Search

Autism is a neurodevelopmental disorder distinguished by impaired social interaction and repetitive behaviors. Global estimates indicate that autism affects approximately 1.6% of children, with the condition progressively becoming more prevalent over time. Despite noteworthy progress in autism research, the condition remains untreatable. This serves as a driving force for scientists to explore new approaches to disease management. Autism is linked to elevated levels of oxidative stress and disturbances in the DNA repair mechanism, which may potentially play a role in its comorbidities development. The current investigation aimed to evaluate the beneficial effect of the naturally occurring flavonoid proanthocyanidins on the behavioral characteristics and repair efficacy of autistic BTBR mice. Moreover, the mechanisms responsible for these effects were clarified. The present findings indicate that repeated administration of proanthocyanidins effectively reduces altered behavior in BTBR animals without altering motor function. Proanthocyanidins decreased oxidative DNA strand breaks and accelerated the rate of DNA repair in autistic animals, as evaluated by the modified comet test. In addition, proanthocyanidins reduced the elevated oxidative stress and recovered the disrupted DNA repair mechanism in the autistic animals by decreasing the expressions of Gadd45a and Parp1 levels and enhancing the expressions of Ogg1, P53, and Xrcc1 genes. This indicates that proanthocyanidins have significant potential as a new therapeutic strategy for alleviating autistic features.

Parallel inverters are commonly used for connecting photovoltaic (PV) and other renewable energy sources to Microgrids (MGs). One of the greatest challenges in MG operation is maximizing the PV system's performance while also enhancing the MG's reliability and efficiency. The PV inverters waste power if the shared load power is less than their maximum output power. When shared load power surpasses the PV inverter's maximum output power, the system may become unstable since PV sources are intermittent. This study proposes a master-slave control system for controlling parallel inverters connected to a PV system. The master inverter is connected to Energy Storage Devices (ESDs) and is responsible for maintaining stable voltage on the load bus. The PV units are connected via slave inverters and are managed using a dual-loop Proportional Integrator Derivative (PID) control approach, with the outer loop maximizing solar panel output. The system is built on a Direct-Quadrature-Zero (d-q-0) inverter architecture, and the controller guarantees that all inverter currents remain in phase to reduce circulating current and enhance overall system efficiency. The simulation model evaluates a system comprising three inverters, with the master inverter powered by ESDs. The PV Units power the other two Slave Inverters. The system is evaluated using four case studies featuring various load and radiation change scenarios. The results demonstrate that the system is highly reliable and operationally efficient, with the absence of circulating currents among the inverters. Moreover, the system is capable of precisely monitoring the MPPs of PV modules with 100% efficiency and a minimal 0.002% fluctuation, while also responding to changes in under 50 ms.

Summary: Background: Infections and sepsis are leading causes of morbidity and mortality in women during pregnancy and the post-pregnancy period. Using data from the 2017 WHO Global Maternal Sepsis Study, we explored the use of early warning systems (EWS) in women at risk of sepsis-related severe maternal outcomes. Methods: On April 27, 2023, we searched the literature for EWS in clinical use or research in obstetric populations. We calculated the proportion of women for whom each existing EWS identified them as at risk for developing severe maternal outcomes by infection severity (complications and severe maternal outcomes). Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, and J statistics were calculated to assess EWS performance. Machine learning was used to test the diagnostic potential of routine maternal sepsis markers. Findings: 21 EWS were assessed in 2560 women from 46 countries with suspected or confirmed infections. The NICE Risk Stratification tool, Modified Shock Index, maternity Systemic Inflammatory Response Syndrome, and Early Maternal Infection Prompts scores had high sensitivity (88.1–97.5%) for identifying sepsis-related severe maternal outcomes. The quick Sequential Organ Failure Assessment (SOFA) in Pregnancy score and Obstetrically modified SOFA had high specificity (90.4–100%) for identifying women with sepsis-related severe maternal outcomes. Furthermore, combinations of sepsis markers had very low sensitivity and high specificity using machine learning. Interpretation: No score demonstrated enough diagnostic accuracy to be used alone to identify sepsis. However, obstetric—and sepsis-specific EWS performed better for early identification of maternal sepsis than non-obstetric and non-sepsis-specific scoring systems. There are limitations to applying EWS to real-world data, mainly due to the incompleteness of medical data that hinders EWS effectiveness. There is a need to continue developing and testing criteria for early identification of maternal sepsis. Funding: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Merck for Mothers, U.S. Agency for International Development, Wellcome Trust, and National Institute for Health and Care Research.

Utilizing plant extracts in the green synthesis of bimetallic nanoalloys receives more attention due to its eco-friendly, cheap, single-step, easy-handling method, producing highly active and biocompatible nanoalloys. Therefore, the aqueous extract of ginger rhizome was used to form bimetallic gold/silver (Au/Ag) nanoalloys. There were 37.3 mg.g−1 of total soluble carbs, 0.75 mg.g−1 of proteins, and 0.03 mg.g−1 of phenolic compounds quantified in ginger rhizome. The production of BAu/Ag-NPs relies on these components. The as-formed BAu/Ag-NPs were characterized using UV–Vis spectroscopy. The results showed that the peak surface plasmon resonance (SPR) occurred between 440 and 545 nm. The existence of several functional groups involved in the reduction and stability of the generated nanoalloys was shown by Fourier-transform infrared (FT-IR). The nanoalloys, with an average size of 49.1 ± 16.2 nm, were observed to be spherical using transmission electron microscopy (TEM). Energy-dispersive X-ray (EDX) indicated that the synthesized nanoalloy mainly consisted of Au and Ag ions, which made up (31.2 % and 47.1 %) and (45.9 % and 28.6 %) of the sample’s atomic and weight percentages, respectively. The crystallography of the nanoalloys was confirmed using XRD analysis. When examined for their capacity to suppress viral replication, the synthesized nanoalloys showed remarkable results, with 78.2 % inhibition against HAV and 69.6 % against Cox-B4. In addition, the anticancer activity of nanoalloys against oral epithelial cells (OEC), MCF7 adenocarcinoma cells, and HepG2 hepatocarcinoma cells was investigated using the MTT assay method. While the nanoalloys exhibited moderate toxicity towards normal OEC (IC50: 502.5 ± 2.8 g.mL−1), they showed substantial cytotoxicity towards cancer cells, MCF7 and HepG2, with IC50 values of 212.6 ± 4.4 and 117.9 ± 6.6 µg.mL−1, respectively. According to these data, BAu/Ag nanoalloys show potential as antiviral and anticancer drugs that selectively kill cancer cells.

