Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

2D finite element analysis and force calculations for induction motors with broken bars

AbstractIn this paper an ABC transient model of the three phase induction motor is developed that depends on self- and mutual inductance calculations based on accurate finite element analysis (FEA). This model can represent both healthy and broken bars’ conditions. The effects of that type of fault on the stator current, rotor bar currents distribution, the forces exerted on the rotor bars, the motor speed and motor torque are studied. It was observed that broken bar faults will cause fluctuations in the stator peak current and in the motor speed and torque. It was found that the asymmetry in the rotor bar currents will lead to asymmetrical distribution of the radial and tangential forces affecting the bars. The asymmetry in the tangential forces causes the fluctuations in the motor torque, while the asymmetry in the radial forces will increase the mechanical stresses on the rotor shaft

Publisher: Institute for Animal Husbandry, Belgrade-Zemun UDC 636.38 FINGERPRINTING OF FECB GENE IN FIVE EGYPTIAN SHEEP BREEDS

Original scientific paper Abstract: Recently, many aspects of FecB gene, including reproductive endocrinology, organs development and body mass have been studied. FecB has an additive effect on litter size and ovulation. The present investigation was carried out to study polymorphism by forced PCR-RFLP of FecB gene in five Egyptian local sheep breeds and its comparison with other foreign sheep breeds. Genomic DNA was isolated from a total of 100 animals of Egyptian sheep breeds namely Rahmani, Ossimi, Awassi, Barki and Awassi x Barki crossbred. Forced PCR of the FecB gene 190 base pair (bp) was amplified using specific primer designed to introduc a point mutation in the resulting PCR products with FecB carrier sheep containing an AvaII restriction site (G|GACC), whereas products from noncarriers lacked (of) this site..Digestion of FecB gene 190 base pair with AvaII restriction enzyme resulted in non carrier 190 bp band (wild type) in all the animals belonging to the five Egyptian breeds studied revealing absence of this restriction site in those five breeds

Influence of air ceiling diffusers in enclosed spaces: An experimental and numerical investigation

Within the past few years, IEQ has been a hot topic among building occupants, government officials, and academics all around the globe. Most modern life is spent indoors, in homes, workplaces, and shopping centres. People’s awareness of the need for healthy indoor air quality (IAQ) rises in tandem with their rising standard of living. Along with air temperature, humidity, and cleanliness, air velocity in a climate-controlled room affects the space’s microclimate. In particular, reducing discomfort in enclosed areas is a function of having an adequate distribution of air velocities. This study employs computational fluid dynamics (CFD) models to examine the effects of types of air diffusers in an enclosed office space in Alexandria, Egypt, on the ensuing air velocities and temperature gradients. Model accuracy has been confirmed by comparing numerical simulations to physical measurements. The simulations demonstrated that the square diffuser was superior in temperature distribution uniformity within the office volume but that there was a significant interaction between supply diffusers. The round diffuser had faster velocities in the standing and sitting planes (1.2 and 1.8 m) and a lower average temperature, implying that it can be employed with a reduced fan speed than the square diffuser, reducing overall power use

Large sized gastrointestinal stromal tumors: Survival and predictors of recurrence after surgical resection

Background: large gastrointestinal stromal tumors (GISTs) represent a surgical challenge for complete en block resection, which is the mainstay strategy for management. This study was done to determine long term oncological outcomes following resection of GISTs >10 cm. Material and methods: This retrospective study included 52 patients who underwent surgical resection for GIST >10 cm. Our main outcome is to determine the overall survival along with the predictors of post-operative recurrence after large GISTs resection. Results: The stomach was the most commonly affected organ (55.8%). Mass size was larger than 20 cm in 36.5% of our patients and the rest of them ranged between 10 – 20 cm. Anatomical/formal resection was performed in 63.5%of patients, and the remaining ones received a limited resection. After follow-up (median 57 months), disease-free and overall survival had mean values of 80.97 and 100.56 months, respectively. Recurrence was encountered in 36.5%, while the total mortality rate was 26.9%. Multivariate analysis revealed that tumor rupture and CD 34 positive tumors were strong predictors of recurrence. Conclusion: surgical resection of GISTs is the mainstay  therapy, but it is associated with relatively high rate of recurrence even with adjuvant tyrosine kinase inhibitor therapy (TKIs)

