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Objectives Patients with acute coronary syndrome (ACS) need to be risk stratified to deliver the most appropriate therapy. There is no appropriate score for early-risk stratification at the time of the first medical contact with ACS patients. Canada Acute Coronary Syndrome Risk Score (Canadian-ACS) is a new risk score for early prognostication in acute coronary syndromes. The aim of our study is to evaluate the accuracy and validity of Canadian-ACS risk score as a prognostic score for in-hospital risk stratification of patients with ACS, as compared to TIMI AND GRACE risk scores in the Egyptian patients. Methods Our study included 79 patients having acute coronary syndrome admitted to CCU. Calculations of The Canada Acute Coronary Syndrome Risk Score (Canadian-ACS) and ranged from 0 to 4, with 1 point assigned for the presence of: age ≥75 years, Killip class >1, systolic blood pressure 100 beats/min. Results In our study, there is a strong association between Canadian-ACS and TIMI risk score with sensitivity 85.7% and specificity 100.0% and Grace risk score with sensitivity 78.1%% and specificity 85.1%. The negative predictive value of a Canadian-ACS score ≥1 is ≥84.4% for short-term in hospital morbidity and mortality, and for score ≥2 at ≥98%. Conclusion the Canadian-ACS is a valid accurate and simple prognostic risk score for short-term risk stratification in patients with ACS independent of hypertension, diabetes, smoking and troponin level.

Background To evaluate the relationship between surgical timing and 1-year mortality in patients requiring hip fracture repair. Methods We analyzed all 720 patients (>65 years) who had hip fracture surgery between March 2005 and February 2015, identifying patients by ICD-9 diagnosis and procedure codes using electronic data query. Mortality data were obtained from the institutional database, state and Social Security Death Indices. The relationship between surgical timing (defined as the interval from admission to the start of surgery) and 1-year mortality was assessed using a multivariable logistic regression, adjusting for baseline clinical status and surgical factors. Results Among the 720 patients, 159 patients (22%) died within 1 year. The median time from admission to surgery was 30 hours. A linear relationship between the surgical timing and 1-year mortality was demonstrated. Delaying surgery was significantly associated with increased 1-year mortality, odds ratio 1.05 (95% CI: 1.02-1.08) per 10-hour delay (P = 0.001). Conclusions A linear relationship was observed between surgical timing and 1-year mortality. Each 10-hour delay from admission to surgery was associated with an estimated 5% higher odds of 1-year mortality. Therefore, we suggest that hip fractures should be treated urgently similar to other time-sensitive pathology such as stroke and myocardial ischemia. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Maintenance of medications that are unconducive to the quality of life is difficult to justify in dying terminally-ill cancer patients. Objective: We aimed at determining the prevalence of administering antidiabetic, antihypertensive, and lipid-lowering medications to elderly patients dying with cancer. Methods: We reviewed the medical records of patients above 60 years of age with advanced cancer who died in a palliative care unit. The collected data included the use of antidiabetic, antihypertensive, and lipid-lowering medications during the last week of life. Results: Of 103 patients, 51.5% were female and the median age was 69 years. The most common cancers included gastrointestinal (40.8%), gynecological (13.6%), and head and neck (12.6%). All patients had advanced cancer and 59.2% had hypertension, 52.4% had diabetes mellitus, and 19.4% had dyslipidemia. During their last week of life, 38.8% received antidiabetic, 23.3% received antihypertensive, and 3.9% received lipid-lowering agents. The data showed that 68.5% of people with diabetes received antidiabetic medications, 37.7% of hypertensive patients received antihypertensive medications, and 20% of dyslipidemics received lipid-lowering agents. Hypoglycemia was reported in 7.5% of patients receiving antidiabetic drugs, while hypotension was reported in 66.7% of patients receiving antihypertensive agents. Conclusion: Many elderly patients dying with advanced cancer in a palliative care unit were maintained on medications for chronic conditions until the very late stages of their lives. For such imminently dying patients, benefits of such medications are unlikely and burdens are possible. Further research is needed to explore physicians’ justifications, if any, for maintaining such patients on apparently futile medications.

