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Background: Substantial blood loss is a major concern in primary total hip arthroplasty and thus various blood conservation techniques are used to reduce blood loss in this surgery. Clonidine is frequently used in anesthesia for its antihypertensive property, however, the efficacy of oral clonidine premedication in reducing bleeding in total hip arthroplasty is not clear.Objectives: This study aimed to evaluate the impact of a single oral dose of clonidine premedication on blood loss and transfusion needs in patients undergoing primary total hip arthroplasty with balanced general anesthesia.Methods: Sixty patients classified as American Society of Anesthesiologists physical status 1 and 2, aged between 18 and 75 years, were randomly assigned to either the clonidine group or the placebo group, with 30 patients in each group. In this study, 60 minutes prior to the surgery, patients in the clonidine group received oral clonidine 0.2 mg and the placebo group received the identical placebo tablet. Intraoperative blood loss, transfusion requirements, need for supplementary remifentanil and nitroglycerin infusion, hemodynamic parameters, postoperative transfusion needs and hemoglobin level were measured and compared between the two groups.Results: The results showed that intraoperative blood loss, remifentanil usage, and the mean systolic and mean arterial blood pressures were significantly lower in the clonidine group compared with the placebo group. The postoperative hemoglobin value was significantly higher, and the reduction in the postoperative Hb level as well as the number of transfused patients were significantly less in the clonidine group.Conclusion: It can be concluded that 0.2 mg oral clonidine premedication significantly reduced intraoperative bleeding, and decreased postoperative changes in hemoglobin level and the number of transfused patients in primary total hip arthroplasty.

Egypt Vision 2030 intends that by this year, education and training will be available to all with high quality without discrimination, within an effective, fair, sustainable and flexible institutional system. It is a prerequisite for providing an appropriate climate for a culture of quality that is reflected in performance, and its importance in providing a suitable ground for employing quality operations. Increasing demand for higher education services requires the presence of a real and clear added value from the educational process through the provision of education through the provision of education, which increases the competitiveness of education. In addition to the provision of higher education to all students without discrimination, and with the same quality, and from here the current research suggests merging the faculties and departments of visual arts education (Fine Arts - Applied Arts - Art Education - Art Education Department of the Faculty of Specific Education) at the university in three main faculties, namely (Fine Arts ), (Applied Arts), (Art Education) and restructuring its curricula in order to achieve comprehensive quality in those colleges, through the question that: “What is the possibility of integrating the colleges and departments of visual arts education (Fine Arts - Applied Arts - Art Education - Art Education Department at the Faculty of Arts)? Specific Education) in Egyptian universities, and restructuring their curricula - to suit the requirements of the labor market - within the framework of Egypt’s Vision 2030? The proposal presented by the researcher serves the sustainable development goals of Egypt’s Vision 2030, to develop university education in a way that achieves quality in the field of visual arts education at the university. The research recommends merging these faculties and departments into three faculties; To study art academically, with the restructuring of its curricula, and the adoption of structural correction programs for these artistic institutions, in line with Egypt’s Vision 2030.

Abstract Relapse and toxicity limit the effectiveness of chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma (LBCL), yet biomarkers that predict outcomes and toxicity are lacking. We examined radiomic features extracted from pre-CAR-T 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scans (n = 341) of 180 patients (121 male; median age, 66 years). Three conventional (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and 116 novel radiomic features were assessed, along with inflammatory markers, toxicities, and outcomes. At both pre-apheresis and pre-infusion time points, conventional PET features of disease correlated with elevated inflammatory markers. At pre-infusion, MTV was associated with grade ≥ 2 cytokine release syndrome (odds ratio [OR] for 100 mL increase: 1.08 [95% confidence interval (CI), 1.01–1.20], P = 0.031), and SUVmax was associated with failure to achieve complete response (CR) (OR 1.72 [95% CI, 1.24–2.43], P

The Devonian outcrops of the Azrou-Khenifra Basin are located in the eastern band of the Moroccan Central Massif. They are characterized by a high geodiversity since they show sedimentary, stratigraphic, paleontological, tectonic and geomorphological aspects. Those outcrops allow the understanding of the evolution and geodynamic of the area during the Devonian. This proves their relevant in term of scientific value. In addition, they also have educational and touristic interests. The objectives of this work are making the inventory and quantitative assessment as well as the mapping of nine Devonian geosites. To approach the topic, the method proposed by Brilha (2016) have been used which based on qualitative and quantitative criteria. The results show that the geosite Famennian zebra griottes limestones of Ziyar has the highest scientific value (345) while the others are characterized by scientific, educational and tourist values ranging from moderate to high. Regarding the degradation risk, the geosites have a low value. This work could be considered as the base of any geoconservation strategy and geotourism action plan in the area since it focused on the two first steps of it. This may help improve the sustainable development through the establishment of geopark consequently and enhance economical level of people living the Azrou-Khenifra area.

