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We present here a case of a symptomatic chest injury with a nail gun causing a delayed occurrence of coronary artery fistula to the left pulmonary artery presenting with unstable angina 4 years after the initial injury, three of which were symptom-free. The patient underwent successful surgical closure of the fistula and removal of the foreign body.

Artificial Neural Networks, ANN, technique is a computerized system that is built to simulate the neural networks in the human brain. Throughout the recent couple decades, ANNs had solved with a good degree of success many problems. In the present work, ANN model was developed by SPSS software for estimating creep strain development of self-compacting concrete mixes produced with different types of Portland cement, Type I and Type IL. The independent variables in this model were: age, compressive strength, modulus of elasticity, applied stress, initial strain, water to powder ratio, water to binder ratio, filler to cement ratio, clinker to cement ratio, aggregate size, and slump flow. The used data for model building were local, extracted from the present work. The predictions of the model have been compared to those of an international well-known model, ACI 209 Committee. The comparison revealed the good reliability of the present models in predictions (r = 0.998). http://dx.doi.org/10.30572/2018/kje/100207

Background: Many types of infection can cause pus Infections involving the bacteria; E.coli, so the assessment of multidrug Bacterial profile and patterns is needed to understand the source and management of these injuries. Purpose: To determine infections and patterns toward antibiotics of pus isolates and recurrent wound infections in nongovernmental hospitals of Jordan Methods: During period eleven months, 607 Patients were involved, out of which 128 patients had pus samples and/or recurrent wound infections. Data analysis was done using SPSS version 20. P value was set at

In this paper a quarter-vehicle full-scale suspension test rig was designed and manufactured,the suspension is considered semi-active as the electrohydraulic (EH) damper used is fullycontrolled. This gives an indoor-based simulation tool which is important for vehicle testing;.This reduces the cost significantly with accurate results, especially when designing a newsuspension system. The aim of the current work was to build a new quarter-vehicle test rigwith expandable capabilities for diverse design objectives, also may be used for academicpurposes. The control objective was achieved by using dynamic characteristics of theelectrohydraulic (EH) damper to suppress the oscillation of the sprung mass due to roadirregularities. The test rig was constructed using a Genesis G80 (2016) suspension system.Finally, the simulation results demonstrated that the proposed controller used be able toefficiently regulate the chassis vertical oscillation under these irregularities. The experimentalresults for the quarter-car model showed good results between experimental and simulatedresults, where the proportion of conformity about 95%

Background: Eye disease is a major public concern and is considered as part of natural aging. Promoting the knowledge of eye disease’s symptoms and risks could decrease the burden of eye problems and achieve an effective treatment. Therefore, we conducted this study to assess the knowledge, attitudes, and self-care practices associated with age-related eye disease (ARED) among the general population in Saudi Arabia. Methodology: A cross-sectional study was conducted among 1,700 participants in Saudi Arabia. An online well-constructed questionnaire was disseminated and self-administered by each participant via e-mail. The data were analyzed using Statistical Package for the Social Sciences version 22. Frequency and percentages were presented in tables for the qualitative data. Univariate odds ratios with a 95% confidence interval were calculated to show the strength of the association between correct knowledge of AREDs and socio-demographic factors. Results: Among the 1,700 participants, 59% were female and 41% were male, with a mean age of 35.6 ± 7 years. Almost 85% of the participants had a proper knowledge of glaucoma, 70% knew of cataract, and 56% knew of age-related macular degeneration (AMD). The majority (94%) provided correct knowledge of glaucoma, 90% of AMD, and 60% could correctly define cataract. Age, education, positive family history, and last visit to an eye practitioner were highly associated with a high level of Saudi population’s knowledge toward ARED. Conclusion: Most participants had an adequate level of awareness regarding AREDs. The highest proportions of the population had a good knowledge of glaucoma, followed by cataract and AMD. Most of the participants provided correct knowledge of glaucoma, followed by AMD and then cataract disease. Age, educational level, positive family history, and last visit to an eye practitioner were the common factors that impacted the level of knowledge toward ARED.

Time-series data can play a significant role in designing useful applications. One can be the collection of mobile sensor data for biometric-based access protection using behavioral information to identify if the user’s access is intentional or spoofed. Such application can be very useful in protecting the victim’s data from being compromised (e.g., the device locks automatically in response). However, identification of correct features and a useful machine learning algorithm can impose limitations on achieving reliable accuracy for use in real-life applications. In a previous work, a novel method was used to extract descriptive numerical features (FAST18) and then transform the features into unique image representations using feature to image transformation (FIT) algorithm, for convolutional neural network (CNN) classification. That work covered intentional and spoofed access classification. In this work, we investigated the problem by introducing more classes, including three intentional (normal, angry, and sad) and two spoofed (forced and asleep). We reported accuracy and true-positive-rate for individual users and all users. Results show high distinction between intentional and spoofed categories, confirming reliability of protection against malicious access behaviors. In addition, the three intentional behaviors were reasonably separated, but with lower accuracy. When training was restricted to three classes (normal, forced, and asleep), accuracy exceeded 95% with small overlap between forced and asleep. Extending the fingerprint application demonstrates the FAST18-FIT method strength and reliability to test other applications, including the study of behaviors and emotion-based actions through utilizing EEG brain signals.

In this work, we have tested time-series classification for UCR archive signals covering 85 datasets. The original competition conducted in 2018 was between 9 algorithms. We used frequency and amplitude-based series timed signals feature extraction algorithm with 16 and 10 features (FASTn), followed by the feature to image transformation algorithm (FIT). Generated images were fed to a CNN classifier. The combined FAST-FIT algorithm achieved 3rd rank under initial settings before optimizations. Performance improved with increased difficulty of the sets yielding a better rank for the hardest 32 sets. When we added some optimization to the FAST feature extraction and improved the images fed to the CNN by adding the signal 2D image, FAST-FIT ranked 1st running on 14 randomly selected sets of the most difficult 32. Scaling from that, we envision to get more reliable and stable rank over the full list. This result promises systematic FAST-FIT algorithm achievement with CNN, where it can be used extensively for diverse input signals including ones with variable time length in 2–3 dimensions, while robustness grows better with problem difficulty. We are finalizing the UCR test by more extensive feature representations that include Fourier transformed signals and refinements of signal segmentation. Possible extensions to this work include classification of medical signals, and experiments where real-time classification is complex.