A new biomaterial Ti–14Cr alloy was designed for biomedical applications. The manufacturing process of Ti alloys through hot deformation is crucial for controlling the grain structure and the mechanical performance of the alloy. In the present study, several compression tests at elevated temperatures (1123–1273 K) and strain rate ranges of 0.01–10 s−1 were conducted using a Gleeble-3800 thermomechanical simulator. A processing map of the studied alloy was constructed using the principles of the dynamic material model to evaluate the hot workability and deformation mechanisms at different ranges of temperature and strain rate. The resulting grain structure was correlated with the processing map.The processing map showed that adiabatic shear bands are expected to form at low temperatures (1123–1223 K) and moderate to high strain rates (1–10 s−1), whereas the nucleation of wedge cracks is likely to develop at the grain boundary at high temperatures and low strain rates (1248–1273/0.01 s−1). Consequently, a deterministic domain in the temperature and strain rate ranges of 1148–1273 K and 0.01–0.1 s−1, respectively, was identified as the domain of dynamic recrystallization with a peak efficiency of the order of ∼70% at 1173 K/0.01 s−1, and these were considered to be the optimum parameters for hot deformation. The constitutive flow behavior was modeled based on the hyperbolic–sinusoidal Arrhenius-type equations, and a mathematical relation was used to elucidate the influence of true strain on material constants.

Context: Anti-double-stranded deoxyribonucleic acid antibodies (dsDNA Abs) are highly specific markers of systemic lupus erythematosus (SLE). Multiple methods are employed for their detection in routine diagnostics. Objectives: The aim of this study was to evaluate a diagnostic approach for anti-dsDNA Abs using DNA-ELISA and Crithidia luciliae fluorescence test (CLIFT), in combination with antinuclear antibody (ANA) screening. Methods: We enrolled 113 patients—53 with SLE, 50 with other systemic autoimmune rheumatic diseases (OSARD), and 10 with non-autoimmune clinical conditions (NAICC).Patients’ samples were tested for anti-dsDNA Abs using an enzyme-linked immunosorbent assay (ELISA) and CLIFT, combined to ANA screening by indirect immunofluorescence assay (ANA-IIFA). Results: The mean age of patients was 39.94 ± 15 years (ranges: 11–85 years). Overall, specimens from 77.3%, 11.7%, and 20% of patients with SLE, OSARD and NAICC respectively were ELISA-positive; and those from 54.7% to 4% of patients with SLE and OSARD, respectively, were CLIFT-positive. CLIFT positivity was significantly associated with high ELISA titers (p = 0.002) and homogeneous ANA-IIF pattern (p = 0.0002). Conclusion: For better clinical relevance of anti-dsDNA antibodies, we suggest a combined detection strategy based on ELISA, CLIFT and ANA-IIFA, considering the clinical criteria of SLE.

The textile and leather industry produces large amounts of wastewater that contains high levels of chemicals and other pollutants, incorporated during the processing stages. We evaluated the efficacy of green synthesized iron oxide (α-Fe2O3) and magnesium oxide (MgO) nanoparticles (NPs) for wastewater treatment of crude textile and tannery effluents. Green synthesis of α-Fe2O3-NPs and MgO-NPs was conducted using the newly obtained Aspergillus carbonarious strain D-1. The optimization of the physicochemical parameters for the biosynthesis of NPs, including incubation periods, contact time, pH, temperature, and precursor concentrations, were assessed. The characterization of NPs obtained under optimal conditions was evaluated using UV–visible spectroscopy, transmission electron microscopy (TEM), X-ray diffraction (XRD) patterns, dynamic light scattering (DLS), and Fourier Transform Infrared (FT-IR) Spectroscopy. The optimal concentration for efficient textile/tannery wastewater decolorization was determined to be 100 mg NPs after eight hours for α-Fe2O3-NPs and after four hours for MgO-NPs. Under these conditions, chemical oxygen deman (COD), pH value, total dissolved solids (TDS), total suspended solids (TSS), and conductivity were greatly reduced as compared to control for crude textile wastewater. GC–MS analysis of NPs-treated textile wastewater revealed that some major compounds were greatly diminished, bio-transformed, or completely degraded. MgO and α-Fe2O3 NPs exhibited a high capacity to reduce the COD of tannery wastewater by 97.5% and 95.0%, respectively. Hematite NPs exhibited higher removal capacity for TDS, TSS, and conductivity compared to MgO-NPs. MgO and hematite NPs exhibited high capacities to remove Cr, with MgO redcing Cr by 87.06 and hematite NPs reducing Cr by 75.4%. MgO-NPs were more effective than α-Fe2O3-NPs at removing Pb, Ni, and Cd.

This research paper reports the implementation of short-term scheduling of hydro-thermal power plants by using an artificial bee colony algorithm. Short-term hydro-thermal scheduling is a type of economic dispatch problem in which thermal power plants are dispatched at the optimized operating point to reduce the fuel cost and to achieve in parallel the maximum cost-benefit from hydel power plants. The power system, considered in this study, is assumed to run optimally and the transmission losses have also been taken into account. The artificial bee colony algorithm proves itself to be most suited for this particular problem as it results in the minimum cost in the shortest time compared with those obtained from previously applied techniques.

Background: Medical laboratory workers are frequently exposed to a wide range of chemicals. This exposure can have adverse effects on their health. Furthermore, a knowledge lack of the chemical risk increases the likelihood of exposure. The chemical risk assessment reduces the risk of exposure to hazardous chemicals and therefore, guarantees health and safety of the workers. Method: The chemical risk assessment was conducted using a modified INRS method, according to the new CLP Regulation, of 11 unit laboratories in a Moroccan medical laboratory. Observation of each workstation and analysis of safety data sheets are key tools in this study. Results: A total of 144 substances and reagents that could affect the health of the analytical technicians were identified. Among these products, 17% are concerned by the low priority risk score, with 55% concerned by the average priority risk score and 28% concerned by the high priority risk score. This study also enabled to better identify the chemical agents that have restrictive occupational exposure limit value and controls were conducted to this effect. On the basis of the results obtained, several corrective and preventive measures have been proposed and implemented. Conclusion: Risk assessment is essential to ensure the health and safety of workers and to meet regulatory requirements. It enables to identify all the risky manipulations and to adopt appropriate preventive measures. However, it is not a one-time activity but it must be continuous in order to master the changes and thus ensure the best safety of all.