This study investigates the effect of wood black charcoal powder (WBCP) as a partial cement (C) replacement and carbon fiber textile on concrete. The objective is to explore the potential benefits of these additions on the properties of the concrete. Sixty concrete cubes and 30 concrete cylinders were prepared for this analysis. Fifteen concrete cylinders were wrapped with carbon fiber textiles, serving as an external reinforcement. The concrete cubes were cured for days 7, 14, and 28 based on the individual procedure. The cement-wood black charcoal powder (C-WBCP) 3 concrete paste had the highest slump value of 20 mm and the compressive strength ([Formula: see text]) of the concrete cubes were higher at C-WBCP 2 concrete with 29.37 N/mm2 with C-WBCP 1 concrete being next at day 28 of curing. The test results proved that C-WBCP 2 concrete cylinders wrapped with carbon fiber textile exhibited improved [Formula: see text] with 34 N/mm2 as the highest on day 28 of curing. It was observed that the density of concrete decreased with the addition of WBCP and a reduction in the cement percentage. Also, the C-WBCP concrete wrapped with carbon fiber textile proved to have a reduced density when compared with the unwrapped C-WBCP concrete. The workability of concrete is affected by the incorporation of the WBCP.

The construction of the six-point block methods with extra derivatives for solving directly is presented in this paper. The suggested block methods concurrently approximate the problem's solution at six points and are formulated using the Hermite Interpolating Polynomial. The block methods do not reduce the equation to a first-order system of initial value problems (IVPs); instead, they directly obtain the numerical solutions. Additionally, the order and zero-stability of the suggested techniques are examined. We present numerical results and draw comparisons with other block methods that are currently in use. The results demonstrate how effective the suggested approaches are at solving second-order IVPs in general.

The activity of anti-CD19 CAR T cell therapy in chronic lymphocytic leukemia (CLL) with Richter's transformation (RT) to aggressive large B cell lymphoma (LBCL) is largely unknown. In a multicenter retrospective study, we report the safety and efficacy of CAR T cell therapy in patients with RT (n=30) compared to patients with aggressive B cell lymphoma (n=283) and patients with transformed indolent Non-Hodgkins Lymphoma (iNHL) (n=141) between April 2016 and January 2023. Two-thirds of patients received prior therapy for CLL before RT and 89% of them received B-cell receptor and B-cell lymphoma 2 (BCL-2) inhibitors. Toxicities of CAR T cell therapy in RT were similar to other lymphomas, with no fatalities related to cytokine release syndrome or immune effector-cell associated neurotoxicity synderome. The 100-day overall response rate and complete response rates in patients with RT were 57% and 47%, respectively. With a median follow up of 19 months, the median overall survival (OS) was 9.9 months in patients with RT compared to 18 months in de-novo LBCL and not reached in patients with transformed iNHL. The OS at 12 months was 45% in patients with RT compared with 62% and 75% in patients with de novo LBCL and transformed iNHL, respectively. In a multivariate analysis, worse OS was associated with RT histology, elevated LDH, and more prior lines of therapy. CAR T cell therapy can salvage a proportion of patients with CLL and RT exposed to prior targeted agents; however, efficacy in RT is inferior compared to de novo LBCL and transformed iNHL

