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Background:Surgical site infection (SSI) is the third most common nosocomial infection, associ­ated with higher morbidity and mortality rates as well as increased cost and prolonged hospital stay for patients. Lidocaine, in addition to being a readily available and accessible local anesthetic, has shown antimicrobial and fungicidal activity. Objectives: Assessing the outcome of using 2% lidocaine irrigation in the prevention of abdominal SSI in grade II (clean-contaminated), Grade III (contaminated) wounds. Subjects and Methods: This prospective randomized clinical trial included patients who underwent elective and emergency abdominal surgeries in the Department of General Surgery at Suez Canal University Hospitals. The participants were randomly divided in two groups: A study group, who received sterile saline plus Lidocaine 2%. And a control group, who received sterile saline only to compare the 30-day postoperative infection outcomes among them. Results: 56.8% of participants were males. The mean age of participants was 48.88 ± 10.18 years. The study group patients had statistically significant lower incidents of SSI than the control group (p=0.03). The overall incidence of SSI was 38.6%. The most prevalent sign of the SSI was pus in 35.3% and in 76.5% of the patients’ SSI lasted for two weeks. There was no statistically significant difference between both groups regarding their hospital stay duration, laboratory measures, and other postoperative complications. Conclusions: 2% lidocaine application before skin closure in grade II and grade III wounds decreased the incidence of SSI) in patients undergoing abdominal surgery.

Objectives: To analyze the outcome of monosymptomatic primary nocturnal enuresis (MPNE) after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Methods: The study included 74 MPNE children with OSAS qualified for an adenotonsillectomy procedure. MPNE was assessed prior to surgical procedure as well as 3 and 6 months after surgery. In addition to polysomnographic parameters, serum antidiuretic hormone (ADH) and brain natriuretic peptide (BNP) levels were measured preoperatively and 3 months postoperatively. Results: The mean age was 9.8 years and the mean number of nocturnal wetting weekly was 4.1. Thirty-eight percent of patients had family history of MPNE. All the patients underwent a successful adenotonsillectomy. Nocturnal enuresis was still reported in 18% of children 6 months after adenotonsillectomy. An increased risk of MPNE was significantly demonstrated in children with high obstructive apnea-hypopnea index (O-AHI), high oxygen desaturation index (ODI), high frequent nocturnal enuresis and family history. After surgery, ADH levels were significantly lower, whereas BNP levels were significantly higher in non-resolution children. Univariate analysis showed that higher O-AHI, higher ODI, severe enuresis, low serum ADH and higher serum BNP levels were indicative of persistent nocturnal enuresis. Multivariate analysis showed that higher ODI and higher BNP levels are independent prognostic markers for MPNE. Conclusions: Adenotonsillectomy in MPNE children with OSAS is an effective treatment for resolution of MPNE. Also, higher ODI caused by apnea and elevated serum BNP levels are the most important factors affecting the outcome of MPNE patients. Level of evidence: Not applicable for this multicentre audit.

Background Assessment of regional myocardial function at native pixel-level resolution can play a crucial role in recognizing the early signs of the decline in regional myocardial function. Extensive data processing in existing techniques limits the effective resolution and accuracy of the generated strain maps. The purpose of this study is to compute myocardial principal strain maps e p 1 and e p 2 from tagged MRI (tMRI) at the native image resolution using deep-learning local patch convolutional neural network (CNN) models (DeepStrain). Methods For network training, validation, and testing, realistic tMRI datasets were generated and consisted of 53,606 cine images simulating the heart, the liver, blood pool, and backgrounds, including ranges of shapes, positions, motion patterns, noise, and strain. In addition, 102 in-vivo image datasets from three healthy subjects, and three Pulmonary Arterial Hypertension patients, were acquired and used to assess the network's in-vivo performance. Four convolutional neural networks were trained for mapping input tagging patterns to corresponding ground-truth principal strains using different cost functions. Strain maps using harmonic phase analysis (HARP) were obtained with various spectral filtering settings for comparison. CNN and HARP strain maps were compared at the pixel level versus the ground-truth and versus the least-loss in-vivo maps using Pearson correlation coefficients (R) and the median error and Inter-Quartile Range (IQR) histograms. Results CNN-based local patch DeepStrain maps at a phantom resolution of 1.1mm × 1.1 mm and in-vivo resolution of 2.1mm × 1.6 mm were artifact-free with multiple fold improvement with e p 1 ground-truth median error of 0.009(0.007) vs. 0.32(0.385) using HARP and e p 2 ground-truth error of 0.016(0.021) vs. 0.181(0.08) using HARP. CNN-based strain maps showed substantially higher agreement with the ground-truth maps with correlation coefficients R > 0.91 for e p 1 and e p 2 compared to R Conclusion CNN-generated Eulerian strain mapping permits artifact-free visualization of myocardial function at the native image resolution.