This study addresses the impacts of metabolites from different microbial taxa on the fabrication and multifunctional biological properties of spherical silver nanoparticles (Ag-NPs). Three microbial taxa, a bacterial (Bacillus cereus A1-5), actinomycetes (Streptomyces noursei H1-1), and fungal (Rhizopus stolonifer A6-2) strains were used for Ag-NPs biosynthesis, whereas Streptomyces noursei is demonstrated for the first time. These isolates were identified using either 16S rRNA or ITS gene sequencing. Characterization of Ag-NPs was done using color change analysis, Uv-Vis spectroscopy, FT-IR spectroscopy, XRD, TEM, SEM-EDX, DLS, and Zeta potential analysis. All biosynthesized NPs exhibited spherical shape with different sizes ranged from 6‒50 nm, 6–30 nm and 6–40 nm for NPs obtained by A1-5, H1-1 and A6-2, respectively. The crystalline center cubic face of Ag-NPs was confirmed using XRD at 2θ values 38.08o, 44.27o, 64.41o and 77.36o. FT-IR analysis revealed varied intense absorption peaks for biomolecules required for NPs synthesize by each microbial strain. The stability of spherical Ag-NPs was confirmed due to highly DLS negative surface charge of ‒17.5mV, ‒18.9mV, and ‒15.6mV for NPs synthesized by strains A1-5, H1-1, and A6-2, respectively. Ag-NPs exhibited a broadspectrum of antibacterial activity against Gram-positive and Gram-negative bacteria with varied effectiveness. They also exhibited a cytotoxic effect against cancer cell line (caco-2) in a dose-dependent pattern with IC50 of 8.9 ± 0.5, 5.6 ± 3.0, 11.2 ± 0.5 μg/ml for NPs synthesized by strains A1-5, H1-1, and A6-2, respectively. Moreover, these spherical Ag-NPs showed larvicidal activity against the 3rd instar larvae of the dengue vector Aedes aegypti.

Summary: Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices. Funding: UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.

The biosynthesis of nanoparticles by microorganisms especially endophytic species isolated from medicinal plant are the prime concern of researchers. In the present study, a novel, non-toxic, eco-friendly copper nanoparticles was biosynthesized by endophytic actinomycetes isolate Ca-1 and optimization processes have been endeavored. The endophytic actinomycete Streptomyces capillispiralis Ca-1, was isolated from healthy medicinal plant (Convolvulus arvensis) (L.) collected from Bahariya Oasis - Giza Governorate – Egypt. The isolate was identified by morphological, cultural and molecular identification techniques. The biosynthesis of CuNPs is confirmed by gradual change of biomass filtrate color from light blue into greenish brown color and characterized by an observation of a characteristic absorption peak by UV-Vis spectroscopy at 600 nm. Also, a spherical-monodispersed shaped CuNPs with particle size of 3.6–59 nm were observed by Transmission Electron Microscopy (TEM). In addition, X-ray diffraction (XRD) exhibited pattern peaks corresponding to 110, 111, 200, 220, 311 and 222 planes, respectively that assigned to face centered cubic forms of metallic copper (JCPDS 04–0836). While FTIR results confirmed the occurrence of bioactive functional groups that are responsible for formation of CuNPs. Moreover, the biosynthesized CuNPs showed various biomedical applications against infectious microorganisms, biocontrol of phytopathogenic fungi and health nasty insects that represent the hopeful uses of copper nanoparticles to be applied as a unique approach to manage these healths threatening problems. Keywords: Copper nanoparticles, Endophytic actinomycetes, Streptomyces capillispiralis, Biomedical applications

Bacterial and fungal endophytes are widespread inhabitants inside plant tissues and have been shown to assist plant growth and health. However, little is known about plant growth-promoting endophytes (PGPE) of medicinal plants. Therefore, the aims of this study were to identify bacterial and fungal endophytes of Teucrium polium and to characterize plant growth-promoting (PGP) properties of these endophytes. Seven bacterial endophytes were isolated and identified as Bacillus cereus and Bacillus subtilis, where five endophytic fungi were obtained and assigned to Penicillium chrysogenum and Penicillium crustosum. The isolated endophytes differentially produced indole acetic acid (IAA) and ammonia, and in addition to their enzymatic and antimicrobial activities, they exhibited variable capacity for phosphate solubilization. In order to investigate the effect of endophytes on plant growth, four representative endophytes and their consortiums were selected concerning to their potential ability to promote plant growth. The results indicated that microbial endophytes isolated from medicinal plants possessing a vital role to improve plant growth and could be used as inoculants to establish a sustainable crop production system.

In this work a physical model has been constructed to simulate sand production from oil and gas reservoirs. The model can accommodate unconsolidated as well as consolidated sandstone cores. The experiments were designed to investigate the effect of confining pressure, flow rate, and the displacing fluid viscosity on sand production mechanism in unconsolidated sandstone formations. Saline water (3.5% NaCl by weight), light (35° API) and heavy (27° API) crude oils were used as displacing fluids in the tests. The main goal of this study was to examine if controlling of the production rate alone can solve the problem of sand production in a Saudi oil reservoir. The oil reservoir is situated in an unconsolidated sandstone formation. A produced sand sample was obtained from this reservoir. Tests were conducted on sand packs having a similar granulomere distribution to that of the reservoir.The experimental results showed that, the magnitude of sand production from the tested porous medium is strongly affected by both flow rate and confining pressure. Sand production decreases with increasing confining pressure and/or decreasing flow rate. Only very fine particles of the porous medium are produced at high confining pressures. When water, or low viscosity crude oil are saturating the porous medium, sand production problem can be managed by controlling the flow rate. In case of saturating the porous medium by heavy crude oil, sand production mechanism becomes different and therefore, controlling only the flow rate cannot stop sand production. Hence, alternative sand control measures must be applied to control sand production in heavy crude oil reservoirs such as down hole emulsification, gravel packing, screen liners, or down hole consolidation.

Natural Gas Liquids (NGL) refer to a mixture of gases that consist mostly of ethane, propane, butane and pentane. The other term which closely related to NGL is Liquified Natural Gas (LNG) which refers to methane and traces of ethane. These products can be extracted by multi-stages of compression and cooling. In addition of being the main feedstock of any petrochemical industry, NGL and LNG are used widely in the industrialized countries as a major source of energy. It is expected that their future role in both the international energy market and the petrochemical industry will continue its historical gradual growing trend.This paper presents the mathematical formulation of an economic model that was developed to optimize the production of LNG and NGL. The objective function of the model is to maximize the net cash flow return of selling LNG and NGL. The explanatory variables of the model are LNG and NGL volumes and prices, oil volume and prices, the initial costs of separators, chillers, demethanizer, compressor, partial condenser and boiler, the running cost which includes cost of refrigerants, cost of steam and other continuous operating and transportion cost. The developed model should be utilized as a useful tool to help the design of an efficient processing of natural gases. A great deal of the unlimited what if questions can be answered using this model. This paper also presents a flow sheet of the natural gas processing model. Each section of the proposed production system is presented schematically. The mathematical formulation of the computation techniques used in each section are given along with all the equation derivations.