The agricultural sector in Egypt is adversely affected by factors such as inadequate soil fertility and environmental hazards such as pestilence and diseases. The implementation of early pest prediction techniques has the potential to enhance agricultural yield. Bactrocera zonata and Ceratitis capitata, known as peach fruit fly and Mediterranean fruit fly, respectively, are the predominant pests that cause significant damage to fruits on a global scale. The present study proposes a deep learning-based approach for the detection and quantification of pests. The proposed approach entails the retrieval of data pertaining to the adhesive trap condition, followed by its examination and presentation through a mobile application. The YOLOV5 model has been implemented for the purpose of pest classification, localization, and quantification. In order to address the issue of a restricted dataset, a hybrid technique of transfer learning and data augmentation (copy and paste) was employed. The proposed approach offers an intelligent real time pest detection, thereby facilitating the prediction of treatment options. An application for smartphones has been developed to aid farmers and agricultural professionals in the management and treatment of pests. The proposed approach has the potential to aid farmers in identifying the existence of pests, thereby diminishing the duration and resources needed for farm inspection. As per the results of the conducted experiments, the proposed approach demonstrates a noteworthy increase in performance. The weighted average accuracy reaches 84%, while precision (P), mean average precision (mAP), and F1-score show enhancements of up to 15%, 18%, and 7% respectively.

Abstract Background Fall armyworm (FAW), Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae), is one of the new alien destructive pests of maize and other 350 economic crops. The majority of farmers are still depended upon chemical insecticides to suppress the pest, but S. frugiperda has succeeded to develop resistance against most of the chemical families. Improving an effective environmentally-friendly approach is highly recommended. Therefore, the egg parasitoids are the best weapon for managing the FAW in the early egg stage due to the feeding behavior of their larvae. In this regard, the impact of FAW egg mass layers and scale thicknesses, as physical barriers, on the parasitic performance of the egg-parasitoid species, Trichogrammatoidea bactrae Nagaraja (Hymenoptera: Trichogrammatidae), in non-choice and choice tests was assessed. Besides, the efficacy of FAW-produced adult wasps on the next generation based on the rates of parasitism, adults' emergence, and female progeny was determined. Results Obtained results exhibited that T. bactrae was able to parasitize all exposed FAW egg masses but with different rates related to the layers’ number and scales' thicknesses in both tests. One-layer (83.18, 78.24%) and two-layer egg masses (65.99, 76.42%) had significantly the highest parasitism rate, while three layers (42.15, 46.05%) was the least one, in both tests, respectively. All parasitoids emerged after 10–12 days with high rates (~ 88–98%) from all the tested egg masses, and the majority offspring were female-biased in both tests. Furthermore, parasitic performance in F1 progeny was similar with that recorded in parental generation in terms of parasitism rate, high parasitoid emergency (~ 87–95%), and strongly female-biased (~ 68–76%) in all the exposed egg masses. Conclusions The egg parasitoid, T. bactrae, could be an efficient and recommended bio-control agent against FAW as its greatest ability to overcome the layers’ number and scales’ thickness.

Artisanal gold mining in Chami is an important lever in the country economy, owing to the benefits it brings, but it is also likely to have a negative impact on various environmental compartments. Contamination of surface and ground water by trace metals elements (ETMs) was studied in the vicinity of the Chami gold processing center. The aim of the study was to assess the water contamination by trace metals (ETMs) in the town of Chami. Nine water samples (process and boreholes) were analyzed for (Co, Cr, Cu, Ni, Pb, Zn and Hg). The analysis was carried out by the DMA 80 technique for Hg at the ONISPA laboratory in Nouakchott and the other ETM at the Kenitra geosciences laboratory by the ICP-MS technique. The results of the analyses show that the ETM concentrations are high in process water samples and low in drilling water samples. Pollution indices and coefficients of variation indicate no contamination or anthropogenic traces in the borehole samples, but high levels of Hg and Ni in the process water. These results show the accumulation of metals in significant quantities in the process waters, especially Hg, proving that the waters of the mining waste basins at the Chami processing site are becoming sources of environmental pollution by mercury, which can be released into the environment by several pathways.

