cholecalciferol (r=−0.27,p=0.04), serum Ca (r=−0.37,p=0.004), and serum phosphorus (r=−0.45,p=0.0003). Conclusion. Our results revealed that hyperparathyroidism, hyperphosphatemia, and hypertension were significantly associated with diastolic dysfunction while hypovitaminosis D was not significantly associated. Vitamin D deficiency was prevalent in all children with CKD. Biomarkers of mineral bone density were significantly associated with left ventricular hypertrophy and increased left ventricular mass index.

1591 Introduction: Molecular imaging of S1P1 expression in the brain provides an important biomarker for elucidating the pathophysiological roles of S1P1 in neuroinflammation and neurodegeneration. We previously reported the radiation dosimetry estimates for [11C]-CS1P1 using PET imaging and ex-vivo biodistribution in rodent. This report provides preliminary safety information from human whole-body biodistribution and dosimetry studies of [11C]-CS1P1 for its potential application in human brain imaging studies. 266.4 and 98.79 MBq of [11C]-CS1P1 was administered intravenously in two normal participants (one male and one female). Shortly after the administration of [11C]-CS1P1, whole body (WB) dynamic acquisition were initiated using Siemens Vision Biograph PET/CT (Siemens, Erlangen, Germany). The emission data were acquired for 180 minutes in 25 WB continuous bed motion sweeps from head to upper thighs. The time per sweeps were 120 s [for WB 1-10], 300 s [for WB 11-15], 600 s [for WB 16 and 20]) and 900 s [for WB 21 and 25]. A low-dose CT was performed before the PET emisision scan for PET attenuation correction and anatomical information. Scans were reconstructed using the ordered subset expectation maximization (OSEM) algorithm (4 iterations and 5 subsets) with a time of flight (TOF) and point spread function (PSF). Three-dimensional volumes of interest (VOIs) over entire organs were manually delineated on PET images using CT for anatomical localization. Eleven organs (lung, brain, kidney, gall bladder, spleen, liver, cardiac, stomach, urinary bladder, intestine and pancreas) were identified as source organs and remainder of the body that significantly took up the tracer and visually assessable amounts over the entire time frame of acquisition. Time-activity curves were obtained for each source organ by calculating the total activity (non decay corrected) in the VOIs and expressing them as the percentage of the total injected activity. Depending on the kinetics, different exponential models reflecting biodistribution and elimination of the tracer were used for different organs. The integrated-time-activity values were entered into a human biodistribution model Internal Dose Assessment by Computer (IDAC-Dose) (Ver. 2.1, Umea University, Sweden). The IDAC-Dose software calculates effective dose (ED) from the individual organ doses with radiation weighting factors and organ weighting factors for each of the source organs based on ICRP Publications 103 for male while ICRP Publications 60 for female. The residence time for all source organs are given in Table 1. The organ with the largest residence time was the liver with 0.064 h while the smallest was the urinary bladder with 0.00030 h. The organ total absorbed doses per MBq were largest for the liver (9.88 ± 0.03 µGy/ MBq), (Table 1). The total effective dose (ED) per MBq of injected activity of [11C]-CS1P1 in human is 1.60 ± 0.15 µSv/MBq. Based on the preliminary results, the radiation doses from PET studies are minimal and any biologically harmful effects on humans are unlikely. The total radiation burden depends largely on the initial organ perfusion and its retention until it clears out (larger effective half-life). Highly perfused organs such as heart, lung, liver, kidney, and brain receive a larger fraction of the absorbed dose due to larger effective half-life; whereas, less perfused organs such as muscle or fat receive a much smaller fraction. Most radiotracer molecules are likely to be cleared via either hepatobiliary (liver, gallbladder) or renal excretion (kidneys, urinary bladder). In our preliminary findings, the liver is a critical dose-limiting organ for [11C]-CS1P1. From our preliminary results, imaging with [11C]-CS1P1 for clinical PET studies is safe. Administration of 10 mCi (370 MBq) of [11C]-CS1P1 is expected to resulting in a total human effective dose of

Editor’s note: This article demonstrates that complete open-source tooling can be used to design industrial quality digital circuits. Using the OpenLane framework, based itself on the OpenROAD tool 2, the authors show a complete set of RISCV-based SoC. — Sherief Reda, Brown University — Leon Stock, IBM — Pierre-Emmanuel Gaillardon, University of Utah

We propose XRC, an explicit rate control algorithm that overcomes the poor performance of commonly used TCP variants in cellular networks. XRC exploits explicit feedback from the radio access network that is aware of the physical, network and transport layer information of all UEs as well as resource distribution policies for users with different traffic characteristics. XRC co-exists fairly with other XRC and non-XRC flows at the wireless and non-wireless bottlenecks while it strictly controls queuing delay within a small threshold. We implement XRC in NS-3 and examine its performance across a range of network loads and dynamics. When competing with CUBIC at a wireless bottleneck, XRC achieves a Jain’s fairness index of 99.7% while providing a 3x lower median queuing delay compared to when CUBIC competes with CUBIC in the same setup.