In Egypt, the distribution of black sand in various coastal regions has been readily apparent by thorough research. Unfortunately, these investigations did not measure radioactivity in black sand, particularly in the vicinity of the Red Sea. Gamma-ray spectroscopy was used to detect the naturally occurring radioactivity from 238 U, 232 Th, 40 K, and 226 Ra in black sand samples from eight locations along the Red Sea coast: Ras Elbehar, Gemsa, Hurghada Elahiaa, Hurghada Titanic, Safaga, Qusier Elsharm Alqbly, Gabal Alrosass, and Marsa Alam. The resultant data were interpolated to represent the spatial distribution. Additionally, the potential rocks sources of radionuclides were geologically mapped to elucidate the relationship between rock components and radioactivity. The results showed that 226 Ra, 232 Th and 238 U were higher at samples collected from Ras Elbehar, Hurghada Elahiaa and Hurghada Titanic compared to the other sites. On the other hand, 40 K showed the lowest mean value (75.3 ± 3.8 Bq/kg) in Hurghada Titanic samples, while it peaked (563 ± 28 Bq/kg) in Qusier Elsharm Alqbly samples. The interpolated results show notable differences in radioactive amounts between the north and south, which are indicative of several environmental conditions and human activities. Alkaline syenite, syenogranite, older granites (tonalite and granodiorite), and minor acidic volcanic/metavolcanic rocks make up the upstream area of the basin area draining into, for example, the Ras Elbehar locality (highest activity concentrations for 238 U (1596 ± 80 Bq/kg) and 226 Ra (886 ± 44 Bq/kg)), while alkali-feldspar granite, schist, and shale rocks make up the mid-stream area. The findings provide a basis for scientific forecasting on the impact of synthetic or naturally occurring radioactive isotopes introduced into aquatic environments., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Lymphocytes are closely linked to mechanisms of action of immuno-oncology (IO) agents. We aimed to assess the prognostic significance of absolute lymphocyte count (ALC) in patients with metastatic renal cell carcinoma (mRCC)., Patients and Methods: Using the International mRCC Database Consortium (IMDC), patients receiving first-line IO-based combination therapy were analysed. Baseline patient characteristics, objective response rates (ORRs), time to next treatment (TTNT), and overall survival (OS) were compared., Results: Of 966 patients included, 195 (20%) had lymphopenia at baseline, and they had a lower ORR (37% versus 45%; P < 0.001), shorter TTNT (10.1 months versus 24.3 months; P < 0.001), and shorter OS (30.4 months versus 48.2 months; P < 0.001). Among 125 patients with lymphopenia at baseline, 52 (42%) experienced ALC recovery at 3 months, and they had longer OS (not reached versus 30.4 months; P = 0.012). On multivariable analysis for OS, lymphopenia was an independent adverse prognostic factor (hazard ratio 1.68; P < 0.001). Incorporation of lymphopenia into the IMDC criteria improved OS prediction accuracy (C-index from 0.688 to 0.707)., Conclusions: Lymphopenia was observed in one-fifth of treatment-naive patients with mRCC and may serve as an indicator of unfavourable oncologic outcomes in the contemporary IO era., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Black sand along the Red Sea is often composed of volcanic minerals and heavy minerals. The Red Sea region is known for its unique geological features, and black sand beaches can be found in various areas along its shores. The study presents a comprehensive semi-quantitative chemical analysis of black sand samples collected from various locations along the red sea, revealing significant variations in their elemental compositions. The main oxides were identified in each sample, determined through X-ray diffraction (XRD) and X-ray fluorescence (XRF) analyses, indicate diverse mineralogical compositions. The spatial distribution of minerals at each site is depicted through mapping. Additionally, Fourier-transform infrared (FTIR) spectra offer information on the functional groups present in the samples, revealing the existence of hydroxyl groups, aliphatic compounds, and adsorbed water molecules. For Qusier-Elsharm Alqbly, Safaga, Marsa Alam, Gabal Alrosass, Hurghada Titanic, Hurghada Elahiaa, Gemsa, and Ras Elbehar samples, the results highlight the presence of various minerals, such as Quartz, Calcite, Titanium Dioxide, Magnetite, Hematite, Aluminum Oxide, Zirconium Dioxide, Chromium (III) Oxide, and others, providing insights into the geological characteristics of each location. The differences in mineral content among the examined sites are linked to the geological and mineralogical makeup of the source rocks upstream and midstream in the basins that discharge into the surveyed regions. So, variations in black sand concentrations among different locations offer insights into the geological and mineralogical diversity of the studied areas along the Red Sea coast. This study addresses the existing knowledge gap by focusing on the preliminary exploration and description of the occurrence, distribution, and composition of black sand along the Red Sea in Egypt. whereas the results provide valuable insights into the geological diversity of black sand deposits in the surveyed areas, underscoring the need for additional research and interpretation of these variations. Therefore, the in-depth examination of mineralogical composition and crystal structures establishes a foundation for future investigations in the field of geology and earth sciences., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

