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BACKGROUND Electronic fetal monitoring or fetal assessment using a cardiotocograph is currently the most commonly employed tool for intrapartum surveillance. Furthermore, there are numerous guidelines informing best practice worldwide. OBJECTIVE This systematic review aimed to compare and appraise all available practice guidelines on intrapartum electronic fetal monitoring to describe the similarities and variations in recommendations. STUDY DESIGN A systematic protocol was developed per Preferred Reporting Item for Systematic Review and Meta-Analysis Protocols. A total of 4 independent reviewers were involved with independent searches and quality assessment using the Appraisal of Guidelines for Research and Evaluation Instrument for guideline quality reporting. RESULTS Overall, 7 international practice guidelines were included in this systematic review. Appraisal of Guidelines for Research and Evaluation Instrument showed higher scores for scope and purpose and for clarity of presentation; however, the overall assessment varied between 25% and 89%. When individual characteristics of electronic fetal monitoring or cardiotocograph were compared, all guidelines and guidance were essentially trying to describe the characters similarly, with critical differences described in the full article. CONCLUSION In the context of globalization, a uniform approach for defining terminology, classifying characters and similar interpretation of results is needed for electronic fetal monitoring. Therefore, we should consider a unified, simple, logistically approved, and acceptable guideline, which is probably accepted worldwide.

Background MR imaging plays a significant role in detection and characterization of different brain diseases. The role of the post-contrast T1-weighted image magnetic resonance imaging (T1W MRI) sequence has been widely established in previous studies and clinical practice. In this study, we aim to share our experience as regards the added value of contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) sequence in the diagnosis of various intracranial pathological conditions and evaluate its usefulness in comparison with post-contrast T1W images. Results Based on the final radiological diagnosis, the total cases were subdivided into three categories, and the majority of our cases were tumors (81.2%), followed by multiple sclerosis (11.8%), and the least was central nervous system infection (7.1%). CE-FLAIR showed superior enhancement in 35 cases (50.7) and equal enhancement in 25 cases (36.3%). However, it showed less enhancement than post-contrast T1W images in 9 cases (13%). Excellent inter-observer agreement (97.65%) was noted. Regarding lesion conspicuity, good delineation was found in the majority of cases (64.7%), fair delineation in 12.9%, and no delineation in 22.4%. A statistically significant difference was found in signal intensity of lesion between pre- and post-contrast FLAIR sequences. Contrast to background ratio was statistically significant in CE FLAIR images in comparison to CE T1 images. Conclusion CE-FLAIR imaging should be used as a routine or adjunctive sequence to CE-T1WI to enhance early detection and increase the diagnostic confidence in MRI examination of different brain pathological conditions.

Background Diffusion tensor imaging (DTI) is a non-invasive MR modality that provides an evaluation of brain tissue microstructure and architecture in vivo. We aimed to assess the diagnostic value of DTI parameters in evaluating cerebral white matter integrity in patients of severe chronic obstructive pulmonary disease (COPD) and correlate these parameters with smoking index (SI) and the number of exacerbations in the last year. This prospective study included 30 COPD male past smoker patients and 15 age- and sex-matched nonsmoker controls. Staging of COPD, SI and number of exacerbations in the last year were obtained. Routine brain MRI and DTI were done in all subjects. The selected white matter tracts’ fractional anisotropy (FA), and mean diffusivity (MD) were calculated in the region of interest in axial slices. Results The mean FA and MD values of all selected white matter tracts showed a high significant difference (p < 0.001) between patients and control group. The correlation between FA, SI and exacerbation frequency was not significant in the majority of white matter tracts (p > 0.05). The correlation between MD, SI and exacerbation frequency was significant for the majority of tracts (p < 0.05). Conclusion DTI metrics are valuable non-invasive tools in evaluating the white matter abnormalities in COPD patients. Smoking index and frequency of exacerbations have possible relation to extra-pulmonary cerebral manifestations of COPD.

The main goal of this paper is to develop and validate the systemidentification of the Displacement Controlled (DC) linear hydraulicsystem. The proposed method depends on finding the transfer functionthat map the simulated output to fit the actual output. To achieve this goal,several experiments have been performed to collect the required data toestimate the parameters including the order of the estimated transferfunction. Experimental results in this paper demonstrate that fifth ordermodel with one zero shows good match between the simulated out and theactual outputs. These results demonstrate that the proposed approach canachieve accurate identification of DC linear hydraulic system. Moreover,the proposed approach is general and can be applied to model anyhydraulic system working in the linear zone.

