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Abstract Central Sahel is affected by a reinforcement of rainfall since the beginning of 1990s. This increase in rainfall is affected by high inter-annual variability and is characterized by extreme rain events causing floods of unprecedented magnitude. However, few studies have been carried out on these extreme events. Moreover, with current climate change expected to strengthen the hydrological cycle, we don’t know if these events could become more frequent. Here, we report the hydrological changes that currently occur in the Lake Chad basin. Based on ground observations and satellite data, we focused on the 2022 flood event, demonstrating that it was the most important event from the last 60 years, comparable to what occurred during the last wet period between the 1950s and the 1960s. We showed that under this precipitation regime and if warming is not regulated at a global scale, the return period of the 2022 major riverine flood is expected to be between 2 and 5 years. By using modelling experiments, our study also suggested that in the next decade, future flow rates of the main rivers draining the Lake Chad basin could reach the values observed in the 1950s. These results strongly suggest anticipating water management in a context of poor infrastructural development.

Abstract Background It was proposed that camels are more effective than other livestock species in selecting plants for their nutritional value. They may self-regulate their voluntary feed intake to satisfy their nutritional needs. This study was designed to investigate camels’ feeding selectivity and ability to cover nutritional requirements when grazing alfalfa (high in protein) and/ or barley (high in energy) in a desert climate. Methods Eighteen lactating camels were equally divided into three feeding treatments. They grazed daily on alfalfa, barley, or a mixed pasture of both, for two periods of one month each. The concentrate supplement was individually administered at 40 g/kg BW0.75, divided into two equal parts, in the morning and in afternoon. Total energy expenditure (EE) was estimated by heart rate (HR) monitors for 48 h after being calibrated by oxygen consumption using an upgraded face mask open-circuit respiratory system. Results During the first period, camels had a greater forage intake and digestibility when they grazed barley rather than alfalfa, while those grazing mixed pasture performed intermediately. In the second period, camels had a similar forage intake and digestibility among treatments due to a decline in barley intake and digestibility compared to the first period, which was expected since the preferred plant part gradually shifted from barley grains to predominantly straw as a function of time. Similar HR and EE were found across periods and treatments. As a result of greater gross and digestible energy intake in period 1, a better energy balance in period 1 was observed compared to period 2. Camels better utilize barley than alfalfa. Grazing on barley had a higher energy balance than grazing alfalfa alone or in combination with barley. However, camels grazing barley produced lower milk yield and energy than those grazing alfalfa alone or in combination with barley, with no interaction detected between period and treatment. Conclusions Lactating camels are able to self-regulate their voluntary intake to cover their energy requirements when they are grazing barley and/or alfalfa supplemented with a concentrate supplement at 40 g/kg BW0.75. Grazing barley is better utilized by camels than alfalfa. The chemical and physical properties of plant species play an important role in the selectivity of foraging camels. It also impacts their intake and digestibility, which is negatively associated with the proportion of cell wall content consumed.

Introduction: Family planning (FP) is less prevalent in South Sudan yet information on the subject is scarce and varied from one source to another. This study assessed the prevalence and associated factors in family planning among students at health science training institutes in Juba City. Method: This was a cross-sectional survey of students’ self-reported utilisation of FP methods. Four hundred randomly selected students from five health training institutes (HTIs) in Juba City participated. Data collection was done using a pretested structured questionnaire. IBM SPSS 23 software was used for data analysis. Chi squared tests and regression analyses were performed to determine the associated factors. Results: Among the 400 participants, the lifetime prevalence of FP methods was 77.3%, of which modern contraceptive use was 22%. FP was more prevalent among participants aged 45-50 (85.7%) and females (80.7%). Eighty-seven percent of divorced couples and 91.3% of traditional believers reported practicing FP. More nursing/midwifery cadres within the professional category reported practicing FP, as well as 90.4% of rural respondents. Eighty-three percent of respondents working in pharmacies said they practice FP, compared to 68.1% of those working in clinics. FP practice was similar among participants who were aware (78.9%) and those who denied being aware (72.5%). Marital status (p < 0.001), religion (p < 0.001), residence (p < 0.001), and place of work (p = 0.037) were significantly associated with FP. Conclusion: The prevalence of family planning among students at Health Training Institutes in Juba City is high compared to national estimates, but the contraceptive overall prevalence rate is still low. It is significantly associated with marital status, religion, residence, and place of work. There is a need to continue the effort.

Background: Tadalafil is a PDE-5 (phosphodiesterase inhibitor) inhibitor that supports endogenous nitric oxide's vasodilatory actions and aids in erection maintenance. The penile duplex has proven to be very useful for imaging superficial structures and for determining the reasons of erectile dysfunction (ED). Objectives: To assess the effect of daily oral tadalafil 5mg for 3 months on penile duplex parameters in erectile dysfunction patients. Patients and Methods: A case control study involved 30 Egyptian patients ED. Appropriate clinical history and penile duplex examination before and after treatment with daily oral tadalafil mg for 3 months were performed. Results: The mean age of the patients was 53.17 ± 7.8 years. We founded that there was significant (p < 0.001) improvement in the level of erection after treatment. The rate of erection E1 and E2 was decreased from 53.3% to 3.3%. Likewise, the rate of E3-E5 was increased from 46.7% to 96.7%. Moreover, the mean duration of erection was elongated from 24.7 ± 5.3 to become 37.4 ± 3.8 and this was statistically significant (p < 0.001). Also, the mean peak systolic volume (PSV) was significantly (p = 0.001) increased after treatment (38.4 ± 9.1 cm/s) compared with the pre-treatment levels (23.9 ± 6.1 cm/s). Unlikely, the mean end diastolic volume (EDV) was insignificantly (p = 0.340) lower in post-treatment (2.25 ± 0.5 mL) compared with pre-treatment levels (2.97 ± 0.4 mL). Likely, the mean resistant index (RI) showed insignificant difference (p = 0.965) after treatment (0.9 ± 0.02) compared with before treatment (0.9 ± 0.08). For penile artery diameter, there was significant (p = 0.009) increase in the diameter after treatment (0.9 ± 0.1 mm) compared with before treatment (0.8 ± 0.1 mm). Conclusion: Oral daily tadalafil 5mg for 3 months is considered an effective treatment for ED according to penile duplex parameters.

Abstract Background Despite the recent progress made in drug-eluting stents (DESs), in-stent restenosis (ISR) is still a common complication of percutaneous coronary interventions. This retrospective study from a single center aimed to compare outcomes in 79 patients with ISR treated with paclitaxel-coated balloon (PCB) angioplasty or DES implantation. Results From January 2017 to December 2021, 83 ISR lesions from 79 patients were included. Thirty-two were treated with PCB and 51 treated with available DES in the catheterization laboratory. Baseline characteristics were similar in both groups. Mean time between index angioplasty and restenosis was 27 months with a minimum of 4 months and a maximum of 70 months. Concerning Mehran ISR angiographic classification, classes II and III were more likely treated with DES. Stenosis diameter and minimal lumen diameter (MLD) were similar in both groups. PCB used was significantly shorter than DES: Mean length was 19.75 ± 5.7 versus 22.1 ± 16.5 (p

