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Heba A Abdeen,1 Zeinab M Helmy,1 Moustafa I Elnaggar,2 Monira I Aldhahi,3 Mona Mohamed Taha,3 Elena Marques-Sule,4 Doaa I Amin,5 Bassem S Ibrahim,6 Ahmed Abdel Aziz,6 Vincenzo Castiglione,7 Hady Atef1,8 1Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt; 2Faculty of Physical Therapy, Heliopolis University for Sustainable Development, Giza, Egypt; 3Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 4Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; 5Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 6Cardiology, National Heart Institute, Giza, Egypt; 7Fondazione Toscana Gabriele Monasterio; “Health Science” Interdisciplinary Research Center, Scuola Superiore Sant’Anna, Pisa, Italy; 8School of Allied Health Professions (SAHP), Keele University, Staffordshire, UKCorrespondence: Mona Mohamed Taha, Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +966118240811, Email momtaha@pnu.edu.saBackground: Multiple comorbidities and physiological changes play a role in a range of heart failure conditions and influence the most effective approach to exercise-based rehabilitation. This research aimed to examine and compare the outcomes of continuous training at three different intensities, focusing on left ventricular (LV) remodeling, functional capacity, and quality of life among patients with heart failure with reduced ejection fraction (HFrEF).Methods: In this randomized control trial, a total of 60 male patients (average age: 54.33 ± 2.35 years) with HFrEF were randomly allocated into three groups: 1) High-intensity continuous training group (HICT), 2) Moderate-intensity continuous training group (MICT), and 3) Low-intensity continuous training group (LICT). All the training was performed on a bicycle ergometer 3 times/week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro–B-type natriuretic peptide (NT-proBNP), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walking test) were assessed before and the end of the study.Results: The HICT group demonstrated the greatest improvements in all measured variables when compared to the other two groups (P < 0.05). These findings were consistent across all measured outcomes.Conclusion: It was determined that HICT appears to yield the most favorable outcomes in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among HFrEF patients.Keywords: heart failure with reduced ejection fraction, aerobic exercises, ventricular remodeling, quality of life

In the advanced metering infrastructure (AMI) of the smart grid, smart meters (SMs) are deployed to collect fine-grained electricity consumption data, enabling billing, load monitoring, and efficient energy management. However, some consumers engage in fraudulent behavior by hacking their meters, leading to either traditional electricity theft or more sophisticated evasion attacks (EAs). EAs aim to illegally reduce electricity bills while deceiving theft detection mechanisms. The current methods for identifying such attacks raise privacy concerns due to the need for access to consumers’ detailed consumption data to train detection mechanisms. To address privacy concerns, federated learning (FL) is proposed as a collaborative training approach across multiple consumers. Adversarial training (AT) has shown promise in countering evasion threats on machine learning models. This paper, first, investigates the susceptibility of traditional electricity theft classifiers trained by FL to EAs for both independent and identically distributed (IID) and Non-IID consumption data. Then, it investigates the effectiveness of AT in securing the global electricity theft detector against EAs, assuming no misbehavior from the participant consumers in the FL process. After that, we introduce three novel attacks, namely Distillation, No-Adversarial-Sample-Training, and False-Labeling, which can be launched during the AT process to make the global model susceptible to evasion at inference time. Finally, extensive experiments are conducted to validate the severity of these proposed attacks. Our findings reveal that the AT can counter EAs effectively when the FL participants are honest, but it fails when they act maliciously and launch our attacks. This work lays the foundation for future endeavors in exploring additional countermeasures, in conjunction with AT, to bolster the security and resilience of FL machine learning models against adversarial attacks in the context of electricity theft detection.

Fraudulent customers in smart power grids employ cyber-attacks by manipulating their smart meters and reporting false consumption readings to reduce their bills. To combat these attacks and mitigate financial losses, various machine learning-based electricity theft detectors have been proposed. Unfortunately, these detectors are vulnerable to serious cyber-attacks, specifically evasion attacks. The objective of this paper is to investigate the robustness of deep reinforcement learning (DRL)-based detectors against our proposed evasion attacks through a series of experiments. Firstly, we introduce DRL-based electricity theft detectors implemented using the double deep Q networks (DDQN) algorithm. Secondly, we propose a DRL-based attack model to generate adversarial evasion attacks in a black box attack scenario. These evasion samples are generated by modifying malicious reading samples to deceive the detectors and make them appear as benign samples. We leverage the attractive features of reinforcement learning (RL) to determine optimal actions for modifying the malicious samples. Our DRL-based evasion attack model is compared with an FGSM-based evasion attack model. The experimental results reveal a significant degradation in detector performance due to the DRL-based evasion attack, achieving an attack success rate (ASR) ranging from 92.92% to 99.96%. Thirdly, to counter these attacks and enhance detection robustness, we propose hardened DRL-based defense detectors using an adversarial training process. This process involves retraining the DRL-based detectors on the generated evasion samples. The proposed defense model achieves outstanding detection performance, with a degradation in ASR ranging from 1.80% to 9.20%. Finally, we address the challenge of whether the DRL-based hardened defense model, which has been adversarially trained on DRL-based evasion samples, is capable of defending against FGSM-based evasion samples, and vice versa. We conduct extensive experiments to validate the effectiveness of our proposed attack and defense models.