International audience; This paper presents a multifunctional, battery-free tag combining Bluetooth Low Energy (BLE) and Ultra-Wideband (UWB) technology powered by the far-field wireless power transmission technique. The proposed tag, with a size of 9 x 8 cm², can be used for asset tracking via UWB at a center frequency of 4 GHz or for wireless temperature and humidity monitoring via BLE at 2.45 GHz. The tag is powered by a highly efficient radiofrequency (RF) energy harvesting (EH) solution at 868 MHz. The proposed solution has been optimized for low power consumption of 5-15 µJ (for a single UWB transmission) and can provide reliable performance in terms of data sensing and geolocation at a low ambient power density. The electronic module that includes the features of the energy harvester (rectifier) and the UWB transceiver was previously developed by Uwinloc. Simulation results for both antennas (UWB and RF EH) were presented. The transmission rate in BLE and UWB configuration was also evaluated as a function of the EIRP power level.

Melanoma is deadly skin cancer. There is a high similarity between different kinds of skin lesions, which lead to incorrect classification. Accurate classification of a skin lesion in its early stages saves human life. In this paper, a highly accurate method proposed for the skin lesion classification process. The proposed method utilized transfer learning with pre-trained AlexNet. The parameters of the original model used as initial values, where we randomly initialize the weights of the last three replaced layers. The proposed method was tested using the most recent public dataset, ISIC 2018. Based on the obtained results, we could say that the proposed method achieved a great success where it accurately classifies the skin lesions into seven classes. These classes are melanoma, melanocytic nevus, basal cell carcinoma, actinic keratosis, benign keratosis, dermatofibroma, and vascular lesion. The achieved percentages are 98.70%, 95.60%, 99.27%, and 95.06% for accuracy, sensitivity, specificity, and precision, respectively.

Automatic classification of color images of skin helps clinicians and dermatologists in examining and investigating skin melanoma. In this paper, a new deep convolutional neural network-based classification method is proposed. The proposed method consists of three main steps. First, the input color images of skin are preprocessed where the region of interest (ROI) are segmented. Second, the segmented ROI images are augmented using rotation and translation transformations. Third, different deep convolutional neural network (DCNN) architectures such as Alex-net, ResNet101, and GoogleNet are utilized. The last three layers are dropped out and replaced with new layers to be more appropriate with the task of lesion classification. The performance of the proposed method has been evaluated using three different datasets, MED-NODE, DermIS & DermQuest and ISIC 2017. The proposed DCNN have fine-tuned and trained using 85%, tested and verified using 15% of the overall datasets. The proposed method significantly improved the classification process especially with modified GoogleNet where the classification accuracy was 99.29%, 99.15%, and 98.14% for MED-NODE, DermIS & DermQuest, and ISIC 2017 respectively.

Background and objective: Acute pancreatitis (AP) is an inflammatory process of the pancreas, with variable involvement of peri-pancreatic tissues and remote organ systems. In this study we discuss surgical and conservative management of acute pancreatitis and its local complication. Methods: This retrospective study was carried out on 128 patients, who were admitted to Gastrointestinal Surgery Unit, Main Alexandria University Hospital, Alexandria University, and who were complaining of acute pancreatitis with fluid collections and sequels (PP, ANC and walled-off pancreatic necrosis (WOPN). Medical information was retrieved retrospectively from patient’s files recorded in Main Alexandria University Hospital and from computerized data system in Gastrointestinal Surgery Department, between October 2013 – October 2018. Results: Forty-five patients with acute edematous pancreatitis with free collection were managed conservatively successfully. Thirty-two patients with PP underwent drainage, endoscopic (n=17), or open (n=15) approach. Twentythree patients with WON underwent drainage and debridement whether by open (n=11), endoscopic (n=9), or PCD (n=3) approaches. Twenty-eight patients with necrotizing pancreatitis, 16 patients were managed conservatively, 12 patients needed intervention either, PCD (n=9) or open surgical necrosectomy (n=3). Conclusions: The operative management of acute pancreatitis is focused on managing the acute complications, and the long-term sequelae. However, the evolution of videoscopic and endoscopic techniques have greatly expanded the tools available.