Introduction Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and effective. However, many people still have poor outcomes despite treatment. The aim of this study was to identify the predictors of good functional outcome in posterior circulation strokes after mechanical thrombectomy from the Trevo Stent‐Retriever Acute Stroke TRACK and the North American Solitaire Stent Retriever Acute Stroke (NASA) registries. Methods Patient‐level data from the TRACK and NASA registries were pooled and patients with posterior circulation stroke were included in the analysis. Patients were dichotomized into those with 90‐day good functional outcome (mRS≤2) and poor functional outcome (mRS>2). Baseline and procedural data were compared between the two cohorts. Multivariate logistic regression was then performed to identify predictors of functional outcome. P‐value < 0.05 was considered significant. Results Out of 119 posterior stroke patients (99 BA, 16 VA, and 4 PCA), a total of 110 patients had mRS data available on follow‐up. Good functional outcome was observed in 44 patients (37%). Patients with mRS≤2 were less likely to have hypertension (61.4% versus 83.3%, p = 0.01), dyslipidemia (38.6% versus 62.1%, p = 0.016), and diabetes (18.2% versus 36.4%, p = 0.040). Patients with mRS≤2 had a lower mean baseline NIHSS (15.2±9.95 versus 22.6±9.50, p< .001). Time to puncture, utilization of BGC, general anesthesia use, number of passes, and successful recanalization (TICI≥ 2B) were not significantly different between the two cohorts. On multivariate analysis, higher baseline NIHSS was associated with worse functional outcome (OR:0.91, CI:0.87‐0.96, P< .001). Use of IV tPA was associated with higher odds of achieving good functional outcomes (OR:2.82, CI:1.06‐7.51, P:0.038). Conclusions In this pooled analysis of the NASA and TRACK Registries, posterior circulation patients achieving good outcome were more likely to have a lower baseline NIHSS and less comorbidities. Use of IV‐tPA and lower baseline NIHSS were independent predictors of functional outcome.

Introduction Endovascular coiling for intracerebral aneurysms has been evolving. Yet, large, and giant aneurysms (LAGA) remain a significant challenge for treatment and carry a high rate of morbidity and mortality. Previous studies have demonstrated 72–76% long‐term adequate occlusion and up to 34% retreatment rate in patients undergoing reconstructive treatment for LAGA. Methods The SMART registry, a prospective, multicenter outcome trial was used to identify patients with LAGA (Sac 10–24mm for large and ≥ 25mm for giant aneurysms) treated with the Penumbra SMART COIL® (SMART) system in the US and Canada. Patients’ characteristics and outcomes were then compared to patients with smaller aneurysms (SA) (Sac≤10mm). Primary effectiveness endpoint was aneurysm occlusion using Raymond‐Roy (RR) scale and safety endpoints included mortality and stroke outcomes. Fisher exact test and T‐test were used to compare categorical and continuous variables, respectively. P‐value

Abstract Background The incidence of in-stent restenosis (ISR) remains relatively common despite the use of drug-eluting stents. Outcomes and prognostic factors following ISR revascularization are still being investigated. We aimed to describe the outcomes following different ISR treatment strategies in order to identify prognostic factors associated with worse outcomes. Results In a retrospective cohort study, we included patients who were admitted to our department and treated for ISR, from January 2017 to December 2018. All patients were followed up for a median period of 24 months. Major cardiac adverse event (MACE) was a composite outcome of the following events: myocardial infarction, target vessel revascularization, target lesion revascularization or cardiovascular death. MACEs were collected during follow-up. Our population consisted of 116 patients. Mean age was 60 years old with a sex ratio of 2.8. During follow-up, 44 patients (37.9%) had at least one MACE. Independent factors identified by multivariate logistic regression were ISR of the proximal left anterior descending artery [Odds ratio (OR) = 1.29; 95% confidence interval (95% CI) 1.16–1.81; p = 0.05], diffuse ISR [OR = 2.16; 95% CI 1.1–3.47; p = 0.022], double or triple vessel disease [OR = 2.97; 95% CI 1.2–6.8; p = 0.008], two or more stents per lesion [OR = 1.82; 95% CI 1.14–2.21, p = 0.031] and absence of post-dilatation in the initial angioplasty [OR = 1.32; 95% CI 1–1.35; p = 0.04]. Conclusions Our study suggested that ISR is related to poor outcomes. Identifying prognostic factors would play a key role in the refinement of interventional techniques.

Energy is regarded as one of the most crucial resources in the industrial process. Numerous measurements were made in the year 2021 in the workshops of the Agricultural Engineering Department, Faculty of Agriculture, Ain Shams University, Egypt, using a gasoline engine (single cylinder with air-cooling) that was used to power an irrigation pump with a discharge diameter of 2 inches, which was manufactured in Egypt. To combine natural gas and air before entering the engine, a variety of mixers were created. Four different types of mixers were employed with iron pipes of various sizes: 90° angle T-mixer (T90), 45° angle T-mixer (T45), 30° angle T-mixer (T30), and venture mixer (VM). The engine shift speeds were set at 1,750, 2,300, 2,900, and 3,500 rpm. The water pump was powered by natural gas and gasoline. The findings in this study focused on the evaluation of technical indicators for several types of mixers that combine natural gas and air to power an irrigation pump, where the actual power (braking power) is superior to all types while operating with gasoline (3.07 kW). A commensurability on every side the report of on the up steam, in the mixer type (T45) (2.83 kW) was 7.8% about than gasoline. The lowest specific fuel consumption (S.fc) for gasoline was 219.025 gm/Kw.h at an engine speed of 2,900 rpm. The T45 mixer had the lowest S.fc of 234.612 gm/KW.h, compared with other types of mixers at an engine speed of 2,900 rpm, an increase of 6.6% compared with gasoline. The T45 mixer had the highest pump discharge of 528.133 L/min, an increase of 2.1% compared with gasoline. Compared with other types of T-mixers, the T45 mixer had the highest actual hydraulic power of 0.6 kW, which was 10.5% lower than that of gasoline. As for the economic indicators, the T90 mixer had the lowest net present value (NPV) of 77219.5, and the T45 mixer had the highest NPV of 106900.7. The mixer-type VM had the lowest benefit–cost ratio (B/C) of 1.38, and the T45mixer had the highest B/C of 1.54.

Background: Electric burn injuries can cause high morbidity and mortality. Case presentation: A 4.5-year-old child was admitted to our facility with deep full-thickness burns on the trunk and both lower limbs. After the patient's general condition was stabilized, numerous procedures were performed. A staged reconstruction resulted in stable coverage of the raw areas by meshed split thickness skin graft and distant posterior thigh flap. Nevertheless, the right limb below knee amputation had occurred. Conclusion: NPWT has a significant role in preparing the burned region for skin grafting, and the distant thigh flap remains a viable option in reconstructing the distal lower third of the leg.

With the proliferation of IoT devices, ensuring the security and privacy of these devices and their associated data has become a critical challenge. In this paper, we propose a federated sampling and lightweight intrusion-detection system for IoT networks that use K-meansfor sampling network traffic and identifying anomalies in a semi-supervised way. The system is designed to preserve data privacy by performing local clustering on each device and sharing only summary statistics with a central aggregator. The proposed system is particularly suitable for resource-constrained IoT devices such as sensors with limited computational and storage capabilities. We evaluate the system’s performance using the publicly available NSL-KDD dataset. Our experiments and simulations demonstrate the effectiveness and efficiency of the proposed intrusion-detection system, highlighting the trade-offs between precision and recall when sharing statistics between workers and the coordinator. Notably, our experiments show that the proposed federated IDS can increase the true-positive rate up to 10% when the workers and the coordinator collaborate.

BackgroundCoronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. ObjectiveThe aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. MethodsWe will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. ResultsIn this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. ConclusionsThis study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial RegistrationClinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID)RR1-10.2196/24595

Given that Internet traffic speed and volume are growing at a rapid pace, monitoring the network in a real-time manner has introduced several issues in terms of computing and storage capabilities. Fast processing of traffic data and early warnings on the detected attacks are required while maintaining a single pass over the traffic measurements. To alleviate these problems, one can reduce the amount of traffic to be processed using a sampling technique and detect the attacks based on the sampled traffic. Different parameters have an impact on the efficiency of this process, mainly the applied sampling policy and sampling ratio. In this study, we investigate the statistical impact of sampling network traffic and quantify the amount of deterioration that the sampling process introduces. In this context, an experimental comparison of existing sampling techniques is performed based on their impact on several well-known statistical measures.

Photorefractive keratectomy (PRK) is considered a safe approach laser procedure with a clinical significance in correcting myopia results. PRK requires removing the whole superficial epithelium. The integrity of the epithelial basement membrane and the deposition of abnormal extracellular matrix can put the cornea in a probable situation for corneal haze formation. Mitomycin C (MMC) is applied after excimer laser ablation as a primary modulator for wound healing, limiting corneal haze formation. We aim to summarize the outcomes of MMC application after laser ablation. We searched Scopus, PubMed, Cochrane CENTRAL, and Web of Science till December 2020 using relevant keywords. The data were extracted and pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI), using Review Manager software (version 5.4). Our analysis demonstrated a statistically significant result for MMC application over the control group in terms of corneal haze formation postoperatively (RR = 0.29, 95% CI: [0.19, 0.45], P < 0.00001). Regarding corrected distance visual acuity (CDVA), no significant difference was observed between the MMC group and the control group (MD = 0.02; 95% CI: [-0.04, 0.07]; P = 0.56). Regarding the uncorrected distance visual acuity (UDVA), the analysis favored the MMC application with (MD -0.03, 95% CI: [-0.06, -0.00]; P = 0.05). There was no statistically significant increase in complications with MMC. In conclusion, MMC application after PRK is associated with a lower incidence of corneal haze formation with no statistically significant side effects. The long term effect can show improvement regarding UDVA favoring MMC. However, there is no significant effect of MMCs application regarding CDVA, and SE.

Objective: To provide an overview of retractions of research papers contributed by authors from the Arab region.Method: Papers in which the first author was affiliated to an Arabian country were selected from the Retraction Watch database covering the period 1 January 1998 to 31 December 2018. The retrieved records were divided into nine categories based on the reasons for retraction.Results: The search yielded 322 retractions, and the most frequent reason for retraction was plagiarism (34.5%). The median time from publication to retraction was 14 (25%-75% percentile 5-30) months. The number of papers retracted each year as well as the number of papers published in a given year but subsequently retracted increased steadily over the 21 years. The proportion of retracted papers to the total number of published papers (0.17%) was higher than the global proportion and was the highest for Algeria (1%) and the lowest for Lebanon (0.03%). Of the countries within the Arab region, 12 out of 14 countries showed either plagiarism or duplication as the most common reason for retraction; however, the countries differed in terms of the number of retractions and the time from publishing to retraction.Conclusion: Plagiarism was the most common cause of retraction in the Arab countries. The increase in the number of papers retracted each year was probably because searches now extend farther in the past, whereas the increase in the number of papers published in a given year but subsequently retracted can be attributed to the overall increase in the number of papers published.

Utilizing electrostatic precipitators (ESPs) is an efficient particle removal method that sees a wide usage in industrial environments. This is mainly because of the low drop of the pressure flow, while retaining high collection efficiency, alongside being cost-effective. This paper reviewed previous works concerning optimizing the performance of single- and multi-stage ESPs by changing several design parameters and evaluating the effects on different performance indices, such as the corona power ratio, current-voltage characteristics, and overall collection efficiency. The review then goes through several modelling methodologies, showcasing their shortcomings and developments, as well as the relationship between the electrohydrodynamic (EHD) flow and the precipitation performance. The performance effects of using different electrode configurations and designs in terms of the number of electrodes, relative dimensions, spacings, channel lengths, and overall design were also reviewed.

Background: Phenols and phthalates are potential endocrine disrupting chemicals (EDCs) that are associated with adverse health outcomes. These EDCs dysregulate a number of biomolecules and pathways, including microRNAs. MicroRNAs can be carried in transport systems called extracellular vesicles (EVs) that are present in most biofluids. EVs in the follicular fluid, which fills the ovarian follicle and influences oocyte developmental competency, carry microRNAs (EV-miRNAs) that have been associated with In Vitro Fertilization (IVF) outcomes. However, it remains unclear whether EDCs affect EV-miRNAs in follicular fluid. Objectives: This study sought to determine whether urinary concentrations of phenols and phthalates biomarkers are associated with EV-miRNAs expression in follicular fluid collected from women undergoing IVF treatment. Methods: This cross-sectional study included 130 women recruited between January 2014 and August 2016 in a tertiary university-affiliated hospital. Participants provided urine samples during ovarian stimulation and on the day of oocyte retrieval. We assessed urinary concentrations of five phenols, eight phthalate metabolites, and one phthalate alternative metabolite. EV-miRNAs were isolated from follicular fluid and their expression profiles were measured using the TaqMan Open Array® Human microRNA panel. We fitted multivariable linear regression models and principal component analysis to examine associations between individual and molar sums of exposure biomarkers and EV-miRNAs. Results: Of 754 miRNAs tested, we detected 133 EV-miRNAs in the microRNA array which expressed in at least 50% of the follicular fluid samples. After adjusting for multiple testing, we identified eight EV-miRNAs associated with individual phenols and phthalate metabolites, as well as molar ΣDEHP that met a q

In a resource-constrained Wireless Sensor Networks (WSNs), the optimization of the sampling and the transmission rates of each individual node is a crucial issue. A high volume of redundant data transmitted through the network will result in collisions, data loss, and energy dissipation. This paper proposes a novel data reduction scheme that exploits the spatial-temporal correlation among sensor data in order to determine the optimal sampling strategy for the deployed sensor nodes. This strategy reduces the overall sampling/transmission rates while preserving the quality of the data. Moreover, a back-end reconstruction algorithm is deployed on the workstation (Sink). This algorithm can reproduce the data that have not been sampled by finding the spatial and temporal correlation among the reported data set, and filling the “non-sampled” parts with predictions. We have used real sensor data of a network that was deployed at the Grand-St-Bernard pass located between Switzerland and Italy. We tested our approach using the previously mentioned data-set and compared it to a recent adaptive sampling based data reduction approach. The obtained results show that our proposed method consumes up to 60% less energy and can handle non-stationary data more effectively.

BackgroundData is lacking on outcomes among COPD patients in sub-Saharan Africa. The objective of the study was to assess the incidence and predictors of mortality among COPD patients enrolled in the Uganda Registry for Asthma and COPD.Research questionWhat is the Incidence and predictors of mortality among COPD patients in Uganda?Study design and methodsIndividuals with a diagnosis of COPD at six hospitals in Uganda were enrolled into the registry, and followed every six months. Mortality was ascertained through post-mortem reports and verbal autopsies. Mortality rates (MR), mortality rate ratios (MRR), and hazard ratios (HR) were computed to assess associations between socio-demographic, behavioural, and clinical characteristics at enrolment into the registry and mortality up to two years after.ResultsWe enrolled 296 COPD patients. Median age was 60 years, and 51·3% were male. The overall mortality rate was 95·90 deaths/1000 person-years. COPD severity by post-bronchodilator FEV1 was the strongest risk factor for mortality. Compared to stage 1, adjusted hazard ratios were as follows for stage 4: 9·86 (95%CI: 1·70-57·14, p = 0·011), stage 3: 6·16 (95%CI: 1·25-30·32, p = 0·025), and stage 2: 1·76 (95%CI: 0·33-9·48, p = 0·51). Underweight patients had a higher incidence of mortality compared to normal weight patients (MRR: 3·47 (95%CI: 1·45-8·31, p = 0·0026).ConclusionAmong COPD patients in Uganda, two-year mortality is high, and disease severity at baseline was the strongest risk factor for mortality. Our findings suggest the need for early, accurate, diagnosis and management of COPD, to potentially improve survival.

