Modified Koyanagi Technique in Management of Proximal Hypospadias

Background/Purpose: One stage urethroplasty with parameatal foreskin flap (OUPF) applicable to all types of hypospadias was first described by Tomohiko Koyanagi, however high complication rates were reported.The aim of this study is to analyze the results of a modification of the Koyanagi technique as a one-stage repair of proximal hypospadias. Patients and Methods: During the period of from March 2008 to March 2009, 30 patients underwent treatment of proximal hypospadias using the modified Koyanagi technique. Patient age at the time of surgery ranged from 6 to 24 months. In all cases, the urethral opening was at or just proximal to the penoscrotal junction. Follow up ranged from 3 months to 1 year. Results: Primary success occurred in 27 cases (90%) with accepted cosmetic appearance. Complications occurred in 3 cases (10%). Urethrocutaneous fistula occurred in 2 cases (6.7%). Meatal recession occurred in 1 case (3.3%). There was no incidence of meatal stenosis, urethral stricture, residual chordee or complete flap necrosis. Conclusion: The modified technique permits one-stage repair of proximal hypospadias with low complication rates. Keywords: Hypospadias, Koyanagi, One stage urethroplasty

Near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy (nesidioblastosis): Mansoura experience

Background/purpose Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of persistent hypoglycemia in infancy with consequences such as seizures and brain damage. Treatment that prevents the occurrence of these sequele is essential. When medical therapy fails or complications are anticipated, early pancreatectomy is recommended to maintain euglycemia. The aim of this study was short-term evaluation of near-total pancreatectomy for PHHI after failure of medical treatment in patients in Mansoura, Egypt.Patients and methods During May 2002 to May 2010, 33 patients suffering from persistent hyperinsulinemic hypoglycemia were admitted to Mansoura university child hospital. Twenty patients responded to medical treatment and 13 patients (eight girls and five boys) were treated by near-total (90–95%) pancreatectomy after failure of medical treatment. Their ages at the time of surgery ranged from 20 days to 27 months. Only patients who were surgically managed were included in this study. All of them suffered from symptoms of PHHI: thermoregulatory problems in five cases, tremors in five cases, seizures in three, irritability in five, respiratory distress in eight, apnea in four, hypotonia in four, lethargy in five, and feeding difficulty in four cases. All cases were diagnosed following strict criteria that included bouts of hypoglycemia without acidosis coinciding with increased insulin level. Follow-up ranged from 3 months to 8 years.Results Primary success occurred in two cases (15%); four more cases (31%) developed temporary diabetes mellitus, and one case (8%) had a temporary pancreatic fistula. Eventually, total cure occurred in seven cases (54%); six cases (46%) developed a variety of complications; and persistent hypoglycemia was seen in two. Persistent diabetes mellitus was observed in three patients, developmental delay in one, and persistent neurological deficit in two patients; there was one case of mortality.Conclusion Near-total (90–95%) pancreatectomy is a suitable procedure for treatment of nesidioblastosis not responding to medical treatment and should be performed as early as possible. Keywords: Mansoura, near-total pancreatectomy, persistent hyperinsulinemic hypoglycemi

The Accessory Nerve

The radical neck dissection (RND) in the management of head and neck cancers may be done in the expense of the spinal accessory nerve (SAN) 1. De-innervations of the muscles supplied by SAN and integrated in the movements of the shoulder joint, often result in shoulder dysfunction. Usually the result is shoulder syndrome which subsequently affects the quality of  life1. The modified radical neck dissections (MRND) and selective neck dissection (SND) intend to minimize the dysfunction of the shoulder by preserving the SAN, especially in supra-hyoid neck dissection (Level I-III±IV) and lateral neck dissection (level II-IV)2, 3. This article aims to focus on the SAN to increase the awareness during MRND and SND.Keywords: Spinal accessory, Sternocleidomastoid, Trapezius, Cervical plexus

Interleukin-6 bedside test in detecting chorioamnionitis in women with preterm premature rupture of fetal membranes