Hamdy A Azim,1 Ashraf Omar,2 Hesham Atef,1,† Heba Zawahry,3 Mohamed K Shaker,4 AH Kamel Abdelmaksoud,5 Mohamed EzzElarab,6 Omar Abdel-Rahman,7 Mohamed Ismail,8 Loay Kassem,1 Imam Waked9 1Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Medical Oncology, National Cancer Institute, Cairo, Egypt; 4Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Department of Diagnostic and Intervention Radiology, Cairo University, Cairo, Egypt; 6National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; 7Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 8Clinical Oncology Department, Cairo Oncology Center, Cairo, Egypt; 9Institute of Liver Disease, Menoufiya University, Menoufiya, Egypt †Dr Hesham Atef passed away on November 16, 2017, during the preparation of the manuscript Background: Phase II trials found that tegafur–uracil (UFT) is an effective drug in hepatocellular carcinoma (HCC), while preclinical data suggested that its combination with sorafenib may have a promising activity. Our Phase II randomized trial aimed to evaluate efficacy and tolerability of sorafenib plus UFT vs sorafenib in advanced HCC.Methods: Patients with advanced HCC, with no prior systemic therapy, were randomized to receive either UFT at 125 mg/m2 twice daily for 4 out of 5 weeks plus sorafenib at 400 mg twice daily (arm 1) or single agent sorafenib at 400 mg twice daily (arm 2). Primary end point was time to progression (TTP).Results: Between March 2012 and March 2014, 76 eligible patients – out of 143 preplanned – were randomized. The study was terminated early because of futility. This is the final analysis of the study, after a median follow-up of 10.2 months and death of 86% of randomized patients (n=64). Median TTP was 7.5 months and 8.2 months in arms 1 and 2 respectively (HR: 1.07; 95% CI, 0.52–2.22; P=0.855), while the median overall survival was 8.2 months and 10.5 months respectively (HR: 1.58; 95% CI: 0.90–2.76, P=0.112). Nine patients (25%) in the combination arm discontinued treatment because of toxicity vs eight patients (21.1%) in the sorafenib monotherapy arm (P=0.899).Conclusion: In patients with advanced HCC, adding UFT to sorafenib is feasible, but it did not improve efficacy outcome over sorafenib monotherapy. Keywords: advanced hepatocellular carcinoma, sorafenib, tegafur/uracil, Egypt

Mohamed Ahmed Eladl,1,2 Wael M Elsaed,2,3 Hoda Atef,4 Mohamed El-Sherbiny2 1Department of Basic Medical Sciences, University of Sharjah, Sharjah, United Arab Emirates; 2Anatomy and Embryology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 3Anatomy and Embryology Department, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia; 4Department of Histology, University of Mansoura, Mansoura, Egypt Background: Several renal disorders affect the glomerular podocytes. Compensatory structural and functional changes have been observed in animals that have undergone unilateral renal ablation. These changes occur as a pliant response to quench the increased functional demand to maintain homeostasis of fluid and solutes. Nestin is an intermediate filament protein present in the glomerular podocytes of the adult kidney and is linked with the maintenance of its foot process structure. Structural changes in the podocytes ultimately restructure the filtration barrier. Very few studies related to the ultrastructural and histopathologic changes of the podocytes are documented. The present study aimed to assess the histopathologic changes at the ultrastructural level in the adapted kidney at different time intervals following unilateral renal ablation in adult rats and its relation with nestin.Methods: Forty-eight rats were divided into four groups (n=12 in each group). The animals of Group A were control naïve rats, while the group B, group C and group D animals underwent left unilateral nephrectomy and the remaining right kidney was removed on days 10, 20 and 30, respectively. Each group included four sham-operated rats, which were sacrificed at the same time as the naïve rats. Each nephrectomized sample was weighed and its sections were subjected to hematoxylin and eosin examination, transmission electron microscopic study as well as immunostaining using the intermediate filament protein nestin.Results: No difference was found between the kidney sections from the control group and the sham-operated groups. A significant increase in the weight of the right kidneys was noted in groups B, C and D (P

