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Objectives: We aimed to assess undergraduate medical students' knowledge, attitude, and perception regarding artificial intelligence (AI) in medicine. Methods: A multi-national, multi-center cross-sectional study was conducted from March to April 2022, targeting undergraduate medical students in nine Arab countries. The study utilized a web-based questionnaire, with data collection carried out with the help of national leaders and local collaborators. Logistic regression analysis was performed to identify predictors of knowledge, attitude, and perception among the participants. Additionally, cluster analysis was employed to identify shared patterns within their responses. Results: Of the 4492 students surveyed, 92.4% had not received formal AI training. Regarding AI and deep learning (DL), 87.1% exhibited a low level of knowledge. Most students (84.9%) believed AI would revolutionize medicine and radiology, with 48.9% agreeing that it could reduce the need for radiologists. Students with high/moderate AI knowledge and training had higher odds of agreeing to endorse AI replacing radiologists, reducing their numbers, and being less likely to consider radiology as a career compared to those with low knowledge/no AI training. Additionally, the majority agreed that AI would aid in the automated detection and diagnosis of pathologies. Conclusions: Arab medical students exhibit a notable deficit in their knowledge and training pertaining to AI. Despite this, they hold a positive perception of AI implementation in medicine and radiology, demonstrating a clear understanding of its significance for the healthcare system and medical curriculum. Clinical relevance statement: This study highlights the need for widespread education and training in artificial intelligence for Arab medical students, indicating its significance for healthcare systems and medical curricula. Key Points: • Arab medical students demonstrate a significant knowledge and training gap when it comes to using AI in the fields of medicine and radiology. • Arab medical students recognize the importance of integrating AI into the medical curriculum. Students with a deeper understanding of AI were more likely to agree that all medical students should receive AI education. However, those with previous AI training were less supportive of this idea. • Students with moderate/high AI knowledge and training displayed increased odds of agreeing that AI has the potential to replace radiologists, reduce the demand for their services, and were less inclined to pursue a career in radiology, when compared to students with low knowledge/no AI training. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the leader–followers Time-Varying Formation Tracking (TVFT) problem of a networked Multi-Agent Systems (MASs) based output feedback. The agents’ behavior is featured by linear dynamics. The interaction topology among the agents is switching over time, directed and only assumed to contain a directed spanning tree. This latter is rooted by a leader-agent whose control input is unknown and bounded. A novel fully distributed TVFT controller is proposed that exhibits a reduced network information exchange property among the agents, thus less communicating-resources are utilized. The proposed controlled design is based on an adaptive observer and disturbance rejection technique, where the unknown leader-input is viewed as an external disturbance. The key feature lies in introducing a local observer in each agent-controller design to observe all the relative neighboring output-measurements and the relative neighboring distributed observer-outputs, all gathered in one signal that we denote the agent’s network information signal. The Lyapunov theory is used to prove that the closed-loop MASs tracking error is stable. An analysis of the effect of the interaction topology structure on the tracking-error convergence rate is further provided, showing the validity of the proposed formation control for switching interaction topologies. Finally, to verify the effectiveness of the obtained results, the proposed controller is extended to a cooperative guidance of a networked quadrotors to track and entrap an uncooperative aerial target that plays the role of a passive leader. [ABSTRACT FROM AUTHOR]

Prime editing is a versatile genome editing tool but requires experimental optimization of the prime editing guide RNA (pegRNA) to achieve high editing efficiency. Here we conducted a high-throughput screen to analyze prime editing outcomes of 92,423 pegRNAs on a highly diverse set of 13,349 human pathogenic mutations that include base substitutions, insertions and deletions. Based on this dataset, we identified sequence context features that influence prime editing and trained PRIDICT (prime editing guide prediction), an attention-based bidirectional recurrent neural network. PRIDICT reliably predicts editing rates for all small-sized genetic changes with a Spearman's R of 0.85 and 0.78 for intended and unintended edits, respectively. We validated PRIDICT on endogenous editing sites as well as an external dataset and showed that pegRNAs with high (>70) versus low (<70) PRIDICT scores showed substantially increased prime editing efficiencies in different cell types in vitro (12-fold) and in hepatocytes in vivo (tenfold), highlighting the value of PRIDICT for basic and for translational research applications. The design of prime editing guide RNAs is optimized by deep learning. [ABSTRACT FROM AUTHOR]

Abstract Gram-positive bacterial infections are among the most serious diseases related with high mortality rates and huge healthcare costs especially with the rise of antibiotic-resistant strains that limits treatment options. Thus, development of new antibiotics combating these multi-drug resistant bacteria is crucial. Oxazolidinone antibiotics are the only totally synthetic group of antibiotics that showed activity against multi-drug resistant Gram positive bacteria including MRSA because of their unique mechanism of action in targeting protein synthesis. This group include approved marketed members (tedizolid, linezolid and contezolid) or those under development (delpazlolid, radezolid and sutezolid). Due to the significant impact of this class, larger number of analytical methods were required to meet the needs of both clinical and industrial studies. Analyzing these drugs either alone or with other antimicrobial agents commonly used in ICU, in the presence of pharmaceutical or endogenous biological interferences, or in the presence of matrix impurities as metabolites and degradation products poses a big analytical challenge. This review highlights current analytical approaches published in the last decade (2012–2022) that dealt with the determination of these drugs in different matrices and discusses their advantages and disadvantages. Various techniques have been described for their determination including chromatographic, spectroscopic, capillary electrophoretic and electroanalytical methods. The review comprises six sections (one for each drug) with their related tables that depict critical figures of merit and some experimental conditions for the reviewed methods. Furthermore, future perspectives about the analytical methodologies that can be developed in the near future for determination of these drugs are suggested. [ABSTRACT FROM AUTHOR]

The present work provides a qualitative analysis of the studied ostracod carapaces of the genus Carbonita. Thirty-seven ostracod specimens were collected from the Late Carboniferous Rod El-Hamal Formation at Rod El-Hamal area, Wadi Araba, north Eastern Desert, Egypt. The collected ostracods were assigned to four species in genus Carbonita; C. fabulina (Jones and Kirkby), C. inflata (Jones and Kirkby), C. humilis (Jones and Kirkby), and C. bairdoides (Jones and Kirkby) according to the qualitative traits. In order to assess the discrimination among the different Carbonita species, a new technique, geometric morphometric analyses, was carried out using ImageJ and MorphoJ software packages. Geometric morphometric analyses included landmark configurations, procrustes superimposition, principle component analysis, and thin plate spline deformation plots. Using nine landmarks, average shapes of the different Carbonita species have been provided. The principle component analysis separated Carbonita fabulina and C. bairdoides from the morphologically overlapped C. inflata and C. humilis. Shape variations in the carapace length, height, anteroventral arc, posterodorsal arc, posteroventral arc, and the anterior margin were demonstrated through the deformation plots. These quantitative analyses, along with the qualitative examination, provided considerable variations among the different Carbonita species, and hence the best way for species discrimination. [ABSTRACT FROM AUTHOR]

Objective The purpose of the current study was to evaluate the effect of Diode laser 650 nm, mineralized Nano-cellulose graft material, and their combination on bone healing using Masson's Trichrome stain. Methods a total of 18 adult male white New Zealand rabbits were used. Two circular full cortical bone defects were drilled in each tibia, creating four bony defects in each rabbit, representing the four main groups of the study; group A (negative control), group B (filled with Tetramethyl pyridine oxyl "TEMPO" oxidized Nano-cellulose combined with Nano Amorphous-calcium-phosphate "nACP", group C (combination group filled with experimental material and subjected to laser), group D (subjected to Diode laser 650 nm). In groups C and D, bony defects were subjected to laser irradiation during surgery, then repeated every other day for two weeks. Animals were sacrificed after two weeks and one month, histological samples were examined by Masson's Trichrome stain. Results after two weeks, group D recorded the greatest mean area percent of osteoid, while group C recorded the lowest value. After one month, groups A and D showed full closure of the defects, groups B and C showed partial defect closure with retained bone graft material, with group B recording the greatest mean area percent of osteoid formation, whereas group C recorded the lowest value. Conclusion Diode laser biostimulation improved bone defects' healing. Mineralized Nano-cellulose as a bone substitute showed a delayed effect in bone healing, and graft material resorption. The combination of LLLT with the mineralized Nano-cellulose material had no positive outcome on bone defect healing. [ABSTRACT FROM AUTHOR]