Allogeneic transplant (alloHCT) and chimeric antigen receptor modified (CAR)-T cell therapy are potentially cuarative options of diffuse large B-cell lymphoma (DLBCL) relapsing after an autologous (auto)HCT. Although the Center for International Blood and Marrow Transplant Research (CIBMTR) prognostic model can predict outcomes of alloHCT in DLBCL after autoHCT failure, corresponding models of CAR-T treatment in similar patient populations are not available. In this noncomparative registry analysis, we report outcomes of patients with DLBCL (≥18 years) undergoing a reduced intensity alloHCT or CAR-T therapy with axicabtagene ciloleucel during 2012 to 2019 after a prior auto-HCT failure and apply the CIBMTR prognostic model to CAR-T recipients. A total of 584 patients were included. The 1-year relapse, nonrelapse mortality, overall survival (OS), and progression-free survival for CAR-T treatment after autoHCT failure were 39.5%, 4.8%, 73.4%, and 55.7%, respectively. The corresponding rates in the alloHCT cohort were 26.2%, 20.0%, 65.6%, and 53.8%, respectively. The 1-year OS of alloHCT recipients classified as low-, intermediate- and high/very high-risk groups according to the CIBMTR prognostic score was 73.3%, 59.9%, and 46.3%, respectively (P = .002). The corresponding rates for low-, intermediate-, and high/very high-risk CAR-T patients were 88.4%, 76.4%, and 52.8%, respectively (P < .001). This registry analysis shows that both CAR-T and alloHCT can provide durable remissions in a subset of patients with DLBCL relapsing after a prior autoHCT. The simple CIBMTR prognostic score can be used to identify patients at high risk of treatment failure after either procedure. Evaluation of novel relapse mitigations strategies after cellular immunotherapies are warranted in these high-risk patients.

PurposeTo describe ocular outcomes in eyes with cytomegalovirus (CMV) retinitis treated with adoptive immunotherapy using systemic administration of CMV-specific cytotoxic Tlymphocytes (CMV-specific CTLs).DesignRetrospective cohort study.ParticipantsPatients with active CMV retinitis evaluated at a tertiary care academic center.MethodsTreatment of CMV retinitis with standard-of-care therapy (systemic or intravitreal antivirals) or CMV-specific CTLs (with or without concurrent standard-of-care therapies).Main outcome measuresThe electronic medical record was reviewed to determine baseline characteristics, treatment course, and ocular outcomes, including best-corrected visual acuity (BCVA), treatments administered (CMV-specific CTLs, systemic antivirals, intravitreal antivirals), resolution of CMV retinitis, any occurrence of immune recovery uveitis, cystoid macular edema, retinal detachment, or a combination thereof.ResultsSeven patients (3 of whom had bilateral disease [n = 10 eyes]) were treated with CMV-specific CTLs, whereas 20 patients (6 of whom had bilateral disease [n = 26 eyes]) received standard-of-care treatment. Indications for CMV-specific CTL therapy included persistent or progressive CMV retinitis (71.4% of patients); CMV UL54 or UL97 antiviral resistance mutations (42.9%); side effects or toxicity from antiviral agents (57.1%); patient intolerance to longstanding, frequent antiviral therapy for persistent retinitis (28.6%); or a combination thereof. Two patients (28.6%; 4 eyes [40%]) received CMV-specific CTL therapy without concurrent systemic or intravitreal antiviral therapy for active CMV retinitis, whereas 5 patients (71.4%; 6 eyes [60%]) continued to receive concurrent antiviral therapies. Resolution of CMV retinitis was achieved in 9 eyes (90%) treated with CMV-specific CTLs, with BCVA stabilizing (4 eyes [40%]) or improving (4 eyes [40%]) in 80% of eyes over an average follow-up of 33.4 months. Rates of immune recovery uveitis, new-onset cystoid macular edema, and retinal detachment were 0%, 10% (1 eye), and 20% (2 eyes), respectively. These outcomes compared favorably with a nonrandomized cohort of eyes treated with standard-of-care therapy alone, despite potentially worse baseline characteristics.ConclusionsCMV-specific CTL therapy may represent a novel monotherapy or adjunctive therapy, or both, for CMV retinitis, especially in eyes that are resistant, refractory, or intolerant of standard-of-care antiviral therapies. More generally, adoptive cell transfer and adoptive immunotherapy may have a role in refractory CMV retinitis. Larger prospective, randomized trials are necessary.