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Information on the prevalence of SARS-CoV-2 antibodies in women and children in Madinah has been limited. The current study aimed to evaluate SARS-CoV-2 IgG seropositivity among women and children at Madinah Maternity and Children’s Hospital. Methods: In this cross-sectional study, 579 participants were recruited between January and April 2021 from Madinah Maternity and Children’s Hospital, Saudi Arabia. Data concerning age, sex (for children), blood group, and height and weight (for women) were collected from the hospital database. SARS-CoV-2 anti-spike (anti-S) IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA). Results: Over 58% of children (n = 195), including 60% of children ≤1 year (n = 75), and 50.2% (n = 124) of women were SARS-CoV-2 anti-S IgG seropositive. Significantly higher anti-S IgG levels were observed in children than in women (0.78 ± 1.05 vs. 0.65 ± 0.98, p = 0.008). Compared with women, children had higher odds of high SARS-CoV-2 anti-S IgG levels (odds ratio: 1.41, 95% confidence interval: 1.01–1.97, p = 0.041). No significant associations were observed for anti-S IgG levels with age in women or children or with body mass index among women. Conclusion: Non-reported COVID-19 infections were more prevalent among children than women, and non-reported COVID-19 infections children represent a viral transmission risk, therefore, increased screening, especially among school-aged children, may represent an important COVID-19 preventive control measure.

This study assessed if race and gender predict known sexual risk factors associated with HPV. Data (n = 301) were from a cross-sectional study conducted at a drag racing event on September 12–13, 2015 in Madison, Illinois. Both multivariable logistic and linear regression models estimated the association between race, gender, and sexual risk factors. About 63% of participants were males, and 65% identified as Blacks. Compared to females, males were more likely to have a higher number of oral sexual partners (OR = 2.10; 95% CI: 1.23, 3.57). Males were also more likely to have earlier oral sexual (b = −2.10; 95% CI: −3.60, −0.60) and vaginal sexual (b = −1.10; 95% CI: −1.69, −0.31) debuts compared to females. Blacks were more likely to have higher number of vaginal sexual partners (OR = 3.38; 95% CI: 1.81, 6.31) and earlier vaginal sex (b = −1.09; 95% CI: −1.78, −0.41) but less likely to have earlier oral sexual debuts compared with Whites (b = 2.67; 95% CI: 1.21, −4.13). Because HPV is associated with several cancers, our findings provide impetus for the development of targeted educational interventions aimed at improving the knowledge of these sexual risk factors, especially among men and across race groups.

Background: Low back pain is the most common health problem in men and women between the ages of 20 and 50 years. The lumbar disc prolapse has a major role in this condition. Treatment is either conservative or surgical. The most common surgical interventions are either laminectomy or interlaminar approach. Objective: To determine which is the best surgical approach for the patient according to his/her type of disc herniation. Patients and methods: A comparative clinical study conducted in the Neurosciences Hospital, Baghdad, Iraq from January 2016 to January 2018. In this paper we evaluated the clinical outcome following both approaches Results: We studied sixty cases; thirty-four patients had interlaminar approach for lumbar discectomy while twenty-six patients had laminectomy with discectomy. Conclusion: Both methods can manage different types of lumbar disc prolapse, apart from far-lateral disc which favors laminectomy approach.

Evidence suggests that professional drivers are at risk for venous thromboembolism (VTE), a life-threatening yet preventable disease. Awareness of VTE among this population has not been assessed in the Middle East. The study aimed to assess professional drivers' awareness of VTE and attitudes toward VTE preventive measures. We used a validated VTE awareness questionnaire to interview 324 drivers in Saudi Arabia during February-March 2020. Knowledge about VTE was the lowest compared to other medical conditions. Less than a third (31.8%) of the drivers were aware of VTE. Only 15.7% of those with prior awareness correctly identified all four deep vein thrombosis symptoms, and only 7.4% correctly identified all five pulmonary embolism symptoms. A significant proportion believed in unrelated practices for VTE prevention. Health promotion campaigns are urgently needed to raise awareness and to promote healthy behaviors.

The purpose of this study is to introduce a compact calorimeter that can offer an additional imaging tool for proton therapy centers. The tungsten, gadolinium, and lanthanide based high-density scintillating glass designed for this purpose has the ability to stop 200 MeV protons with thicknesses less than 60 mm, which allows us to model a compact detector that can be attached to a gantry. The details of the glass development and preliminary imaging efforts with this detector were previously reported. This study summarizes the Artificial Neural Network based imaging efforts with this novel proton imager detector. A library of proton conical beam CT (CBCT) scans of 800 tumors was created via GATE simulations. This tumor library was used for training purposes with two different machine learning tools, Flux and PyTorch. Here, the proof-of-concept machine learning imaging study is reported. The novel material development, compact detector design, and machine learning based imaging can make this approach useful for clinical applications.

Bone marrow-derived mesenchymal stem cells are one of the most extensively characterized cell types in vitro as well in the experimental animal models. During the last decade, MSC-based cell therapy has progressed to phase-III clinical trials for the treatment of patients with heart failure. Although the earlier phase trials provide strong evidence to support the safety of MSCs-based cell therapy, the primary end points set forth for these studies have been only marginally achieved or at least not up to the anticipated levels of achievement. The minimal success in terms of their efficacy has been ascribed to a plethora of factors that encompass the quality of the cell preparation to the method of cell delivery as well as patient-related factors and the assessment methods used for the study end points. Our book chapter provides a brief description of these factors in general and a focussed analysis of published data from phase-II clinical trials to see how the route of cell delivery after myocardial infarction episode has impacted the outcome of these studies.