Background: Scarring or progressive fibrosis and cirrhosis develop over time as a result of chronic viral infection, which induces inflammation and tissue healing via deposition of extracellular matrix. There has been an increase in the sustained virological response (SVR) and the rate of eradication of HCV because of the effectiveness of directacting antiviral drugs (DAAs). Reduced hepatic fibrosis is associated with increased SVR rates. There are a variety of non-invasive fibrosis imaging, scoring, and marker methods: transient elastography, aminotransferase platelet ratio index (APRI), as well as fibrosis-4 (FIB-4) score. Objective: The purpose of this research was comparing the novel fibrosis index to APRI, (FIB-4) score and fibroscan in predicting the degree of hepatic fibrosis in Egyptian chronic HCV patients who were managed by DAAs. Patients and Methods: 100 Egyptians with chronic HCV infection participated in a our 3-month long prospective Cohort research using the IFN-free DAA combination of Sofosbuvir and Daclatasvir ± Ribavirin. Results: There was significant regression of fibrosis with DAAs treatment in all patients achieving SVR by fibroscan, APRI and fib4. Novel fibrosis index is reliable and good tool in estimation of liver fibrosis in correlation to fibroscan, with the cutoff value in prediction of hepatic fibrosis stage 4 was >3.1 and has sensitivity of 81.5% while the specificity was 74.1%. Conclusion Novel fibrosis index has been found to be good reliable marker for assessment of liver fibrosis with high accuracy of predicting f4 fibrosis stage. There was significant marked reduction of fibrosis degree by fibroscan, APRI and FIB4 after DAAs treatment. [ABSTRACT FROM AUTHOR]

Reconfigurable Intelligent Surfaces (RISs), proposed as innovative units, possess the potential to establish reliable connections in Underwater Optical Wireless Communication (UOWC) systems, where direct transmission (DT) experiences significant weakening due to dynamic channel conditions. In this paper, we examine the performance of a UOWC system consisting of an RIS and a modulating retroreflector (MRR), referred to as the RIS-assisted MRR-UOWC system. The channel is affected by a combination of path loss, gamma–gamma (G–G) turbulence, and pointing error (PE). The considered system employs the spectral-power-efficient L -ary Quadrature Amplitude Modulation Multi-Pulse Pulse-Position Modulation (L QAM-MPPM) technique. For our system performance measures, we present upper-bound (UB) and approximate UB expressions for the average bit-error rate (BER) of L QAM-MPPM signals. These expressions are used to analyze the system's performance. Performance metrics are established by deriving the Probability Density Function (PDF), Cumulative Distribution Function (CDF), and Moment-Generating Function (MGF) for the end-to-end signal-to-noise ratio (SNR), resulting from the sum of products of independent but not identically distributed (i.ni.d) channel coefficients. The results of our study indicate that the L QAM-MPPM scheme surpasses traditional schemes. [ABSTRACT FROM AUTHOR]

The increase in antibiotic residues poses a serious threat to ecological and aquatic environments, necessitating the development of cost-effective, convenient, and recyclable adsorbents. In our study, we used cellulose-based layered double hydroxide (LDH) as an efficient adsorbent and nanocarrier for both sulfamethoxazole (SMX) and cefixime (CFX) residues due to their biodegradability and biocompatibility. Chemical processes are measured according to green chemistry metrics to identify which features adhere to the principles. A GREEnness Assessment (ESA), Analytical GREEnness Preparation (AGREEprep), and Analytical Eco-Scale Assessments (ESA) were used to assess the suitability of the proposed analytical method. We extensively analyzed the synthesized Co Fe LDH/cellulose before and after the adsorption processes using XRD, FTIR, and SEM. We investigated the factors affecting the adsorption process, such as pH, adsorbent dose, concentrations of SMX and CFX and time. We studied six nonlinear adsorption isotherm models at pH 5 using Co Fe LDH, which showed maximum adsorption capacities (qmax) of 272.13 mg/g for SMX and 208.00 mg/g for CFX. Kinetic studies were also conducted. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay was performed on Vero cells in direct contact with LDH nanocomposites to evaluate the cytotoxicity and side effects of cellulose-based Co Fe LDH. The cellulose-based Co Fe LDH nanocomposite demonstrated excellent cytocompatibility and less cytotoxic effects on the tested cell line. These results validate the potential use of these unique LDH-based cellulose cytocompatible biomaterials for water treatment applications. The cost of the prepared adsorbents was investigated. • Cellulose-based layered double hydroxide (LDH) as an adsorbent • Removal of drug residues. • A GREEnness Assessment (ESA), Analytical GREEnness Preparation (AGREEprep), and Analytical Eco-Scale Assessments (ESA). • Evaluation of the cytotoxicity. • Cost analysis. [ABSTRACT FROM AUTHOR]

Background: Infection with the hepatitis C virus (HCV) is a worldwide health problem. HCV infection is linked to a variety of metabolic abnormalities as it interferes with lipid metabolism, causing steatosis and a wide range of adipocytokine alterations, as well as impairing glucose metabolism, resulting in a rising prevalence of insulin resistance (IR) and type 2 diabetes. Over the last few years, numerous oral anti-HCV medicines (direct-acting antivirals; DAAs) have been introduced. With DAA therapy, HCV can now be eradicated from the infected host within 12 weeks. There is a need for more research because there is minimal information on the effects of DAA therapy on metabolic profiles, lipid profiles, and adiponectin levels. Thus, the purpose of this study was to see how direct-acting antivirals (DAAs) affected metabolic profiles and serum adiponectin levels in 2 different categories of Egyptian patients with chronic hepatitis C infection. This study included 100 patients with chronic HCV who were separated into two groups. Group I consisted of 50 patients who were treated for 12 weeks with sofosbuvir, daclatasvir, and ribavirin). Group II consisted of 50 patients who were treated for 12 weeks with ombitasvir, paritaprevir, and ritonavir/ribavirin. This regimen was chosen because these patients had an eGFR of 30 ml/min. Fasting lipid profiles (total cholesterol, triglyceride, HDL, and LDL), metabolic profiles (fasting blood sugar, fasting insulin, HOMA-IR, and HbA1C), and serum adiponectin levels were measured before and after the end of treatment. Results: Statistical analysis of the data showed a significant difference in the lipid profile in group I before and after treatment, as we found a significant reduction in serum triglycerides after treatment (113.2 ± 22.9 mg/dL vs 105.6 ± 23.2 mg/dL, P < 0.001) and a significant elevation of serum total cholesterol, LDL, and HDL after treatment (TC: 153.2 ± 20.1 mg/dL vs 174.1 ± 19 mg/dL, P < 0.001; LDL: 74.7 ± 9.9 mg/dL vs 93.3 ± 12 mg/dL, P < 0.001; HDL: 54.6 ± 10.1 mg/dL vs 57.2 ± 10.3 mg/dL, P 0.010). But in group II, there was no significant difference in the lipid profile before and after treatment. We also found a significant reduction in fasting insulin, HOMA-IR, and HBA1C after treatment in group I (fasting insulin: 11.4 ± 3.3 (µU/L)/ml vs 9.7 ± 2.2 (µU/L)/ml, P < 0.001; HOMA-IR: 2.7 ± 0.9 vs 2.2 ± 0.6, P < 0.001; HBA1C: 5.6 ± 0.4 vs 5.4 ± 0.3, P 0.003). But in group II, there was no significant difference in fasting insulin, HOMA-IR, and HBA1C before and after treatment. Also, we found that there were no significant changes in the serum adiponectin level in either group before or after treatment. Conclusion: HCV clearance with DAAs had an impact on the lipid and metabolic profiles of the patients at the end of treatment. This could depend on the type of DAAs used in the treatment, the stage of the liver disease, and the associated conditions of patients. However, serum adiponectin levels are unaffected. [ABSTRACT FROM AUTHOR]

Background: Early detection and screening of breast cancer (BC) might help improve the prognosis of BC patients. This study evaluated the use of serum microRNAs (miRs) as non-invasive biomarkers in BC patients. Methods: Using quantitative real-time polymerase chain reaction, we evaluated the serum expression of four candidate miRs (miR-155, miR-373, miR-10b, and miR-34a) in 99 Egyptian BC patients and 40 healthy subjects (as a control). The miRs expression was correlated with clinicopathological data. In addition, the sensitivity and specificity of the miRs were determined using receiver operating characteristic (ROC) curve analysis. Results: Serum miR-155, miR-373, and miR-10b expression were significantly upregulated (p < 0.001), while serum miR-34a was downregulated (p < 0.00) in nonmetastatic (M0) BC patients compared to the control group. In addition, serum miR-155 and miR-10b were upregulated in BC patients with large tumor sizes and extensive nodal involvement (p < 0.001). ROC curve analysis showed high diagnostic accuracy (area under the curve = 1.0) when the four miRs were combined. Serum miR-373 was significantly upregulated in the human epidermal growth factor 2–negative (p < 0.001), estrogen receptor–positive (p < 0.005), and progesterone receptor (PR)-positive (p < 0.024) in BC patients, and serum miR-155 was significantly upregulated in PR-negative (p < 0.001) BC patients while both serum miR-155 and miR-373 were positively correlated with the tumor grade. Conclusions: Circulating serum miR-155, miR-373, miR-10b, and miR-34a are potential biomarkers for early BC detection in Egyptian patients and their combination shows high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disease that can change a patient's quality of life and impair his daily activities. Non-alcoholic fatty liver disease (NAFLD), on the other hand, has become a widespread condition as the global obesity rates rises. The prevalence of NAFLD has reached up to 25% of the adolescent population. The etiology of both diseases is still not clearly understood. The mechanism linking the two seemingly similar diseases could be immune system activation and tissue inflammation. Objective: The goal of our study was to see if there was a common link between them and to examine NAFLD prevalence and severity in IBS patients. Patients and methods: Our study included 150 patients who had symptoms of IBS with different degrees of severity. IBS was diagnosed according to modified ROME IV criteria. Patients were examined to see if they had NAFLD based on abdominal ultrasonography and NAFLD fibrosis score calculation. Results: Our current study showed that regarding evaluating the association of IBS with NAFLD, there was a highly statistically significant association between both diseases. Furthermore, there was a high statistically significant association between higher grades of NAFLD and lipid profile parameters. Conclusion: Patients with IBS had a higher frequency of NAFLD. In addition, a significant association was noted between IBS severity and increased NAFLD grades. [ABSTRACT FROM AUTHOR]