This report describes conversion of arterio-venous graft or fistula to arterio-arterial vascular access as a new surgical treatment option for central venous occlusion. It starts with control of the axillary vein and the synthetic graft or superficialized vein proximally, the suture line of venous anastomosis is closed and end-to-side anastomosis of the synthetic graft or vein to the brachial artery (BA) is done, then ligation of the BA distal to the anastomosis is done. Now the blood flow is directed through synthetic graft or vein from proximal to distal BA that can be used as arterio-arterial vascular access for hemodialysis., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: Rates of maternal syphilis have increased five-fold in Brazil in the past decade. While penicillin remains the only appropriate treatment for maternal syphilis, we hypothesized that low non-treponemal titers (<1:16) may lead to reduced penicillin treatment in Brazil., Methods: Using Brazilian Ministry of Health data on women diagnosed with maternal syphilis between January 1, 2010, and December 31, 2018, we conducted a random-effects logistic regression model with a cluster correction at the state level to evaluate predictive factors of penicillin treatment., Results: We observed yearly increases in cases of pregnant women with syphilis from 2010 to 2018. There was significant variation by state: 52,451 cases were reported in São Paulo, followed by 26,838 in Rio de Janeiro. Among 215,937 cases of maternal syphilis, 91·3% received penicillin. In the random-effects model, a non-treponemal titer ≥1:16 was associated with 1·44 higher odds of receiving penicillin (95% confidence interval [CI]: 1·391·48), and prenatal care was associated with a 2·12 increased odds of receiving penicillin (95% CI: 2·022·21). Although there is an association between the absence of prenatal care and inadequate treatment for syphilis, 83·2% of women in this cohort who did not receive penicillin were engaged in prenatal care., Conclusions: Providers may inappropriately exclude low non-treponemal titers and thereby fail to use penicillin treatment in maternal syphilis. While the cause of the maternal syphilis epidemic in Brazil is multifactorial, we believe our findings can be used to develop targeted interventions throughout Brazil as well as shape public health initiatives globally., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Osteosarcoma (OS) is an aggressive malignant bone neoplasm that occurs mostly in the appendicular skeleton of dogs and people. OS is classified based on the presence of malignant stroma and the formation of extracellular matrix into osteoblastic, chondroblastic and fibroblastic forms. This study investigated the correlation between the three histological subtypes of canine OS and clinical outcome. Additionally, we examined whether there was any difference in the immunolabelling of desmin, S100 and neuron-specific enolase (NSE) between the three histological subtypes. Formalin-fixed and paraffin wax-embedded tissues from 87 dogs with primary OS were available for this study. The survival times were correlated with appendicular OS subtypes in dogs that were treated surgically, received adjuvant chemotherapy and had no pulmonary metastasis at the time of diagnosis. Dogs with an appendicular fibroblastic OS had significantly prolonged mean average survival times (546 ± 105 days) in comparison with dogs having appendicular osteoblastic (257 ± 48 days) or appendicular chondroblastic (170 ± 28 days) OS (P = 0.003, Log Rank). The results also revealed that the appendicular chondroblastic subtype is a significant indicator for poor prognosis in dogs compared with the fibroblastic or osteoblastic subtypes (P = 0.006, Cox regression). Moreover, the findings indicated that there was no significant correlation between the localization of desmin, NSE or S100 and histological subtypes. Importantly, dogs with appendicular fibroblastic OS were found to have a better prognosis when compared with dogs with other subtypes. This may suggest that histological subtypes of appendicular OS have diverse behaviour and could be used to categorize patients for risk-based assessment., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Nano-cryptomelane was prepared and characterized using SEM with mapping, HRTEM, FT-IR spectra, thermal analysis and surface area. The diameter distribution of nano-cryptomelane was found to be 4-6 nm. Sorption performance of the prepared material was studied for the removal of Co 2+ , Cs + and Pb 2+ from a multi-system solution of equal molar ratio, 1:1:1. The sorption capacity of nano-cryptomelane was found to be 179.6, 442.6 and 716.9 mg/g for Co 2+ , Cs + and Pb 2+ , respectively. The kinetic studies revealed that the sorption process obeys non-linear pseudo-second-order model and is controlled by an intra-particle diffusion mechanism. The equilibrium isotherm investigations outlined that the extended Langmuir isotherm model fits the data reasonably well and it is more applicable than Freundlich multicomponent sorption isotherm. The value of diffusion coefficient for the three metal ions is in the order 10 -17  m 2 /s which indicates the chemisorption nature of the process. The desorption percentage attains the maximum value (98.13%, 97.29 and 97.04 for lead, cesium and cobalt ions, respectively) using 0.7 mol/L of HNO 3 . This revealed that nano-cryptomelane can be regenerated and reused for farther sorption of Pb 2+ , Cs + and Co 2+ from wastewater., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Osteosarcoma (OS) originates from bone-forming mesenchymal cells and represents one of the primary bone tumours. It is the most common primary bone tumour in dogs and man. The characterization of an appropriate natural disease animal model to study human OS is essential to elucidate the pathogenesis of the disease. This study aimed to validate canine OS as a model for the human disease by evaluating immunohistochemically the expression of markers known to be important in human OS. The immunohistochemical panel included vimentin, alkaline phosphatase (ALP), desmin, S100, neuron-specific enolase (NSE), runt-related transcription factor 2 (Runx2) and bone morphogenetic protein 4 (BMP4). Immunohistochemistry was conducted on formalin-fixed, paraffin wax-embedded tissue sections from 59 dogs with confirmed primary OS. Vimentin, ALP, Runx2 and BMP4 were highly expressed by all tumours, while desmin, S100 and NSE were expressed variably. The findings were similar to those described previously for human OS and suggest that canine OS may represent a useful model for the study of the human disease., (Copyright © 2017. Published by Elsevier Ltd.)

Canine mixed mammary tumours (CMMTs) and human metaplastic breast carcinomas (HMBCs) share several histopathological features and risk factors. In both species, these tumours display epithelial and stromal components. HMBCs are rare malignant tumours, but CMMTs are one of the most common mammary tumours in dogs and are more often benign than malignant. In this study, benign (n = 88) and malignant (n = 13) CMMTs were characterized using specific antibodies against oestrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, cytokeratin 5/6, cytokeratin AE1/AE3, vimentin, Ki67, E-cadherin and p63. Cartilage and bone matrices associated with benign and malignant CMMTs were characterized using specific antibodies against BMP4, Runx2, Sox9 and osteopontin. The current study suggested that CMMTs are of epithelial origin, but display a myoepithelial-like differentiation. The findings suggest key roles for Sox9, Runx2 and BMP4 in chondrogenesis and bone formation in CMMTs. The high expression of osteopontin in CMMTs appears to be unrelated to tumour malignancy., (Copyright © 2017. Published by Elsevier Ltd.)

Study Objective: Compare the effectiveness of nerve stimulator-guided pudendal nerve block (PNB) vs general anesthesia (GA) for anterior and posterior (AP) colporrhaphy in terms of pain relief and analgesic consumption within 24 and 48 hours postoperatively., Design: Prospective randomized trial., Patients: Fifty-seven patients whose ages ranged between 20 and 53 years scheduled to undergo AP colporrhaphy due to the presence of cystorectocele., Interventions: Patients were randomly assigned into 2 groups receiving either nerve stimulator-guided PNB (n = 28) or GA (n = 29). A total volume of 0.7 mL/kg of the local anesthetic mixture was injected at 4 sites., Main Results: Both groups were similar with respect to age, weight, height, and surgery duration. There was a significant difference in average pain scores within the first and second postoperative days (P values = .005 and .004, respectively). Total analgesic consumption (ketoprofen and tramadol) was significantly lower in the PNB within the first (P values = .018 and .010) and second postoperative days (P values = .041 and .011), respectively. Return to normal daily activity was significantly (P< .0001) shorter in the PNB group compared with the GA group (3.6 days vs 12.2 days). A total of 71.4% of the patients in the PNB group were satisfied compared with 27.8% in the GA group (P< .0001). Surgeon satisfaction was significantly higher in the PNB group (82.1% vs 34.5%, P< .0001)., Conclusion: This randomized controlled trial demonstrated that nerve stimulator-guided PNB could be used as an alternative to GA for AP repair of stages I and II prolapse because it is associated with less postoperative pain and analgesic consumption, in addition to shorter duration of recovery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Vascular access has always been the Achilles heel of hemodialysis. Advances in health care have brought forward patients requiring treatment who have no veins suitable for creation of arteriovenous fistula (AVF) or insertion of central venous catheters. Use of an artery as permanent vascular access has been reported by many authors. This study reports brachial AAPL as an efficient and safe access for hemodialysis patients with central venous occlusion., Methods: Between January 2011 and December 2014, 35 brachial arterio-arterial prosthetic loops (AAPL) were created. The age of patients ranged between 27 and 72 years, with a mean age of 52.8 years., Results: The primary patency rates were 87.9%, 70.4%, and 38.8% at 12, 24, and 36 months, respectively. The secondary patency was 90.7%, 80.3%, and 67.6% at 12, 24, and 36 months, respectively, after successful thrombectomy in seven cases., Conclusion: Mid-term follow-up results demonstrate patency rates comparable with those of the synthetic AVF. The rate of complications, although slightly higher than that with traditional synthetic AVF, is still acceptable in this population with no option for access., (Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