The limited amount of freshwater is the most important challenge facing Egypt due to increasing population and climate change. The objective of this study was to investigate how climatic change affects the winter potato water footprint at the Nile Delta covering 10 governorates from 1990 to 2016. Winter potato evapotranspiration (ETC) was calculated based on daily climate variables of minimum temperature, maximum temperature, wind speed and relative humidity during the growing season (October–February). The Mann–Kendall test was applied to determine the trend of climatic variables, crop evapotranspiration and water footprint. The results showed that the highest precipitation values were registered in the northwest governorates (Alexandria followed by Kafr El-Sheikh). The potato water footprint decreased from 170 m3 ton−1 in 1990 to 120 m3 ton−1 in 2016. The blue-water footprint contributed more than 75% of the total; the remainder came from the green-water footprint. The findings from this research can help government and policy makers better understand the impact of climate change on potato crop yield and to enhance sustainable water management in Egypt’s major crop-producing regions to alleviate water scarcity.

In emerging mobile networks, control and user plane separation (CUPS) plays a critical role in scaling the control plane and user-plane functions independently and enables network virtualization through network slicing. However, a CUPS hijacking attack on a mobile network slicing system and the resulting network performance degradation is yet to be studied.In this work, we investigate the consequences of CUPS hijacking of a radio access network (RAN) slicing system on the overall network performances. We quantify the impacts of CUPS hijacking by designing an Impact Factor metric I, prototype a real-world RAN slicing use case on an end-to-end mobile network test-bed, and systematically analyze the empirical results to reveal the impacts of CUPS hijacking on the network performance. We show a successful CUPS hijacking by a rogue slice owner in a RAN slicing system increases the RAN slice control-plane signalling delay above 2ms, the operational upper-bound of our system, to disrupt the control plane operations by injecting low rate DoS (LDoS) traffic in user-plane. The naive hijacking can degrade throughput performances of the rogue slice as well as a co-located victim slice down to 0 Mbps. We further show that a carefully crafted user-plane traffic by the attacker can regain ∼92% of its original user-plane packet delivery success rate while other slices are under the denial of service.

Pathologists need a lot of clinical experience and time to do the histopathological investigation. AI may play a significant role in supporting pathologists and resulting in more accurate and efficient histopathological diagnoses. Breast cancer is one of the most diagnosed cancers in women worldwide. Breast cancer may be detected and diagnosed using imaging methods such as histopathological images. Since various tissues make up the breast, there is a wide range of textural intensity, making abnormality detection difficult. As a result, there is an urgent need to improve computer-assisted systems (CAD) that can serve as a second opinion for radiologists when they use medical images. A self-training learning method employing deep learning neural network with residual learning is proposed to overcome the issue of needing a large number of labeled images to train deep learning models in breast cancer histopathology image classification. The suggested model is built from scratch and trained.

We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty.A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE. The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age: 71 years; 72% male) with a median of 2 (1-2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31 (30%), complete occlusion in 15 (14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103 (98%) patients. A total of 55 (52%) were advanced extractions as they required a powered mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p .001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio: 2.89 [1.14-7.32], p = .025). The fluoroscopy time was also significantly longer (14.0 [8.2-18.7] vs. 5.1 [2.1-10.0] min, p .001). The rate of complications did not differ based on the presence of venous lesions.Although procedural success and complication rates were similar, patients with extensive lead-venous wall adherence required a longer fluoroscopy time and were three times more likely to need advanced extraction tools. Conversely, the presence of total venous occlusion had no impact on the procedure complexity.

This study is reporting the long term clinical and radiographic results of a group of 45 patients who underwent total hip arthroplasty following acetabular fractures. The study included 39 males and 6 females. The age of the patients ranged from 32 to 61 with a mean of 46.4 years. The indication for surgery was secondary osteoarthritis in 35 patients and avascular necrosis of the femoral head in the remaining ten. The follow up period ranged from 7 to 15 years with a median of 10.3 years. Uncemented total hip prostheses were used in 37 cases while 8 cases had hybrid prostheses with cemented cups and uncemented stems. Thirty patients (66.7%) needed autogenous acetabular bone grafting. There has been a statistically significant improvement from a preoperative mean Oxford hip score of 16 to a postoperative mean score of 39.8 (p0.001). At the end of follow up, two cases had revision for cup loosening. The complications included one case of transient sciatic nerve palsy, and two cases of heterotopic ossification. Currently, total hip replacement remains the best option for end stage post traumatic arthritis. There are technical challenges associated with this replacement surgery which the surgeon should be aware of.