Objective: To evaluate the efficacy of color Doppler US and tri-phasic CT in discriminating benign from malignant PVT. Patients and methods: This study included 30 patients presented ultrasonically with PVT and referred for color Doppler US and Tri-phasic CT examination for discriminating the benign from malignant PVT. The color Doppler US and tri-phasic CT results were compared and correlated with available histopathological results in the patients who had FNAC. Results: Those 30 patients were classified according to US, Tri-phasic CT, lab., findings into two groups: G.(A) included 16 patients with malignant PVT and G.(B) included 14 patients with benign PVT. Intrathrombus pulsatile flow was depicted in 12 patients with malignant PVT (12/16) (75%), while non-depicted in 14 patients with benign PVT with 100% specificity. On tri-phasic CT, neovascularity and an early arterial enhancement of PVT were depicted in 14 cases with malignant PVT with 87.5% sensitivity and non-depicted in 14 benign cases with PVT with 100% specificity. Conclusion: Distinguishing benign from malignant PVT in patients with HCC is required to determine the management plan. The color Doppler study of PVT should be an essential step in evaluation of patients with HCC. The combination of Color Doppler US and tri-phasic CT is common and essential for more accurate evaluation and differentiation of benign from malignant PVT.

Objective: To evaluate the diagnostic possibilities of multidetector computed tomography (MDCT) virtual cystoscopy (V.C.) in evaluation of urinary bladder carcinoma. Patients and methods: This study included 55 patients with recent initial conventional cystoscopic (C.C.) assessment (at the outpatient clinics) & revealed bladder mass including the followed up patients for U.BL. mass recurrence who were referred for CT virtual cystoscopic (V.C.) evaluation. All patients underwent conventional cystoscopy within a week after the virtual examination. The virtual image, axial 2D, and C.C. reports were compared to each other and to the obtained histopathological results. Results: Out of 93 intravesical masses depicted by C.C., 91 were depicted by V.C. (97.8%). The CT V.C. had higher sensitivity (97.8%) in comparison to that of axial 2D spiral CT (90.3%) in detection of U.BL. masses. V.C. could pass through the narrow neck diverticulae in three cases, while C.C. could not navigate through them. Conclusion: C.C. represents the gold standard for diagnosis & local management of U.BL. carcinoma. The results of V.C. & C.C. were comparable in detection, localization & morphology description of U.BL. masses. MDCT V.C. may be alternative or complementary examination where C.C. is difficult to be performed or contraindicated.

Background: Cisatracurium in clinical practice is devoid of histamine-induced cardiovascular effects. On the other hand, 2 ED 95 doses of cisatracurium (100 μg/kg) do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. The recommended intubating dose of cisatracurium is 3 ED 95 . To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium. Materials and Methods: The study designed as randomized controlled clinical trial to compare between atracurium (2ΧED 95 ) and different doses of cisatracurium (2ΧED 95 , 4ΧED 95 , 6ΧED 95 ) regarding onset time, duration of action, condition of intubation, hemodynamic effects, and sings of histamine release clinically. Sixty four patients were randomly assigned to one of four groups, the first group (group 1) received 2ΧED 95 dose of atracurium, group 2 received 2ΧED 95 dose of cisatracurium , group 3 received 4ΧED 95 dose of cisatracurium, while group 4 received 6ΧED 95 dose of cisatracurium. The Datex relaxograph (Type NMT-100-23-01, S/N: 37541) for neuromuscular monitoring was used. Results : HR, MABP was statistically significant increased post-intubation with administration of 2ΧED 95 dose of atracurium in group 1 and the same dose of cisatracurium in group 2 but 5-20 min later was not statistically significant with administration of 4ΧED 95 and 6ΧED 95 doses of cisatracurium in groups 3 and 4, respectively. Onset time was found to be significantly lower with 2ΧED 95 dose of atracurium than with the same dose of cisatracurium. At the same time, higher doses of cisatracurium (4ΧED 95 and 6ΧED 95 ) showed onset time and longer duration of action that was significantly lower than with atracurium and with lower dose of cisatracurium (2ΧED 95 ). Only 6ΧED 95 dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent condition of intubation. 4ΧED 95 and 6ΧED 95 doses of cisatracurium were significantly better than 2ΧED 95 dose of cisatracurium. 2ΧED 95 dose of atracurium and 2ΧED 95 dose of cisatracurium were similar, while 4ΧED 95 and 6ΧED 95 doses of cisatracurium were significantly better than atracurium and 2ΧED 95 dose of cisatracurium. Conclusion: The same dose (2ΧED 95 dose) atracurium is more effective neuromuscular blocking agent than cisatracurium, while higher doses of cisatracurium 4ΧED 95 and 6ΧED 95 provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, and no associated signs of histamine release clinically.