Objective: The objective of this study was to assess the relationship between retinal vessel diameters, such as retinal arteriolar diameter, retinal venular diameter, and arteriolar/venular ratio (AVR), as clinical parameters of fertility in varicocele patients. Materials and methods: Sixty-eight (68) infertile varicocele men with abnormal semen parameters and sixty-one (61) varicocele normozoospermic men were included in the study. Moreover, fifty-eight (58) healthy normozoospermic men without varicocele were enrolled as a control group. For each participant, retinal vascular diameters were measured from the digital retinal photographs as a central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and AVR. In addition, hormones (total testosterone and FSH), and semen parameters were assessed and correlated with retinal vessel diameters. Results: The mean CRAE, CRVE, and AVR values were 147.8 ± 15.8 μm, 198.3 ± 39.3 μm, and 0.61 ± 0.01 in infertile varicocele patients, respectively. Significant difference of CRAE, CRVE, and AVR were found when comparing infertile varicocele patients with both varicocele and control normozoospermic male groups (p = 0.01, p = 0.006, and p = 0.007; respectively). Larger retinal venular caliber and smaller AVR ratio showed a significant inverse correlation with both sperm parameters and hormones (total testosterone and FSH) (p < 0.05). No significant correlations were found between CRAE with both sperm parameters and hormonal values (total testosterone and FSH) (p > 0.05). Conclusions: Infertile patients with varicocele showed a significant relationship with the retinal vascular diameter (CRVE and AVR ratio). This finding supports recommendation for regular eye examinations in the varicocele population.

BackgroundVaricocele is an abnormal dilatation and tortuosity of the testicular veins. Blocking the reflux in the internal spermatic vein is the cornerstone treatment for varicocele. Other treatment options include inguinal, sub inguinal, retroperitoneal, scrotal, and laparoscopic approaches. Laparoscopic varicocele ligation results in lower morbidity, lower analgesic requirements, and more rapid rates of return to work as compared to the standard open surgical approach.AimTo evaluate the laparoscopic varicocelectomy (at 3 and 6 months postoperatively) as regards the intraoperative, postoperative laboratory, and radiological data.MethodsThis prospective study included 40 patients who underwent laparoscopic varicocelectomy procedure from March to November 2018.ResultsThe study was conducted on 40 patients aged 17–36 years who underwent laparoscopic varicocelectomy. Clinically, only four patients were detected to be bilateral, although radiological assessment revealed 22 patients had bilateral affection. Clinically, the mean grade is 2.15 ± 0.67 for the left side and 0.35 ± 0.74 for the right side, which improved to 0.35 ± 0.57 on the former and 0.1 ± 0.44 on the latter at 6 months postoperatively. Based on ultrasound findings, 11 patients had bilateral affection. The mean grade is 2.25 ± 0.64 for the left side and 0.75 ± 0.78 for the right side, which improved to 0.35 ± 0.67 on the former and 0.35 ± 0.49 on the latter at 6 months postoperatively. In the semen analysis, the sperm count, motility, and abnormal forms significantly improved. The mean operative time and hospital stay were 26.15 + 5.03 min and 1.15 ± 0.36 day, respectively.ConclusionLaparoscopic varicocelectomy is an effective treatment for varicocele. Significant symptom, sperm count, motility, and abnormal form improvements were observed during the postoperative follow-up. Therefore, laparoscopic varicocelectomy is recommended as more beneficial for patients.