Alzheimer’s disease, prevalent in individuals aged 60 and above, constitutes most dementia cases and significantly impairs memory and cognitive functions. With global Alzheimer’s cases projected to triple by 2050, there is a pressing need for effective interventions. Lecanemab, a monoclonal antibody targeting amyloid-beta plaques, shows promise in slowing Alzheimer’s progression. Positive clinical trial results have instilled hope in patients, prompting ongoing research to advance understanding and intervention possibilities. To contribute to this knowledge base, we conducted a systematic review and meta-analysis, focusing on lecanemab’s efficacy and safety at a dosage of 10 mg/kg. This comprehensive approach aimed to address gaps in the current literature, scrutinize research disparities, and guide future investigations. Applying strict inclusion/exclusion criteria, we assessed study details, participant information, and intervention specifics, using the Cochrane risk of bias tool for quality evaluation. Statistical analyses, conducted with R software, included risk ratios and mean differences, assessing heterogeneity and publication bias. The meta-analysis reveals a significant positive effect of lecanemab (10 mg/kg biweekly) on cognitive outcomes in Alzheimer’s disease. Consistent reductions in ADCOMS, CDR-SB, and ADAS-cog14 scores across studies indicate drug efficacy with narrow confidence intervals and no significant heterogeneity. While TEAE shows no significant difference, heightened risks of ARIA-E and ARIA-H associated with lecanemab underscore the need for vigilant safety monitoring in clinical practice. Despite the drug efficacy, the study emphasizes a balanced assessment of benefits and potential risks associated with lecanemab, providing critical insights for clinicians evaluating its use in addressing cognitive impairment in individuals with Alzheimer’s disease. [ABSTRACT FROM AUTHOR]

Natural clinoptilolite was decorated by green MgO nanoparticles (G. MgO/Clino) and characterized as a potential drug delivery system for 5-Fluorouracil drug. The synthetic G. MgO/Clino as carrier exhibits an enhanced loading capacity of 244.5 mg/g which is higher than clinoptilolite (163 mg/g). The loading reaction of 5-FC follows the equilibrium and kinetic properties of Langmuir and Pseudo-first order models, respectively. Therefore, the loaded 5-FC molecules are of homogenous and monolayer forms with Gaussian energy (8.51 kJ/mol) related to physisorption and zeolitic ion exchange processes. Also, the thermodynamic study declared feasible, endothermic, and spontaneous loading reactions of the 5-FC drug. The release study emphasizes a long and continuous profile for 150 h either in gastric buffer (pH 1.2) or intestinal buffer (pH 7.4). The release kinetics follow Higuchi and Hixson-Crowell model in addition to Korsmeyer–Peppas model with diffusion exponent (0.50 at pH 1.2 and 0.47 at pH 7.4). This suggests non-Fickian transport behavior for the released 5-FC molecules by both erosion and diffusion mechanism. The cytotoxicity study on the colorectal normal cell (CCD-18Co) demonstrates significant safety and biocompatibility properties of G. MgO/Clino as a drug carrier. Moreover, the G. MgO/Clino carrier induced the cytotoxic effect on the colon cancer cells (HCT-116) by controlling the diffusion rate and the oxidative effect of the green MgO nanoparticles. [ABSTRACT FROM AUTHOR]

Background: Venous thoracic outlet syndrome (VTOS) is the second most presenting pattern of thoracic outlet syndrome (TOS). Non thrombotic VTOS swollen upper limb is usually overlooked by many surgeons. When there is chronic intermittent arm swelling that is associated with discoloration that worsen with overhead arm movement, McCleery’s syndrome is more likely. Objective: We present the results of our treatment strategy of McCleery’s syndrome consisting of para-clavicular approach for thoracic outlet decompression (PCA-TOD), external venolysis, and combined surgical decompression with or without routine completion venoplasty. Patients and methods: A retrospective analysis of the data of twenty-three patients who presented from January 2016 to February 2021 with chronic intermittent arm swelling, we divided the patients into two groups, group (A): 13 patients who underwent surgical decompression alone and follow up. Group (B): 10 patients who underwent surgical decompression associated with Intraoperative venography and balloon angioplasty. Results: In group (A) complete symptomatic resolution was achieved in 6/13 (46.2%) patients, secondary endovenous intervention was required in 7 (53.8%) patients due to residual symptoms, postoperative average residual arm circumference difference was 0.92 ± 0.86 cm with a statistically significant difference in favor to group (B) (P value = 0.0274). In group (B) complete symptomatic cure achieved in 10/10 (100%) patients with statistically highly significant difference favoring to group (B) (P value = 0.0075). Conclusion: From our results, completion angioplasty of surgically decompressed axillo-subclavian venous segment added a significant cure and symptoms improvement for patients with McCleery’s syndrome and could be considered as a primary therapy in conjunction with surgical decompression. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) incidence has increased worldwide recently, and the death rate from it has increased to reach 10% of cancer-related deaths. Many risk factors are expected to play a role in this high incidence such as the higher age, change in dietary habits, cigarette smoking, low physical exercise, and the increased prevalence of obesity of the populations worldwide. Objectives: To evaluate the role of serum level of osteopontin in prediction of colorectal carcinoma in correlation with tissue histopathology, which is the gold standard test. Patients and Methods: This study was conducted on 80 subjects referred for colonoscopy at the Endoscopic Unit of Ain Shams University Hospitals. Patients were divided into 2 groups: Group A included 40 patients diagnosed as colorectal carcinoma as a patient group and group B that included 40 individuals with age- and sex-matched who had normal colonoscopy and was used as control group. Results: The level of osteopontin was statistically significant higher in CRC patients than in subjects with normal colonoscopy. Also, the ROC curve for osteopontin in prediction of CRC showed the best cut of value of > 12 ng/ml with area under the curve (AUC) = 0.889, sensitivity = 85% and specificity = 77.5%. Conclusion: Serum Osteopontin (OPN) level was detected in our study to be high in patients with CRC in comparison to patients with normal colonoscopy. Therefore, it can be used as a biomarker in the diagnosis of CRC. Also, serum osteopontin level is significantly higher in cancer patients with metastasis according to TNM staging, thus it can be used in prognosis. [ABSTRACT FROM AUTHOR]

Introduction There were forearm-access surgeries other than a radiocephalic arteriovenous fistula (AVF), but they are not popular in practice. We retrospectively reviewed patients who underwent either forearm-loop graft or a radiobasilic AVF for primary and assisted primary patency rates. Patients and methods In total, 43 patients in the period of January 2014 till January 2020, underwent a forearm access other than a radiocephalic AVF, 24 (group A) patients underwent a forearm-loop graft, and 19 (group B) underwent a radiobasilic AVF with basilic transposition in the forearm. Patients were followed up for 24 months, trials of reestablishing patency were recorded to assess primary and primary-assisted patency rates. Results There was no statistically significant difference between both groups as regards the demographic data. The mean operative time for group A was 93.92±8.17 min, while in group B, it was 109.84±14 min, which was a statistically significant result. Technical success was achieved in 100% in both groups, while successful dialysis was achieved in 100% of cases in group A, and 89.5% in group B. The mean time for cannulation was shorter in group A being 20.42±2.69 days compared with 43.11±8.45 days in group B (a statistically significant result). Primary patency rates for group A at 3, 6, 12, 18, and 24 months were 95.83, 79.17, 58.33, 41.67, and 33.33%, respectively, while in group B, they were 89.47, 84.21, 73.68, 63.16, and 52.63%, respectively. There was a statistically significant difference between both groups in the primary-assisted patency rate at 24 months (group A was 58.33%, while group B was 89.47%, P=0.0391). Conclusion Performing a forearm access other than a radiocephalic gives the patient an option before converting to an upper-arm access. Basilic transposition was a better option as regards primary patency and assisted patency rates if it is feasible, if compared with forearm-loop graft. But forearm-loop graft has the advantage of less operative time and earlier cannulation compared with basilic vein transposition. [ABSTRACT FROM AUTHOR]