There is an ongoing debate about the relative merits of overall survival (OS) and other metrics that can be used as primary end points in cancer clinical trials. Although survival time is arguably the most objective metric for assessing the efficacy of anticancer treatment, OS as a clinical-trial end point needs to be conceptually distinguished from increased survival time as a goal desired by patients, clinicians and public-health policy makers. OS presents several drawbacks as a primary end point that threatens to hamper further drug development, including the increase in the number of patients and the much longer follow-up required in a clinical trial. In many settings of first-line therapy for metastatic disease, median OS is currently two to four times longer than median progression-free survival. As a result, the analysis of OS may be increasingly confounded by the effect of salvage therapies used after disease progression. In this review, we use straightforward statistical reasoning and examples from the oncology literature to argue that OS should no longer be the primary end point of most future phase III cancer clinical trials that aim at assessing the efficacy of novel therapies in the setting of metastatic disease., (© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: In early breast cancer, adjuvant chemotherapy decreases the risks of recurrence and breast cancer mortality, and neoadjuvant treatment leads to equivalent long-term outcomes. A large number of clinical trials have attempted to refine systemic therapeutic strategies in early breast cancer, but little attention has been paid to the sequence of anthracyclines and taxanes. Based on preclinical observations, there is limited rationale to administer the taxane before the anthracycline., Methods: We searched PubMed, the American Society of Clinical Oncology website, and clinicaltrials.gov with the goal of identifying published or ongoing studies that aimed at comparing reverse sequences of anthracyclines and taxanes. Given the nature and the small number of studies identified, we did not attempt to quantitatively pool the study results., Results: We retrieved seven studies in the adjuvant setting and eight in the neoadjuvant setting: 10 randomized trials (only 2 were phase IIII), 3 retrospective studies, and 2 ongoing phase II trials. A total of nearly 5000 patients were included in such studies. None of the clinical trials has shown disadvantages in terms of efficacy or toxicity for sequences in which the taxane was administered first. In the neoadjuvant setting, studies have collectively shown similar or increased pathological complete response rates for sequences in which the taxane was administered first., Conclusion: Given the available information, there seems to be sufficient evidence to suggest that a taxane followed by an anthracycline is a sequence option that can be incorporated into daily clinical practice., (© The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

A series of organo-modified nanoclays was synthesized using three different surfactants having different alkyl chain lengths and concentrations [0.5-5.0 cation exchange capacity (CEC)]. These surfactants were Ethanolamine (EA), Cetyltrimethylammoniumbromide (CTAB) and Tetraoctadecylammoniumbromide (TO). The obtained modified nanoclays were characterized by X-ray diffraction (XRD), Fourier Transform Infrared spectroscopy (FTIR) and Scanning electron microscopy (SEM) and compared with unmodified nanoclay. The results of XRD analysis indicated that the basal d-spacing has increased with increasing alkyl chain length and surfactant concentration. From the obtained microstructures of these organo-modified nanoclays, the mechanism of surfactant adsorption was proposed. At relatively low loading of surfactant, most of surfactant entered the spacing by an ion-exchange mechanism and is adsorbed onto the interlayer cation sites. When the concentration of the surfactant exceeds the CEC of clay, the surfactant molecules then adhere to the surface adsorbed surfactant. Some surfactants entered the interlayers, whereas the others were attached to the clay surface. When the concentration of surfactant increased further beyond 2.0 CEC, the surfactants might occupy the inter-particle space within the house-of-cards aggregate structure., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Obstructive azoospermia constitutes 35 to 40% of azoospermia. Etiologies may be acquired or rarely congenital. Congenital utricular or Mullerian duct cyst may result in compression of ejaculatory ducts. However, they must be differentiated from exceptional wolffian or urogenital cysts, which are located at the same site but in which ejaculatory ducts may drain inside. We report a case of retroprostatic duct cyst diagnosed during work up of male infertility where magnetic resonance imaging (MRI) showed the drainage of both ejaculatory ducts inside and the presence of a thin canal ended blindly in the wall of prostatic urethra. Transurethral resection guided by MRI has been performed resulting in urethral drainage of the cyst, relieving of obstruction and normalization of spermogramm., (Copyright © 2013. Published by Elsevier SAS.)

The luminescence arising from lanthanide cations offers several advantages over organic fluorescent molecules: sharp, distinctive emission bands allow for easy resolution between multiple lanthanide signals; long emission lifetimes (μs-ms) make them excellent candidates for time-resolved measurements; and high resistance to photo bleaching allow for long or repeated experiments. A time-resolved (gated) luminescence-based method for determination of pesticides methomyl, aldicarb and prometryne in microtiterplate format using the long-lived terbium-3-carboxycoumarin in 1:3 metal:ligand ratio has been developed. The limit of detection is 1.20×10(6), 5.19×10(5) and 2.74×10(6)ng L(-1) for methomyl, prometryne and aldicarb, respectively. The quantum yield (QY=0.08) of Tb(III)-3-carboxycoumarin was determined using 3-(2-benzothiazolyl)-7-diethylamino-coumarin (coumarin 6). Stern-volmer studies at different temperatures indicate that collisional quenching dominates for methomyl, aldicarb and prometryne. Binding constants were determined at 303, 308 and 313 K by using Lineweaver-Burk equation. A thermodynamic analysis showed that the reaction is spontaneous with negative ΔG. Effect of some relevant interferents on the detection of pesticides has been investigated., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: The American Society of Clinical Oncology Annual Meeting is the largest forum for presentation of clinical research in oncology. We quantified the contribution of countries and assessed correlates of their presence at such meetings., Methods: After stratifying abstracts according to category of presentation (oral, poster, and 'publication only'), we took a random sample of 10% of the studies presented at years 2001-2003 and 2006-2008. We assigned abstract nationality using the affiliation of authors. For multinational studies, we developed an algorithm to assign nationality., Results: Of the 22 045 eligible abstracts, 2206 were analyzed and represented 71 countries: 905 (41%) abstracts were from a single institution, 969 (44%) were multicenter, uninational studies, and 332 (15%) were multinational studies. United States nationality was assigned to 49% of all abstracts and the next 14 countries with a higher number of studies accounted for 41%. There was a statistically significant temporal trend in the proportion of multinational studies. Also, multinational studies and abstracts with United States nationality were more frequently presented in oral and poster fashion and had more frequent involvement of the pharmaceutical industry., Conclusion: This study provides a geographic overview of clinical cancer research and indicates that multinational collaboration is increasing.

Significant achievements in the systemic treatment of both advanced breast cancer and advanced colorectal cancer over the past 10 years have led to a growing number of drugs, combinations, and sequences to be tested. The choice of surrogate and true end points has become a critical issue and one that is currently the subject of much debate. Many recent randomized trials in solid tumor oncology have used progression-free survival (PFS) as the primary end point. PFS is an attractive end point because it is available earlier than overall survival (OS) and is not influenced by second-line treatments. PFS is now undergoing validation as a surrogate end point in various disease settings. The question of whether PFS can be considered an acceptable surrogate end point depends not only on formal validation studies but also on a standardized definition and unbiased ascertainment of disease progression in clinical trials. In advanced breast cancer, formal validation of PFS as a surrogate for OS has so far been unsuccessful. In advanced colorectal cancer, in contrast, current evidence indicates that PFS is a valid surrogate for OS after first-line treatment with chemotherapy. The other question is whether PFS sufficiently reflects clinical benefit to be considered a true end point in and of itself.

