Diaphragmatic Plication for Acquired Phrenic Nerve Injury after Congenital Cardiac Surgeries

Background: Phrenic nerve injury and diaphragmatic dysfunction are common after pediatric cardiac surgery leading to failure to wean from ventilatory support. Diaphragmatic plication is the standard management of diaphragmatic paralysis. The aim of this retrospective study is to review our experience with diaphragmatic plication and its effect on the operative outcome. Methods: This retrospective cohort study included all patients who underwent diaphragmatic plication from June 2010 to June 2017. Seventy-six patients (2.87%) had unilateral diaphragmatic paralysis following 2646 congenital cardiac procedures. Sixty-four patients (2.4%) underwent diaphragmatic plication. Results: The median age for the patients who had plication was 2.75 months (range 0.5- 36) and 3.7 months (range 0.66 to 123) for non-plicated patients. Thirty-six were males (56.25%), and the most common procedure associated with diaphragmatic plication was modified Blalock Taussig Shunt (n= 13; 20.3%). Left-sided diaphragmatic plication was performed in 44 patients (68.7%). The mean time between the primary surgery and diaphragm plication was 6.42±4.51 days. The mean ventilation period before plication was 4.93±3.71 days, and post plication ventilation median time was 2.11±1.82 days. Two patients (3.1%) required tracheostomy for prolonged respiratory insufficiency. One patient (1.6%) needed surgical revision, and two patients (3.1%) had their diaphragmatic plication during the initial surgery. Conclusion: Diaphragmatic plication is an effective procedure in the management of postoperative diaphragmatic paralysis. We recommend early plication for patients with symptomatic diaphragmatic paralysis causing prolonged ventilatio

Semantic-driven matchmaking of web services using case-based reasoning

With the rapid proliferation of Web services as the medium of choice to securely publish application services beyond the firewall, the importance of accurate, yet flexible matchmaking of similar services gains importance both for the human user and for dynamic composition engines. In this paper, we present a novel approach that utilizes the case based reasoning methodology for modelling dynamic Web service discovery and matchmaking. Our framework considers Web services execution experiences in the decision making process and is highly adaptable to the service requester constraints. The framework also utilises OWL semantic descriptions extensively for implementing both the components of the CBR engine and the matchmaking profile of the Web services

The diwan of Abu Al-Hasan Al-Tihami

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Cancer Stem Cell-Related Markers in Normal and Neoplastic Oral Mucosa. A study on human samples and experimental models

The existence of cancer stem cells (CSCs) in solid cancers is still a controversial issue. Several markers were successfully used to enrich for cells with stem cell-like properties in oral squamous cell carcinoma (OSCC). Among these, ALDH1 was reported in both OSCC and several other human cancers. The aim of this study was to investigate the pattern of expression of several CSC-related markers including ALDH1 and the normal oral keratinocyte stem cell marker p75NTR relative to each other in patient samples and OSCC-derived cells, and the potential of p75NTR to identify and isolate CSCs in OSCC. To simultaneously detect several CSC-related markers in patient samples, a multiple IHC protocol engaging three un-conjugated monoclonal primary antibodies from the same Ig subclass was first developed, based on previously reported protocols. Compared to other methods, stripping of the preceding reaction by microwave heating, combined with additional suppression of enzyme activity, has enabled specific detection of all three reactions by using the same detection system, with no detectable cross reactivity. Archival formalin-fixed paraffin embedded tissues from OSCC (n=177), oral dysplasia (OD, n=10), and normal human oral mucosa from healthy donors (NHOM, n=31) have been subjected to the developed multiple IHC protocol, while keratinocytes derived from OSCC, OD and NHOM were subjected to multiple fluorescent activated cell sorting (FACS). The findings of the two approaches showed a wider range of variability in the level of expression and localization of the CSCrelated markers in OSCC and OD as compared to NHOM. In addition, the data also indicated a functional difference between different cellular phenotypes positive for either p75NTR or ALDH1A1. Firstly, higher proliferation (Ki67) was observed in p75NTR+ cells in comparison to ALDH1+ or p75NTR+ALDH1+ cells. Secondly, the frequency of p75NTR+ cells was higher in OSCCs of small size (T1 & T2) and OSCCs with poor to moderate differentiation grade, and correlated with poor survival of patients clinically deemed as of better prognosis. High frequency of ALDH1+ cells was found to be associated with lymph node metastasis. No statistically significant association was found between any of the clinical variables investigated and the frequency of the co-localization of CSC-related markers. Thirdly, OSCC cells sorted for p75NTR and ALDH1 displayed different expression profile of several CSC-EMT related genes. OSCC-derived cells sorted for p75NTR expression were compared for stem cell properties using both in vivo and in vitro assays. Statistically significant higher stem cell properties were found for the p75NTRHigh cells than for the p75NTRLow cells in all assays performed. This suggested that p75NTR can be used for isolating a subpopulation enriched for cells with stem cell–like properties in OSCC. Nevertheless, the p75NTRLow subpopulation did also exhibit some stem cell features, but to a lesser extent. Propagation of p75NTRLow cells for several passages in culture showed that the expression of p75NTR could rise spontaneously. This finding was also supported by the similar expression of p75NTR by the xenografts generated by both subpopulations in NOD\SCID IL2R null mice. Similar spontaneous generation of ALDH1High cells by propagation of ALDH1Low cells was observed, although with a different kinetic. Taken together, the data from this study showed high inter-patient variability in the expression of the CSC markers investigated, and high intra-tumor heterogeneity of the CSC subpopulation. The results presented here suggest also that some OSCC might have several distinct CSC phenotypes, each with impact on different clinical aspects, while other OSCC might completely lack a hierarchical organization. De novo generation of p75NTRHigh or ALDH1High cells from their negative counterparts might indicate the existence of a dynamic equilibrium between cancer cells with different degrees of differentiation