The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p

Cardiovascular diseases (CVDs) carry significant morbidity and mortality and are associated with substantial economic burden on healthcare systems around the world. Coronary artery disease, as one disease entity under the CVDs umbrella, had a prevalence of 7.2% among adults in the United States and incurred a financial burden of 360 billion US dollars in the years 2016–2017. The introduction of artificial intelligence (AI) and machine learning over the last two decades has unlocked new dimensions in the field of cardiovascular medicine. From automatic interpretations of heart rhythm disorders via smartwatches, to assisting in complex decision-making, AI has quickly expanded its realms in medicine and has demonstrated itself as a promising tool in helping clinicians guide treatment decisions. Understanding complex genetic interactions and developing clinical risk prediction models, advanced cardiac imaging, and improving mortality outcomes are just a few areas where AI has been applied in the domain of coronary artery disease. Through this review, we sought to summarize the advances in AI relating to coronary artery disease, current limitations, and future perspectives.

Today, we are awash in a flood of data coming from different data generating sources. Wireless sensor networks (WSNs) are one of the big data contributors, where data are being collected at unprecedented scale. Unfortunately, much of these data are of no interest, meaningless, and redundant. Hence, data reduction is becoming fundamental operation in order to decrease the communication costs and enhance data mining in WSNs. In this paper, we propose a two-level data reduction approach for sensor networks. The first level operated by the sensor nodes consists of compressing collected data while using the Pearson coefficient. The second level is executed at intermediate nodes (e.g., aggregators, cluster heads, and so on). The objective of the second level is to eliminate redundant data generated by neighboring nodes using two adapted clustering methods: EKmeans and TopK. Through both simulations and real experiments on real telosB sensors, we show the relevance of our approach in terms of minimizing the big data collected in WSNs and enhancing network lifetime, compared to other existing techniques.

Objective: To assess the applicability of salivary C‐reactive protein, mean platelet volume, neutrophil–lymphocyte ratio, and platelet lymphocyte ratio in the diagnosis of neonatal sepsis. Methods: Prospective case‐control study of 70 full‐term neonates, 35 with sepsis (20 with proven sepsis and 15 with clinical sepsis) and 35 healthy controls. Serum and salivary CRP concentrations were measured by ELISA while MPV, NLR, and PLR were measured by automated blood cell counter. Results: This study showed statistically significant difference of mean salivary CRP between septic neonates and controls (12.0 ± 4.6 ng/L vs. 2.8 ± 1.2 ng/L) respectively. At a cut‐off point of 3.48 ng/L, salivary CRP showed 94.3% sensitivity and 80% specificity. Salivary CRP also showed good predictive accuracy for predicting elevated serum CRP values in septic neonates. MPV and NLR showed significant difference between septic neonates and controls (10.2 ± 1.2 fL vs. 8.0 ± 0.5 fL; 2.9 ± 1.7 vs. 1.6 ± 0.4, respectively). At a cut‐off point of 10.2 fL, MPV presented 80% sensitivity and specificity. At a cut‐off point of 2.7, NLR presented 80% sensitivity and 57.1% specificity. Conclusion: This study provides support for further studies on the usefulness of salivary CPR, MPV, and NLR as diagnostic markers for neonatal sepsis.

Wireless sensor networks (WSNs) are almost everywhere, they are exploited for thousands of applications in a densely distributed manner. Such deployment makes WSNs one of the highly anticipated key contributors of the big data nowadays. Hence, data aggregation is attracting much attention from researchers as efficient way to reduce the huge volume of data generated in WSNs by eliminating the redundancy among sensing data. In this paper, we propose an efficient data aggregation technique for clustering-based periodic wireless sensor networks. Further to a local aggregation at sensor node level, our technique allows cluster-head to eliminate redundant data sets generated by neighbouring nodes by applying three data aggregation methods. These proposed methods are based on the sets similarity functions, the one-way Anova model with statistical tests and the distance functions, respectively. Based on real sensor data, we have analyed their performances according to the energy consumption and the data latency and accuracy, and we show how these methods can significantly improve the performance of sensor networks.

More than half of deaths in end-stage kidney disease (ESKD) patients are due to cardiovascular disease. Elevated fibroblast growth factor 23 (FGF-23) was found to be associated with mortality in hemodialysis (HD) patients and correlates with peripheral calcification. Aortic calcification is associated with coronary artery calcification. Both aortic and peripheral vascular calcifications were associated with mortality in chronic kidney disease. We aimed to investigate the relation between intact FGF-23 and cardiovascular calcification in patients with ESKD who were maintained on regular HD. Sixty clinically stable ESKD patients on regular HD were enrolled into this cross-sectional study. They were evaluated by basal abdominal X-ray. They were divided into two groups: (Group A, n = 30), patients with abdominal aortic calcification who underwent multislice computerized tomography scan to measure coronary artery calcification score; and (Group B, n = 30), patients without abdominal aortic calcification. All of them were evaluated by lipid profile and dialysis adequacy parameters. Fifty percent of patients had vascular calcification. We found a significant positive correlation between age and intact FGF-23; significant positive correlations between age, body mass index, duration of HD, and abdominal aortic calcification score. FGF-23 of all patients was elevated and had significant positive correlation with aortic and coronary calcifications in addition to lipid profile, left ventricular mass index (LVMI), and inflammatory markers. Plasma intact FGF-23 was elevated in nondiabetic ESKD patients, and vascular calcification was prevalent in such group of patients with many traditional and nontraditional risk factors. Possibly through its disturbing effects on minerals and parathyroid hormone, FGF-23 might indirectly affect vascular calcification. LVMI was higher in patients with vascular calcification and correlated positively with it.

INTRODUCTION : il est considéré que la mort subite qui survient lors d'une activité sportive touche un patient ayant une cardiopathie ignorée. L'ECG du sportif de race noire a été peu étudié et des particularités liées à l'ethnie ont été évoquées. Notre travail a pour objectif d'étudier le profil épidémiologique et les particularités de la repolarisation du sportif de race noire.Méthodes: une étude descriptive a été menée durant 8 mois de mars à octobre 2014, incluant des sportifs de race noire sélectionnés parmi tous les sportifs qui étaient suivi dans le centre sectoriel de la Médecine et des Sciences de sports de Sousse. Le recueil de données a été réalisé grâce à un questionnaire médical.Résultats: trente-cinq (35) athlètes ont été colligés, avec une prédominance masculine (94,28%), ayant un âge moyen de 24,34 ans. Quatre athlètes avaient une hypertrophie ventriculaire gauche à l'échographie cardiaque. Il y'avait 8 athlètes avec un BAV de 1er degré et 8 athlètes avaient un HVG électrique. Les modifications du segment ST étaient plus marquées au niveau des dérivations précordiales. Cinq athlètes (14,2%) avaient des ondes T négatives en V2 et V3, et il s'agissait des mêmes athlètes qui avaient le sus décalage du segment ST dans ces mêmes dérivations. Un aspect de repolarisation précoce a été constaté chez 3 athlètes. Tous ces cas étaient type notch.Conclusion: les sportifs de race noire semblent avoir des modifications électriques assez spécifiques dont il importe de connaitre. Toutefois, notre échantillon n'est pas suffisamment important pour affirmer ces résultats. Une étude comparative avec des sportifs de race blanche serait très intéressante.