Background. The coronavirus disease 2019 (COVID- 19) pandemic has emerged as one of the greatest challenges faced by humankind in the recent past. People with diabetes and related comorbidities are at increased risk of its complications and of COVID- 19- related death. Older age, multimorbidity, hyperglycemia, cardiac injury and severe inflammatory response are predictors of poor outcome. Aims. This article summarizes current data on the clinical presentation and risks of COVID- 19 in diabetic patients. We also provide some recommendations for the management of diabetic patients with COVID- 19. Results: According. to current data, diabetic patients do not appear to be at increased risk of contracting SARS- CoV- 2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID- 19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID- 19, as well as the prognostic impact of diabetes on the course of COVID- 19, are under current investigation. Obesity, the main risk factor for incident type 2diabetes, is more common in patients with critical forms of COVID- 19 requiring invasive mechanical ventilation. On the other hand, COVID- 19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and Sodium-glucose transport protein- 2)SGLT2( inhibitors should be discontinued in patients with severe forms of COVID- 19 owing to the risks of lactic acidosis and ketoacidosis. Conclusion: There are currently no data showing an increased risk of contracting COVID- 19 in diabetic patients. On the other hand, diabetic patients require special attention, since diabetes is associated with a higher risk of severe, critical, and fatal forms of COVID- 19. Our knowledge about this new Coronavirus progresses day by day. Ongoing studies will make it possible to better define the profile(s) of diabetic patients at increased risk of poor prognosis. In any case, the importance of blood glucose monitoring and control over the course of the infection should be emphasized, as well as that of screening for (pre) diabetes in all patients with a confirmed infection by COVID- 19.

Since the topic of e-Abacus diagram appeared in 1978 through its application within the partition theory, where this representation was one of the ideas of cryptography, many researchers study this subject from a purely theoretical perspective without practical application to it. Many researchers have shown interest in it by starting to apply purelymathematically, but starting in the past few years they have been searching for ideas that serve the topic. This research deals with the Vigenere Cipher, which is one of the multi­alphabet ciphers and in the past it was one of the most popular ciphers. For its simplicity and resistance to frequency analysis tests for messages encoded with simple ciphers such as Caesar’s Cipher through. Its application to the Syriac letters, which is one of the oldest ancient languages, used exclusively when reading religious hymns, for Christians in some regions of the world and in other regions as a trading language. In 2017 it was carefully studied through the above diagram and made the application more confidential among its users in terms of trying to find a suitable agreement between the English language letters and Syriac. Special signs and symbols were used in the Syriac language to be able to address the problem of the difference in the number of letters between the two languages. As well as the possibility of using the Cipher between the letters of the Syriac language

We examine 112,792 daily candles using more than one million spot quotes among 24 currency pairs between 2000 and 2018. We find that chart patterns are profitable. Relying on these visually based patterns achieves returns of more than 600% after accounting for the transaction costs. Nevertheless, the transaction costs are substantial. In particular, the spread is a large burden on profitability. Overall, our evidence suggests that technical analysis could generate excess returns and that the profitability of technical analysis cannot be explained by market inefficiency. Rather, the evidence is consistent with that on the link between the efficiency and profitability of technical analysis.

Fingerprints are common biometrics in smartphones as they are used for access to the device itself, or for authentication in applications. While fingerprints provide many benefits, they are vulnerable to spoofing attacks. This paper investigates countermeasures to spoofing attacks that use live fingerprints without consent either by force or by theft. We used behavioral biometrics to differentiate between intentional and forced fingerprint authorization attempts. Data was collected from several sensors and the most discriminating one was the accelerometer. A total of six data subsets, each with about 100 instances were collected, four for testing and two for calibration. A corresponding six tests were made on the subsets, in addition to one test on the combination of feature vectors from all sensors before and after using Correlation-based Feature Selection (CFS) to reduce the number of combined features. We used Naive Bayes, Linear-Kernel and Cubic-Kernel Support Vector Machines (SVMs), and Deep Neural Network (DNN) classifiers. For the accelerometer-combined data, the classifiers scored 61%, 81%, 88% and 94%, respectively showing the DNN as the most powerful classifier, and for individual runs, performance was higher. The investigation was successful in differentiating between intentional and forced uses of fingerprint authentication systems.

Introduction Obstructive sleep apnea (OSA) patients show hippocampal-related autonomic and neurological symptoms, including impaired memory and depression, which differ by sex, and are mediated in distinct hippocampal subfields. Determining sites and extent of hippocampal sub-regional injury in OSA could reveal localized structural damage linked with OSA symptoms. Methods High-resolution T1-weighted images were collected from 66 newly-diagnosed, untreated OSA (mean age ± SD: 46.3 ± 8.8 years; mean AHI ± SD: 34.1 ± 21.5 events/h;50 male) and 59 healthy age-matched control (46.8 ± 9.0 years;38 male) participants. We added age-matched controls with T1-weighted scans from two datasets (IXI, OASIS-MRI), for 979 controls total (426 male/46.5 ± 9.9 years). We segmented the hippocampus and analyzed surface structure with “FSL FIRST” software, scaling volumes for brain size, and evaluated group differences with ANCOVA (covariates: total-intracranial-volume, sex; P, Highlights • The hippocampus in OSA shows areas of increased and decreased volume. • The injury is sex-specific, in subregions related to symptoms in females and males. • Injury may be inflammation (volume increases) or cell death (volume decreases).

Low serum total adiponectin is associated with a high incidence of type 2 diabetes or coronary artery disease in the general population. Paradoxically, serum total adiponectin is elevated in patients with chronic kidney disease (CKD), such as overt diabetic nephropathy. The current study aimed to investigate whether or not anemia to be dependently associated with serum level of total adiponectin in non-albuminuric male patients with type 2 diabetes . The study included 42 type 2 diabetic male patients. Anemia was defined as hemoglobin (Hb) below 14.0g/dL. All the patients were without microalbuminuria, to exclude diabetic nephropathy. The diabetic patients were divided into 2 groups according to the hemoglobin level in addition to 16 healthy control group. Serum total adiponectin levels were measured by a sandwich enzyme-linked immunosorbent assay. In all 42 patients with type 2 diabetes, serum total adiponectin levels were correlated positively with serum creatinine and age, whereas, negative correlations were found with Hb. A stepwise regression analysis demonstrated that among several significant variables, Hb had the strongest independent influence on total adiponectin (β = -0.512, at P < 0.01). In conclusion, anemia could be associated with a marked elevation in serum total adiponectin levels of diabetic patients without a detectable nephropathy (-ve microalbuminuria). Key words: Type2 Diabetes, Adiponectin, Hemoglobin,Microalbuminuria.