Bacillus genus members are dominant in the Eastern Arabian Sea and are known for producing many industrial enzymes. Bacillus australimaris B28A, isolated from seawater, had an enzymatic activity. Here, the whole genome sequence of Bacillus australimaris B28A is reported. The 3,766,107-bp genome, with a GC content of 41.6%, comprised 3936 protein-coding genes, seven ribosomal RNA, and 75 transfer RNA. Several bioactive secondary metabolite genes in the genome, including surfactin, lichenysin, bacillibactin, bacilysin, paenilamicin, fengycin, and carotenoid, were identified using antiSMASH. The 1396 proteins were predicted using RAST, including asparaginase enzyme: an anticancer enzyme. Sequence data have been deposited in the DDBJ/ENA/GenBank database under the accession number JAGQFH000000000. The version described in this paper is JAGQFH000000000.1. The BioProject ID in the GenBank database is PRJNA670955. The raw data is publicly available at " https://www.ncbi.nlm.nih.gov/sra/SRR14203888 ".

Background Hypertension increases the risk of atrial fibrillation by about twofold. Micro-albuminuria is an independent predictor of cardiovascular morbidity and mortality in patients with atrial fibrillation. Aim of the work The aim of this work was to investigate the relationship between micro-albuminuria 1 (MAU) and occurrence of atrial fibrillation in patients with arterial hypertension. Patients and methods Our study was conducted in Cardiology Department, Zagazig University. We recruited 300 consecutive patients with newly diagnosed hypertension from outpatient clinics. In this prospective study, we checked for micro-albuminuria (MAU) 1 at presentation. Then a follow up for 6 months to all cases to elicit any documented attack(s) of paroxysmal or persistent atrial fibrillation. Then patients were classified according to development of AF into Group I (patients who did not develop AF during 6 months after diagnosis of hypertension) (230 patients) and Group II (patients who developed AF during 6 months after diagnosis of hypertension) (70 patients). Results The micro-albuminuria was the strongest predictor to develop AF in our cases as the upper and lower “confidence interval” CI was (0.138–0.014) with high significant difference ( p p Conclusion Micro-albuminuria was the strongest predictor of AF in hypertensive patients. Recommendation and clinical implications The early detection and treatment of micro-albuminuria is accompanied by an improved cardiovascular prognosis in hypertensive patients and prevent new onset of atrial fibrillation.

The dermatomal level of analgesia achieved with quadratus lumborum blocks varies according to the location of injection. The most commonly used approaches are either at the postero-lateral aspect or anterior to the quadratus lumborum muscle.To determine whether the site of injection of contrast dye around the quadratus lumborum muscle of cadavers affects the extent and mechanism of dye spread.Observational human cadaver study.Cleveland Clinic cadaveric laboratory.Six fresh human cadavers.The cadavers received either a posterior quadratus lumborum block or an anterior subcostal quadratus lumborum block on each side.Cadavers were dissected to determine the extent of dye spread.The posterior quadratus lumborum block approach revealed consistently deep staining of the iliohypogastric, ilioinguinal, subcostal nerve, T11 to 12 and L1 nerve roots. In addition, staining of the middle thoracolumbar fascia was seen in all specimens but only variable staining of T10 nerve roots. The anterior subcostal quadratus lumborum block approach in all specimens demonstrated predictable deep staining of the iliohypogastric and ilioinguinal nerves, subcostal nerves, T11 to 12 and L1 nerve roots, and in addition traversing the arcuate ligaments to involve T9 to 12 nerve roots with variable staining of higher thoracic nerve roots.Our cadaveric study demonstrates that injection of dye on the posterior aspect of quadratus lumborum muscle led to injectate spread through the lateral and posterior abdominal wall but with limited cranial spread, whereas the anterior approach produced broader coverage of the lower to mid-thoracic region. Clinical translation of these findings to determine the practical significance is warranted.

Here, we synthesize zwitterionic polymer brushes on polyester fabrics by atom transfer radical polymerization (ATRP) after a prefunctionalization step involving an aminolysis reaction with ethylenediamine. Aminolysis is an easy method to achieve homogeneous distributions of functional groups on polyester fibers (PET) fabrics. Varying the polymerization time and the prefunctionalization conditions of the reaction, it is possible to tune the amount of water retained over the surface and study its effect on protein adhesion. This study revealed that the polymerization time plays a major role in preventing protein adhesion on the PET surface.