Background: The growing availability of active agents makes the development of novel therapies increasingly complex and the choice of end points critical. We assessed the frequency of use of efficacy end points in advanced breast cancer., Methods: We searched PubMed for randomized trials published between 2000 and 2007 in 10 leading medical journals. We abstracted data on progression-free survival (PFS), time to tumor progression (TTP), response rate (RR) and overall survival., Results: A total of 58 studies enrolled 23,371 assessable patients in 122 treatment arms. The primary end points most frequently used were RR and TTP (n=21 each), followed by PFS (n=14). In five of the trials using TTP as the primary end point, no definition of TTP was reported; in 13 of the other 16 cases, death was counted as an event, making TTP indistinguishable from PFS. Trials having PFS, TTP or time to treatment failure as the primary end point (n=36) had a higher mean number of patients than those using RR (P=0.061)., Conclusion: Investigators seem to be frequently using PFS and TTP interchangeably in advanced breast cancer. Such use of terms may lead to confusion when results of different trials are compared, and uniform use of definitions seems in order.

The retention profile of uranium (VI) as uranyl ions (UO(2)(2+)) from the aqueous media onto the solid sorbent date pits has been investigated. The sorption of UO(2)(2+) ions onto the date pits was achieved quantitatively (98+/-3.4%, n=5) after 15 min of shaking at pH 6-7. The sorption of UO(2)(2+) onto the used sorbent was found fast, followed by a first order rate equation with an overall rate constant, k of 4.8+/-0.05 s(-1). The sorption data were explained in a manner consistent with a "solvent extraction" mechanism. The sorption data were also subjected to Freundlich isotherm model over a wide range of equilibrium concentration (1-20 microgmL(-1)) of UO(2)(2+). The results revealed that, a "dual-mode" of sorption mechanism involving absorption related to "solvent extraction" and an added component for "surface adsorption" is most likely operated simultaneously for uranyl ions uptaking the solid sorbent. The thermodynamic parameters (-DeltaH, DeltaS and DeltaG) of the uranyl ions uptake onto the date pits indicated that, the process is endothermic and proceeds spontaneously. The interference of some diverse ions on the sorption UO(2)(2+) from the aqueous media onto the date pits packed column was critically investigated and the data revealed quantitative collection of UO(2)(2+) at 5 mLmin(-1) flow rate. The retained UO(2)(2+) was recovered quantitatively with HCl (3.0 molL(-1)) from the column at 5 mLmin(-1) flow rate. The mode of binding of the date pits with UO(2)(2+) was determined from the IR spectral date bits before and after extraction of uranium (VI). The height equivalent (HETP) and the number (N) of theoretical plates of the date pits packed column were determined from the chromatograms. Complete retention and recovery of UO(2)(2+) spiked to wastewater samples by the date pits packed column was successfully achieved. The capacity of the used sorbent towards retention of uranium (VI) from aqueous solutions was much better than the most common sorbents.

Background: Although pulmonary vein (PV) antrum isolation is effective in curing atrial fibrillation (AF) in a variety of heart diseases, results in patients with hypertrophic obstructive cardiomyopathy (HOCM) have not been reported., Objectives: The purpose of this study was to report the results and outcome of PV antrum isolation in patients with AF and HOCM., Methods: Data from patients with AF and HOCM who underwent PV antrum isolation between February 2002 and May 2004 were analyzed retrospectively. An intracardiac echocardiographic-guided ablation technique with an 8-mm-tip catheter was used in all patients. Patients were followed in the outpatient clinic at 3, 6, and 12 months after ablation., Results: Twenty-seven patients with AF and HOCM (mean age 55 +/- 10 years) underwent PV antrum isolation. Mean AF duration was 5.4 +/- 3.6 years. AF was paroxysmal in 14 (52%), persistent in 9 (33%), and permanent in 4 (15%). During a mean follow-up of 341 +/- 237 days, 13 patients (48%) had AF recurrence. Of these patients, five maintained sinus rhythm (SR) with antiarrhythmic drugs, one patient remained in persistent AF, and seven patients underwent a second PV antrum isolation. After the second PV antrum isolation, five patients remained in SR, giving a final success rate of 70% (19/27). Two patients had recurrence after second PV antrum isolation; one maintained SR with antiarrhythmic drugs and one remained in persistent AF., Conclusion: Compared with previously reported results in patients with lone AF, AF recurrence after the first PV antrum isolation is higher in patients with HOCM. However, after repeated ablation procedures, long-term cure can be achieved in a sizable number of patients. PV antrum isolation is a feasible therapeutic option in patients with AF and HOCM.

Objectives: The goal of this study was to assess the safety and efficacy of pulmonary vein antrum isolation in patients with moderate valvular heart disease or open-heart surgery and atrial fibrillation (AF)., Background: Valvular heart disease and open-heart surgery are commonly associated with AF and increase the risk of adverse events in AF patients., Methods: A total of 391 consecutive patients who had pulmonary vein antrum isolation performed between December 2000 and December 2002 were screened. A total of 142 of these patients had clinically significant valvular disease or prior cardiac surgery. End points included AF recurrence and pulmonary vein antrum isolation complication rates., Results: Patients with valvular heart disease or prior open-heart surgery were older, had larger left atria and a more advanced New York Heart Association class. They did not differ significantly with respect to gender, but had a longer history of AF. Procedure times were similar between patients with and without valvular heart disease or prior open-heart surgery. After 18 +/- 7 months in the lone AF patients, 11 +/- 5 months in patients with valvular heart disease, and 10 +/- 5 months in patients with prior open heart surgery, there was a trend toward lower recurrence of AF in patients with lone AF who enjoyed a 98% overall cure rate after up to 2 pulmonary vein antrum isolations versus 93% among patients with valvular heart disease (P = .04) and prior open heart surgery (P = .07). Complication rates were comparable between groups., Conclusions: Pulmonary vein antrum isolation is safe and effective in patients with moderate valvular heart disease and the patients who developed AF after open-heart surgery. These results have implications for our understanding of the pathophysiology of AF in patients with moderate valvular heart disease or past cardiac surgery and should be considered when discussing treatment options in these patients.