Melanoma is a type of skin cancer with a high mortality rate. The different types of skin lesions result in an inaccurate diagnosis due to their high similarity. Accurate classification of the skin lesions in their early stages enables dermatologists to treat the patients and save their lives. This paper proposes a model for a highly accurate classification of skin lesions. The proposed model utilized the transfer learning and pre-trained model with GoogleNet. The model parameters are used as initial values, and then these parameters will be modified through training. The latest well-known public challenge dataset, ISIC 2019, is used to test the ability of the proposed model to classify different kinds of skin lesions. The proposed model successfully classified the eight different classes of skin lesions, namely, melanoma, melanocytic nevus, basal cell carcinoma, actinic keratosis, benign keratosis, dermatofibroma, vascular lesion, and Squamous cell carcinoma. The achieved classification accuracy, sensitivity, specificity, and precision percentages are 94.92%, 79.8%, 97%, and 80.36%, respectively. The proposed model can detect images that do not belong to any one of the eight classes where these images are classified as unknown images.

The aim of this prospective study was to evaluate the results of combined lateral sagittal resection osteotomy with subtalar distraction fusion in heels with painful malunion of the os calcis. This case series included 22 patients (23 feet). The mean age of the patients was 37.52 years. Sixteen (69.6%) patients were initially treated conservatively, 5 (21.7%) patients were treated surgically, and 2 (8.7%) patients were missed. The mean time lapsed before surgery was 11.43 months. A wedge of bone was resected to reduce the width of the malunited os calcis and was used as a local graft for subtalar joint fusion and to increase the height of the os calcis. The mean follow-up period was 56.83 ± 6.09 months. According to the scoring system, satisfactory results were found in 18 (82.6%) patients, and 4 (17.4%) patients had unsatisfactory results. Postoperative radiographic assessment revealed an average increase in the heel height of 7.70 ± 1.22 mm and an average decrease in heel width of 8.39 ± 1.47 mm. The average correction in the coronal axis was approximately 8.04° ± 1.26°. Complications included infection and nonunion in 3 (13%) heels. Two heels still had residual varus postoperatively, and 1 patient had injury to the sural nerve. The restoration of heel height, the reduction in heel width, and the primary fracture pattern had a significant relation with the final score. This method is a successful method for the management of subtalar arthritis caused by malunited calcaneal fractures with broadening leading to lateral abutment.

Neutrophil gelatinase-associated lipocalin (NGAL) is a rapidly emerging biomarker for early detection of acute kidney injury (AKI). The aim of the study is to evaluate the impact of sepsis on serum NGAL in critically ill children and to investigate whether the presence of sepsis affects the ability of serum NGAL to predict AKI. Sixty-eight patients, who met criteria of sepsis and related syndromes, were classified into two groups (septic shock and severe sepsis). They were reclassified regarding who developed AKI into AKI and non- AKI groups. Twenty sex and age-matched healthy subjects served as a control group. Serum NGAL was assayed using Enzyme-linked Immunosorbent Assay (ELISA), and serum creatinine was measured using the kinetic spectrophotometric method. Serum NGAL levels were significantly high in critically ill septic patients compared to healthy controls (median: 100.4ng/ml vs. 47.1 ng/ml, P>0.0001), and were significantly higher in septic shock (median 105.1ng/ml) than in severe sepsis (median 96ng/ml) with P values of 0.005. However, there was no significant difference in the levels of serum NGAL between AKI patients and non- AKI patients (P=0.3). Receiver operating characteristic (ROC) curve analysis of serum NGAL for prediction of AKI in critically ill septic children showed an area under the curve (AUC) was 0.56 (95% C.I. =0.42-0.70) with an optimal cutoff value of 102.5ng/ml, sensitivity=56.2%, specificity 55.6%, PPV =52.9%, NPV =58.8%, and accuracy=55.9%. For serum creatinine, the AUC was 0.97 (95% C.I. =0.94- 1.00) with an optimal cutoff value of 0.6 mg/dl, sensitivity= 90.6%, specificity 91.7%, PPV=90.6%, NPV=91.7% and accuracy=91.2%. In conclusion, serum NGAL is raised in critically ill septic children and is a marker of bacterial infection and systemic inflammation. However, in AKI associated with sepsis, serum NGAL is not a specific biomarker for the prediction of AKI and it loses its early predictive property. In such patients, serum creatinine is more specific than serum NGAL.