Background: Drug–drug interactions (DDIs) refer to processes triggered by the administration of two or more drugs leading to side effects beyond those observed when drugs are administered by themselves. Due to the massive number of possible drug pairs, it is nearly impossible to experimentally test all combinations and discover previously unobserved side effects. Therefore, machine learning based methods are being used to address this issue. Methods: We propose a Siamese self-attention multi-modal neural network for DDI prediction that integrates multiple drug similarity measures that have been derived from a comparison of drug characteristics including drug targets, pathways and gene expression profiles. Results: Our proposed DDI prediction model provides multiple advantages: (1) It is trained end-to-end, overcoming limitations of models composed of multiple separate steps, (2) it offers model explainability via an Attention mechanism for identifying salient input features and (3) it achieves similar or better prediction performance (AUPR scores ranging from 0.77 to 0.92) compared to state-of-the-art DDI models when tested on various benchmark datasets. Novel DDI predictions are further validated using independent data resources. Conclusions: We find that a Siamese multi-modal neural network is able to accurately predict DDIs and that an Attention mechanism, typically used in the Natural Language Processing domain, can be beneficially applied to aid in DDI model explainability. [ABSTRACT FROM AUTHOR]

Summary: This study introduces a novel sensor for glucose measurement based on a rectangular dielectric resonator (RDR) excited by a rectangular slot fed by a 50‐Ω microstrip line. The RDR operates at 6 GHz and incorporates a cubic portion section for accommodating a finger or container containing the test sample. By utilizing the distinctive resonant frequencies associated with varying dielectric permittivity of different glucose concentrations, the proposed RDR functions as a reliable sensor. The sensor's performance is evaluated through a 3D electromagnetic model of the human thumb and the application of the Cole‐Cole method for modeling the blood layer. Experimental validation is conducted using three alternatives (water, glucose, and alcohol) and a range of glucose concentrations (70 to 2000 mg/dL) in simulation. During experimental verification, an invasive glucometer is employed as a reference for blood sugar levels. Results demonstrate that the proposed RDR sensor exhibits higher sensitivity (36.86 MHz/(mg/dL)) than other sensor counterparts. The experimental outcomes confirm the resonance frequency alignment between the manufactured sensor and the simulated projections. Considering its economic viability and applicability, this sensor represents a promising alternative biosensor for monitoring blood glucose levels. [ABSTRACT FROM AUTHOR]

We investigate the harvesting of sound waves by exploiting a 3D-printed gradient-index phononic crystal lens. The concept is demonstrated numerically and experimentally for focusing audio frequency range acoustic waves in air to enhance sound energy harvesting. A finite-element model is developed to design the unit cell dispersion properties and to construct the 3D lens for wave field simulations. Numerical simulations are presented to confirm the focusing of incident plane waves and to study the sensitivity of the refractive index profile to the direction of wave propagation. The theoretical predictions are validated experimentally using a scanning microphone setup under speaker excitation, and a very good agreement is observed between the experimental and numerical wave fields. A circular piezoelectric unimorph harvester is placed at the focal position of the lens, and its performance is characterized with a resistor sweep in the absence and presence of the lens, resulting in more than an order of magnitude enhancement in the harvested power with the lens. The 3D-printed lens presented here substantially enhances the intensity of sound energy via focusing, yielding micro-Watt level power output, which can find applications for wireless sensors and other low-power electronic components. [ABSTRACT FROM AUTHOR]

Harvesting energy from multiple sources, antenna gain, rectifier power conversion efficiency, and rectenna size are essential properties to consider while designing an antenna for ambient energy harvesting. This paper represents two high-gain, dualband antennas using a metamaterial Artificial Magnetic Conductor array. Both antennas are designed to harvest energy from GSM-1800, and the 2.45 GHz Industrial, Scientific, and Medical (ISM) frequency bands. The first antenna achieves a gain of 6.85 dB and 6.57 dB at 1.8 GHz and 2.45 GHz, respectively. The second configuration shows a gain of 7.11 dB at 1.8 GHz and 6.79 dB at 2.45 GHz. The antennas are circularly polarized at 2.45 GHZ. A dualband rectifier is designed based on a novel matching procedure to complete the energy harvesting system. The measured peak conversion efficiency is 72 % at 1.8 GHz and 65 % at 2.45 GHz with an area of 33 ×55 mm2. [ABSTRACT FROM AUTHOR]

Background: There are several possible causes of vocal fold polyps in adults. The mechanical damage is the main cause for polyp formation. Laryngopharyngeal reflux and human papilloma virus are possible co-factors. Objective: The aim of this study was to find out the associated roles of laryngopharyngeal reflux and human papilloma virus in the development of adult vocal fold polyps. Patients and Methods: This cross-sectional observational study included 50 adult patients presented with vocal fold polyps. Patients were preoperatively assessed for the presence of laryngopharyngeal reflux using the validated nine-item reflux symptom index and eight-item reflux finding score. All patients were subjected to excision of the laryngeal polyp by microlaryngoscopic surgery. The excised samples were sent for human papilloma virus (HPV) detection by PCR. Results: Laryngopharyngeal reflux (LPR) was presented in 34 patients (68%). Reflux symptom index ranged from 6 to 25 (mean 13.06 ± 4.95). Reflux finding score ranged from 3 to 18 (mean 10.08 ± 4.32). Seventeen patients (34%) had positive HPV-6. Fifteen patients had positive HPV-6 out of 34 patients diagnosed with LPR (44.11%), compared to only two patients had positive HPV-6 among 16 patients without LPR (12.5%) (P = 0.027). There were significant relations between presence of HPV-6 and both reflux symptom index and reflux finding score; both were significantly higher among patients with positive HPV-6 (P = 0.028) and (P < 0.001) respectively. Conclusion: Both laryngopharyngeal reflux and human papilloma virus play important associated roles in the development of vocal fold polyps in adults. [ABSTRACT FROM AUTHOR]

Background: Benefits associated with squat performance are not limited to the athletic population. Given that most activities of daily living necessitate the simultaneous coordinated interaction of numerous muscle groups, the squat is considered one of the best exercises for improving quality of life because of its ability to recruit multiple muscle groups in a single maneuver. Objective: To determine the effect of inclined squat position on the vastus medialis oblique (VMO) and gluteus maximus (GM) at the different ankle angles 5°-10° degrees of inclination in normal children. Subjects and methods: thirty non-athletic children of both genders, age ranged from 14 to 18 years, were selected from the Egyptian governmental schools at Sixth of October City and Sixth of October Sporting Club. The maximum voluntary isometric contraction (MVIC) was measured after the electrodes were attached to the GM and the VMO of the subject during squat postures which applied on two inclined borders 5 and 10 degree of inclination; the feet are spread out shoulder width, hip 70° flexion, knee 75° flexion and in the erect posture. Results: There was a significant increase in the VMO activity in 5° ankle angle compared with that of 10° ankle angle (p = 0.0001). There was a significant decrease in the GM activity in 5° ankle angle compared with that of 10° ankle angle (p = 0.0001). Conclusion: modification of ankle dorsiflexion during squat position should be integrated in the rehabilitation programs of the different injuries. [ABSTRACT FROM AUTHOR]

Background: Patients increasingly turn to search engines and online content before, or in place of, talking with a health professional. Low quality health information, which is common on the internet, presents risks to the patient in the form of misinformation and a possibly poorer relationship with their physician. To address this, the DISCERN criteria (developed at University of Oxford) are used to evaluate the quality of online health information. However, patients are unlikely to take the time to apply these criteria to the health websites they visit.Methods: We built an automated implementation of the DISCERN instrument (Brief version) using machine learning models. We compared the performance of a traditional model (Random Forest) with that of a hierarchical encoder attention-based neural network (HEA) model using two language embeddings, BERT and BioBERT.Results: The HEA BERT and BioBERT models achieved average F1-macro scores across all criteria of 0.75 and 0.74, respectively, outperforming the Random Forest model (average F1-macro = 0.69). Overall, the neural network based models achieved 81% and 86% average accuracy at 100% and 80% coverage, respectively, compared to 94% manual rating accuracy. The attention mechanism implemented in the HEA architectures not only provided 'model explainability' by identifying reasonable supporting sentences for the documents fulfilling the Brief DISCERN criteria, but also boosted F1 performance by 0.05 compared to the same architecture without an attention mechanism.Conclusions: Our research suggests that it is feasible to automate online health information quality assessment, which is an important step towards empowering patients to become informed partners in the healthcare process. [ABSTRACT FROM AUTHOR]