Radiation and nuclear technologies have side effects in addition to their important applications, so appropriate shields must be used to protect users and the public from high doses as a result of exposure to this radiation. In this work, the attenuation coefficients for polyester composites doped with waste iron filings (IFs) were studied. Six samples of different IF concentrations were manufactured, namely, Poly, Poly-IF20, Poly-IF30, Poly-IF40, Poly-IF50, and Poly-IF60 (where Poly-IF60 represents 40% polyester and 60% IF). We measured the attenuation factors using high purity germanium (HPGe)-detector along with three radioactive sources 241Am (emitting energy of 0.06 MeV), 137Cs (emitting energy of 0.662 MeV), and Co-60 (emitting energy of 1.173 and 1.333 MeV). We compared the linear attenuation coefficient (LAC) obtained by theoretical (i.e., XCOM software) and experimental (i.e., HPGe-detector) approaches for the prepared polyester composites at various photon energies (0.060, 0.662, 1.173, and 1.333 MeV). The greatest difference between the LAC values of the samples occurs at 0.060 MeV, where the Poly-IF60 sample has a much greater LAC than the other shields, followed by the Poly-IF50 sample, Poly-IF40 sample, and so on until the pure polyester shield. Specifically, their values are equal to 0.245, 0.622, 0.873, 1.187, 1.591, and 2.129 cm−1 for Poly, Poly-IF20, Poly-IF30, Poly-IF40, Poly-IF50, and Poly-IF60, respectively. We calculated the transmission factor (TF) and the radiation shielding efficiency (RSE), and found that the TF for Poly-IF30 is equal to 28.82%, 77.94%, 82.75%, and 83.75% at 0.060, 0.662, 1.173, and 1.333, respectively, while its RSE is equal to 82.57%, 24.00%, 18.80%, and 17.72%, respectively. The fast neutron removal cross-section (FNRC) of the polyester samples was calculated and the values increase when more Ifs are added to the samples. More specifically, the FNRC values are equal to 0.095, 0.100, 0.103, 0.107, 0.110, and 0.113 cm−1 for Poly, Poly-IF20, Poly-IF30, Poly-IF40, Poly-IF50, and Poly-IF60, respectively.

Background. Since the beginning of COVID-19 pandemic, the importance of clinical criteria for tracheal intubation in critically ill patients with respiratory failure became more noteworthy, especially in resource limitations. The objective was to evaluate the importance of hemoglobin oxygen saturation as a criterion for tracheal intubation in patients with COVID-19. Materials and methods. This is a multi-center, prospective, observational cohort study. We included 117 patients with COVID-19 who needed respiratory support between March to June 2021. Patients were intubated by the protocol of each institution participating in the study and the anesthesiologist’s clinical judgement. Signs of respiratory failure, methods of respiratory support and patient outcome were recorded. Results. Among 117 studied cases, 100 patients had hemoglobin oxygen saturation of 60–90 % in whom 58 were intubated. During hospitalization, 56 intubated patients and 14 non-intubated patients died (96.6 % Vs. 33.3 %). Conclusion. Arterial blood hemoglobin oxygen saturation of 60–90 could not be the correct key to unlock the problem of intubation decision in patients with COVID-19. Therefore, hemoglobin oxygen saturation should not be solely regarded as an indication for intubation in COVID-19.

Introduction: A better understanding of the mechanism and / or pathophysiology of shoulder pain syndrome after laparoscopic gynecological surgery leads to an increase in the number of clinical trials to prevent this complication. Therefore, the present study was conducted with aim to define the mechanism and prevention methods of shoulder pain syndrome after laparoscopic gynecology surgeries.Methods: In this narrative review study, to find the articles related to shoulder pain syndrome after laparoscopic gynecology surgeries, the published articles from 2000 including observational and clinical trials, descriptive and correlational studies were searched in the electronic databases of PubMed, Scopus, EMBASE, PEDro, Google Scholar, CINAHL , SID and Magiran with the keywords of shoulder pain syndrome, shoulder pain, surgery, laparoscopy, gynecology, postoperative and gynecology laparoscopy.Results: The main searched mechanisms included the pain mechanism, pain due to surgical incision, causes of shoulder pain syndrome after laparoscopic surgery in women, use of an alternative blowing gas to reduce shoulder pain syndrome, use of low pressure pneumoperitoneum to reduce the shoulder pain syndrome, gas-free laparoscopy and active gas excretion to reduce shoulder pain syndrome, use of heated or heated and humidified CO2 to reduce shoulder pain syndrome, use of sub-diaphragmatic intraperitoneal anesthesia or localized intraperitoneal anesthesia to reduce tip shoulder pain and use of pulmonary recurrence maneuvers in reducing shoulder pain syndrome.Conclusion: Shoulder pain syndrome in laparoscopic gynecological surgeries can be minimized with preventive measures such as the use of hot and humid gas, intraperitoneal administration of local analgesics and pulmonary recovery maneuver.