Communication and Content Trust Aware Routing For Clustered IoT Network

Security has become a major concern in practical applications related to Internet of Things, a Trust Aware Routing is found as second line of defence. To ensure a secure and hassle-free communication in IoT, this paper proposes a new routing strategy called as Communication and Content Trust Aware Routing (CCTAR) for Clustered IoT network. CCTAR is applied on a clustered IoT network in which the entire nodes are clustered into different clusters. Distance, initial energy, transmission range, angle of overlap and the sensing range are the fur major metrics used to cluster the network into hierarchical clusters followed by Cluster Head Selection. Next, the Trust Aware routing computes three different trust metrics namely Nobility rust, bilateral trust and Data oriented trust to determine the trustworthiness of Cluster Heads. The experimental evaluation of the proposed mechanism shows its superiority in terms of malicious nodes identification, Storage overhead reduction and Network lifetime improvisation

Evaluation of the Properties of 4-Year Old Rubberwood Clones Rrim 2000 Series for Particleboard Manufacture

With drastic depleting rubberwood supply, the Lembaga Getah Malaysia (LGM) has identified new clones of rubber trees that are expected to produce not solely latex but also timber. Among these clones, several clones from RRIM 2000 series were found to be fast growing with high yield of latex, high growth vigor, good growth form and are very suitable for timber production, particularly for the biocomposite industries. In this study, particleboards were manufactured from rubber tree clones of RRIM 2002, RRIM 2020 and RRIM 2025 which are also categorized as Latex Timber Clone (LTC). The properties of these particleboards were compared with those made from the currently planted tree clone ; PB 260. All clones from RRIM 2000 series were planted at 1000-1100 trees planting density and harvested for this study at 4 year-old. The resin used was E1-grade urea formaldehyde (UF) and the target density of the particleboard was 700 kgm-3. The basic and adhesion properties of these woods were evaluated and discussed in relation to the board performance i.e. physical and mechanical properties, and dimensional stability. These properties were determined according to Japanese Industrial Standard for Particleboard (JIS A 5908-2003). Among the clones studied, RRIM 2002 showed the best overall wood basic properties and board performance, which are comparable to or better than those of matured clone PB 260. The 25-year old PB 260 gives the highest specific gravity (0.601), lowest moisture content (70%), longer fibre length (1.3 mm) and thickest fibre wall thickness (6.2 μm). Clone RRIM 2002 gives comparable wood basic properties except for specific gravity (0.570), higher wood moisture content (94%) relatively longer fibre length (1.4 mm) and thicker fibre wall (5.5 μm). Except for specific gravity, the other two clones give poorer overall wood properties particularly the RRIM 2025. Both clones, however, produced relatively high specific gravity, 0.589 and 0.582 for RRIM 2020 and RRIM 2025. The adhesion properties of all 4-year old clones show almost similar properties. For the particle analysis, PB 260 gives the highest acceptable particle distribution (63.5%), whilst RRIM 2002, RRIM 2020 and RRIM 2025 had respectively, 56.8%, 57.9%, 58.3%. The particleboards of PB 260, RRIM 2002, RRIM 2020 recorded similar modulus of elasticity (MOE) of 2156 Nmm-2, 2145 Nmm-2, and 2122 Nmm-2, respectively, which were significantly higher (p< 0.05) than that of RRIM 2025 board (1931 Nmm-2). The board’s strength (MOR) of clones RRIM 2002, RRIM 2020, RRIM 2025 and PB 260 were 20.4 Nmm-2, 19.9 Nmm-2, 18.0 Nmm-2 and 21.0 Nmm-2, respectively. The internal bond (IB) of all of the boards ranged from 1.24 Nmm-2 to 1.49 Nmm-2, and were not significantly different. Among the four rubber tree clones, PB 260 board was the most stable as indicated by the low values in thickness swelling (RRIM 2002, 22.4 %; RRIM 2020, 21.2 %; RRIM 2025, 19.7 % and PB260, 18.1 %). No significant difference in water absorption of particleboard was found for all clones studied. The overall results indicate that 4-year old rubberwood clones can be used as raw material for particleboard manufacture where clone RRIM 2002 as the most suitable clone as it produced comparable particleboard properties with matured clone particleboard