Objective: To develop Orthodontic Patient Information Leaflets (PILs) in Arabic. Material & method: This study included five phases starting with Arabic translation of existing British Orthodontic Society leaflets; initial face validation with three orthodontists; content validation with ten orthodontists; final face validation with ten orthodontists, five postgraduate students, and ten patients; and re-translation to English prior to comparing the new documents with the original PILs to verify that all the necessary information were included. The content validity index (CVI) assessed item level (I-CVI) and scale level (S-CVI). Results: The three Arabic PILs were face validated with inclusion of mini-screws, rapid maxillary expansion, and interproximal reduction. Content validity was perfect with no item I-CVI

This study was conducted to prepare a map of the biological properties in the gypsiferouse soil using geomatic techniques at the Tikrit city site. (20) soil samples of the surface layer of gypsum soil were collected randomly according to differently in the nature of agricultural exploitation as survey study. Analyses and measurements of physical (texture and bulk density) and chemical characteristics were carried out: pH, EC, O.M, CaSO4.2H2O and the bacteria and fungi numbers were estimated by methods Certified in the laboratory. Used satellite Images acquired at 24Feb.2019 and 20sep.2019 were used and processed digitally and calculated the following vegetation indicators as follows: NDVI, OSAVI, LAI and LST. Maps of the biological properties (Bacteria and Fungi) were prepared using the Kriging interpolation according to The Spheroidal Model in the ArcGIS Ver environment.10.2. The show results the effect of gypsum content in the bacteria and fungi with the R2 (0.75 and 0.79). The results reached the importance of indices in evaluating the state and activity of bacteria as a positive regression relationship between the NDVI, LAI and OSAVI with the numbers of bacteria and fungi range (0.49-0.80) and were negative regression with the earth’s surface temperature LST. Therefore, spectral indices has proved important in spatial forecasting of the distribution and activity of organisms and the control of seasonal changes in soil surface.

Congenital anomalies of lumbosacral nerve roots are rare. These anomalies had been infrequently described in literatures with different classification systems. However, it is very rare to find a combination of more than one kind of anomalies in a single person. In this article, we report a duplicate L5 nerve root anomaly with anastomosis in between, which is considered rare among the other nerve root anomalies. It was discovered during microsurgically treated L5-S1 disc herniation. All spine surgeons should keep in mind that, although nerve root congenital anomalies are rare, they do exist. Care must be taken when a nerve root anomaly is discovered during surgical procedures in order not to cause iatrogenic nerve element injury.

In this work, an optical heterodyne temperature sensor system had been designed using Fiber Bragg Grating (FBG). Two techniques implemented. The first standard design uses dual laser diodes LDs as a laser sources that satisfy the condition of beat frequency range. The second new heterodyne optical system designed to get tunable source from single laser source using FBG, which is used as tunable element. By controlling the ambient temperature of the FBG, the wavelengths and their ranges can be controlled in way that satisfies the condition of beat frequency range. Mach-Zehnder interferometer (MZI) sensing technique had used with FBG element in both reference arm and sensing arm. Then the new modified heterodyne optical system had done by utilizing FBG in both reference arm and sensing arm with single source. A comparison study of results by using Optisystem software shows that, the modification of the second design provides better performance by increasing the wavelength shift and the sensitivity of the modified heterodyne temperature sensor.

Recently, increasing battery lifetime in wireless sensor networks has turned out to be one of the major challenges faced by researchers. The sensor nodes in wireless sensor networks use a battery as their power source, which is hard to replace during deployment. Low Energy Adaptive Clustering Hierarchy (LEACH) is one of the most prominent wireless sensor network routing protocols that have been proposed to improve network lifetime by utilizing energy-efficient clustering. However, LEACH has some issues related to cluster-head selection, where the selection is done randomly. This leads to rapid loss of energy in the network. Improved LEACH is a LEACH alternative that has the ability to increase network lifetime by using the nodes’ residual energy and their distance to the base station to select cluster-head nodes. However, Improved LEACH causes reduced stability, where the stability period is the duration before the death of the first node. The network stability period is important for applications that require reliable feedback from the network. Thus, we were motivated to investigate the Improved LEACH algorithm and to try to solve the stability problem. A new protocol is proposed in this paper: Stable Improved Low Energy Adaptive Clustering Hierarchy (SILEACH), which was developed to overcome the flaws of the Improved LEACH protocol. SILEACH balances the load between the nodes by utilizing an optimized method that considers the nodes’ distance to the base station and their residual energy to select the cluster-head nodes and considers the nodes’ distance to the cluster head and the base station to form clusters. The simulation results revealed that SILEACH is significantly more efficient than Improved LEACH in terms of stability period and network lifetime.

The present work evaluated the differences in mechanical properties of two athletic prosthetic feet samples when subjected to impact while running. Two feet samples designated as design A and B were manufactured using layers of different orientations of woven glass fiber reinforced with unsaturated polyester resin as bonding epoxy. The samples’ layers were fabricated with hand lay-up method. A theoretical study was carried out to calculate the mechanical properties of the composite material used in feet manufacturing, then experimental load-deflection test was applied at 0 degree position and 25 degree dorsiflexion feet position and impact test were applied for both feet designs to observe the behavior of the feet under static and impact loading and compare properties like stiffness, efficiency, rigidity, and shock absorption at different drop angles range from 25 degrees to 60 degrees which perform the foot positions while running. The load-deflection test result shows that the maximum deflection of the proposed design B was 32.2 mm at 0° and 38.45mm at 25°. While it was 41mm at 0˚ and 39mm at 25˚ for design A. Impact test result shows that design B foot gives peak load of 128 .7 kg with a peak time of 0.06 sec, while design Afoot gives 125.32 kg peak load with a time of 0.069 sec.