BackgroundThe FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI).MethodsData for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%).ResultsAmong the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals (n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; pConclusionsData from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals.

Nowadays, wireless sensor networks (WSNs) are more and more used in applications such as environment monitoring, healthcare monitoring, etc...The challenge in sensor networks is to ensure the sustainability of the system by guaranteeing the required performance level. However, with the limited capacity of finite power sources and the need of guaranteeing a long lifetime of those systems, it is suitable to use energy harvesting which allows to supply low-power electronic systems by converting ambient energy into electric power. Hence, our study is concerned with the problem of soft periodic and aperiodic tasks scheduling in sensor nodes powered by energy harvesters. In this paper, we address this issue by proposing three energy-aware schedulers, namely BG-Green-RTO, BG-Green-BWP and Green-AWP which aim to improve the responsiveness of aperiodic tasks while still guaranteeing the execution of periodic tasks considering their timing and energy constraints. Such algorithms allow to gracefully cope with processing overload and energy starvation. Moreover, a simulation study permits to show their performance.

Background: The aim of our study was to assess the delay of fibrinolysis in ST elevation myocardial infarction (STEMI) in our region and to identify characteristics associated with prolonged delay. Patients and Methods: We analyzed clinical characteristics of a prospective cohort of unselected patients admitted for (STEMI). The study was conducted over three years 2007-2009 and 250 patients were included in a single center without capability of percutaneous coronary intervention. Results: The mean age of our patients was 58±13, 7 years. Ninety percent of our patients consult directly the emergency department and 61, (5%) of them were admitted within first 6 hours of onset of symptoms. Median time to reperfusion was 46 min. Predictor of this long delay to initiate fibrinolysis were inter-department decision OR 6; 95% CI 3,48-10,34, diabetes OR 2,25; 95% CI 1,28-3,96 age >58,4 years OR 1,97; 95% CI 1,19-3,25 and transfer from regional hospital to our center OR 1,78; 95% 1,03-3.07. Conclusion: These results suggest that improvement in organization health care system can shorten delay to fibrinolysis in a center without percutaneous coronary intervention capability.

In Body Sensor Networks (BSNs), two types of events should be addressed: periodic and emergency events. Traffic rate is usually low during periodic observation, and becomes very high upon emergency. One of the main and challenging requirements of BSNs is to design Medium Access Control (MAC) protocols that guarantee immediate and reliable transmission of data in emergency situations, while maintaining high energy efficiency in non-emergency conditions. In this paper, we propose a new emergency aware hybrid DTDMA/DS-CDMA protocol that can accommodate BSN traffic variations by addressing emergency and periodic traffic requirements. It takes advantage of the high delay efficiency of DS-CDMA in traffic burst, and the high energy efficiency of DTDMA in periodic traffic. The proposed scheme is evaluated in terms of delay, packet drop percentage, and energy consumption. Different OPNET simulations are performed for various number of nodes carrying emergency data, and for various payload sizes. The protocol performance is compared to other existing hybrid protocols. Results show that the proposed scheme outperforms the others in terms of delay and packet drop percentage for different number of nodes carrying emergency data, as well as for different payload sizes. It also offers the highest energy efficiency during periodic observation, while adjusting the energy consumption during emergency by assigning spreading codes only to nodes holding emergency data.

There is a growing interest in the use of video sensor networks in surveillance applications in order to detect intruders with low cost. The essential concern of such networks is whether or not a specified target can pass or intrude the monitored region without being detected. This concern forms a serious challenge to wireless video sensor networks of weak computation and battery power. In this paper, our aim is to prolong the whole network lifetime while fulfilling the surveillance application needs. We present a novel scheduling algorithm where only a subset of video nodes contributes significantly to detect intruders and prevent malicious attacker to predict the behavior of the network prior to intrusion. Our approach is chaos based, where every node based on its last detection, a hash value and some pseudorandom numbers easily compute a decision function to go to sleep or active mode. We validate the efficiency of our approach through theoretical analysis and demonstrate the benefits of our scheduling algorithm by simulations. Results show that in addition to being able to increase the whole network lifetime and to present comparable results against random attacks (low stealth time), our scheme is also able to withstand malicious attacks due to its fully unpredictable behavior.

Background The effects of L-asparaginase on hemostasis during induction chemotherapy are less defined in adults than in children. We, therefore, studied the effects of L-asparaginase in adult patients.Design and Methods This was a retrospective analysis of 214 patients treated with L-asparaginase (7500 IU/m2 x 6) for acute lymphoblastic leukemia or lymphoblastic lymphoma. Between day 1 of the induction course and discharge, clinical events, and biological and therapeutic modifications were reviewed.Results Antithrombin and fibrinogen levels were lower than 60% and 1 g/L in 71% and 73% of patients, respectively. Twenty thromboses occurred in 9.3% of the patients; these patients had a median antithrombin level of 53% (range, 21–111) at the time of the event. Forty-two episodes of bleeding occurred in 31 patients with a median fibrinogen level of 1.3 g/L. Infusions of L-asparaginase were reduced or delayed in 64% of patients due to low fibrinogen and/or antithrombin levels. Fresh-frozen plasma, antithrombin and fibrinogen were infused in 31%, 41% and 52% of patients, respectively. The mean antithrombin and fibrinogen levels increased from 61% to 88% and from 1 to 1.4 g/L after infusion of antithrombin or fibrinogen respectively, while both levels remained unchanged after the infusion of fresh-frozen plasma. In patients who received antithrombin concentrates L-asparaginase injections were less frequently omitted or delayed (53% vs. 72%, p=0.005), the rate of thrombosis was lower (4.8% vs. 12.2%, p=0.04) and the disease-free survival was also reduced (p=0.05).Conclusions This retrospective study suggests that antithrombin concentrates may have a beneficial effect on the outcome of adults treated for acute lymphoblastic leukemia with L-asparaginase; prospective studies are essential to confirm this hypothesis.

Abstract Objective: To assess the applicability of salivary C-reactive protein, mean platelet volume, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio in the diagnosis of neonatal sepsis. Methods: Prospective case-control study of 70 full-term neonates, 35 with sepsis (20 with proven sepsis and 15 with clinical sepsis) and 35 healthy controls. Serum and salivary C-reactive protein concentrations were measured by enzyme-linked immunosorbent assay while mean platelet volume, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio were measured by automated blood cell counter. Results: This study showed statistically significant difference of mean salivary C-reactive protein between septic neonates and controls (12.0 ± 4.6 ng/L vs. 2.8 ± 1.2 ng/L) respectively. At a cut-off point of 3.48 ng/L, salivary C-reactive protein showed 94.3% sensitivity and 80% specificity. Salivary C-reactive protein also showed good predictive accuracy for predicting elevated serum C-reactive protein values in septic neonates. Mean platelet volume and neutrophil-lymphocyte ratio showed significant difference between septic neonates and controls (10.2 ± 1.2 fL vs.8.0 ± 0.5 fL; 2.9 ± 1.7 vs. 1.6 ± 0.4, respectively). At a cut-off point of 10.2 fL, mean platelet volume presented 80% sensitivity and specificity. At a cut-off point of 2.7, neutrophil-lymphocyte ratio presented 80% sensitivity and 57.1% specificity. Conclusion: This study provides support for further studies on the usefulness of salivary C-reactive protein, mean platelet volume, and neutrophil-lymphocyte ratio as diagnostic markers for neonatal sepsis.