Nivolumab, a completely human programmed death-1 inhibitor antibody, was first approved by the Food and Drug Administration for patients with advanced malignant melanoma resistant to other modalities of treatment. In 2015, it received approval as the first line of treatment for malignant melanoma. We aimed to synthesize evidence from published randomized-controlled trials on the safety and efficacy of nivolumab, either alone or in combination with ipilimumab, in the management of advanced unresectable melanoma. We searched the following electronic databases: PubMed, Scopus, Web of Science, and Cochrane Central. The records retrieved were screened for eligibility. Time-to-event data were pooled as Hazard ratio using the generic inverse variance method and dichotomous data were pooled as relative risk (RR) in a random-effects model. We used Review Manager 5.3 software for windows. Four unique randomized-controlled trials (five reports) with a total of 1910 patients (nivolumab group, n=1207 and control group, n=703) were included. The overall effect estimate favored nivolumab plus ipilimumab versus ipilimumab alone in terms of the objective response rate [RR: 3.58, 95% confidence interval (CI): 2.08-6.14], the complete response rate (RR: 5.93, 95% CI: 2.45-14.37), the partial response rate (RR: 2.80, 95% CI: 2.16-3.64), the stable disease rate (RR: 0.56, 95% CI: 0.41-0.76), and progression-free survival (hazard ratio: 0.67, 95% CI: 0.60-0.74). The pooled studies were homogenous. Similar results were obtained for nivolumab monotherapy versus chemotherapy comparison. Nivolumab alone or combined with ipilimumab significantly improved the overall and complete response rates compared with ipilimumab alone. In addition, nivolumab resulted in longer progression-free survival with a comparable safety profile.

PurposeAdults with Turner syndrome (TS) have an increased predisposition to ischemic heart disease. The quantitative relationship between coronary atherosclerosis and TS has yet to be established.MethodsA total of 128 females (62 with TS) participated in this prospective study. Coronary computed tomography angiography was performed to measure coronary calcified plaque burden, and prevalent noncalcified plaque burden. Regression analysis was used to study the effects of TS and traditional cardiovascular disease risk factors on coronary plaque burden.ResultsAdults with TS were 63% more likely to have coronary calcifications than controls (odds ratio 1.63, 95% confidence interval: 1.02, 2.61, P = 0.04), with an age cutoff of 51.7 years for a probability of50% for the presence of coronary calcifications, when compared to 55.7 years in female controls. The average age of TS patients with calcified plaques was significantly lower than that of controls with calcified plaques (51.5 ± 8.9 years vs. 60.5 ± 7.0 years, P 0.001). Age increased the likelihood of coronary calcifications by 13% per year (odds ratio 1.13, confidence interval 95%: 1.07-1.19, P 0.001).ConclusionThis study demonstrates a higher prevalence and earlier onset of calcified coronary plaques in TS. These findings have important implications for cardiovascular risk assessment and the management of patients with TS.

The aim of this study was to evaluate the role of platelet count (PLT) and platelet volume indices (PVI) such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) as a clinical biomarker in 64 infertile males with varicocele and 45 controls. In addition, semen parameters, serum total testosterone, FSH and testicular volume were measured before and at 6 months after varicocelectomy. The mean PLT, MPV, PDW and PCT were 231 ± 42 × 103/µl, 9.6 ± 1.8 fl, 16.2 ± 2.5 fl and 0.18% in the patient group respectively. When the patient and control groups were compared, there was a significant increase in mean MPV, PDW and PCT (p < .0001), while platelet count was lower in patients than control group, but with no significant relationship. MPV had a significant negative correlation with total testosterone (p < .03). No significant correlations were found between PVI and testicular volume. After follow-up of 37.1 ± 1.9 months, a significant negative correlation was found between the preoperative MPV and varicocelectomy outcome in terms of semen values (p < .007). So, the increase in MPV and low total testosterone in men with varicocele may be a feature of high risk of infertility.