This paper presents an experimental investigation for the effect of opposed lateral and vertical eccentricities on free convective heat transfer through elliptical annulus enclosures in blunt and slender orientations. Three test specimens of elliptical cylinders having an equal radius ratio and an equal length were prepared. The surface area of the inner cylinder is the same for each specimen as well as the area of the outer cylinder. Different elliptical ratios of 0.662, 0.866 and 0.968 were investigated. Experimental tests were done by maintaining constant heat flux on the inner cylinder and the outer one was exposed to approximately constant temperature of the closed laboratory. Both annuals ends of the annular elliptical cylinders were closed by cork to form the annular enclosure space. The experimental tests monitored Rayleigh number (1.642 × 103 ≤ Ra* ≤ 3.849 × 106). The effects of both opposed vertical and lateral eccentricities for both blunt and slender orientations were investigated. The experimental results were fitted by correlations. Considerable agreement was found in the comparison among the results of present and previous works. Opposed eccentricity enhances free convective heat transfer by about 40 % from concentric. Slender orientation results in more enhancements in free convection than blunt one.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematologic malignancy with historically poor outcomes and no established standard of care. Nearly 100% of patients with BPDCN overexpress CD123, and targeting CD123 has therefore emerged as an attractive therapeutic target. UCART123v1 is an allogeneic "off the shelf" product composed of genetically modified T-cells expressing an anti-CD123 CAR and a RQR8 depletion ligand, which confers susceptibility to rituximab. The expression of the T-cell receptor αβ (TCRαβ) is abrogated through the inactivation of the TRAC gene, using Cellectis' TALEN® gene-editing technology. We have previously reported the selective in vitro anti-tumor activity of UCART123v1 cells against primary BPDCN samples using cytotoxicity and T-cell degranulation assays, as well as the secretion of IFNγ and other cytokines (IL2, IL5, IL6, IL-13 and TNF-α) by UCART123v1 cells when cultured in the presence of BPDCN cells (Cai et al, 2017 ASH). To evaluate anti-tumor activity of UCART123v1 cells in vivo, we established two relapsed BPDCN patient-derived xenografts (PDX1 and 2) in NSG-SGM3 mice. In PDX-1 model, mice were randomized upon tumour engraftment (D21 after primary BPDCN injection) into 4 groups and received an IV injection of either vehicle, 10×106 TCRαβ KO control T-cells, or UCART123v1 cells (3×106 or 10×106 cells). Mice from vehicle group died by D53 after BPDCN injection with high tumor burden in PB, spleen and BM. 3 out of 9 (33%) mice treated with 3×106 and 6 out of 9 (67%) mice treated with 10×106 UCART123v1 were alive and disease-free at the end of the study (D299 after primary BPDCN injection). In PDX-2 model, which received the same treatment as PDX-1 (at D19 after primary BPDCN cell injection), all vehicle-treated mice died by D49. UCART123v1 therapy extended survival of treated mice to 104-241 days, but tumors relapsed at 90-155 days (Fig. 1A). The relapses in UCART123v1 treated mice were associated with the emergence of CD123-, CD56+CD45+ BPDCN cells infiltrating spleens and BMs (Fig. 1B). To understand the molecular basis for CD123 loss, we isolated RNA from CD123+ cells from two of the vehicle-treated mice and CD123- cells from four of the UCART123v1-treated mice and performed RT-PCR and RNA-sequencing. The cells from all samples were hCD45+ and hCD56+, indicating leukemic origin. These analyses detected the presence of full-length transcripts (exons 2-12) in both CD123+ control samples (Sample 1 and 2in Fig. 1C). In 2 of the 4 CD123- samples, CD123 transcripts were absent, as were transcripts of neighbouring genes (samples 3 and 9 in Fig. 1C). RNA-sequencing reads aligned to Genome Browser tracks for CD123 and housekeeping gene GPI showed no reads present for CD123 but reads present for GPI in the two samples with CD123 loss. The aCGH (Array‐Based Comparative Genomic Hybridization) results showed that samples 3 and 9 (CD123-) had large regional deletions on chromosome X, which includes the CD123 gene. In another sample (sample 5), the splicing analysis algorithm MAJIQ detected CD123 transcripts containing only exons 2-9, indicating premature transcription termination. If translated, this truncated transcript would produce a protein isoform lacking the transmembrane domain in exon 10. Finally, MAJIQ also revealed canonical splicing of exon 2 to exon 3 in all CD123+ samples but a sharp increase in skipping from exon 2 to exon 5 in sample 16 (Fig. 1D). This exon-skipping event preserves the open-reading frame and yields the previously reported transcript variant 2. Per UniProt, the resultant protein will retain the ligand-binding domain but lack several glycosylation sites and two beta sheets in the extracellular domain, potentially compromising recognition by UCART123v1 cells. The aCGH and FISH results further showed that this patient sample harbored TP53 deletion, which could have contributed to DNA instability observed in different mice engrafted with these tumor cells. In summary, allogeneic anti-CD123 CAR T therapy resulted in eradication of BPDCN in vitro and in increased disease-free survival in primary BPDCN PDX models. However, CD123 loss was observed in one PDX model harboring a TP53 deletion. These results provide preclinical proof-of-principle that UCART123v1 cells have potent anti-BPDCN activity, and indicate potential mechanisms leading to antigen loss and disease relapse. Disclosures Galetto: Cellectis Inc: Employment. Gouble:Cellectis: Employment. Zhang:The University of Texas M.D.Anderson Cancer Center: Employment. Kuruvilla:The University of Texas M.D.Anderson Cancer Center: Employment. Neelapu:Cellectis: Research Funding; Celgene: Consultancy, Research Funding; Kite, a Gilead Company: Consultancy, Research Funding; BMS: Research Funding; Poseida: Research Funding; Novartis: Consultancy; Karus: Research Funding; Acerta: Research Funding; Incyte: Consultancy; Pfizer: Consultancy; Merck: Consultancy, Research Funding; Unum Therapeutics: Consultancy, Research Funding; Precision Biosciences: Consultancy; Cell Medica: Consultancy; Allogene: Consultancy. Lane:AbbVie: Research Funding; Stemline Therapeutics: Research Funding; N-of-One: Consultancy. Kantarjian:BMS: Research Funding; Amgen: Honoraria, Research Funding; Cyclacel: Research Funding; Agios: Honoraria, Research Funding; Novartis: Research Funding; Immunogen: Research Funding; Jazz Pharma: Research Funding; Pfizer: Honoraria, Research Funding; Ariad: Research Funding; Takeda: Honoraria; Astex: Research Funding; Daiichi-Sankyo: Research Funding; Actinium: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Research Funding. Guzman:Cellectis: Research Funding; Samus Therapeutics: Patents & Royalties: intellectual rights to the PU-FITC assay; SeqRx: Consultancy. Pemmaraju:Stemline Therapeutics: Consultancy, Honoraria, Research Funding; samus: Research Funding; plexxikon: Research Funding; incyte: Consultancy, Research Funding; affymetrix: Research Funding; sagerstrong: Research Funding; Daiichi-Sankyo: Research Funding; cellectis: Research Funding; celgene: Consultancy, Honoraria; abbvie: Consultancy, Honoraria, Research Funding; novartis: Consultancy, Research Funding; mustangbio: Consultancy, Research Funding. Konopleva:Genentech: Honoraria, Research Funding; Ablynx: Research Funding; Astra Zeneca: Research Funding; Agios: Research Funding; Eli Lilly: Research Funding; Forty-Seven: Consultancy, Honoraria; Calithera: Research Funding; Stemline Therapeutics: Consultancy, Honoraria, Research Funding; F. Hoffman La-Roche: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Cellectis: Research Funding; Amgen: Consultancy, Honoraria; Ascentage: Research Funding; Kisoji: Consultancy, Honoraria; Reata Pharmaceuticals: Equity Ownership, Patents & Royalties.