Background and Objectives: Bacteriocins are considered alternative non-conventional antimicrobials produced by certain bacteria with activity against closely related species. The present study focuses on screening, characterization, and partial purification of bacteriocins produced by Staphylococcus sp. isolated from different clinical sources such as pus and blood. Materials and Methods: A total of 100 Staphylococcus isolates were screened for bacteriocin production using spot on lawn assay and agar diffusion method against five indicator bacteria. Bacteriocins from five selected highly active isolates were subjected to proteinase-K enzyme, different pH, and heating at different temperatures, and investigated the stabilities of their antimicrobials. Two selected isolates, MK65 and MK88, were molecularly identified by 16S rRNA gene sequencing, explored for the presence of 18 bacteriocin genes, and liquid chromatography-high resolution electrospray ionization mass spectrometry (LC-HRESIMS) was used to identify their different metabolites. Results: Twenty isolates exhibited inhibitory effect against at least one indicator bacteria. Micrococcus luteus ATCC 4698 showed the highest sensitivity to such bacteriocins. Proteinase K, acidic pH, and heating at 100°C triggered marked activity inhibition. However, amylase enzyme, alkaline pH, and heating at 80°C caused trivial effects. Four out of eighteen bacteriocin genes were detected using PCR. Fermentation, partial purification, and LC-HRESIMS of total protein extracts of two selected isolates, MK65 and MK88, revealed the production of different antimicrobial peptides. Conclusion: To the best of our knowledge, this is the first study to report the production of micrococcin and α-circulocin from Staphylococcus aureus MK65 and the production of amonabactin from Staphylococcus epidermidis MK88.

Computer-aided systems for skin lesion diagnosis is a growing area of research. Recently, researchers have shown an increasing interest in developing computer-aided diagnosis systems. This paper aims to review, synthesize and evaluate the quality of evidence for the diagnostic accuracy of computer-aided systems. This study discusses the papers published in the last five years in ScienceDirect, IEEE, and SpringerLink databases. It includes 53 articles using traditional machine learning methods and 49 articles using deep learning methods. The studies are compared based on their contributions, the methods used and the achieved results. The work identified the main challenges of evaluating skin lesion segmentation and classification methods such as small datasets, ad hoc image selection and racial bias.

Background and Objectives: Bacteriocins are considered alternative non-conventional antimicrobials produced by certain bacteria with activity against closely related species. The present study focuses on screening, characterization, and partial purification of bacteriocins produced by Staphylococcus sp. isolated from different clinical sources such as pus and blood. Materials and Methods: A total of 100 Staphylococcus isolates were screened for bacteriocin production using spot on lawn assay and agar diffusion method against five indicator bacteria. Bacteriocins from five selected highly active isolates were subjected to proteinase-K enzyme, different pH, and heating at different temperatures, and investigated the stabilities of their antimicrobials. Two selected isolates, MK65 and MK88, were molecularly identified by 16S rRNA gene sequencing, explored for the presence of 18 bacteriocin genes, and liquid chromatography-high resolution electrospray ionization mass spectrometry (LC-HRESIMS) was used to identify their different metabolites. Results: Twenty isolates exhibited inhibitory effect against at least one indicator bacteria. Micrococcus luteus ATCC 4698 showed the highest sensitivity to such bacteriocins. Proteinase K, acidic pH, and heating at 100°C triggered marked activity inhibition. However, amylase enzyme, alkaline pH, and heating at 80°C caused trivial effects. Four out of eighteen bacteriocin genes were detected using PCR. Fermentation, partial purification, and LC-HRESIMS of total protein extracts of two selected isolates, MK65 and MK88, revealed the production of different antimicrobial peptides. Conclusion: To the best of our knowledge, this is the first study to report the production of micrococcin and α-circulocin from Staphylococcus aureus MK65 and the production of amonabactin from Staphylococcus epidermidis MK88.