Fifteen patients on maintenance haemodialysis were studied before and after reuse of cuprophane hollow-fiber dialysers to assess its biocompatibility and efficiency. There was a significant increase in hematocrit value and hemoglobin level by the end of dialysis. Also, there was a significant decrease in total leukocyte (neutrophilic & eosinophilic) and platelet counts with a peak at 15 minutes after the start of dialysis, then there was a gradual increase till the end of dialysis reaching near the predialysis value. These changes occurred both in the first use and the reuse sessions. The decrease in the neutrophilic count with the reused dialyzer was significantly less compaired to first use dialyzer. The terminal complement complex (TCC) significantly increased and reached its maximum after 15 minutes, then it began to decline till the end of the dialysis. Similarly, these changes were significantly less in the reuse dialyzers. No correlation was found between the changes of the TCC and the decrease in different cellular elements.There was an increase in plasma bicarbonate and pH by the end of dialysis. Also, hypoxia and hypocapnea occured shortly after the start of dialysis session with acetate dialysate, but they returned to their predialysis values at the end of both dialysis sessions. This can be attributed to the loss of carbon dioxide into the dialysate with subsequent hypoventilation. The clearances of urea, creatinine and phosphorus showed insignificant difference between the new and reused dialyzers at zero and 4hr time with significant decrease by the end of dialysis in both dialysis session. This could be explained by keeping the surface area of the reused dialyzers within the acceptable values (80-100%) of the first use dialyzer. It can be concluded that reused dialyzers were to some extent more hemocompatible than the first use dialyzers. Complement activation is not the sole factor for the biocompatible reactions during dialysis. Reuse of dialyzers can be a safe procedure by adopting appropriate sterilization, reprocessing and storage techniques and limited number of reuse.

In this study, we develop the heat conduction equation for bio-thermoelastic skin tissue with one relaxation time using Penne's principle, the first law of thermodynamics, and the second law of thermodynamics. We use these novel governing equations to explore the influence of arterial blood temperature on physical parameters in homogeneous, isotropic, thermally conducting half-space skin tissue. Normal mode analysis is applied in the domain to acquire analytical results for measured quantities. For a given skin tissue, these expressions are numerically calculated and graphically illustrated. The findings were predicted and tested for various values of arterial blood temperature. [ABSTRACT FROM AUTHOR]

We obtain muti-dimensional generalizations of the N. Wiener and P. Lévy theorems. We also give two applications of the real analytic functional calculus for several variables in p-Banach algebras (0 < p ≤ 1). The first one consists of giving the real-analytic versions of P. Lévy theorem for several functions of a single variable. The second consists of giving a generalization of N. Wiener and P. Lévy theorems for functions of several variables. [ABSTRACT FROM AUTHOR]

Over the past years, non‐stop research and development has continued to find the most suitable bleaching sequence for each source of fibrous raw materials, both wood and non‐wood, by improving mixing technology. In this work, the role of ozone bleaching and nano‐filler loading on the quality of papermaking from sorghum bagasse as an alternative available agriculture residue in Egypt was studied. We bleached the sorghum Kraft pulp using D0EOD1 and ZEOD sequences to achieve a final high brightness and suitable mechanical strength. The quality of the pulp obtained is proved to be excellent for paper industry. CaCO3 nano‐filler was applied on bleached pulp sheets in order to decrease the production costs through increasing filler loading. The FTIR spectrum of this filler loaded on the pulp indicates the existence of some kind of bonds between them. In addition, it was observed that the particle size was reduced after the milling process. The nano‐filler significantly enhanced the retention and consequently all the paper optical properties. Addition of nano‐filler loading leads to improving brightness, opacity, scattering coefficient, and acceptable mechanical strength of sheet formation needed for papermaking. It is of interest to note that adopting the ZEOD sequence gave a brightness increase from 86 ISO in case of DoEOD1 to 90 ISO. Furthermore, the paper sheets filled with the nano‐filler, according to this sequence, improved the brightness to be 94.6 ISO, a value higher than that produced by the standard commercial filler of 93.3 ISO. [ABSTRACT FROM AUTHOR]