Background In 2013, the Zambian Ministry of Health through its National Malaria Control Programme distributed over two million insecticide-treated bed nets (ITNs) in four provinces using a door-to-door distribution strategy, and more than 6 million ITNs were allocated to be distributed in 2014. This study was commissioned to measure attendance rates at a community point distribution and to examine the impact of follow-up community health worker (CHW) hang-up visits on short and medium-term ITN retention and usage with a view of informing optimal ITN distribution strategy in Zambia. Methods Households received ITNs at community point distributions conducted in three rural communities in Rufunsa District, Zambia. Households were then randomly allocated into five groups to receive CHW visits to hang any unhung ITNs at different intervals: 1–3, 5–7, 10–12, 15–17 days, and no hang-up visit. Follow-up surveys were conducted among all households at 7–11 weeks after distribution and at 5–6 months after distribution to measure short- and medium-term household retention and usage of ITNs. Results Of the 560 pre-registered households, 540 (96.4 %) attended the community point distribution. Self-installation of ITNs by households increased over the first 10 days after the community point distribution. Retention levels remained high over time with 90.2 % of distributed ITNs still in the household at 7–11 weeks and 85.7 % at 5–6 months. Retention did not differ between households that received a CHW visit and those that did not. At 7–11 weeks, households had an average of 73.8 % of sleeping spaces covered compared to 80.3 % at 5–6 months. On average, 65.6 % of distributed ITNs were hanging at 7–11 weeks compared to 63.1 % at 5–6 months. While a CHW hang-up visit was associated with increased usage at 7–11 weeks, this difference was no longer apparent at 5–6 months. Conclusions This evaluation revealed that (1) the community point distributions achieved high attendance rates followed by acceptable rates of short-term and medium-term ITN retention and usage, as compared to reported rates achieved by door-to-door distributions in the recent past, (2) CHW hang-up visits had a modest short-term impact on ITN usage but no medium-term effect, and (3) community point distributions can yield sizeable time savings compared to door-to-door distributions.

Background and Purpose— Stroke development is a major concern in patients undergoing coronary artery bypass grafting (CABG). Whether asymptomatic severe carotid artery stenosis (CAS) contributes to the development of stroke and mortality in such patients remains uncertain. Methods— A retrospective analysis of 878 consecutive patients with documented carotid duplex ultrasound who underwent isolated CABG in our institution from January 2003 to December 2009 was performed. Patients with severe CAS (n=117) were compared with those without severe CAS (n=761) to assess the rates of stroke and mortality during hospitalization for CABG. The 30-day mortality rate was also assessed. Results— Patients with severe CAS were older and had a higher prevalence of peripheral arterial disease and heart failure. Patients with severe CAS had similar rates of in-hospital stroke (3.4% versus 3.6%; P =1.0) and mortality (3.4% versus 4.2%; P =1.0) compared with patients without severe CAS. The 30-day rate of mortality was also similar between the 2 cohorts (3.4% versus 2.9%; P =0.51). Conclusions— Severe CAS alone is not a risk factor for stroke or mortality in patients undergoing CABG. The decision to perform carotid imaging and subsequent revascularization in association with CABG must be individualized and based on clinical judgment.