Objective: The aim of the study was to investigate the prevalence, and determinants, of nonpharmacological pain management practices among nurses in multiple settings. Materials and Methods: A cross-sectional examination was conducted involving 324 nurses from 16 hospitals in Hai'l, Saudi Arabia. Participants completed a self-reported survey utilizing established tools to assess the frequency of nonpharmacological pain management interventions utilization and identify associated barriers. Data analysis was performed using SPSS version 29.0. Results: Nonpharmacological pain management practices were found to be utilized “sometimes,” with a score of 2.89 ± 0.48. Commonly employed techniques included placing patients in comfortable positions and providing a tranquil environment. Gender was the sole demographic factor significantly affecting the use of these techniques (P < 0.001), with female nurses demonstrating higher utilization. Barriers to implementation varied based on the hours of recent pain management education (P = 0.004), with prevalent barriers including nurse shortages, multiple responsibilities, heavy workloads, and nurse fatigue. Conclusion: The study reveals moderate utilization of nonpharmacological pain management approaches, primarily focusing on patient positioning and creating a calm environment. Female nurses exhibited higher adoption rates of these techniques. Barriers to implementation, such as nurse shortages and heavy workloads, were influenced by recent pain management education. Consequently, enhancing education and fostering supportive work environments are crucial for surmounting these barriers and promoting pain management awareness among nurses.

The importance of environmental protection and control services, which have a significant place among municipal services, is gradually increasing today. Municipalities, which are among the administrations responsible for meeting local and common needs, constitute the administration of the locality where environmental problems are most intense. On the other hand, the fact that environmental problems observed in heavily industrialized and urbanized areas are intense causes these administrations to use more financial resources in fulfilling their environmental protection and control duties. The share and rate of environmental protection and control service expenditures in the budget expenditures of district municipalities within the municipal boundaries of the metropolitan municipalities, which are local administrative organizations, is the subject of our study. In this study, the ratio of environmental protection service expenditures, environmental protection, and control directorate expenditures, and environmental protection services and environmental protection and control directorate expenditures within the budget expenditures of İzmir-Selçuk District Municipality, according to the functional classification, which is a form of analytical budget classification, within the years 2014-2019 is analyzed by evaluating their ratio to the total municipality expenditures,. Along with literature and resource review, the study is an evaluation of the results of the ratio of the environmental protection expenditures and the expenditures of the environmental protection and control directorate, which are among the finalized budget items of the Selçuk District Municipality, which is on the UNESCO World Heritage List within the borders of İzmir Metropolitan Municipality, to the total budget figures between the years 2014-2019.

Proceeding from the role of Art Education in preserving literary heritage, the current research aims to draw inspiration from the Egyptian Gnostic heritage, which is represented in the manuscript of Nag Hammadi VI, entitled (Thunder: Pure Mind), which includes non-Christian Gnostic texts, which contain poetic texts that express about the goddess Isis, as a woman in the absolute, which makes her a fertile material for creativity in the Art of Painting. The research followed an empirical methodology; Where the researcher conducted a Self-Artistic experiment through which she presented figurative works, in which she employed the capabilities and aesthetic dimensions of the elements and vocabulary of poetic verses that speak about the woman. The results of the research came to indicate that plastic Art and literature are a common area, as they are two different languages in rules and tools, but they share the way in which the process of substantive capture occurs between the linguistic and the visual. The research recommended preserving the written heritage. Opening new horizons for experimentation by benefiting from the openness of the arts to each other to create artistic works and directing students in specialized technical colleges to read literary texts and visually translate them into works of art, in a marriage between literature and plastic Art, through the curricula of art colleges, in addition to paying attention to teaching the ancient Egyptian reading heritage.

Introduction: Most women who undergo first trimester medical abortion experience abdominal pain and cramps. The present study was performed aimed to evaluate the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on reducing the pain of induction of abortion in the first trimester of pregnancy. Methods: In this single-blind clinical trial which was performed in 2020-2021, for 40 women in the first trimester of pregnancy who were candidate for medical abortion with misoprostol in order to reduce pain, randomly administered Ibuprofen and inactive TENS or Ibuprofen and active TENS with a frequency of 80 Hertz and intensity of 0 to 80 milliampere to reduce pain. These two groups were compared in terms of pain intensity before and after the use of TENS, the amount of used Ibuprofen, satisfaction from the process of medical abortion and complications. Data were analyzed by SPSS (version 16) and Chi-square and Mann-Whitney statistical tests. P