A structural graft is often used to maintain correction and achieve union after anterior calcaneal lengthening osteotomy for treatment of flexible flatfoot. Autograft, the current gold standard, is limited in availability and configuration and is associated with donor site morbidity in as much as 48%, whereas the alternative allograft carries risks of disease transmission and collapse. Polyaryletherketone cage, with a healing rate similar to that of autograft, high stability, and no donor-site morbidity, has been used in spine surgery. However, its use has not been documented in foot and ankle surgery. We reviewed 15 patients with painful flatfeet after failure of conservative treatment who were treated by anterior calcaneal lengthening osteotomy using polyaryletherketone cage instead of bone graft. Minimum follow-up was 1 year (average, 1.27 years; range, 1-1.5 years). The male-female ratio was 1:1.5 (six males, nine females). Mean age at time of surgery was 10.8 +/- 1.7 years (range, 8-13.5 years). Minimum follow-up was 1 year (average, 1.27 years; range, 1-1.5 years). Nine patients had a unilateral procedure and three had a simultaneous bilateral procedure, for a total of 15 operated feet (seven right and eight left). The paired t-test result was statistically significant in comparison of radiographic measurements at presurgery and postsurgery with P value

Textiles represent promising support materials for enzymes. The goal of the present work was to investigate the immobilization of commercial peroxidase on a polyester needle felt and the repeated use in the gentle degradation of norbixin in whey from dairy cheese as a practical application. High enzyme loads were obtained by a 2-step immobilization procedure. First, the number of functional groups on the textile surface was increased by a modification with amino-functional polyvinylamine. Second, the enzyme was immobilized by using 2 types of crosslinking agents. Due to the iron content of peroxidase, inductively coupled plasma–optical emission spectrometry was used for the quantitative determination of the enzyme load on the textile. The enzyme activity was evaluated using common 2,2'-azino-di-(3-ethylbenzthiazoline-6-sulfonic acid) assay for peroxidases. By the variation of enzyme input and crosslinker concentration, a maximal enzyme load of 80 mg/g of textile was achieved, and a maximum specific activity of 57 U/g of textile. For the visualization of the enzyme on the fiber surface, fluorescence microscopy as well as scanning probe microscopy were used. The immobilized peroxidase showed significant activity, even after 50 reuse cycles. In addition, the potential of the new support and enzyme combination in commercial whey bleaching was demonstrated successfully on a 10-L scale.

Aim of the study: At current, forest management in the Eastern Mediterranean region is largely based on experience rather than on management plans. To support the development of such plans, this study develops and compares site index equations for pure even-aged Pinus brutia stands in Syria using base-age invariant techniques that realistically describe dominant height growth.Materials and methods: Data on top height and stand age were obtained in 2008 and 2016 from 80 permanent plots capturing the whole range of variation in site conditions, stand age and stand density. Both the Algebraic Difference Approach (ADA) and the Generalized Algebraic Difference Approach (GADA) were used to fit eight generalized algebraic difference equations in order to identify the one which describes the data best. For this, 61 permanent plots were used for model calibration and 19 plots for validation.Main results: According to both biological plausibility and model accuracy, the so-called Sloboda equation based on the GADA approach showed the best performance.Research highlights: The study provides a solid classification and comparison of Pinus brutia stands growing in the Eastern Mediterranean region and can thus be used to support sustainable forest management planning.Keywords: site index; Generalized Algebraic Difference Approach (GADA); Sloboda equation.