Objectives: About 30–80% of preterm deliveries following preterm premature rupture of fetal membranes (PPROM) are complicated by histological chorioamnionitis. To evaluate the accuracy of Interleukin-6 (IL-6) bedside test in detecting chorioamnionitis in women with PPROM.Material and methods: One hundred and ten (110) pregnant women with PPROM > 24 and < 34 weeks’ gestation, admitted for conservative management were included in this study. Participants were examined on admission using sterile speculum examination for assessment of IL-6 in the cervico-vaginal secretions using the IL-6 bedside test. The IL-6 bedside test was repeated for all participants once termination of pregnancy (TOP) decided. After TOP, placenta, umbilical cord, and fetal membranes samples were examined for histologic detection of chorioamnionitis (gold standard). The histological results were compared with IL-6 bedside test results to evaluate the accuracy of IL-6 bedside test in detecting chorioamnionitis in women with PPROM.Results: The IL-6 bedside test had 98.6% sensitivity, 94.7% specificity, 97.3% positive predictive value (PPV), 97.3% negative predictive value (NPV) and 97.3% overall accuracy in detecting chorioamnionitis. The sensitivity, specificity, NPV and overall accuracy of IL-6 bedside test (98.6%, 94.7%, 97.3%, and 97.3%; respectively) were significantly higher than the clinical and laboratory parameters of chorioamnionitis (65.3%, 57.9%, 46.8%, and 62.7%; respectively) (p = 0.04, 0.02, 0.001 and 0.03; respectively).Conclusions: The IL-6 bedside test is an accurate, non-invasive bedside test with 98.6% sensitivity, 94.7% specificity, 97.3% PPV, 97.3% NPV, and 97.3% overall accuracy in detecting chorioamnionitis. The IL-6 bedside test had significantly higher sensitivity, specificity, NPV, and overall accuracy than the clinical and laboratory parameters of chorioamnionitis

Modeling and Optimization of Microwave Devices and Circuits Using Genetic Algorithms

Abstract-This paper presents a new approach for the simulation and optimization of microwave devices using a genetic algorithm (GA). The proposed technique solves the equations that describe the semiconductor transport physics in conjunction with Poisson's equation, employing an adaptive real-coded GA. An objective function is formulated, and most of the GA parameters are recommended to change during the simulation. In addition, different methods for describing the way the GA parameters change are developed and studied. The effect of GA parameters including the mutation value, number of crossover points, selection criteria, size of population, and probability of mutation is analyzed. The technique is validated by simulating a submicrometer field-effect transistor, and then compared to successive over relaxation, showing the same degree of accuracy along with a moderate speed of convergence. The purpose of this paper is to introduce a new vision for a GA capable of optimizing real value functions with a considerably large number of variables. This paper also represents a fundamental step toward applying GAs to Maxwell's equations in conjunction with the hydrodynamic model, aiming to develop an optimized and unconditionally stable global-modeling simulator

Improved charge storage performance of a layered Mo1.33C MXene/MoS2/graphene nanocomposite

The construction of nanocomposite electrodes based on 2D materials is an efficient route for property enrichment and for exploitation of constituent 2D materials. Herein, a flexible Mo1.33C i-MXene/MoS2/graphene (MOMG) composite electrode is constructed, utilizing an environment-friendly method for high-quality graphene and MoS2 synthesis. The presence of graphene and MoS2 between MXene sheets limits the commonly observed restacking, increases the interlayer spacing, and facilitates the ionic and electronic conduction. The as-prepared MOMG electrode delivers a volumetric capacitance of 1600 F cm(-3) (450 F g(-1)) at the scan rate of 2 mV s(-1) and retains 96% of the initial capacitance after 15 000 charge/discharge cycles (10 A g(-1)). The current work demonstrates that the construction of nanocomposite electrodes is a promising route towards property enhancement for energy storage applications

Hepatitis C Virus (HCV) Vertical Transmission in 12-Month-Old Infants Born to HCV-Infected Women and Assessment of Maternal Risk Factors

Background. Hepatitis C virus (HCV) is an underappreciated cause of pediatric liver disease, most frequently acquired by vertical transmission (VT). Current guidelines that include the option of screening infants for HCV RNA at 1–2 months are based on data prior to current real-time polymerase chain reaction (PCR)-based testing. Previous studies have demonstrated VT rates of 4%–15% and an association with high maternal viral load. We evaluated HCV RNA in infants with HCV VT and assessed maternal risk factors in a prospective cohort in Cairo, Egypt