Epidemiology of antibiotic resistance in culture-positive hospitalized patients in selected hospitals in Khartoum, Sudan

Objective: To study the prevelence of antibiotic resistance and the prevalent bacterial isolates in hospitalized patients in Khartoum hospitals. Materials & Methods: A cross-sectional prevalence study was carried out during the period of April–November 2015 in Khartoum; 226 bacterial cultures were included. Identification of isolates using standard biochemical tests and antibiotic susceptibilities were determined using disc diffusion method. Results were interpreted according to the standards of the British society of antimicrobial chemotherapy. Results: Eight bacterial species were isolated: Staphylococcus aureus, Enterococcus faecalis, Streptococcus spp., Klebsiella pneumoniae, Pseudomonas spp., Escherichia coli, Proteus spp., and Acinetobacter spp. S. aureus was the most prevalent, the majority of which were resistant to methicillin/oxacillin (MRSA). Cultures in our study were mainly from urine (36.7%), blood samples (37.2%), and wound cultures (19%). More than 90% of the tested isolates were resistant to cefuroxime; 54% and 73.8% of Gram-positive and Gram-negative isolates, respectively, were resistant to ceftazidime. Furthermore, there was a high meropenem resistance among Gram-negative isolates tested. Multi-resistant Acinetobacter spp. as well as vancomycin-resistant S. aureus was isolated. Gram-negative isolates showed good susceptibilities to aminoglycosides as well as ciprofloxacin. However, the high resistance rate to these antibiotics was observed in Gram-positive isolates in these hospitals. Conclusion: Methicillin-resistant S. aureus was the most prevalent organism. Gramnegative isolates showed good susceptibilities to aminoglycosides and ciprofloxacin. There were high resistance rates to cefuroxime, ceftazidime, and meropenem. Five vancomycin-resistant S. aureus were identified

Multimodal Affect Recognition: Current Approaches and Challenges

Many factors render multimodal affect recognition approaches appealing. First, humans employ a multimodal approach in emotion recognition. It is only fitting that machines, which attempt to reproduce elements of the human emotional intelligence, employ the same approach. Second, the combination of multiple-affective signals not only provides a richer collection of data but also helps alleviate the effects of uncertainty in the raw signals. Lastly, they potentially afford us the flexibility to classify emotions even when one or more source signals are not possible to retrieve. However, the multimodal approach presents challenges pertaining to the fusion of individual signals, dimensionality of the feature space, and incompatibility of collected signals in terms of time resolution and format. In this chapter, we explore the aforementioned challenges while presenting the latest scholarship on the topic. Hence, we first discuss the various modalities used in affect classification. Second, we explore the fusion of modalities. Third, we present publicly accessible multimodal datasets designed to expedite work on the topic by eliminating the laborious task of dataset collection. Fourth, we analyze representative works on the topic. Finally, we summarize the current challenges in the field and provide ideas for future research directions