Coronary plaque burden measured by coronary computerized tomography angiography (CCTA), independent of stenosis, is a significant independent predictor of coronary heart disease (CHD) events and mortality. Hence, it is essential to develop comprehensive CCTA plaque quantification beyond existing subjective plaque volume or stenosis scoring methods. The purpose of this study is to develop a framework for automated 3D segmentation of CCTA vessel wall and quantification of atherosclerotic plaque, independent of the amount of stenosis, along with overcoming challenges caused by poor contrast, motion artifacts, severe stenosis, and degradation of image quality. Vesselness, region growing, and two sequential level sets are employed for segmenting the inner and outer wall to prevent artifact-defective segmentation. Lumen and vessel boundaries are joined to create the coronary wall. Curved multiplanar reformation is used to straighten the segmented lumen and wall using lumen centerline. In-vivo evaluation included CCTA stenotic and non-stenotic plaques from 41 asymptomatic subjects with 122 plaques of different characteristics against the individual and consensus of expert readers. Results demonstrate that the framework segmentation performed robustly by providing a reliable working platform for accelerated, objective, and reproducible atherosclerotic plaque characterization beyond subjective assessment of stenosis; can be potentially applicable for monitoring response to therapy.

PURPOSE: To demonstrate the association between coronary vessel wall thickness (VWT) measured at MRI and coronary artery disease (CAD) risk in asymptomatic groups at low and intermediate risk on the basis of Framingham score. MATERIALS AND METHODS: A total of 131 asymptomatic adults were prospectively enrolled. All participants underwent CT angiography for scoring CAD, and coronary VWT was measured at 3.0-T MRI. Nonlinear single and multivariable regression analyses with consideration for interaction with sex were performed to investigate the association of traditional atherosclerotic risk factors and VWT with CT angiography–based CAD scores. RESULTS: The analysis included 62 women and 62 men with low or intermediate Framingham score of less than 20%. Age (mean age, 45.0 years ± 14.5 [standard deviation]) and body mass index were not different between the groups. Age, sex, and VWT were individually significantly associated with all CT angiography–based CAD scores (P < .05). Additionally, sex was a significant effect modifier of the associations with all CAD scores. In men, age was the only statistically significant independent risk factor of CAD; in women, VWT was the only statistically significant independent surrogate associated with increased CAD scores (P < .05). CONCLUSION: In asymptomatic women, VWT MRI was the primary independent surrogate of CAD, whereas age was the strongest risk factor in men. This study suggests that VWT may be used as a CAD surrogate in women at low or intermediate risk of CAD. Further longitudinal studies are required to determine the potential implication and use of this MRI technique for the preventative management of CAD in women. © RSNA, 2019

PURPOSE: The purpose of this study is to investigate the use of fundamental rheological parameters as quantified by MR-Elastography (MRE) to measure liver fibrosis and inflammation simultaneously in humans. METHODS: MRE was performed on 45 patients at 3T using vibration frequency of 56Hz. Fibrosis and inflammation scores were obtained from liver biopsies. Biomechanical properties were quantified in terms of complex shear modulus G* as well as shear wave phase velocity c and shear wave attenuation α. A rheological fractional derivative order model was used to investigate the linear dependence of the free model parameters (dispersion slope y, intrinsic speed c(0), and intrinsic relaxation time τ) on histopathology. Leave-one-out cross-validation was then utilized to demonstrate effectiveness of the model. RESULTS: The intrinsic speed c(0) increases with hepatic fibrosis, while an increased relaxation time τ is reflective of more inflammation of the liver parenchyma. The dispersion slope y does neither depend on fibrosis nor on inflammation. The proposed rheological model, given this specific parameterization, establishes the functional dependencies of biomechanical parameters on histological fibrosis and inflammation. The leave-one-out cross validation demonstrates that the model allows for identifying, from the MRE measurements, the histology scores when grouped into low/high grade fibrosis and low/high grade inflammation with significance levels of P=0.0004 (fibrosis) and P=0.035 (inflammation). CONCLUSION: The functional dependencies of intrinsic speed and relaxation time on fibrosis and inflammation, respectively, shed new light onto the impact hepatic pathological changes on liver tissue biomechanics in humans. The dispersion slope y appears to represent a structural parameter of liver parenchyma not impacted by the severity of fibrosis/inflammation present in this patient cohort. This specific parametrization of the well-established rheological fractional order model is valuable for the clinical assessment of both fibrosis and inflammation scores, going beyond the capability of the plain shear modulus measurement commonly used for MRE.

Background and aims Autosomal dominant hyper-IgE (AD-HIES) is a primary immunodeficiency caused by mutations in STAT3. Elevated levels of IgE, an ineffective immune response, connective tissue abnormalities, and coronary arterial dilation and tortuosity characterize AD-HIES. To date, coronary artery evaluation in AD-HIES patients has been limited to lumenography measurements. Direct in vivo coronary vessel wall (VW) imaging may allow for better interrogation of coronary vessel abnormalities. The goal of this prospective study was to evaluate the coronary VW of AD-HIES patients using Magnetic Resonance Imaging (MRI) and histology. VW image findings were compared in healthy subjects and subjects with coronary atherosclerotic disease (CAD). Methods A total of 28 subjects (10 with AD-HIES, 8 healthy, 10 with CAD) were studied by coronary VW MRI imaging. Additionally, a post-mortem coronary artery from one VW imaged AD-HIES patient was examined. Results Coronary VW in AD-HIES was thicker than in healthy controls but not significantly different from VW thickness in CAD subjects. AD-HIES coronaries showed increased VW area compared to healthy controls and CAD subjects. On histology, the AD-HIES coronary artery had findings consistent with atherosclerotic plaque, but had minimal luminal narrowing, deficient adventitia thickening and absence of both internal and external elastic laminae. Conclusions This is the first study to demonstrate subclinical coronary atherosclerosis in AD-HIES patients on VW imaging by MRI. Histologic evaluation confirmed the presence of atherosclerosis with lack of supportive adventitial thickening and elastic components. These findings suggest mechanisms for coronary dilation in AD-HIES and thereby help direct clinical management.

Three-dimensional (3D) computed tomography (CT) imaging is becoming an essential demand in several clinical procedures. Mobile C-arm is a useful imaging tool for image-guided interventional radiology. C-arm systems are provided with X-ray image intensifier (XRII) or flat-panel detectors. Essentially, C-arm CT systems requires scanners with flat-panel detectors for its ability to provide homogenous image quality and improve the resolution of low-contrast subjects compared to those equipped with XRII. However, C-arm systems with XRIIs are widely used in several interventional procedures. Such systems can provide a high quality two-dimensional (2D) fluoroscopic images that facilitates minimal invasive surgery. However, it is unable to provide depth information for 3D imaging due to several factors. First, the gantry of XRII-based C-arms is usually operated manually, where the rotation angle is determined using printed angle scale attached to the scanner gantry. Second, the gantry orbital rotation is normally limited to angular range less than theoretically required for exact 3D reconstruction. Third, considering the offset-scan geometry, which is common configuration in mobile C-arm with XRII, the number of rays passing through field-of-view (FOV) is limited. In this paper, we develop a 3D angiographic imaging system using commercial C-arm system equipped with XRII. First, an in-house made gantry rotation unit is developed to control the scanner orbital rotation. Second, the gantry rotation is traced using inertial measurement unit (IMU) sensor attached to the scanner gantry. Geometry information obtained from IMU sensor are used to define the gantry position in the 3D space and synchronized with detector measurements. The SCAN algorithm is used for the 3D reconstruction and achieved results are of high quality.