Acoustic power transfer (APT) for wireless electronic components has received growing attention as a viable approach to deliver power to remotely located small electronic devices. The design of an efficient APT system requires accurate models to describe its individual components as well as the interaction between them. Most of the analytical models available to represent the bulk piezoelectric transducers used in APT are limited to either thin rod or thin plate transducers. However, transducers with moderate aspect ratios are often used, especially at the receiver end. In this work, in addition to reviewing standard theories, models based on the Rayleigh and Bishop rod theories are developed to analyze transducers [transmitter (TX) or receiver (RX)] with various aspect ratios. Results from these models are compared with experimental data and finite-element analysis to determine the range of aspect ratios in which they are valid. In addition, fluid loading effects on the predictions of all models are investigated, and the generated pressure fields by the transducers with different aspect ratios are compared. The resulting models are used to analyze the effect of aspect ratio on the performance of the transducer when operated as a TX or an RX in an APT setting. [ABSTRACT FROM AUTHOR]

Background Repeated interventions to keep the well-functioning dialysis vascular access represent the Achilles heel for hemodialysis patients. Thrombosed permanent dialysis access, either arteriovenous fistula or arteriovenous graft (AVG) remains one of the most common and debatable complications regarding frequency of occurrence and how to manage. Objective Our study aims to evaluate mid-term outcomes of surgical thrombectomy of clotted AVG with adjunctive venous outflow procedures mainly patch angioplasty versus balloon dilatation to restore their function regarding patency as primary endpoint and safety as secondary endpoint. Patients and methods Between May 2016 and April 2019, 96 of 125 patients with first-time thrombosed dialysis AVGs were prospectively evaluated after block randomization for surgical patch angioplasty (group A) versus balloon angioplasty (group B) for venous anastomotic side after surgical thrombectomy in four tertiary referral hospitals in Egypt. Results Over 18-month follow-up period of our enrolled patients, immediate technical success was 100% with regaining graft functionality in 100% of 45 patients in group A patients versus 89.6% (P=0.056) in group B with achieving optimum graft functionality in 100% of technically successful declotting procedures (43 patients) in group B. The primary patency at 6, 9, 12 and 18 months in group A was 66, 63.6, 52.3 and 31.8%, respectively, versus 48.8, 48.8, 37.2 and 18.6%, respectively, in group B. The secondary patency in group A at 6, 9, 12 and 18 months was 86.4, 100, 88.6 and 77.3%, respectively, versus 72.1, 90.7, 79.1 and 69.8%, respectively, that was not statistically significant except 12-month primary patency (P=0.014). Conclusion Our study found no statistically significant difference in 18-month outcomes between patients treated with surgical thrombectomy with patch angioplasty and surgical thrombectomy with balloon angioplasty for thrombosed AVGs regarding regaining functionality and patency, however patients treated with balloon angioplasty required more additional secondary interventions and most of them were to manage graft venous anastomotic site restenosis. [ABSTRACT FROM AUTHOR]

Background Continuous and rapid advancement in percutaneous endovascular therapy has led to a significant increase in its use as a primary option for revascularization replacing surgical bypass, and it has become a standard treatment for critical limb ischemia (CLI). Clinical success of percutaneous revascularization has been mostly judged by patency rate and limb salvage, but there is paucity of reports on the outcomes of the wound. We present a retrospective study of immediate angiographic and 6-month clinical outcome of patients who underwent endovascular recanalization of tibial arteries for CLI followed by surgical debridement and wound reconstruction with split-thickness skin graft (STSG) for patients with grade 2 ulcer according to the Wound, Ischemia, foot Infection score. Patients and methods Between January 2016 and April 2017, 47 consecutive adult patients with CLI who underwent endovascular recanalization of infra-popliteal arteries due to more than 50% stenosis or chronic total occlusion with grade 2 chronic wound that was reconstructed using STSG and who had a clinical follow-up of at least 6 months were selected for analysis. Results Forty-seven patients underwent endovascular reconstruction. Forty (85.1%) patients underwent only balloon angioplasty and remaining seven (14.9%) underwent additional bailout stenting for proximal tibioperoneal or anterior tibial arteries. Twenty-eight (59.6%) patients had multiple vessel recanalization, while 19 (40.4%) patients had single vessel recanalization. Linear flow to the foot was achieved in at least one artery, mostly the anterior tibial artery in 32 (68.1%) patients postrevascularization. Successful wound healing occurred in 37 (80.4%) patients, 24 (64.9%) of them underwent wound covering with STSG with graft uptake in 20 (83.3%) patients. Limb salvage was achieved in 41 (89.1%) patients at a 6-month follow-up. Conclusion Endovascular recanalization of tibial arteries is an effective procedure for the treatment of CLI. STSG can be considered a reliable option for achieving wound healing in diabetic foot patients after successful revascularization and proper wound debridement. Normal outflow with at least one of the three infra-popliteal vessels being patent is essential for adequate healing and graft taking. [ABSTRACT FROM AUTHOR]

A spatially reversible and programmable piezoelectric metamaterial concept is introduced for the manipulation of surface acoustic waves to achieve on-demand wave mode conversion and reflection. The concept uses an array of inductive-shunted piezoelectric elements (with gradually varying inductors in space) attached to the surface of an elastic propagation domain. The value of each inductor directly controls the phase velocity of the Rayleigh wave locally as quantified through unit cell band diagram analysis that guides the design process. By varying the spatial inductance distribution, the proposed piezoelectric metamaterial domain can be programed to convert incident surface waves into bulk shear waves or reflect them completely. The location of surface-to-bulk wave mode conversion or wave reflection can be tailored by means of the inductance distribution, and the directional behavior in space can be reversed. The proposed concept may enable novel surface acoustic wave devices and filters, via digital or analog programmable shunt circuits. [ABSTRACT FROM AUTHOR]

A new highly accurate optical biomedical sensor is proposed for cancer detection characterized by high sensitivity, small footprint, low cost, and low limit of detection. The sensor is based on double-ring resonators made of silicon on insulator. The type of the waveguide is critical in determining the sensor performance. To compromise the advantages and disadvantages of strip and slot waveguides, a mixed design of both has been introduced in literature at the expense of increased footprint compared to traditional sensors. Indeed, almost 27-fold footprint increase is required to improve the sensitivity by only one third of that of slot waveguide's sensitivity. In this paper, we introduce a new design that keeps the same footprint of traditional sensors, while achieving high sensitivity. This sensitivity depends on the resonance wavelength shift due to different refractive indices of the biosample. It has the value 109.8 nm/RIU compared to 55.57 nm/RIU and 129.621 nm/RIU for strip and slot waveguides, respectively. The hybrid waveguide quality factor is 537.7 while the quality factors of the strip and the slot waveguides are 627.99 and 380.76, respectively. In addition, the new design achieves the minimum limit of detection (0.0255) when compared to that of traditional designs. Furthermore, a new method of detection is proposed with the same design, providing a higher sensitivity over both traditional waveguide types with a value of 15.3, compared to 13.2 and 11.5 for strip and slot waveguides, respectively. In this method, the sensitivity relies on various values of output transmitted light at the same wavelength due to altering the biocell refractive index. The biosensor output equation is developed. In addition, the relationship between the supermodes and the sensitivity is determined at variance conditions. It is found that there is an inverse relation between them. [ABSTRACT FROM AUTHOR]

This paper presents a high-efficiency rectenna based on a high-gain wideband antenna and a wideband rectifier circuit with a fourth-order bandpass impedance matching transformer. The peak measured power conversion efficiency (PCE) of the rectifier hits 73.57% at an input power level of 10 dBm and at a center frequency of 5.4 GHz. The maximum measured DC output voltage is 4.82 V and 4.7 V at 5.2 GHz and 5.8 GHz, respectively. The proposed rectifier exhibits broadband high-efficiency rectification performance concerning PCE and output voltage as its PCE is higher than 50% within a range from 4.9 to 6.1 GHz at a wide range of input power levels from −4 to 10 dBm. The stacked back-to-back profile saves 50% of the total area of the rectenna. The rectenna operates through a wide bandwidth of 1.3 GHz. It is capable of harvesting power at six interesting bands 4.9 GHz (5G), 5 GHz (WLAN), 5.2 GHz (Wi-Fi), 5.5 GHz (WLAN), 5.8 GHz (ISM), and 6 GHz (Wi-Fi 6E). The maximum measured PCE and DC voltage of the rectenna are 71.46% and 1.87 V, respectively at 10 dBm, 2 KΩ load termination, and 50 cm transmitter-rectenna spacing. [ABSTRACT FROM AUTHOR]