Multifocal fatty liver disease, insulin resistance and carotid atherosclerosis: exploring the interrelated relationship

Introduction: Multifocal fatty liver infiltrations are not uncommon ultrasonographic finding; they are explained by the presence of aberrant vascular supply independent of the portal circulation or insulin resistance. Aim: To study the significance of this ultrasonographic finding. Methods: A study group (n = 96) with multifocal fatty liver and two control groups: healthy subjects (n = 100) and patients with diffuse fatty liver disease (n = 100) were enrolled. They were tested for fasting blood glucose, lipid profile, transaminases, serum insulin, glycated hemoglobin, Homeostatic Model Assessment of Insulin Resistance, high-sensitivity C-reactive protein and liver stiffness in Fibroscan. Results: Patients with multifocal fatty liver showed a statistically significant higher values of serum transaminases, markers of insulin resistance, high-sensitivity C-reactive protein, and neutrophil lymphocyte ratio (p <0.05). Lipid profile parameters were significantly higher (p <0.05). Mean liver stiffness (9.8 ± 1.2 kPa) and carotid intima media thickness (1.16 ± 0.2 mm) were significantly higher when compared to healthy subjects and patients with diffuse fatty liver disease. Independent predictors of insulin resistance and premature carotid atherosclerosis in patients with multifocal fatty liver disease were: serum gamma-glutamyl transferase (odds ratio 1.69), high-sensitivity C-reactive protein (odds ratio 1.62), uric acid (odds ratio 1.55), very low-density lipoprotein (odds ratio 1.74), total cholesterol/high-density lipoprotein (odds ratio 1.58) and severity of liver stiffness measured by Fibroscan (odds ratio 1.9). Conclusions: Multifocal fatty liver is an aggressive form of nonalcoholic fatty liver disease and should be considered a radiological sign of insulin resistance that needs special attention and management

Association between serum visfatin and carotid atherosclerosis in diabetic and non-diabetic patients on maintenance hemodialysis

Introduction: Adipose tissue releases bioactive factors termed adipokines. Visfatin is an adipokine that plays an active role promoting vascular inflammation and atherosclerosis. The purpose of this study was to determine the association between serum visfatin levels and carotid atherosclerosis in diabetic and non-diabetic patients on maintenance hemodialysis (HD) in order to clarify the role of serum visfatinas, a risk factor for cardiovascular complications in HD patients. Methods: Forty patients on maintenance hemodialysis were enrolled in this case-control study in 2015. They were subdivided into two groups, i.e., a diabetic group (n = 20) and a non-diabetic group (n = 20). Twenty healthy subjects who were age and gender matched were included as a control group. Carotid Duplex studies were performed on all patients, and serum visfatin was determined by a competitive enzyme immunoassay. Results: HD patients showed a highly significant increase in serum visfatin, urea, creatinine, Ca×Ph, K, fasting glucose, triglycerides, LDL levels, and a significant decrease in eGFR, Na, HDL, and Hb compared to the control group. Also, serum visfatin levels showed a highly significant increase in the diabetic HD group compared to both the non-diabetic HD and control groups. Serum visfatin showed a highly significant increase in non-diabetic HD patients compared to the control group. Carotid intima-media thickness (IMT) showed a highly significant increase in HD group compared to the control group. Serum visfatin correlated positively with serum urea, creatinine, glucose, and IMT, but it was negatively correlated with eGFR, Na, and HDL Conclusion: We concluded that serum visfatin is increased in HD patients with and without diabetes. Moreover, its association with IMT may be involved in the pathogenesis of atherosclerosis in CRF patients