IMPORTANCE: Opioid-induced ventilatory depression and hypoxemia is common, severe, and often unrecognized in postoperative patients. To the extent that nonopioid analgesics reduce opioid consumption, they may decrease postoperative hypoxemia. OBJECTIVE: To test the hypothesis that duration of hypoxemia is less in patients given intravenous acetaminophen than those given placebo. DESIGN, SETTING, AND PARTICIPANTS: Randomized, placebo-controlled, double-blind trial conducted at 2 US academic hospitals among 570 patients who were undergoing abdominal surgery, enrolled from February 2015 through October 2018 and followed up until February 2019. INTERVENTIONS: Participants were randomized to receive either intravenous acetaminophen, 1 g (n = 289), or normal saline placebo (n = 291) starting at the beginning of surgery and repeated every 6 hours until 48 postoperative hours or hospital discharge, whichever occurred first. MAIN OUTCOMES AND MEASURES: The primary outcome was the total duration of hypoxemia (hemoglobin oxygen saturation [Spo(2)]

The quadratus lumborum (QL) block provides analgesia to the abdominal wall while sparing the side effects of neuraxial blocks. We describe a case series of eight patients treated with a continuous infusion of local anesthetic via bilateral posterior QL catheters infusion block for analgesia after abdominal surgeries. We found that the median duration of the procedure was 26 min and the median opioid consumption over the first postoperative 72 h was 110 mg of morphine equivalents. The bilateral continuous posterior QL block is a feasible analgesic intervention and can be considered as a component of multimodal analgesic pathways.

Author(s): Elsharkawy, Hesham; Barnes, Theresa; Babazade, Rovnat; Huarte, Maria; Ali Sakr Esa, Wael; Ilfeld, Brian M | Abstract: BACKGROUND:Various methods for peripheral nerve and epidural catheter location assessment exist, with varying degrees of ease of use, utility, and accuracy. Pulsed wave Doppler (PWD) evaluates the presence of fluid flow and is possible modality to assess the location of a percutaneously inserted perineural catheter. METHODS:A retrospective chart review was conducted in which PWD ultrasonography was used to confirm the position of nerve catheters for regional anesthesia. Data was collected to assess 24-hour postoperative pain scores, opioid consumption, complications, and the incidence of catheter replacement. RESULTS:Eighty-six patients were included; average age was 58 years and a 27% incidence of chronic pain. These catheters were left in place based on the PWD images. Three catheters failed and a total of 16 catheters were repositioned. In the first 24 hours average pain scores ranges between 3.5 to 5.9 and median postoperative opioid consumption range was 11.3 mg to 60.8 mg. For epidural catheters, PWD changes were more obvious with air injection and there was only one episode of hemodynamic instability. CONCLUSIONS:Our preliminary experience with PWD ultrasonography suggests that they may offer the ability to selectively assess flow at different locations to identify the proper location of epidural and perineural catheters. Future randomized, controlled investigations are warranted to further evaluate the effectiveness and safety of this modality.

In this work, a pioneering study on the electrical properties of composite carbon nanofibres (CNFs) using current-sensitive atomic force microscopy (CS-AFM) has been demonstrated. CNFs are highly interesting materials which are usable in a wide array of applications

Although current desalination technologies are mature enough and advanced, the shortage of freshwater is still considered as one of the most pressing global issues. Therefore, there is a strong incentive to explore and investigate new potential methods with low energy consumption. We have previously reported that reversible thermally induced sorption/desorption process using polymeric hydrogels hold promise for water desalination with further development. In order to develop a more effective hydrogels architecture, polyelectrolyte moieties were introduced in this work as pendent chains and a thermally responsive polymer as network backbone using reversible addition-fragmentation chain transfer (RAFT) polymerisation. The ability of the comb-type polymeric hydrogels to desalinate water was evaluated. These hydrogels were proved to absorb water with low salinity from brine solution of 2 g L − 1 NaCl and release the absorbed water at relatively low temperature conditions of 50 ∘ C. The fraction of the grafted polyacrylic acid and the comb-chain length were varied to understand their influence on the swelling/deswelling behaviour for these hydrogels. The ionic fraction in the hydrogels and the resulting hydrophilic/hydrophobic balance are crucial for the proposed desalination process. In contrast, the comb-chain length impacted the swelling behaviour of hydrogels but showed relatively little influence on the dewatering process.