Background: Mitral valve operations require excellent exposure. The description of an extended vertical transseptal atriotomy by Guiraudon and associates promises to provide optimal exposure of the mitral valve. A prospective study was carried out to evaluate the merits of the extended vertical transseptal atriotomy in comparison with the conventional left atriotomy for mitral valve operations., Methods: Conventional atriotomy was performed in 24 patients (group I) whereas 65 patients underwent the extended vertical transseptal offroach (group II). They were similar in age, sex, cause of disease, New York Heart Association functional class, left atrial size, and left ventricular function. The early postoperative rhythm changes in these two groups were compared. Statistical studies to analyze the significance of incidence of junctional arrhythmia in these two groups were carried out., Results: Of the 24 patients in group I, 3 had development of transient junctional rhythm after operation, lasting less than 24 hours. None had this arrhythmia at the time of discharge. Of the 65 patients in group II, junctional rhythm was documented in 25, with a rate of occurrence of 38% (95% confidence interval, 27.6% to 52.2%). At the 6-week follow-up, 3 patients still had this junctional rhythm, with a failure to recover rate of 12% (3 of 25)., Conclusions: The surgical exposure was considered excellent and closure of the atriotomy was thought to be easy in group II. However, this should be balanced against a significant (38%) incidence of transient junctional rhythm in the early postoperative period in group II, probably from injury to sinus node artery or atrial conduction pathways.

Valve replacement still represents a problem in the very young patient. Between July 1988 and November 1993, 96 CarboMedics mechanical valves were implanted in 75 patients with a mean age of 11.76 years (range, 5 months to 20 years). The mean preoperative New York Heart Association functional class was 3.2, and 89.3% of the patients were in sinus rhythm. The cause was rheumatic in 60%, congenital in 24%, and infective in 12%. Mitral valve replacement was undertaken in 43 patients, aortic in 11, and mitroaortic in 21. Among the 18 patients with congenital defects, 13 required simultaneous repair of their complex lesions. The hospital mortality was 12% (9 patients). Cause and age were significant factors responsible for mortality. The mortality was 27.8% for patients with congenital disease and 6.7% for those with rheumatic defects (p = 0.0365); it was 40% for patients younger than 2 years, 14.3% for those between 3 and 10 years old, and 5.9% for those older than 10 years (p = 0.0108). The maximum follow-up was 54 months (mean, 18 months). There were 10 late deaths (15.15%). No embolic events occurred. All patients were on anticoagulation therapy except 2 who were on antiaggregant therapy. One of them underwent successful reoperation for treatment of mitral prosthetic thrombosis. Three reoperations were performed: one for thrombosis, one for perivalvular leak, and one for endocarditis. The total actuarial survival was 68.19% +/- 7.02%. Freedom from embolism was 100%; from thrombosis, 96.72% +/- 3.22%; from severe hemorrhage, 94.94% +/- 3.67%, and from reoperation, 83.07% +/- 9.51%.

Purpose: This article reports our experience with externally supported, preclotted knitted Dacron grafts in femoropopliteal bypass., Methods: This is a retrospective analysis of a consecutive series of 154 patients who received 200 grafts (175 above knee and 25 below knee). Follow-up extended to 12 years (mean 59 1/2 months)., Results: Primary patency rates for the entire series were 75%, 70%, and 47% at 3, 5, and 10 years, respectively. Above-knee grafts had 76%, 71%, and 50% rates and 3, 5, and 10 years, respectively. Below-knee grafts had 65% and 57% at 3 and 5 years, respectively. Limb-salvage rates were 87%, 79%, and 73% at 3, 5, and 10 years, respectively, for the 57 limbs operated on because of critical ischemia. The most significant predictor of graft failure was poor runoff as determined by preoperative arteriography. The effect of poor runoff was most pronounced in the first 3 months., Conclusion: Externally supported, preclotted knitted Dacron grafts provide encouraging primary patency rates for above-knee femoropopliteal bypass. Poor leg vessel runoff is a major determinant of early graft failure.

Purpose: Our purpose was to evaluate whether a method for quantification of platelet aggregability will predict failure of knitted Dacron femoropopliteal bypass grafts., Methods: A numerically derived platelet aggregation (PA) score, based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 femoropopliteal bypass grafts with preclotted, 6 mm, externally supported knitted Dacron grafts from 1981 to 1991 (mean follow-up 50 months). The preoperative score was found to remain stable after surgery, enabling the use of postoperative values when preoperative values were not available. The PA score was available in 19 patients (23 grafts) before surgery and 23 patients (30 grafts) after surgery. The following factors were analyzed for predicting graft failure by the Cox proportional hazards regression model: PA score, age, gender, history of smoking, coronary artery disease, hypertension, hyperlipidemia, cerebrovascular disease, diabetes, claudication versus limb salvage, site of the distal anastomosis, previous ipsilateral bypass, and state of the runoff as determined by preoperative angiography., Results: Of the studied risk factors, the value of the PA score was the most significant predictor of graft closure (p < 0.0001). An increase of 10 units was associated with an increased relative risk of 2.02. Throughout the follow-up period, 15 of 16 grafts remained patent in patients with a PA score of 15 or less, but only 2 grafts out of 17 remained patent in patients with a PA score of 30 or greater., Conclusions: These data suggest that the PA score is a potential risk factor for failure of femoropopliteal bypass with externally supported knitted Dacron grafts.

Purpose: The purpose of this study was to review our experience with externally supported, knitted Dacron grafts used for axillofemoral bypass., Methods: Retrospective analysis was performed on records of 79 consecutive axillofemoral bypass graft operations performed on 77 patients from January 1978 to April 1990., Results: The mortality rate within 30 days of operation was 5% (four of 79); 36 patients died in the follow-up period; none died of graft causes. During this 12-year period (mean follow-up 42 months) three patients were unavailable for follow-up. The primary patency rate was 78% at 5 years and 73% at 7 years, with no change thereafter. Neither the graft configuration (i.e., axillounifemoral [n = 50] vs axillobifemoral [n = 29]) nor patency of the superficial femoral artery had an impact on the primary patency rate. Patients who underwent surgery for disabling claudication (n = 30 grafts) had a primary patency rate of 80% at 6 years compared with 65% at 6 years for those who required surgery for limb salvage (n = 49 grafts); the difference was not significant (p = 0.37). Actuarial survival of patients with axillofemoral grafts was 23% at 10 years compared with 72% in a concurrent population of patients with aortofemoral bypass (p < 0.001)., Conclusion: These findings indicate that axillofemoral bypass grafts may be appropriate for high-risk patients with severe aortoiliac disease who require revascularization for either limb salvage or incapacitating claudication.

The stability of methionine enkephalin (M-E) during long term storage was investigated using various anticoagulants and enzyme inhibitors, eg EDTA, heparin, trasylol, citric acid. Plasma was stored for different lengths of time up to six weeks. High pressure liquid chromatography (HPLC) was used to separate and quantify M-E. We found that EDTA, heparin or trasylol per se are ineffective in preserving M-E for short term extraction. Blood collected in chilled heparin tubes with citric acid crystals and the plasma further acidified with hydrochloric acid gave the highest recovery. With storage times up to six weeks further degradation was marked in samples taken in plain tubes but did not occur with tubes containing citric acid crystals and hydrochloric acid.