Introduction: The two methods of treatment of humeral shaft fractures, namely minimally invasive plate osteosynthesis (MIPO), and antegrade intramedullary nailing (IMN) are reported as satisfactory procedures. Objective: To compare the clinical and radiological results of MIPO and IMN techniques in surgical treatment of mid humeral shaft fractures. Patients and methods: From March 2017 to July 2018, a prospective study on 60 patients with closed unilateral mid- humeral shaft fractures were surgically treated with MIPO or IMN. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes (clinically and radiologically) were recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. Complications in both groups have been reported. The follow-up duration ranged from 6 to 12 months with a mean duration of 6.7 months. Results: For group 1 having MIPO technique, the average operative time was 90.3 min (range 50–110), while mean blood loss was 167 ml (range 120–200). In group II patients (interlocking humeral nail), the average time of operation was 100.1 min (range 65–120), and mean blood loss was 118 ml (range 90–150). The mean Constant-Murley shoulder score was 86.95±15.7 in MIPO group and 88.75±13.7in IMN group. The mean Mayo Elbow Performance score in MIPO and IMN groups was 96.5 ± 5.87 and 95.8 ± 6.77, respectively. Radiologic bony union was achieved in 29 out of 30 patients in MIPO group and in 28 out of 30 in IMN group. All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in both groups. Shoulder impingement was found in 2 patients in IMN group. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.

Magnetic materials with competing magnetocrystalline anisotropy and dipolar energies can develop a wide range of domain patterns, including classical stripe domains, domain branching, and topologically trivial and nontrivial (skyrmionic) bubbles. We image the magnetic domain pattern of Fe3Sn2 by magnetic force microscopy and study its evolution due to geometrical confinement, magnetic fields, and their combination. In Fe3Sn2 lamellae thinner than 3 μm, we observe stripe domains whose size scales with the square root of the lamella thickness, exhibiting classical Kittel scaling. Magnetic fields turn these stripes into a highly disordered bubble lattice. Complementary micromagnetic simulations quantitatively capture the magnetic field and thickness dependence of the magnetic patterns, reveal strong reconstructions of the patterns between the surface and the core of the lamellae, and identify the observed bubbles as skyrmionic bubbles. Our results imply that geometrical confinement together with competing magnetic interactions can provide a path to fine-tune and stabilize different types of topologically trivial and nontrivial spin structures in centrosymmetric magnets.

Purpose The goal of this research was to enhance the transdermal delivery of lornoxicam (LX), using nanovesicular carriers composed of the bile salt sodium deoxycholate (SDC), soybean phosphatidyl choline (SPC) and a permeation enhancer limonene. Methods Thin-film hydration was the technique employed for the fabrication using a Box–Behnken design with three central points. The investigated factors were SPC molar concentration, SDC amount in mg and limonene percentage (%). The studied responses were percent entrapment efficiency (%EE), particle size (PS), polydispersity index (PDI), zeta potential (ZP), and in vitro drug release (after 2, 10 h). In order to obtain the optimum formula, numerical optimization by Design-Expert® software was used. Electing the optimized bilosomal formula was based on boosting %EE, ZP (as absolute value) and in vitro drug release, taking in consideration diminishing PS and PDI. Further assessment of the selected formula was achieved by transmission electron microscopy (TEM), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), stability testing, ex vivo skin permeation and deposition. The in vivo pharmacodynamics activities of the optimized formula were examined on male rats and mice and compared to that of the oral market product. Results The optimized bilosomal formula demonstrated to be nonirritant, with noticeably enhanced anti-inflammatory and antinociceptive activities. Superior in vivo permeation was proved by confocal laser scanning microscopy (CLSM). Conclusion The outcomes demonstrated that bilosomes could improve transdermal delivery of lornoxicam., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/G8p7XhM43Og

Skin cancer is the most common type of cancer that affects humans and is usually diagnosed by initial clinical screening, which is followed by dermoscopic analysis. Automated classification of skin lesions is still a challenging task because of the high visual similarity between melanoma and benign lesions. This paper proposes a new residual deep convolutional neural network (RDCNN) for skin lesions diagnosis. The proposed neural network is trained and tested using six well-known skin cancer datasets, PH2, DermIS and Quest, MED-NODE, ISIC2016, ISIC2017, and ISIC2018. Three different experiments are carried out to measure the performance of the proposed RDCNN. In the first experiment, the proposed RDCNN is trained and tested using the original dataset images without any pre-processing or segmentation. In the second experiment, the proposed RDCNN is tested using segmented images. Finally, the utilized trained model in the second experiment is saved and reused in the third experiment as a pre-trained model. Then, it is trained again using a different dataset. The proposed RDCNN shows significant high performance and outperforms the existing deep convolutional networks.