Objective The aim of this work is to assess the role of MRI in the diagnosis of ACL graft failure and detection of complications that may follow ACL reconstruction. Patients and methods This study included 55 patients (50 male & 5 female) with age ranged from 18 to 60 years with a mean age of 32y. All patients underwent MRI using sagittal T1WI, T2WI, proton density WI, and axial T2 and coronal STIR images. MRI images were assessed by two radiologists who were blinded to each other. Arthroscopic knee examination was considered as a gold standard of reference. Results Observer one found that the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MRI in the detection of ACL graft failure were 97.8%, 80%, 95.6%, 88.9 and 94.5% respectively. Observer two found that MRI has a sensitivity of 95.6%, specificity of 70%, PPV of 93.5%, NPV of 77.8% and accuracy of 90.9%. Conclusion MRI is considered as a reliable method for assessment of ACL graft failure and detection of complications following ACL reconstruction.

Objective We evaluated multidetector computed tomography (MDCT) accuracy for the prediction of the optimal prosthetic aortic valve deployment angle in trans-catheter aortic valve implantation (TAVI) with the different variables. Methods Sixty-six patients underwent contrast-enhanced MDCT before TAVI. From the three-dimensional aortic root reconstructions, we get the appropriate perpendicular aortic valve projection at which the bases of the aortic valve cusps were on a straight line. The predicted angles by MDCT were compared to the perpendicular fluoroscopic angles of the prosthetic valve. The degree of MDCT accuracy was defined as accurate, suitable or inaccurate according to the difference between the predicted angles and the perpendicular prosthetic valve projections. The degree of aortic cusp calcification, annular ellipticity, the type of aortic valve (to be tricuspid or bicuspid), were compared in patients with accurate, suitable and inaccurate prediction. The radiation exposure and volume of the used contrast agent were also considered in the comparison. Results MDCT prediction was accurate in 84.8% of cases, suitable in 9.1% and inaccurate in 6.1% of cases. There was a significant association between MDCT accuracy and the valve type with higher rates of accurate prediction with tricuspid aortic valves than bicuspid valves (93.1% versus 25%, respectively). The mean number of aortograms and the volume of contrast agent used for TAVI procedure were significantly less in patients with accurate CT prediction ( p Conclusion MDCT allows accurate prediction of the proper deployment angle for TAVI. Bicuspid aortic valve is significantly associated with fewer rates of accurate prediction.

Objective Collagen vascular diseases (CVD) are a varied group of immune-mediated disorders that affect multiple organs, such as affection of interstitium in the form of interstitial lung disease (ILD). High-resolution computed tomography is the cornerstone for appropriate diagnosis of ILD. Aim This study aimed to study the radiological features of ILD associated with CVD in Fayoum University Hospital. Design This was a cross-sectional study. Setting The study was conducted at Fayoum University Hospital in Egypt during January 2018 to June 2018. Patients and methods This study included 100 patients with diagnosis of CVD who were referred from Rheumatological Department of Fayoum University Hospital complaining of chest symptoms. For the diagnosis of these cases, we needed a full medical history, a detailed clinical examination, spirometry, 6-min walk test, and high-resolution computed tomography. Results The most important radiologic pattern for ILD-CVD was the nonspecific interstitial pneumonia pattern, representing 50% of cases, followed by the usual interstitial pneumonia pattern, representing 13% of cases. Conclusion Nonspecific interstitial pneumonia is the most common radiological pattern among patients of CVD in Fayoum University Hospital.

The determination of gender of unknown persons is of vital importance in forensic investigations. The present study aimed to evaluate the accuracy and reliability of frontal sinus (FS) dimensions measurement in gender identification. One hundred people (50 males and 50 females) with age range from 20 to 70 years were selected in this study. FS dimensions for both right and left sinuses (transverse, height & anteroposterior lengths) were measured from axial and coronal sections (4-mm slice thickness) using multi-detector computed tomography (MDCT) scanner. Statistically significant lower values for the maximum transverse length of both right and left FS in female group were detected in comparison to the male group ( p =0.002). In addition, the maximum height of right and left FS in females showed statistically highly significant lower values for in comparison to males ( p =0.001). Also, the maximum anteroposterior length of the frontal sinus for right and left sides in female group had statistically significant lower values ( p =0.001and 0.01 respectively) in comparison to the male group. Multiple regression equations revealed that among all FS measurements, the right FS anteroposterior length was the best discriminate variable between genders with overall accuracy 67.0% (70.0% for women and 64.0% for men). It can be concluded that FS dimensions measurement especially the right anteroposterior length are valuable in studying sexual dimorphism using MDCT image.