The exact age estimation is often treated as a classification problem; while it can be formulated as a regression problem. In this article, three different classifiers based on KNN classifier's concept for facial age estimation were designed and developed to achieve high efficiency calculation of facial age estimation. In the first classifier, we adopt KNN-distance approach to calculate minimum distance between test face image and all instances belong to the class that has the highest number of nearest samples. Additionally, in the second classifier a modified-KNN version was proposed and the classifier scoring results interpolated to calculate the exact age estimation. Furthermore, KNN-regression classifier as third classifier that used to combine the classification and regression approaches to improve the accuracy of the age estimation system. Moreover, we compared age estimation errors under two situations: case 1, age estimation is performed without discrimination between males and females (gender unknown); and case 2, age estimation is performed for males and females separately (gender known). Results of experiments conducted on well know benchmark FG-NET Database show the effectiveness of the proposed approach.

Egypt is witnessing over the next decade many challenges in the field of healthcare, especially with regard to the spread of hepatitis and coincides with the spread of liver hepatocellular carcinoma. Because most cases of liver cancer in Egypt are detected in very late stages, the use of surgical resection, liver transplantation and percutaneous ablative therapies constitutes unsuitable therapeutic options either due to high recurrence rate or unfeasibility. Therapy sessions can be made through the introduction of chemotherapy using a catheter directly into the hepatic artery supplying the tumor guided by angiography imaging system. This method of treatment known to prevent the patient from different problems associated with surgical treatment, but it is still needs to be further improved to maximize the benefits and minimize the risks. Hepatic angiography is an x-ray study of the blood vessels that supply the liver. The procedure uses a catheter that is placed into a blood vessel through a small incision. The catheter is guided using the xray images obtained through the interventional session. During angiography, hepatic arterial supply is usually displayed in one, two or three projections. Mental 3D interpretation of the anatomy is not an easy task. Reaching the target supply artery by the catheter tip is mandatory to obtain satisfactory tumor response and reduce complications and recurrence. This work aims to develop an interactive 3D imaging system of hepatic angiography. The developed system uses a set of 2D images measured over few view angles to reconstruct a full 3D volume of the hepatic arteries. The problem can be thought as a combination of three main approaches. (1) Image reconstruction of 3D artery volume from few number of projections (each is presented as 2D image), (2) automatic detection of the catheter roadmap to the labeled artery which feed the tumor, and (3) interactive system to control and display images using simple gestures of the physician.

Colour fundus images play an important role in diagnosing and screening diabetic macular edema (DME). In rural areas, content-based image retrieval (CBIR) might compensate the lack of expert ophthalmologists. In this work, we present a fully automated CBIR system that retrieves fundus images according to their content (quantity and location) of exudates. First, the macula is divided into three concentric regions whose texture discontinuities are used to represent lesion content of the retina. The image-to-image distance measure gives higher weights to lesions closer to the fovea to reflect the severity of the DME. Retrieval results of the system show precision of 79.2%.

Association rule mining algorithms provide different search strategies to discover the frequent itemsets; however the problem of large search space is still hard to handle. The present paper suggests a novel hybrid search technique based on reducing the search space, I/O, and CPU times. This can improve the performance up to several orders of magnitude compared to APRIORI algorithm.

Content-based image retrieval (CBIR) provides a flexible means of searching a digital image library based on the description of the desired image. In this paper, we integrate CBIR, RIS, and HIS in PACS to allow retrieving images of similar features. Once the system finds the related images, the embedded CBIR retrieves the radiological reports and medical records of the output images, which can be used to increase diagnostic accuracy. The CBIR system is implemented on a separate server based on multi-resolution image matching. To reduce the retrieval loading on the server and network shanks, a procedure to use copies of images that are temporarily located in some workstations in the PACS is applied. These copies are stored on a temporary database space created on the different workstations. A new image retrieval management server contains image IDs in the database and the IP addresses of the workstations containing temporary image copies. Data on the management server are continuously updated with each addition or retrieval operation. When a display workstation needs a specific image, it sends a request with the required image ID to the management server, which in turn replies with the IP of the workstation containing the inquired image ID.© (2001) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.