Although current desalination technologies are mature enough and advanced, the shortage of freshwater is still considered as one of the most pressing global issues. Therefore, there is a strong incentive to explore and investigate new potential methods with low energy consumption. We have previously reported that reversible thermally induced sorption/desorption process using polymeric hydrogels hold promise for water desalination with further development. In order to develop a more effective hydrogels architecture, polyelectrolyte moieties were introduced in this work as pendent chains and a thermally responsive polymer as network backbone using reversible addition-fragmentation chain transfer (RAFT) polymerisation. The ability of the comb-type polymeric hydrogels to desalinate water was evaluated. These hydrogels were proved to absorb water with low salinity from brine solution of 2 g L − 1 NaCl and release the absorbed water at relatively low temperature conditions of 50 ∘ C. The fraction of the grafted polyacrylic acid and the comb-chain length were varied to understand their influence on the swelling/deswelling behaviour for these hydrogels. The ionic fraction in the hydrogels and the resulting hydrophilic/hydrophobic balance are crucial for the proposed desalination process. In contrast, the comb-chain length impacted the swelling behaviour of hydrogels but showed relatively little influence on the dewatering process.

The renin angiotensin system (RAS) is thought to be the body's main vasoconstrictor system, with physiological effects mediated via the interaction of angiotensin II with angiotensin I receptors (the "classic" RAS model). However, since the discovery of the heptapeptide angiotensin 1-7 and the development of the concept of the "alternate" RAS system, with its ability to reduce arterial blood pressure, our understanding of this physiologic system has changed dramatically. In this review, we focus on the newly discovered functions of the RAS, particularly the potential clinical significance of these developments, especially in the realm of new pharmacologic interventions for treating cardiovascular disease.

High-speed train (HST) has drawn considerable attention and become one of the most preferable conveyance mechanisms. Every year the manufacture corporations achieve a higher speed record and expect to attain 1000 km/h by 2021 using hyperloop one technology. Moving at such a high speed results in a high handover rate which makes it challenging for high speed railway (HSR) mobile wireless communication to preserve steady link performance. Employing distributed antenna systems (DASs) along with the two-hop architecture, this paper proposes a fast predictive handover algorithm. In this strategy, the serving cell starts the handover preparation phase in advance by inferring the train's current location. Issuing the handover preparation phase in advance reduces the handover latency and handover command failure probability as well. Lower handover command failure probability means lower handover failure probability which could greatly improve the end-users' quality of services (QoS). The analytical results show that the proposed scheme outperforms the conventional handover scheme.

Designing of Wireless Multimedia Sensor Network (WMSN) routing protocols limited by conventional sensor network protocols. They have been designed for scalar data such as sensor data; which is small in size compared to multimedia data. The addressed challenges were the motivation to design mobile reliable routing protocol based on greedy routing structure. In this paper, we propose a new routing protocol for greedy forwarding based on throughput energy aware multi-path routing protocol(GFTEM), which is based on selection of next hop node that has the highest throughput and closer to destination node. GFTEM performance is seen and compared against Ad hoc on-demand distance vector routing protocol (AODV), Dynamic MANET on-demand routing protocol(DYMO) and greedy perimeter stateless routing for wireless networks (GPSR). The OMNET++ simulator has been used to study the behavior of the protocols in terms of end-to-end delay, packet error rate and residual energy. The protocols has been tested under various sensor node speed and the simulations demonstrate that GFTEM has better end-to-end delay, packet loss ratio, with good energy efficiency compared to GPSR, AODV, DYMO routing protocols.

High-speed trains have become one of the most leading transportation means, where each year the manufacture companies reach a new speed record. This progressive speed records increase the handover (HO) rate which makes it very difficult for high speed railway (HSR) mobile communication to sustain a reliable communication link. Utilizing distributed antenna systems (DASs) along with the two-hop architecture, this paper analyzes the conventional handover scheme based on this architecture and proposes a faster HO strategy. The proposed scheme reduces the HO latency and failure probability which could greatly improve the end-users quality of services (QoS). The analytical results show that the proposed scheme performs better than the conventional HO scheme.