SUMMARYObjectives This study aims to assess how conflict has affected the function of Iraqi health services and its doctors. Methods Interviews were conducted in person or by mobile phone with 401 Iraqi doctors entering Jordan since 2003, using respondent-driven sampling methods. Results Of the Iraqi doctors interviewed in 2008, 94% came from Baghdad, although 25% had moved within Iraq in the past year. They reported a steady year-by-year decline in Iraqi health services from 2003 through 2006, with perhaps some improvement in 2007. By 2006, 67% of doctors said essential drugs were present less than half of the time (95% confidence interval [CI] 54–81), and 69% (95% CI 56–84) said essential equipment was available or working half the time or less. By 2006, 95% said their facilities lacked skilled health workers, and 90% noted reduced quality of care. Violent death rates among doctors in Baghdad reached 47.6/1000/yr (95% CI 42.0–53.7) in 2006. In the same year, migration rates for Baghdad doctors moving elsewhere in Iraq were 143.8/1000/yr (95% CI 134.0–154.1), and departure from Iraq was 299.5/1000/yr (95% CI 285.3–314.3). Conclusions Deterioration of health services quality, staffing levels and violence against doctors continued from 2003 through 2006, although these may have improved slightly in 2007. In 2009 and 2010, reports suggest that assassinations of doctors and out-migration have continued. Few have returned. Copyright © 2011 John Wiley & Sons, Ltd.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematologic malignancy with historically poor outcomes and no established standard of care. Nearly 100% of patients with BPDCN overexpress CD123, and targeting CD123 emerged as an attractive therapeutic target given its differential expression on BPDCN cell surface. UCART123 product (Cellectis) uses genetically modified allogeneic T-cells (derived from healthy donors, so-called “off the shelf”) containing an anti-CD123 CAR and a RQR8 depletion ligand that confers susceptibility to rituximab. The expression of the T-cell receptor (TCR) is abrogated through the inactivation of the TCRα constant gene, using Cellectis' TALEN® gene-editing technology. We have previously reported the selective in vitro anti-tumor activity of UCART123 cells against CD123+ primary BPDCN samples using cytotoxicity assays, T-cell degranulation assay and the secretion of IFNγ and other cytokines (IL2, IL5, IL6, IL-13 and TNF-α) by UCART123 cells when cultured in the presence of BPDCN cells (Tianyu Cai, 2017 ASH). However, UCART123 had minimum toxicity against normal bone marrow cells. To evaluate in vivo anti-tumor activity of UCART123 cells, we established two patient-derived xenografts (PDX1-2) from patients with relapsed BPDCN in NSG-SGM3 mice. In PDX-1 model, all mice in vehicle-treated group died by D53, with high tumor burden in peripheral blood, spleen and bone marrow. Three out of 9 (33%) mice treated with 3×106 UCART123 and Six out of 9 (67%) mice treated with 10×106 UCART123 were alive and disease-free at the end of the study (D299). In PDX-2 model, while UCART123 similarly extended survival of the mice (D104-241), relapses occurred in all treatment cohorts at D90-155. Flow cytometric analysis showed that all of the relapses were associated with emergence of CD123- BPDCN clones (95-96% CD123-). To understand the molecular basis for loss of CD123 surface expression, we isolated RNA from two CD123 positive samples from vehicle group and two CD123 negative samples from 1×106 UCART123 group. RT-PCR and RNA-seq detected the presence of full-length transcripts containing exons 1-12 in both CD123 positive samples. In one of the two CD123 (-) samples, CD123 transcripts were completely absent, along with loss of transcripts of neighboring genes. In another CD123 (-) sample, CD123 transcripts containing only exons 1-9 were detected, indicating the presence of a truncation. Interestingly, if translated, this transcript would produce a protein isoform lacking the transmembrane domain (Ex 10). In summary, UCART123 therapy results in BPDCN eradication and long-term disease-free survival in a subset of primary BPDCN PDX models. However, loss of CD123 through diverse genetic mechanisms could lead to escape from UCART123 therapy and cause relapses. A phase I trial of UCART123 in BPDCN is opened for enrollment (NCT03203369). Citation Format: Tianyu Cai, Kathryn L. Black, Ammar Naqvi, Roman Galetto, Agnès Gouble, Julianne Smith, Antonio Cavazos, Lina Han, Qi Zhang, Vinitha Kuruvilla, Sergej Naumovich Sergej Konoplev, Sattva S. Neelapu, Andrew A. Lane, Monica L. Guzman, Hagop Kantarjian, Andrei Thomas-Tikhonenko, Naveen Pemmaraju, Marina Konopleva. Preclinical efficacy of allogeneic anti-CD123 CAR T-cells for the therapy of blastic plasmacytoid dendritic cell neoplasm (BPDCN) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2560.

Background: Early readmission after coronary artery bypass grafting (CABG) is an expensive adverse outcome. Although the perioperative experience of high-risk CABG patients has been studied extensively, little attention has been paid to low-risk CABG patients. The primary goal of this study was to identify the preoperative characteristics and to define risk predictors of readmission and preventive factors for readmission in low-risk isolated-CABG patients.Methods: We identified 2157 patients who underwent CABG between January 2000 and December 2005 at Washington Hospital Center, Washington, DC, and defined as low risk patients who had a Parsonnet bedside risk score lower than the 25th percentile. Patients who were rehospitalized within 30 days after surgery were compared with those who were not rehospitalized during this period.Results: The overall readmission rate for this study cohort was 6.3%. Compared with non-readmitted patients, early-readmitted patients were more likely to have diabetes mellitus (27.94% versus 20.88%, P = .05) and less likely to have hypertension (42.65% versus 51.36%, P = .05). Blood product transfusion (P < .01), postoperative length of intensive care unit stay (P = .01), and length of hospital stay (P = .05) were all significantly increased in the readmitted patients. The use of ?-blockers (P = .03) and angiotensin-converting enzyme inhibitors (P = .04) was significantly lower at discharge in this group of patients; however, multivariate regression analysis demonstrated diabetes (odds ratio, 1.59; 95% confidence interval, 1.08-2.42) to be the only independent predictor of early readmission.Conclusions: For low-risk CABG patients, diabetes mellitus is the risk predictor of early readmission. Early discharge was not associated with early readmission.

Self-expanding transcatheter aortic valve replacement (TAVR) is superior to medical therapy for patients with severe native valve aortic stenosis unsuitable for surgery. Its use in patients with low-gradient, low output aortic stenosis has not been prospectively studied. The CoreValve US Expanded

Since the representation theory start, the mathematics science especially in algebra began to open many new researches such our this one, we start from Schur algebra in his new representation described by Green [6], passing through his relation with semi-standard tableaux according to Green. The number of these tableaux still unknown, so we tried hardly to find the mathematical rule for this problem, but as these tableaux become great, the counting of them become difficult. Therefore, we tried to write an algorithm and a program to do so. As a result, we find the appropriate mathematical rule.