Abstract Background Eplerenone and spironolactone, recognized as mineralocorticoid receptor antagonists (MRAs), have been reported to improve clinical prognosis among individuals diagnosed with heart failure (HF). However, the difference in the clinical effects between eplerenone and spironolactone in individuals with HF remains uncertain. We aimed to assess the impact of eplerenone compared to spironolactone on clinical outcomes within the HF population. Methods An extensive search was executed in several databases (PubMed, Web of Science, Scopus, Cochrane Library). All relevant studies evaluating eplerenone compared to spironolactone in patients with HF were included. Dichotomous data were pooled as Hazard ratio (HR) or Risk ratio (RR) with a 95% confidence interval (CI). Our main outcome was all-cause mortality. Secondary outcomes included death from cardiovascular causes, treatment withdrawal, and gynecomastia. Results Ten studies, comprising 21,930 HF individuals, were included in our investigation. Eplerenone showed a lower risk of all-cause mortality (HR = 0.78, 95%CI [0.64 to 0.94], P = 0.009) and cardiovascular mortality (HR = 0.54, 95%CI [0.39, 0.74], P = 0.0001) compared to spironolactone. Furthermore, eplerenone exhibited a reduced risk of treatment withdrawal (RR = 0.69, 95% CI [0.62, 0.78], P = 0.0001) and gynecomastia (RR = 0.07, 95% CI [0.02 to 0.31], P = 0.0001) than spironolactone. Conclusion Eplerenone revealed lower all-cause and cardiovascular mortality events in comparison to spironolactone. Moreover, eplerenone was associated with lower gynecomastia and treatment withdrawal events compared to spironolactone. Further well-designed randomized controlled trials are still warranted better to identify the clinical differences between eplerenone and spironolactone. Trial registration Protocol registration: https://doi.org/10.17605/OSF.IO/VNMGK

The interaction between the exited semiconductor medium with the induced magnetic field is investigated. The medium is taken during a microtemperature process in hydrostatic initial stresses. The problem is studied when the thermal conductivity is variable that depends on the temperature (which can be taken in a linear form of temperature). The main quantities are obtained in the context of the photo-thermoelasticity theory when the medium is in a rotator case. The two dimensions (2D) deformation equations are obtained during the thermo-elastic-plasma transport processes. The governing equations can be investigated under the integral transformations of Fourier and Laplace with the impact of microelements vector. The basic analytical solutions of the physical quantities in this phenomenon are obtained under transformations in the physical domain. The thermal ramp type (heating type) is used with some othermechanical-plasma conditions which they can be applied at the free external surface. To obtain the main solutions of basic quantities in space–time domain, some inversion methods of Fourier and Laplace transformations are applied numerically. Many comparisons between several parameters are made numerically and they are shown graphically and discussed. [ABSTRACT FROM AUTHOR]

Abstract Background The Bric-a-Brac/Tramtrack/Broad Complex (BTB) gene family plays essential roles in various biological processes in plants. These genes encode proteins that contain a conserved BTB domain, which is involved in protein-protein interactions and regulation of gene expression. However, there is no systematic reports on the BTB gene family in G.max. Results In total, 122 soybean BTB genes were identified, which were classified into four groups based on the phylogenetic analysis. Gene structures analysis indicated that the number of exon–intron in GmBTBs ranges from 0 to18. Cis-element analysis revealed that most GmBTB genes contained cis-elements related to an abiotic stress response. In addition, qRT-PCR analyses indicated that most GmBTBs are significantly up-regulated under salinity, drought, and nitrate stresses. They suggested their potential for targeted improvement of soybean response to multiple abiotic stresses and nitrate availability. Conclusion These results provide valuable information for identifying the members of the GmBTB gene family in soybean and could provide a functional characterization of GmBTB genes in further research.

6082 Al-alloy underwent a friction stir drilling (FSD) processing. Subsequently, a two-stage post-heat treatment (PHT) procedure, i.e., solution treatment at 550 °C for 2 h, followed by artificial aging at 175 °C for 18 h, was implemented to significantly enhance microstructure and mechanical performance of the alloy. The microstructure was characterized by optical, laser, scanning electron and electron backscattered diffraction microscopes, while the mechanical behavior was assessed by a micro-indentation hardness tester, employing the indentation hardness (HIT) technique. Corrosion behavior of FSD as well as PHT specimens was investigated through electrochemical techniques.The microstructure of the base metal (BM) manifested an α-Al matrix with an average grain size of approximately 50 μm. FSD resulted in the creation of stirring zone (SZ) and thermo-mechanical affected zone (TMAZ), with respective widths of 400 ± 50 and 950 ± 100 μm. The SZ exhibited a very fine structure with an average grain size of 0.5 μm, thereby displaying increased hardness. The PHT microstructure displayed the formation of fine βʹ and βʺ second phase precipitate types, whereas the HIT hardness of the PHT α-aluminum matrix in the SZ, was lower than TMAZ and BM, due to reductions of βʹ in the SZ compared to TMAZ and BM. Moreover, the corrosion rate of the SZ decreased after the heat-treatment cycle, attributed to the recovery of strain energy induced during friction drilling and the increased solubility of solute atoms within the α-Al matrix.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a major risk for pulmonary hypertension with poor prognosis. Limited data is available on the optimal treatment of choice. We aimed to comprehensively assess the efficacy and safety of CTEPH targeted therapies and update the evidence. Methods: We searched PubMed, Scopus, and the Cochrane library up to December 2023 to include randomized controlled trials comparing different therapies in patients with CTEPH. Primary outcomes were 6-minute walk distance (6 MWD), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). While secondary outcomes were the mean right atrial pressure (mRAP), Borg dyspnea score, cardiac output (CO), cardiac index, adverse events, and all-cause mortality. Results: Fourteen RCTs comprising 1047 patients were included in this network meta-analysis. Regarding 6 MWD, PADN (MD=113.59, 95% CI: 53.80; 173.39), BPA (MD=48.84, 95% CI: 27.99; 69.69), riociguat (MD=42.59, 95% CI: 22.01; 63.18), treprostinil (MD=41.60, 95% CI: 17.07; 66.13), and macitentan (MD=34.00, 95% CI: 3.50; 64.50) were favored compared to placebo. In terms of PVR, BPA (MD=-392.19, 95% CI: -571.77; -212.62), treprostinil (MD=-287.20, 95% CI: -475.63; -98.77), PADN (MD=-280.61, 95% CI: -506.69; -54.52), bosentan (MD=-176.00, 95% CI: -340.91; -11.09), and riociguat (MD=-171.61, 95% CI: -298.40; -44.81) displayed statistically significant results. Conclusion: Current therapeutic modalities are effective in terms of improving exercise capacity, pulmonary hemodynamics, and reducing adverse events and all-cause mortality. Overall, BPA and PADN were superior to all other targeted medications in the studied outcomes.

Auxetic structures, characterized by showing negative Poisson's ratio (ʋ) when loaded, are cellular metamaterials consisting of connected struts in repeating unit cells. The mechanical behavior of auxetics depends on dimensions of the unit cell such as height and length of the unit cell, strut thickness (St), and orientation angle (θ) of the struts. The present study investigates effects of variations in St and θ on ʋ and stiffness (E) of additively manufactured 316L stainless steel with re-entrant honeycomb auxetics fabricated by laser powder bed fusion technique. Poisson's ratio was acquired through linear elastic simulations via finite element analysis (FEA) and verified experimentally through digital image correlation (DIC) facility attached to tensile tests. The design of the auxetic patterns entailed a simulation of thirty-five distinct models, incorporating St values of 0.4–1.6 mm, as well as θ values of 70–90°. In comparison, experimental validation was conducted on nine specimens, featuring St values of 0.6–1.4 mm, and θ values of 70–80°. FEA and experimental results obtained by DIC exhibited ʋ values of −5.23 to −0.3 (for St 0.6-1.4 mm and θ 70–80°), displaying increased ʋ with reductions in both St and/or θ. Meanwhile, E increased with St increase or θ decrease, exhibiting values of 18.9–72 GPa, which could be optimized to fit with human bones stiffness as potential orthopedics implantation in future.

In the dynamic landscape of advanced manufacturing, the confluence of laser powder bed fusion (LPBF) and machine learning (ML) has recently garnered significant attention in many applications. This review investigates the confluence of LPBF and ML, specifically within the specific domain of stainless steel. Firstly, it delves into LPBF principles, including an overview of critical process parameters and associated defects. Secondly, the paper meticulously addresses the distinct challenges posed by steel in additive manufacturing (AM), highlighting factors such as chemical composition, anisotropic microstructure, and oxide film formation, all of which require specialized considerations. Thirdly, the spotlight shifts to the pivotal role of ML, covering predictive modeling for process parameters, real-time defect detection, and quality control. This paper highlights recent advances, revealing how data-driven approaches can accelerate process understanding and part qualification. Eventually, this review offers insights into the future integration of ML in LPBF for steel, providing valuable perspectives on potential advancements in the field of AM.

The increasing demand for materials possessing enhanced mechanical strength, high thermal conductivity, and excellent electrical properties has grown significantly. Cu-matrix composites, especially Cu– Ni, present a promising candidate to fulfill these demands. In this study, Cu–Ni composites were successfully synthesized using powder metallurgy with various additions (0–1.5 wt%) of Yttria (Y2O3)-reinforcement aiming to enhance their mechanical, thermal, and electrical properties. The microstructural investigations demonstrated a uniform distribution of Y2O3 particles and a slight increase in porosity of the Cu–Ni matrix. The Cu–Ni composites with 1.5 wt% Y2O3 showed the presence of Cu2NiZn intermetallic compounds, potentially harming their physical and mechanical properties. Y2O3-reinforcement significantly increased the hardness and led to a moderate rise in the yield and ultimate compressive strengths. The results indicated that the Cu–Ni matrix without Y2O3-reinforcement had the highest coefficient of thermal expansion, which decreased with the addition of Y2O3, potentially leading to improved thermal properties of Cu–Ni composites. This study puts an emphasis on the importance of Y2O3 particles dispersion and on the extent of porosity in enhancing the thermal and mechanical properties of Cu–Ni composites.