Aim of the study It is a retrospective study aiming to provide diagnostic characterization of ILC in Dynamic MR-Mammography and to compare its diagnostic performance to mammography and ultrasonography. Material and Method A total of 56 cases of ILC were selected in retrospective review of mammography, ultrasonography and Dynamic MRM of 420 patients with invasive breast cancer. Results Asymmetric density was the commonest mammography finding and the measured sensitivity of mammography in detecting ILC was 87.5% (9/56 FN).The most common US manifestation of ILC was focal shadowing without a discrete mass and its sensitivity in detecting ILC was 84.9% (10/56 FN). At MR imaging, the most common manifestation of ILC was a solitary irregular or angular mass with speculated or ill-defined margins (33.9%of cases [n = 19]).The measured sensitivity is 96.5% (2/56 FN). Additional data such as those affected the patient management including the presence of multifocal or multicentric disease, chest wall involvement and contralateral breast cancer were encountered in 48.2% of cases [n = 27]. ILC has a tendency to demonstrate delayed maximum enhancement with washout exhibited by only a minority of lesions (21.4% [n = 12]). Conclusion MR imaging has proved to be superior to mammography and US in the detection and management of ILC. It provides useful information for further management and pre-surgical planning.

Calprotectin is a potent acute phase reactant with increases of more than 100 fold during inflamed conditions. We measured the diagnostic and prognostic value of serum calprotectin (SC) in septic shock. We enrolled 50 adult shocked patients admitted to intensive care unit. Then, classified into 2 groups; septic group (25) with well-defined septic shock with positive cultures. Non-septic group (25) with negative cultures or no source of sepsis. Blood samples for SC), C-reactive protein (CRP) and white blood cell count (WBCC) in the first 6 hours of ICU admission and re-obtained again on day 3. We observed the weaning of vasopressor and 7-days in ICU mortality. SC measured on day 1 was significantly higher in the septic group than the non-septic group (p

This study, conducted in the tertiary Foetal Medicine Unit at St Michael's Hospital, Bristol, was designed to obtain information regarding neonatal outcomes of pregnancies affected by haemolytic disease of the foetus and newborn and managed by intrauterine transfusion, and to determine whether a change in intrauterine transfusion protocol in 2004 had improved safety. The new protocol included attendance of two Foetal Medicine Unit consultants, foetal sedation and use of the intrahepatic vein as an alternative route to placental cord insertion if deemed safer.Data for pregnancies affected by haemolytic disease of the foetus and newborn as a result of haemolytic red cell alloimmunisation and managed with intrauterine transfusion at St Michael's Hospital between 1999 and 2009 were retrospectively collected using local databases, and medical note review.Overall, 256 relevant intrauterine transfusions were performed. The median number of intrauterine transfusions per pregnancy was two. Ninety-three per cent of the live deliveries had 5-minute APGAR scores ≥9 and 98% were admitted to a Neonatal Intensive Care Unit/Special Care Baby Unit, requiring phototherapy (96%), top-up transfusions (44%: 23.2% immediate, 13.4% late, 7.3% both), and exchange transfusion (37%). An association was found between increased intrauterine transfusion number and reduced phototherapy duration and hospital admission: each additional intrauterine transfusion reduced the duration of phototherapy by 16% (95% CI: 0.72-0.98), and Neonatal Intensive Care Unit/Special Care Baby Unit admission by 44% (95% CI: 0.48-0.66). Following the change in intrauterine transfusion protocol, there was a significant reduction in the number of emergency Caesarean sections occurring directly after an intrauterine transfusion (n =5 vs 0; P =0.02). The foetal loss rate within 48 hours of an intrauterine transfusion was 1.9% per pregnancy, or 0.8% per intrauterine transfusion: no losses occurred under the new protocol (n =3 vs 0; P = NS).Although the majority of neonates required admission to a Neonatal Intensive Care Unit/Special Care Baby Unit and phototherapy, the medium-term outcomes were positive. Importantly, the safety of the intrauterine transfusion procedure has improved significantly since the change in protocol.

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