Liver inflammatory diseases are marked by serious complications. Notably, nicardipine (NCD) has demonstrated anti-inflammatory properties, but its benefits in liver inflammation have not been studied yet. However, the therapeutic efficacy of NCD is limited by its short half-life and low bioavailability. Therefore, we aimed to evaluate the potential of NCD-loaded chitosan nanoparticles (ChNPs) to improve its pharmacokinetic profile and hepatic accumulation. Four formulations of NCD-ChNPs were synthesized and characterized. The optimal formulation (NP2) exhibited a mean particle diameter of 172.6 ± 1.94 nm, a surface charge of +25.66 ± 0.93 mV, and an encapsulation efficiency of 88.86 ± 1.17 %. NP2 showed good physical stability as a lyophilized powder over three months. It displayed pH-sensitive release characteristics, releasing 77.15 ± 5.09 % of NCD at pH 6 (mimicking the inflammatory microenvironment) and 52.15 ± 3.65 % at pH 7.4, indicating targeted release in inflamed liver tissues. Pharmacokinetic and biodistribution studies revealed that NCD-ChNPs significantly prolonged NCD circulation time and enhanced its concentration in liver tissues compared to plain NCD. Additionally, the study investigated the protective effects of NCD-ChNPs in thioacetamide-induced liver injury in rats by modulating the NFκB/NLRP3/IL-1β signaling axis. NCD-ChNPs effectively inhibited NFκB activation, reduced NLRP3 inflammasome activation, and subsequent release of IL-1β, which correlated with improved hepatic function and reduced inflammation and oxidative stress. These findings highlight the potential of NCD-ChNPs as a promising nanomedicine strategy for the treatment of liver inflammatory diseases, warranting further investigation into their clinical applications, particularly in hypertensive patients with liver inflammatory conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background/objectives: Tamoxifen has well-known retinal toxicity, but the epidemiology of this toxicity is poorly defined. This study aims to 1) evaluate the prevalence of tamoxifen retinopathy in a major northeastern metropolitan area based on multimodal retinal imaging and 2) determine whether the additional peripheral retina captured in ultra-widefield (UWF) imaging aids in the diagnosis of tamoxifen retinopathy., Methods: This retrospective cohort study examined female patients initiated on tamoxifen for at least 12 months prior to their first retinal exam. Two independent graders performed blinded review of spectral-domain optical coherence tomography (OCT) images for evidence of macular toxicity and UWF images for signs of central and peripheral toxicity. A one-tailed two-proportion Z-test determined whether peripheral pigmentary changes were more prevalent in the tamoxifen cohort than age- and gender-matched controls., Results: 241 eyes from 123 patients were included in the tamoxifen cohort, and 258 eyes from 132 patients were included in the control cohort. Two patients demonstrated definitive tamoxifen retinopathy, for a prevalence of 1.6%. One patient demonstrated crystalline maculopathy on OCT and UWF imaging, while another demonstrated pseudocystic cavitations on OCT imaging. Neither patient had peripheral findings on UWF imaging. Peripheral pigmentary changes were not significantly more prevalent in the tamoxifen cohort., Conclusions: These findings suggest that UWF imaging does not contribute to diagnosis of tamoxifen retinopathy, and OCT may be the most valuable tool in diagnosing tamoxifen retinopathy. Our prevalence (1.6%) diverges from higher rates in studies screening with similarly advanced retinal imaging. Further large population studies are needed., (Copyright © 2024 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Persistent chemicals from industrial processes, particularly perfluoroalkyl substances (PFAS), have become pervasive in the environment due to their persistence, long half-lives, and bioaccumulative properties. Used globally for their thermal resistance and repellence to water and oil, PFAS have led to widespread environmental contamination. These compounds pose significant health risks with exposure through food, water, and dermal contact. Aquatic wildlife is particularly vulnerable as water bodies act as major transport and transformation mediums for PFAS. Their co-occurrence with microplastics may intensify the impact on aquatic species by influencing PFAS sorption and transport. Despite progress in understanding the occurrence and fate of PFAS and microplastics in aquatic ecosystems, the toxicity of PFAS mixtures and their co-occurrence with other high-concern compounds remains poorly understood, especially over organisms' life cycles. Our study investigates the chronic toxicity of PFAS and microplastics on the sentinel species Daphnia, a species central to aquatic foodwebs and an ecotoxicology model. We examined the effects of perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and polyethylene terephthalate microplastics (PET) both individually and in mixtures on Daphnia ecological endpoints. Unlike conventional studies, we used two Daphnia genotypes with distinct histories of chemical exposure. This approach revealed that PFAS and microplastics cause developmental failures, delayed sexual maturity and reduced somatic growth, with historical exposure to environmental pollution reducing tolerance to these persistent chemicals due to cumulative fitness costs. We also observed that the combined effect of the persistent chemicals analysed was 59% additive and 41% synergistic, whereas no antagonistic interactions were observed. The genotype-specific responses observed highlight the complex interplay between genetic background and pollutant exposure, emphasizing the importance of incorporating multiple genotypes in environmental risk assessments to more accurately predict the ecological impact of chemical pollutants., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective : The aim of this in vitro investigation is to study the effect of endodontic cavity design on interfacial voids, class II resin composite sealing ability, and fracture resistance in mandibular premolars. Methods : A total of 48 single-rooted mandibular premolars received compound class II preparations with either traditional flare access cavities (group A) or contracted endodontic cavity preparations (group B). Each study group was subdivided according to the coronal restoration into two sub-groups as α and β. In the α group, a microhybrid composite was used after etch-and-rinse bonding technique using an MDP-containing universal adhesive. In the β group, a self-adhesive composite was used as coronal restoration after endodontic treatment ( n = 12) for each subgroup. A micro-CT analysis was performed to assess the obturation interfacial voids and tracing of class II cervical interfacial adaptation. The tooth fracture resistance testing was then performed adding an extra group of 12 sound non-prepared teeth, which were tested as the control for fracture strength testing. A one-way ANOVA and post-hoc testing were used together with descriptive statistics for an analysis of the mean values of obturation interfacial voids. A two-way ANOVA was used to assess the fracture resistance test results, and to find the influence of endodontic access design and the type of composite material on the fracture resistance testing. Chi-square testing was employed to analyze the cervical interfacial seal of the class II restorations. Results : A one-way ANOVA revealed that there were no statistically significant differences between test groups in the amount of obturation interfacial voids ( p > 0.05). There were no statistically significant differences between test groups in terms of cervical interfacial sealing ability ( p > 0.05). A two-way ANOVA revealed that no statistically significant differences between test groups including the control group existed in terms of the fracture resistance testing ( p > 0.05). Conclusions : Although it does not improve tooth fracture resistance, the contracted endodontic access cavity does not deteriorate the quality of obturation in terms of the interfacial porosity. The self-adhesive composite does not improve the efficiency of cervical interfacial adaptation or tooth fracture resistance regardless of the endodontic access cavity shape, yet it revealed a substantial load-bearing capacity.