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Today almost half the world's population does not have Internet access. This is particularly the case in rural and undeserved regions where providing Internet access infrastructure is challenging and expensive. To this end, we present demonstration of WhiteHaul [5], a low-cost hybrid cross-layer aggregation system for TV White Space (TVWS) based backhaul. WhiteHaul features a custom-designed frequency conversion substrate that efficiently handles multiple noncontiguous chunks of TVWS spectrum using multiple low-cost COTS 802.11n/ac cards but with a single antenna. At the software layer, WhiteHaul uses MPTCP as a link-level tunnel abstraction to efficiently aggregate multiple chunks of the TVWS spectrum via a novel uncoupled, cross-layer congestion control algorithm. This demo illustrates the unique features of the WhiteHaul system based on a prototype implementation employing a modified version of MPTCP Linux Kernel and a custom-designed conversion substrate. Using this prototype, we highlight the performance of the WhiteHaul system under various configurations and network conditions.

Objectives: The new generation antiplatelets are generally recommended by the current US and European guidelines. This article aimed to address the efficacy and safety of using ticagrelor in patients with ST-elevated acute coronary syndromes.Methods: This was a prospective observational study on 120 patients admitted to the Cardiology Care Unit of Assiut University Hospital with ST-segment elevation acute coronary syndrome, who were admitted for urgent revascularization and received aspirin and the P2Y12 antagonist ticagrelor. The patients were followed for three months between May 2018 and September 2019. The primary efficacy end point was the incidence of major adverse cardiovascular events (MACE).Results: At three months, the primary efficacy endpoint, a composite of cardiovascular death, myocardial infarction, or stroke - occurred in 11/120 (9.2%) patients. The primary safety endpoint, the incidence of major bleeding, was observed in two patients (1.7%) with no fatal bleedings. Minor and minimal bleeding occurred in 2.5% and 20.8% of patients, respectively. Other efficacy endpoints were myocardial infarction 4.2% and stent thrombosis (1.7%). Severe dyspnea found in 5.0% of patients and led to 1.7% ticagrelor discontinuation. Multivariate regression analysis revealed no association between bleeding and patients’ age, sex nor IV administration of glycoprotein IIb/IIIa inhibitor. Conclusion: The MACE with ticagrelor was higher than previously reported in most studies. Dyspnea rate was higher and more pronounced than bleeding rate. The majority of bleeding cases were minimal with no fatal major bleeding and no bleeding led to comorbidity.

Co3Sn2S2 has generated a growing interest as a rare example of the highly uniaxial anisotropic kagome ferromagnet showing a combination of frustrated-lattice magnetism and topology. Recently, via precise measurements of the magnetization and AC susceptibility we have found a low-field anomalous magnetic phase (A-phase) with very slow spin dynamics that appears just below the Curie temperature (T_C). The A-phase hosts high-density domain bubbles after cooling through T_C as revealed in a previous in-situ Lorentz-TEM study. Here, we present further signatures of the anomalous magnetic transition (MT) at T_C revealed by a study of the critical behaviors of the magnetization and magnetocaloric effect using a high-quality single crystal. Analyses of numerous magnetization isotherms around T_C (177 K) using different approaches (the modified Arrot plot, Kouvel-Fisher method and magnetocaloric effect) result in consistent critical exponents that do not satisfy the theoretical predictions of standard second-order-MT models. Scaling analyses for the magnetization, magnetic entropy change and field-exponent of the magnetic entropy change, all consistently show low-field deviations below TC from the universal curves. Our results reveal that the MT of Co3Sn2S2 can not be explained as a conventional second-order type and suggest an anomalous magnetic state below T_C., 22 pages with 6 captioned Figures and 1 table