Context Anticoagulant therapy remains the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive rise in the use of percutaneous endoluminal clot dissolution techniques such as using catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy (MAT) devices due to their established short-term benefits. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue. Aims Our study aims to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and MAT techniques. Settings and design Retrospective. Patients and methods Percutaneous endoluminal clot dissolution using either CDT or MAT for proximal lower extremity DVT was performed on 64 limbs in 58 patients of 148 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 32 patients prior or during the procedure. Statistical analysis Statistical analysis was performed by using IBM SPSS Statistics, version 22, for Windows program package (SPSS Inc., Chicago, Illinois, USA). Results From 58 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 30 (51.7%) patients. Trapped thrombus in the deployed filters as revealed on venocavography was observed in 8/30 (26.7%) filters deployed prophylactically with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques was 11/58 (18.9%) patients. Conclusion CDT could be done safely and effectively without routine prophylactic IVC filter placement in treating acute DVT. Selective filter placement may be considered in patients undergoing mechanical thrombectomy or patients with more proximal thrombus pattern with multiple risk factors. [ABSTRACT FROM AUTHOR]

Design and Setting. A retrospective study was conducted on all 2WW referrals made to our tertiary head and neck centre in a 12-month period. Methods. Sensitivity, specificity, and PPV of presenting complaints in H&N cancer diagnosis using Excel® and the statistical package SPSS®. Results. The sensitivity and specificity of 2005 NICE guidelines in detecting H&N cancers were 91.2% and 59%, respectively; their PPV was 9%. The sensitivity and specificity of 2015 NICE guidelines were 75.4% and 71%, respectively; their PPV was 10.3%. Eight out of 85 patients who presented with unilateral sore throat for more than 4 weeks, with or without otalgia and normal otoscopy, had H&N cancer (PPV 9.5%). Conclusions. Although the 2015 NICE guidelines have a high rate in detecting H&N cancers, consideration of reincluding unilateral sore throat in the referral criteria might be necessary. [ABSTRACT FROM AUTHOR]

Background Bare-metal stent (BMS) scaffolding of superficial femoral artery occlusive lesions has been associated with high rates of late clinical failure. Maintaining the patency of recanalized arterial segments was the main issue behind the concept of leaving nothing behind to be evolved and percutaneous balloon angioplasty becomes the preferred option for endovascular therapy. Drug-eluting balloons (DEBs) have shown to be an effective alternative to BMS for patients with de novo complex superficial femoral occlusive disease. Aims The aim was to compare the outcome of DEB versus BMS in treating complex chronic total occlusion of superficial femoral and proximal popliteal artery in patients with disabling claudication and critical limb ischemia regarding technical success, primary patency, clinically driven target lesion revascularization (cd-TLR), and limb salvage rate. Materials and methods The current study is a multicenter, prospective, randomized study. Ninety patients (110 limbs) complaining of disabling and critical limb ischemia due to complex femoropopliteal occlusive lesions were randomly allocated into two groups according to the intervention method performed. Group A included 48 patients (57 limbs) who were submitted for treatment with paclitaxel DEBs and group B included 42 patients (53 limbs) submitted for treatment with BMS. The follow-up period was for 1, 6, and 12 months. Statistical analysis was performed by using the IBM SPSS Statistics version 22 for Windows Program Package (SPSS Inc., Chicago, IL, USA). Results BMSs seem to have lower patency and higher cd-TLR rates compared with patients who received paclitaxel drug-coated balloons but was not statistically significant. The primary patency rates were 100, 96, and 86.2% at 1, 6, and 12 months' respectively' in the DEB group versus 100, 89.8, and 77.6% at 1, 6, and 12 months, respectively, in the BMS group. Clinically driven TLR rates were 2 and 7.8% at 6 and 12 months, respectively, in the DEB group versus 6.1 and 14.2% at 6 and 12 months, respectively, in the BMS group. Conclusion Percutaneous therapy for Trans atlantic inter-societies consensus (TASC) C and D femoropopliteal lesion using DEB or BMS is safe and effective with a high patency rate of 1 year. Paclitaxel drug-eluting balloons seem to have a promising role in the prevention of restenosis and recurrence of peripheral arterial occlusive disease. However, stents are still playing important bailout role in the treatment of residual stenosis and dissection. Further follow-up is essential to obtain and document long-term outcome of different percutaneous therapy for complex and long superficial femoral artery (SFA) lesions. [ABSTRACT FROM AUTHOR]

Context Iliac vein compression syndrome (IVCS) or May–Thurner syndrome is an anatomically variable condition of venous outflow obstruction caused by extrinsic compression. The pathology of this condition is secondary to a partial obstruction of the common iliac vein by an overlying common iliac artery with subsequent entrapment of the left common iliac vein. Clinical presentations include, but not limited to, pain, swelling, venous stasis ulcers, and skin discoloration. With extensive deep venous thrombosis, postphlebitic syndrome, with all its sequelae, may also develop. Endovascular interventions of this syndrome have become first-line therapy. Aims To estimate the prevalence of IVCS in patients with unilateral left lower limb venous disease [chronic venous disease (CVD)], assess the sensitivity and specificity of modified computed tomography venography in the diagnosis of IVCS, and evaluate the feasibility and effectiveness of the endovascular treatment. Settings and design This was a prospective case series study. The study was performed at three tertiary referral centers in Kingdom of Saudi Arabia (Security Forces Hospital Program, Al-Noor Specialist Hospital, Makkah, Almoosa Specialist Hospital, Al-Ahsaa) and three hospitals in Egypt (Benha University Hospitals, Nile Insurance Hospital, and Kuwaiti Specialized Hospital, Benha). Patients and methods Between March 2015 and February 2018, we evaluated 369 patients with unilateral left lower limb symptomatic CVD in the outpatient clinic of vascular surgery in the study hospitals. Sixty-one symptomatic patients with IVCS who received endovascular treatment were included in our study. Statistical analysis used The initial data entry used Microsoft excel (2010 version) for logical proofreading and analysis. We expressed continuous data as mean±SD and compared continuous variables using two-sided Student's t tests. We estimated stent patency using Kaplan–Meier method. We considered P value less than 0.05 to be statistically significant. Statistical analysis was performed by using IBM Statistical Package for the Social Sciences software (version 22 for Windows program package). Results The 1-year patency rates in the nonthrombotic and thrombotic IVCS groups were 95.7 and 80%, respectively (P=0.146). The overall primary patency rate at 1 year after treatment was 93%. Complete pain relief was achieved in 76.7% of patients. The overall edema relief rate was 78.1%. Of the 12 limbs with active ulceration before treatment, 10 (83.3%) healed completely. Conclusion IVCS is not an uncommonly encountered condition, especially among patients with unilateral left lower extremity CVD. Computed tomography venography with three-dimensional reconstruction images was more sensitive and specific as a diagnostic approach for IVCS and provided useful information for the endovascular treatment planning. Moreover, endovascular therapy is feasible and effective for treating left-sided IVCS with high technical success rate and with an acceptable complication profile. So, we concluded that endovascular treatment should be considered as the first line of therapy for patients experiencing IVCS. [ABSTRACT FROM AUTHOR]

New tricyanofuran intramolecular charge transfer dyes comprising the hydrazone group were prepared and fully characterized in order to study their possible solvatochromism, dyeing ability, and antimicrobial activity. The preparation of the hydrazone dyes was achieved in relatively good yields starting from different aromatic amines. The hydrazone functional group was presented via the azo-coupling reaction of the tricyanofuran compound by the properly substituted diazonium chloride. Chemical structures of the prepared hydrazones were confirmed via nuclear magnetic resonance spectroscopy (1H- and 13C-NMR), Fourier-transform infrared spectroscopy (FT-IR), and elemental analysis (C, H, and N). The UV-visible absorption spectra of the produced sensor colorants displayed interesting solvatochromism in solvents with a different polarity, which was found to be affected by the substituents bonded to the aromatic hydrazone moiety. The pH molecular switching was investigated through tuning the intramolecular charge transfer stimulated by the reversible deprotonation/protonation process in acetonitrile solution showing color change from yellow to purple. The produced disperse dyestuffs were employed for dyeing polyester fibers to introduce acceptable color strength and colorfastness properties. Moreover, the dyes verified a weak to moderate antimicrobial activity against some selected pathogens, including S. aureus, E. coli, and Candida albicans. [ABSTRACT FROM AUTHOR]