Abstract High temperatures (HT) and drought are two major factors restricting wheat growth in the early growth stages. This study investigated the role of glutathione (GSH) amendment (0.0, 0.5, 1.0, and 2.0 mM) to soil in mitigating the adverse effect of HT (33 °C, with 25 °C as a control), water regimes (60% of field capacity and control), and their combinations. HT decreased the length, project area, surface area, volume, and forks of the root, while drought had the reverse effect. Shoot length, leaf area, leaf relative water content, and shoot and root dry matter were significantly decreased by HT and drought, and their combined impact was more noticeable. GSH significantly promoted the root system, shoot growth, and leaf relative water content. The combined treatment reduced chlorophyll a, chlorophyll b, and total chlorophyll. However, 0.5 mM GSH raised chlorophyll a, chlorophyll b, and total chlorophyll by 28.6%, 41.4%, and 32.5%, respectively, relative to 0.0 mM GSH. At combined treatment, 0.5 mM GSH decreased malondialdehyde (MDA) by 29.5% and increased soluble protein content by 24.1%. GSH meaningfully enhanced the activity of superoxide dismutase, catalase, and ascorbate peroxide in different treatments. This study suggested that GSH could protect wheat seedlings from the adverse effects of HT and/or drought stresses.

This study investigates various processing approaches, interface characteristics, and mechanical properties of an aluminum (Al) matrix composite reinforced with additively manufactured (AM) 316L stainless-steel (SS) lattice. The AM-316L-SS lattice, boasting a 30 % infill density, was fabricated using the laser powder bed fusion technique. The Al-matrix was integrated with the AM-316L-SS reinforcement through experimentation involving pre-stirring of the molten Al under pressurized and unpressurized die-casting conditions. A well-bonded interface, with cohesive regions, was obtained in the pre-stirred structures. In contrast, regions of decohesion were displayed in cast structures without pre-stirring, leading to the presence of pores and the manifestation of imperfect bond interfaces. Compression tests conducted on the sound composite demonstrated enhanced mechanical properties, with a compressive strength of approximately 163 MPa, significantly higher than that of the pure Al-matrix (approximately 80 MPa). Localized interface cracking was initiated by stress gradients and plastic deformation, leading to microcrack propagation into the Al-matrix.

This study aims to research the influence of the magnetic field on the 2-D generalized thermo-viscoelastic material in five theories. The amended Ohm Law, which includes temperature gradient (effect of Seebeck) and charging density effects and the existing Fourier Law (effect of Peltier), is adopted. In the physical domain, the analytical expressions for the physical quantities are obtained using the normal mode analysis. These expressions are measured numerically for a specific substance and graphically illustrated. Moreover, the results predicted by (C-T, L-S, G-L, G-N II and DPL) theories also examined the existence and nonexistence of the viscosity and (Seebeck–Peltier) coefficients. [ABSTRACT FROM AUTHOR]

The aim of this work is to evaluate the potency of sorghum stalks as an alternative fiber for pulp and papermaking for the first time in Egypt. Sorghum Kraft pulp was bleached using D0EOD1 sequences to achieve a final high brightness and suitable mechanical strength. The results revealed that pulping alkali of 14% Na2O concentration is the best choice. In addition, this percentage preserved high pulp brightness with a value of 86 ISO together with low fiber degradation besides imparting a high mechanical strength to the product. So, sorghum bagasse can be utilized as an important available low‐cost non‐wood fiber for paper industry. [ABSTRACT FROM AUTHOR]

Charcot neuro-osteoarthropathy (CNO), mainly as a result of diabetic neuropathy, is a complex problem which carries significant morbidity, and is an increasing burden on healthcare as demographics change globally. A multi-disciplinary team (MDT) is necessary to treat the multiple facets of this disease. The multifactorial and non-homogenous nature of this condition and its management, has prevented the development of comprehensive guidelines based on level 1 evidence. Although there is a trend to surgically treat these patients in tertiary centres, the increasing prevalence of CNO necessitates the capability of all units to manage this condition to an extent locally. This article conducted a thorough literature search of Pubmed and Embase from 2003 to 2023 including the following search terms; “Charcot” “neuroarthropathy” “diabetic foot” “management” “surgery” “treatment” “reconstruction”. The results of this review have been summarised and synthesised into an evidence-based algorithm to aid in the surgical decision-making process, and improve the understanding of surgical management by the whole MDT.

The study examined a cohort of women in the U.S. to describe the timing of elective repeat cesarean deliveries and assess the link between delivery before 39 weeks of gestation and the risk of adverse neonatal outcomes. Findings suggest that elective repeat cesarean delivery before term is common and is associated with adverse neonatal outcomes.