High-speed railway (HSR) has witnessed a huge growth globally, and now is reaching a maximum speed of 575 km/h. This record of speed makes mobile communications difficult for HSR since the handover (HO) frequency increases which results in a high loss of connectivity. Based on distributed antenna systems (DASs), this paper utilizes the two-hop network architecture for HSR broadband wireless communication systems. With the target of achieving high system capacity, superior transmission reliability, and consequently high-quality broadband wireless communication service for passengers in HSR. Moreover, a Frequency Switch (FSW) scheme is proposed for the two-hop network architecture to alleviate the frequent HO issue in traditional HSR wireless communication systems where HO generally happens between the successive remote antenna units (RAUs) connecting to the same central unit (CU) control. The FSW scheme provides mobility robustness signalling process that guarantees a successful frequency switching instead of HO, and reduces the probability of radio link failure (RLF) compared to HO process in traditional HSR systems, where the HO failure (HOF) rate is about 21%. The analytical results show that the proposed scheme outperforms traditional HO schemes.

Background: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. Methods: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. Results: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of −0.16 [−0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of −5% [−25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of −0.28 [−0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of −2% [−22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. Conclusion: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.

Background: Terminal QRS complex distortion on admission electrocardiography (ECG) has been used to estimate the final infarct size and the prognosis after acute coronary syndrome (ACS); however, it is not sure whether the QRS distortion is more reliable for predicting the severity of coronary artery lesions or not. The Aim of the Work: The aim is to analyze the admission ECG in ACS based on abnormality observed in the terminal QRS complex distortion and ST-segment and its relation to coronary artery lesion severity. Patients and Methods: We included 150 patients presented with ACS. Patients were divided according to the presenting ECG in two major groups, 120 patients presented with ST-segment elevation myocardial infarction (STEMI) who were classified into two groups according the presence or absence of the QRS distortion: 42 patients with +ve QRS distortion (Group I) and 78 patients with −ve QRS distortion (Group II), and 30 patients presented with non-ST-segment elevation (NSTE)-ACS who were also further classified according the magnitude of ST shift by millimeter into three groups. All patients underwent primary percutaneous coronary intervention, and Gensini score defined the severity of coronary artery lesions. Results: In this study, in STEMI patients groups, we observed that QRS distortion on admission, ECG has a significant relationship with high Gensini score values, whereas in NSTE-ACS patients, we demonstrated no significant difference between the extents of ST-segment shift and Gensini score values. Conclusion: QRS distortion has a significant value in predicting severe coronary artery lesions in STEMI patients while the extent of ST-segment shift has no benefits in predicting the severity of coronary artery lesion in NSTE-ACS patients.

Objectives: Contrast-induced nephropathy is one of the most common adverse side effects in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Serum cystatin C level is a biomarker of the renal function test. We aimed to compare the degree of renal dysfunction in transradial primary PCI versus transfemoral primary PCI and to use of serum cystatin C as a predictor of contrast-induced nephropathy. Methods: This study included 90 patients who were admitted to the hospital with STEMI and who underwent a primary PCI and they were divided into Group I (45 patients): a primary PCI via femoral approach and Group II (45 patients): a primary PCI via radial approach. We estimated both serum cystatin C and serum creatinine after 72 h of primary PCI. Results: Serum cystatin C level post-PCI had high sensitivity results in correlation with CIN and non-CIN groups. Further, the significant effects were found in all patients in association with serum cystatin C before and after PCI. The cutoff value of serum cystatin C with receiver operating characteristic curve analysis before PCI was 1.1 mg/dL and after PCI was 1.3 mg/dL. Conclusion: The transradial approach for a primary PCI is an effective and safe approach alternative to the femoral approach. Serum cystatin C is a biomarker and a predictor of the occurrence of contrast-induced nephropathy in STEMI patients who underwent a primary PCI and is one of the most sensitive renal markers regarding CIN in comparison to serum creatinine level.