Purpose: Antiretroviral therapy has revolutionized HIV treatment with didanosine (DDI) as a pioneering drug. However, DDI has been associated with retinal toxicity, characterized by peripheral chorioretinal degeneration with macular sparing. Despite its clinical recognition, the prevalence and risk factors for didanosine-induced retinopathy are not well described., Methods: This retrospective case series analyzed 127 DDI-treated patients at Weill Cornell Medicine Department of Ophthalmology. Inclusion criteria included at least 6 months of DDI use and available ultra-widefield imaging. Patients were categorized as affected or unaffected based on retinal imaging assessed by two reviewers. The affected group was further divided into "probable" or "possible" retinopathy. Patient demographics, DDI usage characteristics, and imaging findings were analyzed with statistical comparisons drawn between affected and unaffected cohorts., Results: Of the 127 patients, 9 (7%) showed signs of didanosine-induced retinal toxicity. On average, the affected group was older compared with the unaffected group (65.1 vs. 56.5 years, P = 0.025), with lower BMI (23.2 vs. 27.4, P = 0.04), and older at the start of the treatment (51.6 vs. 40.8 years, P = 0.026). Mild phenotypes with peripheral pigmentary changes were also identified using ultra-widefield imaging., Conclusion: This pioneering academic study highlighted a notable prevalence of DDI-induced retinal toxicity. Statistical analysis demonstrated age, BMI, and age at treatment initiation as potential risk factors. Ultra-widefield autofluorescence emerged as a valuable tool in detecting and delineating findings. Follow-up studies are needed to determine the necessity of regular screening for individuals on or with a history of didanosine use.

Objective: Meat processing is among the most extensive industries globally. However, data on the effects of occupational exposure on the pulmonary health of slaughterhouse workers is limited. Ascertaining the impact of the slaughterhouse atmosphere on the breathing habits of laborers exposed to it and the inflammatory markers associated with it was the aim of the current investigation., Methods: A cross-sectional study was performed on 82 non-smoker subjects of 41 male workers working in one of the major slaughterhouses in Cairo, Egypt, matched to 41 controls of administrative personnel. An elaborate questionnaire encompassing medical and occupational history was administered to each participant in the research. General and local systemic examinations and ventilatory function tests were carried out, and serum levels of interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were measured., Results: Respiratory symptoms were more prevalent with a statistically significant decline in ventilatory function parameters (FVC%, FEV1%, FEV1/FVC, FEF 25%, FEF 50%, FEF 75%, and PEF%) among the exposed group compared to those of control. In addition, there was a significantly higher serum level of inflammatory markers (IL-6 and hsCRP) among the exposed group compared to the control group, with a negative correlation with ventilatory functions. Moreover, there was a positive association between levels of serum IL-6 and hsCRP and the age and duration of employment of workers., Conclusion: There was a notable increase in the prevalence of respiratory disorders and inflammatory markers among slaughterhouse workers. Additionally, there was a substantial decrease in ventilatory function parameters, which could be attributed to the bioaerosols they encountered in the workplace., (© 2024. The Author(s).)

Objective: To evaluate a newly designed minimally invasive palatal-plate face mask combination for the management of developing Class III malocclusion due to maxillary deficiency., Methods: A sample of 16 Class III patients due to maxillary deficiency in the early mixed dentition (8 boys and 8 girls) aged between 7 and 9 years participated in this study and were treated with a combination of palatal plate face masks. Extra-oral elastics were attached between the intra-oral and extra-oral appliances; the elastics were set at 30° to the occlusal plane. The force magnitude was 250-300 g per quadrant. Cephalometric radiographs were taken before and immediately after maxillary protraction. In addition, skeletal measurements were measured, tabulated, and statistically analyzed. The pre- and post-protraction measurements were compared using the Student's t-test, and the significance level was set at a p-value <0.05., Results: A statistically significant increase in SNA angle and maxillary length was observed by 3.13±1.52 degrees and 2.60±0.75 mm (p<0.05), respectively, indicating forward maxillary growth. The skeletal and soft tissue patterns were also improved, as evidenced by the statistically significant increase in the ANB angle, Wits appraisal, and H angle by 4.50±1.28 degrees, 5.30±1.86 mm, and 5.02±3.24 degrees (p<0.05), respectively. A favorable clockwise mandibular rotation was observed as evidenced by the increase in the SN/MP angle and the decrease in the SNB angle by 1.46±1.96 degrees and -1.38±1.86 degrees (p<0.05), respectively., Conclusion: The palatal-plate facemask combination is an effective treatment alternative for Class III malocclusion due to maxillary deficiency with minimal pain and discomfort., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of Turkish Orthodontic Society.)

Microplastics (MPs) are a group of emerging contaminants that attracted increasing scientific and societal attention over the past decade. So far, most studies on MPs focus on characterizing their occurrence, fate, and impact in the aquatic environment. In contrast, very little is known about the magnitude, patterns, and associated risks of human exposure to MPs, particularly indoors, despite people spending most of their time indoors. This paper provides the first study hitherto of MPs in indoor air via both active and passive sampling from 30 homes and 30 workplaces in Birmingham, UK. The average concentration of MPs in the active air samples was 15.6 ± 5.4 MP/m 3 in homes and 13.1 ± 6.5 MP/m 3 in workplaces. For atmospheric deposition samples (passive sampling), the average MPs concentrations were 3735 ± 1343 MP/m 2 /day in homes and 3177 ± 1860 MP/m 2 /day in workplaces. Mean concentrations of MPs in UK homes were significantly higher (P<0.05) than those in workplaces for both active and passive air samples. This was mainly driven by carpeted floors in all the studied homes, while 13 of the sampled workplaces were uncarpeted. MPs concentrations in atmospheric deposition (passive) samples were significantly higher (P < 0.05) than airborne (active) MPs samples in the studied microenvironments. Nonetheless, a strong correlation (P < 0.01) was observed between the concentrations of MPs measured by active and passive sampling, indicating common sources of MPs to both active and passive samples collected from the same microenvironments. In terms of morphology, fibres were the dominant shape of MPs, followed by fragments, constituting together ≥90% of the identified MPs in all samples, with the remaining minor percent made up by foams. Airborne MPs were dominated by particles in the size range (10-25 μm), and the particles abundance decreased with increasing particle size. MPs in atmospheric fallout particles, were dominated by larger particles (50-100 μm) with lower contribution from smaller particles (10-25 μm) compared to airborne particles. Nonetheless, combined with the predominance of fibres, this raises concern over the risk from inhalation exposure because MPs fibres in the detected size ranges were observed to penetrate into human lung tissue. PET and PVC were the most abundant polymer types in the studied samples followed by PP and PE. The average daily inhalation exposure of UK adults and toddlers was estimated at 3.0 and 6.3 MP/kg body weight/day, respectively. The higher inhalation exposure of UK toddlers raises concern due to their incompletely developed immune and nervous systems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aimed to compare outcomes of hand-sewn and stapler closure techniques of pancreatic stump in patients undergoing distal pancreatectomy (DP). Impact of stapler closure reinforcement using mesh on outcomes was also evaluated. Literature search was carried out using multiple data sources to identify studies that compared hand-sewn and stapler closure techniques in management of pancreatic stump following DP. Odds ratio (OR) was determined for clinically relevant postoperative pancreatic fistula (POPF) via random-effects modelling. Subsequently, trial sequential analysis was performed. Thirty-two studies with a total of 4,022 patients undergoing DP with hand-sewn (n = 1,184) or stapler (n = 2,838) closure technique of pancreatic stump were analyzed. Hand-sewn closure significantly increased the risk of clinically relevant POPF compared to stapler closure (OR: 1.56, p = 0.02). When stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.54, p = 0.002). When only randomized controlled trials were considered, there was no significant difference in clinically relevant POPF between hand-sewn and stapler closure techniques (OR: 1.20, p = 0.64) or between reinforced and standard stapler closure techniques (OR: 0.50, p = 0.08). When observational studies were considered, hand-sewn closure was associated with a significantly higher rate of clinically relevant POPF compared to stapler closure (OR: 1.59, p = 0.03). Moreover, when stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.55, p = 0.02). Trial sequential analysis detected risk of type 2 error. In conclusion, reinforced stapler closure in DP may reduce risk of clinically relevant POPF compared to hand-sewn closure or stapler closure without reinforcement. Future randomized research is needed to provide stronger evidence.