Selective laser sintering (SLS) is a bed fusion additive manufacturing technology that facilitates rapid, versatile, intricate, and cost-effective prototype production across various applications. It supports a wide array of thermoplastics, such as polyamides, ABS, polycarbonates, and nylons. However, manufacturing plastic components using SLS poses significant challenges due to issues like low strength, dimensional inaccuracies, and rough surface finishes. The operational principle of SLS involves utilizing a high-power-density laser to fuse polymer or metallic powder surfaces. This paper presents a comprehensive analysis of the SLS process, emphasizing the impact of different processing variables on material properties and the quality of fabricated parts. Additionally, the study explores the application of machine learning (ML) techniques—supervised, unsupervised, and reinforcement learning—in optimizing processes, detecting defects, and ensuring quality control within SLS. The review addresses key challenges associated with integrating ML in SLS, including data availability, model interpretability, and leveraging domain knowledge. It underscores the potential benefits of coupling ML with in situ monitoring systems and closed-loop control strategies to enable real-time adjustments and defect mitigation during manufacturing. Finally, the review outlines future research directions, advocating for collaborative efforts among researchers, industry professionals, and domain experts to unlock ML’s full potential in SLS. This review provides valuable insights and guidance for researchers in regard to 3D printing, highlighting advanced techniques and charting the course for future investigations.

In this study, 316L austenitic stainless-steel (ASS) plates fabricated using an additive manufacturing (AM) process were joined using tungsten inert gas (TIG) and laser welding techniques. The 316L ASS plates were manufactured using a laser powder bed fusion (LPBF) technique, with building orientations (BOs) of 0° and 90°, designated as BO-0 and BO-90, respectively. The study examined the relationship between indentation resistance and microstructure evolution within the fusion zone (FZ) of the welded joints considering the effects of different BOs. Microstructural analysis of the weldments was conducted using optical and laser confocal scanning microscopes, while hardness measurements were obtained using a micro-indentation hardness (HIT) technique via the Berkovich approach. The welded joints produced with the TIG technique exhibited FZs with a greater width than those created by laser welding. The microstructure of the FZs in TIG-welded joints was characterized by dendritic austenite and 1–4 wt.% δ-ferrite phases, while the corresponding microstructure in laser-welded joints consisted of a single austenite phase with cellular structures. Additionally, the grain size values of FZs produced using the laser welding technique were lower than those produced using the TIG technique. Therefore, TIG-welded joints showcased hardness values lower than those welded by laser welding. Furthermore, welded joints with the BO-90 orientation displayed the greatest cooling rates following welding processing, leading to FZs with hardness values greater than BO-0. For instance, the FZs of TIG-welded joints with BO-0 and BO-90 had HIT values of 1.75 ± 0.22 and 2.1 ± 0.09 GPa, whereas the corresponding FZs produced by laser welding had values of 1.9 ± 0.16 and 2.35 ± 0.11 GPa, respectively. The results have practical implications for the design and production of high-performance welded components, providing insights that can be applied to improve the efficiency and quality of additive manufacturing and welding processes.

Comparison of maternal and perinatal outcomes between women who underwent a trial of labor and women who had an elective repeated cesarean delivery without labor is presented. Although there are low absolute risks, a trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor.

Weekly injections of a hormone called 17 alpha-hydroxyprogesterone caproate can lower the risk of premature birth in pregnant women with a previous premature birth. This was the conclusion of a study of 463 pregnant women. The newborn babies of women who received the injections were also less likely to have necrotizing enterocolitis, brain hemorrhage, or the need for oxygen at birth.

The increasing demand for orthopedic implants has driven the search for materials that combine strength, biocompatibility, and long lifetime. Compared to stainless steel and Co-Cr-based alloys, titanium (Ti) and its alloys are favored for biomedical implants because of their high strength, corrosion resistance, and biocompatibility. This comprehensive review delivers a wide overview of the field of Ti-based biomaterials for orthopedic implants applications, focusing on their types, mechanical and chemical resistance, surface modifications, innovations in fabrication techniques, Ti matrix composites, and machine learning (ML) advancements. Ti alloys of different crystalline phases, including α, near-α, (α + β), β, and shape memory alloys, offer diverse options for orthopedic applications. Strengthening properties, wear, fatigue, and corrosion resistance are crucial factors influencing the performance and reliability of Ti implants. Moreover, this review discussed the challenges to Ti-based biomaterial durability through surface modifications to enhance their biofunction, wear resistance, corrosion resistance, and antibacterial properties. Recent developments in fabrication techniques for Ti-based biomaterials are also discussed. Eventually, this review investigated how ML revolutionized Ti orthopedic implants by providing insights into the behavior of new alloys, aiding in manufacturing optimization, allowing for real-time quality control, and advancing the development of personalized, biocompatible, and reliable implants.