The present work aimed to investigate the effect of supplementing different levels of sea algae in diets on fertilizing ability of bucks and fertility traits of New-Zealand White (NZW) rabbit does. The study lasted five months. A total number of 204 NZW rabbits (48 males aged 3 months and 156 females aged 2.5 months) were used in the present work. Animals were divided into three comparable experimental groups (16 males and 52 females each). The first group was fed a commercial diet and kept untreated (control group), while the 2nd and 3rd groups (treated groups) were fed the same diet but supplemented with 200 and 400 g sea algae/ ton diet, respectively. Results obtained indicated that, age at first mating of NZW rabbit males significantly (P ≤ 0.05) decreased, while weight at first mating and alive body weight significantly (P ≤ 0.05) increased due to feed diets supplemented with different levels of sea algae. Absolute and relative weights of testes; epididymis; sexual accessory glands and pituitary gland, as well as, scrotal circumference; testicular index and mating activity of NZW rabbit bucks increased significantly (P ≤ 0.05 or 0.01) in descending order with diets supplemented with 400 and 200 g sea algae, respectively. Male and female sexual hormones significantly (P ≤ 0.01) increased due to sea algae supplementation to the diets. Conception and abortion rates, litter size and weight at birth and at weaning, as well as, bunny weight at birth and at weaning were improved significantly (P≤0.05 or 0.01) by supplementing 400 and 200 g sea algae, respectively. Milk yield and composition and total pre-weaning mortality rates improved significantly (P≤0.05 or 0.01) by feeding diets supplemented with sea algae. Conclusively, it could be concluded that, supplementing sea algae toNZW rabbit diets caused significant improvement in fertilizing ability of bucks and fertility traits of does. From the economical point, 200 g/ ton diet is recommended for rabbits.

Possible interaction between carbamazepine and different HPMC grades was done using DSC thermal analysis. The results indicated that the drug was compatible with these grades. Seven preparations of carbamazepine 200 mg controlled release tablets were prepared by wet granulation method and one preparation was prepared by direct compression method where different HPMC grades with different ratios were used. Concerning uniformity of weight, hardness and assay; all tablets conformed to pharmacopeal limits. Dissolution of the prepared tablets was done using basket method for 24 hours and paddle method for 4 hours. Tablets prepared by 30.0, 35.0 and 40.0% w/w HPMC K 100, 25.0% HPMC K 100 in combination with 5.0% HPMC K 4M and 15.0% w/w HPMC K 4M were conforming to USP limits, while tablets prepared by 15% K4M are not conforming to these limits. Tablets prepared by 12.5% HPMC K 15M by direct compression technique showed similar dissolution values to the innovator in five different media: distilled water, distilled water containing 1.0% SLS, buffer pH 1.2, acetate buffer pH 4.5 and phosphate buffer pH 6.8. The difference and similarity factors were found very acceptable. Scaling up of carbamazepine 200 mg controlled release tablets formulation from lab scale (500 tablets) to full production scale (500,000 tablets) was done. All the results of the scaling up were conforming to specifications and indicated that scaling up process has been done successfully and drug release kinetics indicated that the drug dissolution was zero order.

BACKGROUND Ultrasound-guided nerve blocks have become the standard when performing regional nerve blocks in anaesthesia. Infiniti Plus (CIVCO Medical Solutions, Kalona, Iowa, USA) is a needle guide that has been recently developed to help clinicians in performing ultrasound-guided nerve blocks. OBJECTIVES We tested the hypothesis that femoral nerve catheter placement carried out with the Infiniti Plus needle guide will be quicker to perform than without the Infiniti Plus. Secondary aims were to assess whether the Infiniti Plus needle guide decreased the number of block attempts and also whether it improved needle visibility. DESIGN A randomised, controlled trial. SETTING Cleveland Clinic, Cleveland, Ohio, USA. PATIENTS We enrolled adult patients having elective total knee arthroplasty with a femoral nerve block and femoral nerve catheter. Patients, who were pregnant or those who had preexisting neuropathy involving the surgical limb, coagulopathy, infection at the block site or allergy to local anaesthetics were excluded. INTERVENTIONS Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide. MAIN OUTCOME MEASURES The time taken to place the femoral nerve catheter, the number of attempts, the success rate and needle visibility were recorded. We used an overall α of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons. RESULT The median (interquartile range Q1 to Q3) time to perform the femoral nerve catheter placement was 118 (100 to 150) s with Infiniti Plus and 177 (130 to 236) s without Infiniti Plus. Infiniti Plus significantly reduced the time spent performing femoral nerve catheterisation, with estimated ratio of means [(95% confidence interval), P value] of 0.67 [(0.60 to 0.75), P