Background: Parturient health is a priority worldwide. In this regard, the promotion of natural childbirth has always been considered by health policy makers. However, the most important cause of parturient tendency to caesarean section is fear of labour pain and lack of information about surgery complications, leading to inappropriate rate of caesarean. Midwives, attending in prenatal visits and labour, may have a key role in encouraging pregnant patients through labour analgesia. In this study we evaluate midwives’ attitude through necessity of labour analgesia and their understanding of neuraxial analgesia for labour pain. Methods: One hundred and five midwives working educational hospitals, participated in this observational study. All participants were asked to fill questionnaires. Each questionnaire consists of 15 questions, each answer had 1 to 3 points. Total score of 15 to 25 was considered as poor, score 26 to 35 as intermediate and 35 to 45 as good attitude. Results: Forty-nine percent of midwives had experience with labour analgesia. Forty-one percent participated in relevant educational workshops. About 40% presumed these techniques would result in immobility, while 66% assumed it will lengthen the procedure. 63% believed labour analgesia will increase mother’s satisfaction. Overall, 73% of them agreed with regional analgesia. In regards to attitude score, 22% were scored poor, 65% intermediate and 13% good. Conclusion: Midwives’ attitude was estimated low. Participating in workshops improved their attitude, yet the difference was not significant. Attitude of those who participated in labour analgesia was significantly better than others.

Von Gierke disease, also known as glycogen storage disease type I, co-existent with an abdominal aortic aneurysm (AAA), is an extremely rare combination of diseases that requires challenging therapeutic measures. We present, for the first time in literature, the case of a 62-year-old female with von Gierke disease who required open surgical repair of an AAA with challenging neck anatomy outside of instructions for use of endovascular repair. Even though the surgical risks for life-threatening complications, such as pancreatitis, metabolic acidosis, and kidney failure, were high, the 6-month postoperative course was uneventful. Despite the invasiveness of the treatment, surgery to treat the AAA was safe and effective. Further data is needed to draw robust conclusions about the treatment of choice for those patients with diseases in co-existence with AAAs.

Based on analytical and experimental data, the durability properties of reinforced concrete and reinforcement necessary for modeling degradation and calculating the durability of reinforced concrete elements under various types of corrosion damage are substantiated. A probabilistic model has been developed for predicting and assessing the durability and reliability of reinforced concrete elements, taking into account the statistical variability of design parameters and the kinetics of degradation processes during long periods of operation. An analysis of the method for calculating and predicting the durability of reinforced concrete elements based on deterministic probabilistic models of degradation of structural elements operating under aggressive environmental influences has been carried out. The necessary assessment of the stress-strain state of reinforced concrete structures under conditions of long-term operation in aggressive environments as a result of corrosion damage is given, and their residual life is studied, taking into account the reduction in the cross-sectional area of concrete and reinforcement

BackgroundWe examined the impact of vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research database.MethodsAdult and pediatric patients (N = 7128) who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012 were analyzed as 3 groups-VRE BSI, non-VRE BSI, without BSI-according to BSI status at 100 days (D100) after allogeneic HCT. Multivariable models examined the effect of VRE BSI for overall survival (OS) and nonrelapse mortality (NRM) at 1 year.ResultsOf 7128 patients, 258 (3.2%) had VRE BSI, 2398 (33.6%) had non-VRE BSI, and 4472 (63%) had no BSI. The median time to VRE BSI and non-VRE BSI were D11 and D15, respectively. Compared with non-VRE BSI patients, VRE BSI patients were older, had advanced-stage acute leukemia, and received umbilical cord blood (UCB) allografts. In multivariable models, VRE BSI was associated with lower OS (relative risk [RR], 2.9;(99% confidence interval [CI], 2.2-3.7) and increased NRM (RR, 4.7; 99% CI, 3.6-6.2) (P < .0001) for both. Other predictors for worse OS and increased NRM were non-VRE BSI, older age, advanced disease stage, UCB allograft, - mismatch, comorbidity index ≥3, and cytomegalovirus seropositivity (P < .001 for all variables).ConclusionsVRE BSI is associated with lowest OS and highest NRM compared with patients without BSI or non-VRE BSI. Novel interventions that address the pathophysiology of VRE BSI have the potential of improving survival after HCT.

Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range,