Background/Purposes Despite enhanced immediate technical success, neointimal hyperplasia and restenosis remain the Achilles' heel of endovascular interventions. Drug-coated balloons (DCBs) have shown promise in improving the outcomes of patients with peripheral arterial disease. Several trials have shown that DCB angioplasty has superior antirestenotic efficacy in the femoropopliteal artery (FPA) disease. This controlled, prospective, multicenter study was designed to establish the efficacy of DCB to improve angiographic outcomes and inhibit restenosis of the FPAs in an exclusive diabetic population in a 12-month follow-up period. Aim This controlled, prospective, multicenter study was designed to establish the efficacy of DCB to improve angiographic outcomes and inhibit restenosis of the FPAs in an exclusive diabetic population in a 12-month follow-up period. Settings and design A randomized, controlled, prospective, and multicenter study was conducted. Patients and methods Between January 2016 and December 2017, 84 consecutive adult patients with type 1 and 2 diabetes with oral euglycemics or insulin injection had been enrolled. Overall, 42 patients were treated with DCB angioplasty and 42 were treated with plain old balloon angioplasty (POBA) in a 1 : 1 randomization pattern. The primary end point of the study was the primary patency, mean diameter restenosis, and binary restenosis of the treated sites at 12 months without reintervention in the interim. Results The 12-month mean diameter restenosis was significantly lower in the DCB arm than in the POBA group (27.9±35.1 vs. 44.8±33.9%, P=0.034). Furthermore, analysis showed that the binary (≥50% diameter stenosis) restenosis rates were significantly lower in DCB patients as compared with the POBA patients (28 vs. 47%, P=0.029). The primary patency was significantly better in DCB group (71 vs. 49%, P=0.028). On the contrary, we noted that the rate of clinically driven target lesion revascularization was slightly higher in the POBA patients, though not statistically significant as compared with the paclitaxel-coated balloon group (28 vs. 20%, P=0.13). There were no procedure-related or device-related deaths in either study arm. The 12-month adverse effects, in terms of all-cause death (N3=7.1% POBA vs. N2=4.8% DCB), minor amputation (N5=12% POBA vs. N4=9.5% DCB), major amputation (0% POBA vs. N1=2.4% DCB), and myocardial infarction (N1=2.4% POBA vs. 0% DCB) were equal in both groups (P=713). Causes of mortality included myocardial infarction, cerebral infarction, and sudden death. Conclusions The treatment of diabetic peripheral arterial disease of FPA disease with IN.PACT paclitaxel-coated balloon angioplasty is associated with superior antirestenotic efficacy that provides a better primary patency rate compared with POBA at 12 months. However, DCB showed no clinical benefit over POBA at this 12-month follow-up period. The number of major adverse clinical events was comparable between DCB and POBA groups of patients. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the impact of perinatal potassium bromate (KBrO3) exposure on the development of sensorimotor reflexes and redox status, and on the histological architecture of the brain, liver, and kidney of newborn mice. Pregnant mice received 1-ml bottled drinking water daily by oral intubation and served as the control group. Another group of pregnant mice were supplemented orally with 200 mg/kg body weight KBrO3 dissolved in drinking water from gestation day 5 to postnatal day 21. KBrO3 induced a decrease in the postnatal body weight in the newborn mice. KBrO3-exposed newborn mice showed poor performance and delayed development of the sensorimotor reflexes. Histological changes, increased lipid peroxidation, and altered antioxidants were reported in the cerebrum, cerebellum, medulla oblongata, liver, and kidney of the KBrO3-exposed newborn mice. In conclusion, these findings demonstrated that perinatal exposure to bromate induced oxidative stress, histological and behavioral alterations, and was a potential teratogen in newborn mice. [ABSTRACT FROM AUTHOR]

Introduction With raising the demand for hemodialysis (HD) owing to concomitant increased incidence of nephropathic disease, which has led to associated increased patients' life expectancy in the past three decades, it becomes necessary to establish a secondary or a tertiary HD vascular access to overcome the exhausted peripheral veins and central venous occlusion. Aims Our case study reports midterm (24-month follow-up) results with infraclavicular arterioarterial loop graft and evaluates its efficacy and safety in construction of HD vascular access for patients with end-stage renal disease. Material and methods This was a prospective study. From December 2014 to December 2017, 45 patients with end-stage renal disease on chronic HD with exhausted all peripheral and central veins or were considered unsuitable for creation of arteriovenous fistula/graft owing to heart failure underwent arterioarterial chest wall prosthetic graft implantation for creation of HD vascular access. The data analysis was done using SPSS version 20.0 for Windows. Results The primary patency rates were 100, 97.7, 93, 77.5, and 73.7% at 6, 9, 12, 18, and 24 months, respectively. The secondary patency rates were 100, 85.7, and 66.6% at 6, 9, and 12 months, respectively, after successful thrombectomy in nine patients. There were 20 (44.4%) secondary variable procedures performed in 18 (40%) patients during follow-up period, with no procedure-related mortality or limb-threatening conditions being documented in our study. Conclusion Our case study reports a reasonable midterm patency rate, and complications associated with this pattern of vascular access show that infraclavicular arterioarterial loop grafts are a valid alternative option for complex patients. We advocate the use of this technique in patients with exhausted all vascular access possibilities in both upper extremities with central venous obstruction. We also indicate it in case of patients with cardiac insufficiency who could not tolerate long-term hemodynamic effect of arteriovenous fistula/graft. [ABSTRACT FROM AUTHOR]

Summary: An innovative, high‐quality factor, and small‐area V‐shaped inductor is presented in this article to improve the performance of voltage‐controlled oscillators (VCOs). The differential inductance of the suggested V‐shaped inductor in the resonator and the buffer is 280 pH and 630 pH, respectively. The inductor area is compacted by 42% and 76% compared to the conventional inductor with the same inductance value. Using 0.18‐ μm CMOS technology, the proposed V‐shaped inductor is employed to design a compact VCO operating at Ku‐band. The proposed VCO has a simulated phase noise range of −114 to −114.6 dBc/Hz, which is relatively constant. Also, its simulated frequency tuning range (FTR) is 5.6 % from 14.03 to 14.74 GHz. The power consumption is 2.2 mW. The simulated figure of merit (FoM) ranges from −193.5 to −194.2 dBc/Hz, which is enhanced by 6%. The designed VCO core area is 0.034 mm2, which is compacted by 35% compared to using a conventional spiral inductor. The achieved area‐included figure of merit (FoMA) is −208.7 dBc/Hz. The VCO has an output power of −6.8 dBm and a good harmonic suppression of 29.4 dB between the fundamental and the second harmonic. [ABSTRACT FROM AUTHOR]

Background Aortoiliac arterial occlusive disease (AIOD) is one of the commonest patterns of systemic atherosclerosis with a spectrum of chronic symptoms from intermittent claudication to critical limb ischemia, which is a common therapeutic challenge. A meaningful shift has evolved in treating symptomatic AIOD from open to endovascular repair, which are becoming an attractive treatment option even in complex lesions, especially in patients with considerable risk. Aim The aim of this study was to assess the feasibility, that is, technical success rates, primary patency, and safety outcome for Trans-Atlantic Inter-Society Consensus (TASC) D lesions treated endovascularly with analysis of outcome of stent graft versus bare metal stent in patients with advanced Leriche syndrome. Patients and methods A prospective case series study: over 30 months, our case study was conducted on 22 patients with TASC D lesion morphology undergoing treatment for symptomatic chronic AIOD at the Vascular Unit, General Surgery Department, Benha University Hospitals, Vascular Surgery Department, Nile Insurance Hospital and Vascular Surgery Department, Security Forces Hospital and Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The patients were enrolled from April 2015 until October 2016 with a 12-month follow-up period from the last patient enrolled. SPSS, version 20.0 for Windows was used for statistical analysis. Results Our study had a technical success rate of 95.5% in crossing TASC D lesion with immediate angiographic success (91%). The 12-month primary patency rate was 85% for TASC D lesions with a target lesion revascularization of 15%. Stent grafts had a higher 1-year patency rate (91.7%) versus bare metal stent (75%). The total procedure-related complications rate was 18.1% and 30 days procedure-related mortality was 4.7%. Conclusion Our study shows that technical success of endovascular therapy for TASC D lesions was 95.5% with a 1-year primary patency of 85% and a complication rate of 22.7% in TASC D lesions. Utilizing more than one access with antegrade crossing the lesion through brachial access was paramount for technical success. Long-term follow-up is mandatory to support the durability of the procedure. [ABSTRACT FROM AUTHOR]

Context Femoral artery-infected pseudoaneurysm (fa-IPA) is very common in modern societies, and it represents a difficult problem to the vascular surgeon, as surgical management remains controversial, which ranges from ligation with debridement to extra-anatomical bypass. The present study was carried out to evaluate the outcome of silver-coated grafts used for the management of fa-IPA secondary to illegal drug injections. Aim To assess the outcome of silver-coated graft as bailout revascularization conduit in patients with infected pseudoaneurysm regarding success of the procedure, limb salvage, infection rate, and primary patency rate. Settings and design A prospective study was conducted. Patients and methods The study included 30 patients who presented with fa-IPAs and were admitted to Emergency Department of Benha University Hospital, Ain Shams University Hospitals, and Security Forces Hospital, Makkah, Saudi Arabia, during a 30-month period. Overall, 24 (80%) patients were male and six (20%) patients were female, with age range from 25–46 years. Twenty-one (70%) patients underwent surgical resection and immediate revascularization using silver collagen-coated polyester graft (InterGard Silver; Maquet), whereas nine (30%) patients underwent surgical ligation, with delayed revascularization in four (13.3%) patients through transobturator bypass using the same graft. Results Immediate revascularization using either in situ or extra-anatomic bypass is associated with risk of graft infection [early, five patients of 21 (23.8%); late, two patients of 21 (9.5%), with limb salvage rate of 86.7%]. Conclusion However, no surgical treatment for fa-IPA has been proved to be safe in terms of the overall surgical complications. Our study shows promising results for possibility of using silver-coated grafts as bailout option for limb revascularization. Long-term antimicrobial therapy is advised, and longer follow-up periods are needed to provide accurate results. [ABSTRACT FROM AUTHOR]