The functional and molecular imaging characteristics of ischemic ventricular tachycardia (VT) substrate are incompletely understood. Our objective was to compare regional (18)F-FDG PET tracer uptake with detailed electroanatomic maps (EAMs) in a more extensive series of postinfarction VT patients to define the metabolic properties of VT substrate and successful ablation sites. Methods: Three-dimensional (3D) metabolic left ventricular reconstructions were created from perfusion-normalized (18)F-FDG PET images in consecutive patients undergoing VT ablation. PET defects were classified as severe (defined as 1.5 mV), or border zones (defined as voltage of 0.5–1.5 mV). Results: All 56 patients had ischemic cardiomyopathy (ejection fraction, 29% ± 12%). Severe PET defects were larger than dense scarring, at 63.0 ± 48.4 cm(2) versus 13.8 ± 33.1 cm(2) (P < 0.001). Similarly, moderate/severe PET defects (≤70%) were larger than areas with abnormal voltage (≤1.5 mV) measuring 105.1 ± 67.2 cm(2) versus 56.2 ± 62.6 cm(2) (P < 0.001). Analysis of bipolar voltage (23,389 mapping points) showed decreased voltage among severe PET defects (n = 10,364; 0.5 ± 0.3 mV) and moderate PET defects (n = 5,243; 1.5 ± 0.9 mV, P < 0.01), with normal voltage among normal PET areas (>70% uptake) (n = 7,782, 3.2 ± 1.3 mV, P < 0.001). Eighty-eight percent of VT channel or exit sites (n = 44) were metabolically abnormal (severe PET defect, 78%; moderate PET defect, 10%), whereas 12% (n = 6) were in PET-normal areas. Metabolic channels (n = 26) existed in 45% (n = 25) of patients, with an average length and width of 17.6 ± 12.5 mm and 10.3 ± 4.2 mm, respectively. Metabolic channels were oriented predominantly in the apex or base (86%), harboring VT channel or exit sites in 31%. Metabolic rapid-transition areas (>50% change in (18)F-FDG tracer uptake/15 mm) were detected in 59% of cases (n = 33), colocalizing to VT channels or exit sites (15%) or near these sites (85%, 12.8 ± 8.5 mm). Metabolism–voltage mismatches in which there was a severe PET defect but voltage indicating normal myocardium were seen in 21% of patients (n = 12), 41% of whom were harboring VT channel or exit sites. Conclusion: Abnormal (18)F-FDG uptake categories could be detected using incremental 3D step-up reconstructions. They predicted decreasing bipolar voltages and VT channel or exit sites in about 90% of cases. Additionally, functional imaging allowed detection of novel molecular tissue characteristics within the ischemic VT substrate such as metabolic channels, rapid-transition areas, and metabolism–voltage mismatches demonstrating intrasubstrate heterogeneity and providing possible targets for imaging-guided ablation.

Background: The definitive reconstructive technique of the pancreatic stump after pancreaticoduodenectomy (PD) differs among centers. Purpose: The purpose of this study was to evaluate the surgical outcome of stented pancreaticogastrostomy (PG) and the long-term survival after PD in a single center. Patients and Methods: A prospective study of stented PG was performed on 152 patients by the same surgical team over a 7-year period from January 2010 to January 2017. In the early postoperative period, patients were examined for morbidity and mortality related to the procedure. After that, patients were followed up for long-term survival. Results: There were 88 men (57.9%) and 64 women (42.1%); with a mean age of 62.6 (35-87) years. Early postoperative complications occurred in 47 patients (30.9%) including five patients with the pancreatic leak. The survival rate at the end of 1 year, 3 and five years were 80%, 58%, and 42% respectively. Univariate and multivariate analysis revealed that longer survival was found in patients with lower tumor grades and stages, CA 19.9 level less than 100 ng/ml, negative R status and in patients not receiving chemotherapy. Conclusion: The present technique with its low morbidity rate approaches the parameters of an ideal pancreatic anastomotic technique after PD. Factors associated with better survival should be considered for the sake of obtaining the best prognosis. [Arch Clin Exp Surg 2018; 7(4.000): 133-146]

The Alam El Bueib 3C Field is located in the eastern part of the Dahab-Mireir sedimentary basin in the north Western Desert of Egypt. The Lower Cretaceous Alam El Bueib Sandstone reservoir is a potentially producing reservoir in the field. Lithostratigraphic correlation and ditch cutting description have helped in stratigraphically locating the potential sandstone reservoirs within the basal part of Alam El Bueib 3A Bed and locally dividing it into three potential separate reservoirs. Qualitative analysis of borehole depth imaging logs helped in revealing the stratigraphic trap style of Basal Alam El Bueib sandstone reservoirs and detection of deposition paleoenvironment as a shallow marine environment of wave-dominated estuary channelized system. Structural seismic interpretation for available Pre-Stack-Depth-Migrated 3D seismic data has revealed that AEB 3C Field structure is a four-way dip anticlinal closure that trends north east-south west. A better understanding of the geological nature of the Alam El Bueib 3A sandstone reservoirs combined with the structural-stratigraphic trap style has led to a lower risk exploratory/development plan for Alam El Bueib potential sandstone reservoirs in the Alam El Bueib 3C field. Borehole depth imaging analysis results, integrated with seismic structural interpretation maps and information from conventional electrical well logs, represented a high-quality workflow that showed remarkable efficiency in a better understanding of reservoir distribution in the case of present heterogeneous Alam El Bueib sandstone reservoirs and providing the optimum solution for similar geological conditions in other areas.