Purpose: P2X7 receptor (P2X7R) is a purinergic cation channel whose activation has been linked with age-related macular degeneration (ARMD). Several nucleoside reverse transcriptase inhibitors, zidovudine (AZT), lamivudine (3TC) and abacavir (ABC), have been shown to inhibit P2X7R and improve outcomes in animal models of ARMD. Our aim is to investigate the association between chronic AZT, 3TC, and ABC therapy and ARMD in a clinical setting., Methods: This is a retrospective cohort study comparing 445 patients with HIV and confirmed usage of AZT, 3TC, and ABC against 200 patients with HIV without usage of AZT, 3TC, and ABC and 445 non-HIV infected patients. Fundus examination and spectral domain optical coherence tomography (SD-ODT) were used to measure prevalence of early-intermediate stage ARMD, geographic atrophy, and exudative ARMD., Results: There was no statistically significant difference in the prevalence of early-intermediate stage ARMD between the HIV infected patients with a history of AZT, 3TC, and ABC use and the HIV infected patients without AZT, 3TC, and ABC use (p = 0.887). There was also no statistically significant difference in the prevalence of geographical atrophy (p = 0.062) and exudative AMD (p > 0.999) between the HIV infected patients with a history of AZT, 3TC, and ABC use and non-HIV infected patients., Conclusion: We did not find an effect of P2X7R inhibiting antiretrovirals usage on early-intermediate stage ARMD, geographical atrophy, or exudative ARMD. Studies with larger cohort and more rigorous medication history are needed to assess the effects on geographical atrophy or exudative ARMD., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Demonstration of glycogen in tissue holds considerable diagnostic relevance across various pathological conditions, particularly in certain tumors. The histochemical staining of glycogen using methods utilizing Schiff's reagents is subject to influences arising from the type of fixative, fixation temperature, and oxidizing agents employed. This study aimed to assess diverse fixatives, fixation temperatures, and oxidizing agents, each with variable treatment durations, in conjunction with Schiff's reagent for optimal glycogen demonstration. Paraffin blocks derived from a rabbit's liver served as the experimental substrate, encompassing 340 paraffin sections subjected to different procedures. For tissues fixed at 4 °C, good staining outcomes, as determined by the periodic acid-Schiff (PAS) stain, were observed with 10% neutral buffered formalin (NBF), 80% alcohol, and Bouin's solution. Tissues fixed at room temperature (RT) demonstrated good PAS staining results with both 10% NBF and 80% alcohol. Notably, other oxidizing agents exhibited poor outcomes across all fixatives and fixation temperature, with two exceptions, as satisfactory staining results were obtained when using 5% chromic acid. Consequently, Both 10% NBF and 80% emerge as preferred fixatives of choice for glycogen demonstration when coupled with PAS stain. It is noteworthy that Bouin's solution could also provide good outcomes when fixation occurred at 4 °C., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Whether dye spray chromoendoscopy (DCE) adds value in surveillance colonoscopy with high-definition (HD) scopes remains controversial. This updated meta-analysis compares dysplasia detection using DCE and high-definition white light endoscopy (HD-WLE) in patients with inflammatory bowel disease (IBD) undergoing surveillance colonoscopy., Methods: A comprehensive search was performed for randomized controlled trials (RCT) comparing HD-WLE and DCE in patients with IBD. The primary outcome was to compare the proportion of patients with at least 1 dysplastic lesion detected by DCE vs HD-WLE. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using the random-effects model, with I2 > 60% indicating substantial heterogeneity. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence (CoE)., Results: Six RCT involving 978 patients were analyzed (DCE = 479 vs HD-WLE = 499 patients). DCE detected significantly more patients with dysplasia than HD-WLE (18.8% vs 9.4%), OR 1.94 (95% CI 1.21-3.11, I2 = 28%, P = 0.006, high CoE). This remained significant after excluding 2 RCT published as abstracts. A sensitivity analysis excluding a noninferiority RCT with a single experienced operator eliminated the results' heterogeneity, OR 2.46 (95% CI 1.56-3.90, I2 = 0%). Although high-grade dysplasia detection was numerically higher in the DCE group (2.8% vs 1.1%), the difference was statistically insignificant, OR 2.21 (95% CI 0.64-7.62, I2 = 0%, low CoE)., Discussion: Our updated meta-analysis supports DCE as a superior strategy in overall dysplasia detection in IBD, even with HD scopes. When expertise is available, DCE should be considered for surveillance colonoscopy in patients with high-risk IBD, with the acknowledgment that virtual chromoendoscopy shows equivalence in recent studies. Further multicenter trials with multiple endoscopists with varying expertise levels and longer-term outcome data showing a reduction in cancer or cancer-related death are needed., (Copyright © 2023 by The American College of Gastroenterology.)

Introduction: Clostridioides difficile infection (CDI) remains a global health challenge. Bezlotoxumab (BEZ) is a monoclonal antibody against C. difficile toxin B. Two randomized controlled trials (RCTs), MODIFY I and II, confirmed BEZ efficacy in preventing recurrent Clostridioides difficile infection (rCDI). However, there are safety concerns about its use in patients with a history of congestive heart failure. Observational studies have since been conducted, and it is important to explore the consistency of BEZ efficacy, cost-effectiveness, and its safety utilizing these real-world data., Methods: We performed a systematic review and meta-analysis to pool the rate of rCDI in patients receiving BEZ and explore its efficacy and safety in preventing rCDI compared with control. We searched PubMed, EMBASE, Cochrane Library, and Google Scholar from inception through April 2023 for relevant RCTs or observational studies assessing BEZ in preventing rCDI. Single-arm studies describing experience with BEZ in preventing rCDI were also included for proportion meta-analysis. A proportion meta-analysis with a random-effects model was used to pool the rCDI rate with its corresponding 95% CI. In a meta-analysis of efficacy, we generated the relative risk (RR) to compare BEZ versus control in preventing rCDI., Results: Thirteen studies including 2 RCTs and 11 observational studies totaling 2337 patients, of which 1472 received BEZ, were included in the analysis. Of the constituent studies, 5 (1734 patients) compared BEZ versus standard-of-care (SOC). Pooled rate of rCDI in patients receiving BEZ was 15.8% (95% CI: 14%-17.8%), and was 28.9% (95% CI: 24%-34.4%) in the SOC. BEZ significantly reduced rCDI risk compared with SOC [RR=0.57 (95% CI: 0.45-0.72, I2 =16%)]. There was no difference in the overall mortality or heart failure risk. Of the 9 included cost-effectiveness analyses, 8 demonstrated BEZ+SOC cost-effectiveness compared with SOC alone., Discussion: Our meta-analysis comprising real-world data revealed lower rCDI in patients receiving BEZ and supported its efficacy and safety when added to SOC therapy. The results were consistent across various subgroups. Available cost-effectiveness analyses mostly support BEZ+SOC cost-effectiveness compared with SOC alone., Competing Interests: C.R.K. was a site investigator for clinical trials of SER109 (Seres Health) and CP101 (Finch Therapeutics). She also has consulted for Sebela Pharmaceuticals. Otherwise, the authors declare that the research was conducted in the absence of significant commercial or financial relationships that could be construed as a potential conflict of interest. The remaining authors declare that they have nothing to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)