Self-reported health literacy measures have seen increased application throughout the last years, among those are the brief health literacy screeners (BHLS) developed by Chew and colleagues (2004). There has been little systematic research on the performance of these measures across different contexts, including countries and languages, to draw conclusions about their predictive power outside of the United States. This study aimed at replicating the original validation of the BHLS. Receiver operating characteristic (ROC) analysis was applied to data from Hungary, Italy, Lebanon, Switzerland, and Turkey. In addition, logistic regression models incorporating ROC analysis using BHLS as predictors were compared to models using socio-demographics only to identify individuals with inadequate and inadequate or marginal health literacy as measured with the Short Test of Functional Health Literacy in Adults. Analyses showed that in all cases the BHLS were not sufficiently able to identify individuals with different health literacy levels. Logistic regression models using socio-demographics only as predictors outperformed models using the BHLS. The findings highlight the limitations of using the BHLS outside the United States. Further, they question in how far self-reported health literacy measures are comparable across different contexts and whether thresholds for different health literacy levels are universally applicable. [ABSTRACT FROM AUTHOR]

Eudragit-loaded silymarin nanoparticles (SNPs) and their formulation into buccal mucoadhesive tablets were investigated to improve the low bioavailability of silymarin through buccal delivery. Characterisation of SNPs and silymarin buccal tablets (SBTs) containing the optimised NPs were performed.Ex vivopermeability of nominated SBTs were assessed using chicken pouch mucosa compared to SNPs and drug suspension followed by histopathological examination. Selected SNPs had a small size (<150 nm), encapsulation effciency (>77%) with drug release of about 90% after 6 h. For STBs, all physicochemical parameters were satisfactory for different polymers used. DSC and FT-IR studies suggested the presence of silymarin in an amorphous state.Ex vivopermeation significantly emphasised the great enhancement of silymarin permeation after NPs formation and much more increase after formulating into BTs relative to the corresponding drug dispersion with confirmed membrane integrity. Incorporation of SNPs into BTs could be an efficient vehicle for delivery of silymarin. [ABSTRACT FROM AUTHOR]

Graphene presents practical applications in energy storage devices, especially supercapacitors. However, mainstream synthesis of graphene includes toxic chemical usage, which threatens the environment. With the recent attention shift to synthesizing nanomaterials from agro-waste due to their easy availability, cost-effectiveness, and, most importantly, their environmental friendliness, we present, in this work for the first time, a novel and green synthesis of few-layered graphene sheets using pomegranate peels as a precursor at a low temperature of 80 °C. The surface morphology and microstructural properties are determined by Transmission Electron Microscopy (TEM), Energy Dispersive X-Ray spectroscopy (EDX), X-Ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), UV–visible spectroscopy (UV–vis), and the electrical properties determined by Hall Effect Measurement. The application as a supercapacitor is also examined using Cyclic Voltammetry (CV), Charge–Discharge Cycling (GCD), and Electrochemical Impedance Spectroscopy (EIS). The resulting supercapacitor delivers an areal capacitance of 3.39 m F cm - 2 at a current density of 15.6 μA cm - 2 , making our synthesized graphene a good choice for electrochemical storage devices. [ABSTRACT FROM AUTHOR]

As people's health, and in some cases even their lives are at stake, the quality of health information on the web becomes a prime public health concern. Attempts at measuring or certifying quality usually use a set of quality markers, but their individual contribution to overall quality, and further to user perception and attitudes, is largely unknown. This study aims at assessing this contribution, using the topic of vaccination. It combines data from three sources, a survey participants filled in after completing an information search task, records of the webpages visited during that task, and a content analysis of these webpages determining the presence or absence of quality markers and the pages' tone towards vaccination. Results show that the tone of the webpages participants rated and were exposed to, is highly correlated with their attitude towards vaccination. Markers shown to be associated with high quality were also correlated with attitude, in particular when they were related to the quality of information content (such as “medical ownership”, “specific accreditations” of health content and reporting “benefits of treatment/vaccination”) rather than esthetic/visual and design markers. The results suggest that the approach to measuring the quality of health websites using such markers is both necessary and promising. [ABSTRACT FROM AUTHOR]

A two-dimensional active acoustic metamaterial with controllable anisotropic density is introduced. The material consists of composite lead-lead zirconate titanate plates clamped to an aluminum structure with air as the background fluid. The effective anisotropic density of the material is controlled, independently for two orthogonal directions, by means of an external static electric voltage signal. The material is used in the construction of a reconfigurable waveguide capable of controlling the direction of the acoustic waves propagating through it. An analytic model based on the acoustic two-port theory, the theory of piezoelectricity, the laminated pre-stressed plate theory, and the S-parameters retrieval method is developed to predict the behavior of the material. The results are verified using the finite element method. Excellent agreement is found between both models for the studied frequency and voltage ranges. The results show that, below 1600 Hz, the density is controllable within orders of magnitude relative to the uncontrolled case. The results also suggest that simple controllers could be used to program the material density toward full control of the directivity and dispersion characteristics of acoustic waves. [ABSTRACT FROM AUTHOR]

Background: Parsley was employed as an experimental probe to prevent the behavioral, biochemical and morphological changes in the brain tissue of the albino mice following chronic cadmium (Cd) administration. Methods: Non-anesthetized adult male mice were given parsley juice (Petroselinum crispum, Apiaceae) daily by gastric intubation at doses of 10 and 20 g/kg/day. The animals were divided into six groups: Group A, mice were exposed to saline; Groups B and C, were given low and high doses of parsley juice, respectively; Group D, mice were exposed to Cd; Groups E and F, were exposed to Cd and concomitantly given low and high doses of parsley, respectively. Results: Cd intoxication can cause behavioral abnormalities, biochemical and histopathological disturbances in treated mice. Parsley juice has significantly improved the Cd-associated behavioral changes, reduced the elevation of lipid peroxidation and normalized the Cd effect on reduced glutathione and peroxidase activities in the brain of treated mice. Histological data have supported these foundations whereas Cd treatment has induced neuronal degeneration, chromatolysis and pyknosis in the cerebrum, cerebellum and medulla oblongata. Conclusion: The low dose (5 g/kg/day) of parsley exhibited beneficial effects in reducing the deleterious changes associated with Cd treatment on the behavior, neurotransmitters level, oxidative stress and brain neurons of the Cdtreated mice. [ABSTRACT FROM AUTHOR]

Background Despite being committed to the immunization agenda set by the WHO, Italy is currently experiencing decreasing vaccination rates and increasing incidence of vaccine-preventable diseases. Our aim is to analyze Italian online debates on pediatric immunizations through a content analytic approach in order to quantitatively evaluate and summarize users’ arguments and information sources. Methods Threads were extracted from 3 Italian forums. Threads had to include the keyword Vaccin* in the title, focus on childhood vaccination, and include at least 10 posts. They had to have been started between 2008 and June 2014. High inter-coder reliability was achieved. Exploratory analysis using k -means clustering was performed to identify users’ posting patterns for arguments about vaccines and sources. Results The analysis included 6544 posts mentioning 6223 arguments about pediatric vaccinations and citing 4067 sources. The analysis of argument posting patterns included users who published a sufficient number of posts; they generated 85% of all arguments on the forum. Dominating patterns of three groups were identified: (1) an anti-vaccination group ( n = 280) posted arguments against vaccinations, (2) a general pro-vaccination group ( n = 222) posted substantially diverse arguments supporting vaccination and (3) a safety-focused pro-vaccination group ( n = 158) mainly forwarded arguments that questioned the negative side effects of vaccination. The anti-vaccination group was shown to be more active than the others. They use multiple sources, own experience and media as their cited sources of information. Medical professionals were among the cited sources of all three groups, suggesting that vaccination-adverse professionals are gaining attention. Conclusions Knowing which information is shared online on the topic of pediatric vaccinations could shed light on why immunization rates have been decreasing and what strategies would be best suited to address parental concerns. This suggests there is a high need for developing automated approaches to detect misleading or false information on the Internet. [ABSTRACT FROM AUTHOR]