The use of skin traction splintage is established in the treatment of phalangeal fractures of the fingers. We report our experience with this technique. Fifty patients with 53 different types of closed displaced proximal and middle phalangeal fractures were included in a 4-year study period. Satisfactory radiological reduction was obtained by 48 traction splints applied (90.56%) while five cases required operative intervention (9.44%). The mean duration of traction splint application was 21 days (range 14–28 days). The mean duration of the physiotherapy required after removal of the traction splint was 19 days (range 5–51 days). The mean follow-up period was 39.2 days (range 14–365 days). Out of the 48 traction splints used, full range of movement was obtained in 45 fingers (93.75%). We recommend the use of this technique, as it is a simple, quick, inexpensive, and noninvasive procedure with excellent results.

Background The premise of coronary revascularization without cardiopulmonary bypass (off-pump coronary artery bypass graft [CABG]) proposes that patient morbidity and, potentially, mortality can be reduced without compromising the excellent results of conventional revascularization techniques (on-pump CABG). High-risk patients may benefit the most from off-pump CABG. The aim of this study was to compare early and mid-term clinical outcomes after off-pump CABG with on-pump CABG in a subset of high-risk patients. Methods Between January 1, 2000 and December 31, 2000, 513 high-risk patients with a Parsonnet's risk scores of 20 or higher underwent CABG; 38.6% (n = 198) underwent on-pump CABG, and 61.4% (n = 315) had off-pump CABG. Logistic regression was used to calculate the probability of being selected for on-pump CABG given a set of preoperative risk factors. Propensity scores or the probability of being selected for on-pump CABG were computed. Relative risks, heterogeneity among strata, and interactions between surgery type and the propensity score were assessed by a multivariate Cox proportional-hazards regression for the outcomes mortality and major adverse cardiac events (death, acute myocardial infarction, stroke, reoperative CABG, percutaneous coronary intervention). Results Operative mortality was lower after off-pump versus on-pump CABG between the two groups after controlling for preoperative risk factors using the propensity score (odds ratio=2.10; 95% confidence intervals=1.02 to 4.36, p = 0.04). In the Cox-regression analysis, off-pump CABG was associated with an improved survival rate compared with on-pump CABG ( p = 0.03). Off-pump CABG was associated with a comparable event-free survival ( p = 0.14) compared with on-pump CABG. Conclusions Off-pump CABG can be performed with a reasonably low morbidity and lower early and late mortality in high-risk patients. Off-pump CABG may be a better operative strategy in this subset of patients.

Objective: Off-pump coronary artery bypass (CABG) is a safe revascularization option with comparable or superior results to the conventional on-pump CABG. However, comparative analysis of the type of surgical approach on the mortality rate is largely unknown. This study sought to investigate whether CABG without cardiopulmonary bypass (off-pump CABG) is associated with lower operative mortality than the conventional on-cardiopulmonary bypass (on-pump) approach. Methods: From October 1998 to June 2001, off-pump CABG was performed on 2477 patients and on-pump CABG was performed on 3077 patients. The patients undergoing off-pump CABG were randomly matched to on-pump patients via propensity score. Seventy-four percent of the off-pump CABG patients were matched with on-pump patients via propensity scores. A logistic regression model was used to test the difference in the postoperative mortality rate between off-pump CABG and on-pump CABG, controlling the correlation between matched sets. A multiple logistic regression model predicting the risk of mortality adjusted by risk factors of mortality and operation type was computed. Results: Results from the general estimating equation showed that patients who had on-pump CABG were 1.6 (95% confidence intervals (CI) = 1.2-2.0, P < 0.01) times more likely to die during the first 30 days after surgery than patients who had off-pump CABG. Independent predictors of 30-day mortality identified from the multiple logistic model included on-pump CABG (versus off-pump CABG), advanced age, female gender, carotid artery disease, chronic renal failure, depressed ejection fraction, reoperative CABG, preoperative intraaortic balloon counterpulsation, and recent myocardial infarction. Conclusion: Excellent clinical results and a lower operative mortality rate can be achieved with the off-pump CABG technique compared with the conventional on-pump approach.

OBJECTIVES We sought to investigate whether the chronologic distribution of the onset of stroke occurring after coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass (off-pump CABG) is different from the conventional on-pump approach (CABG with cardiopulmonary bypass). BACKGROUND Off-pump CABG has been associated with a lower stroke rate, compared with conventional on-pump CABG. However, it is unknown whether the chronologic distribution of the onset of stroke is different between the two approaches. METHODS We evaluated the chronologic distribution of postoperative stroke in patients undergoing CABG from June 1996 to August 2001 (n = 10,573). Preoperative risk factors for stroke were identified using the Northern New England preoperative estimate of stroke risk. Multivariate logistic regression analysis was used to determine the independent predictors of early stroke and to delineate the association between the surgical approach and the chronologic distribution of the onset of stroke. RESULTS Stroke occurred in 217 patients (2%, n = 10,573). A total of 44 (20%) and 173 (80%) of these patients had stroke after off-pump CABG and on-pump CABG, respectively. The median time for the onset of stroke was two days (range 0 to 11 days) after on-pump CABG versus four days (range 0 to 14 days) after off-pump CABG (p < 0.01). On-pump CABG was associated with a higher risk of early stroke (odds ratio 5.3, 95% confidence interval 2.6 to 10.9; p < 0.01) compared with off-pump CABG. CONCLUSIONS Compared with off-pump CABG, on-pump CABG is associated with an earlier onset of postoperative stroke during the recovery phase, suggesting different mechanisms in the pathogenesis of stroke between the two surgical approaches.

Cardiac computed tomography (CT) allows the surgeon to create a pre-operative “road map” to mitigate morbidity from surgical re-entry prior to reoperative cardiac surgery (RCS). There are few prospective data on cardiac CT and RCS because previous data on CT were based on retrospective

Background . Minimally invasive direct coronary artery bypass, without cardiopulmonary bypass, through a left lateral thoracotomy approach (lateral MIDCAB), is a safe alternative to coronary artery bypass surgery using cardiopulmonary bypass (on-pump CABG) of the circumflex system via median sternotomy. However, it is unknown whether lateral MIDCAB may yield an improved long-term outcome over the conventional on-pump median sternotomy approach. Methods . We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included. Results . Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 ± 2 vs 7 ± 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 ± 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group ( p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG ( p = 0.1). Conclusions . Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG.