Geometrical Effect of Under-reamed Pile in Clay under Compression Load Numerical-Study

Recently, the use of deep foundations has increased as a result of the expansion in the construction of high-rise buildings, train tracks, and port berths. As a result of this expansion, it was necessary to use deep foundations that have low cost, high bearing loads, low settlement, and construction time, and such foundations are subjected to different types of loads such as lateral, vertical compression, and tension loads. This research paper will present one of the most important types of deep foundations that are aptly used in such structures and the most important factors affecting their bearing capacity and settlement in stiff clay. This type of deep foundation is called an under-reamed pile. The factors used in this study are pile length to diameter ratio L/D = 30, bulb diameter ratio (Du/D = 1.5, 2, 2.25, and 2.5), number of bulbs (N = 1, 2, and 3), and spacing ratio (S/D = 2 to 8). To investigate the effects of these parameters and obtain optimal results, the PLAXIS 3D was used. The analysis shows that the increase in bulb diameter increases the bearing load by 43%. Bulb spacing controls the failure mechanisms, whether cylindrical shear failure or individual failure and increases the capacity by 66% and 99%, respectively, for two and three bulbs when the bulb spacing becomes S/D = 8. When the number of bulbs increases to three, the capacity increases by 90%. If each bulb works individually, the bearing capacity double

Case Report Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT) obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools

Comparative Study: PRP Enhanced Fat Graft Versus Fat Graft Alone in Treatment of Postacne Scars with Clinical and Histopathological Eyes

Fat grafting has a role in rejuvenation owing to its mesenchymal cell precursor content especially with growth factors added. Platelet Rich Plasma (PRP) is known for its high growth factor content. The objective of this study is to compare the effect of PRP when added to fat graft in acne scars. 28 patients were randomly divided into 2 groups. Group A was treated with fat grafting while group B was treated with PRP enhanced fat grafting. All patients received a single treatment session. Assessment was conducted by comparing digital photos and biopsies before and after 6 months of treatment. The results shows that acne scars improved with PRP enhanced fat graft (93%) more than fat graft (64%). The biopsy results also confirmed the significantly better improvement for PRP group (85.7%) than the fat graft group (58%) (p=0.042). PRP has provided an enhancement of fat grafting in treatment of post acne scars. Icepick scars were better treated by fat grafting alone, while rolling and boxcars showed better results with the addition of PRP

Ultrasensitive in-vitro monitoring of monoamine neurotransmitters from dopaminergic cells

The design of biosensing assay of monoamine neurotransmitters (MANTs) such as epinephrine (Ep), norepinephrine (NE), and dopamine (DA), as well as the monitoring of these MANTs released from dopaminergic cells, are of particular interest. Electrochemical sensors based on the novel construction of nickel oxides (NiO) were fabricated and employed for electrochemical screening of MANTs. A novel NiO-lacy flower-like (NLF) geometrical structure with semi-spherical head surfaces connected with a trunk as an arm was achieved. The designed semi-spherical head associated with abundant and the well-dispersed tubular branches with needle-like open ends might lead to the creation of vascular vessels for facile diffusion and suitable accommodation of the released MANTs throughout active and wide-surface-area coverage, multi-diffusive pores, and caves with connective open macro-/meso-windows along the entire top-view nanoneedles of lacy flower head and trunk. These electrode surfaces possess high-index catalytic site facets associated with the formation of ridges/defects on {110}-top-cover surface dominants for strong binding, fast response, and signaling of MANTs. The NLF- modified electrode enabled high sensitivity for MANTs and a low limit of detection of 6 nM. Ultrasensitive in-vitro monitoring of DA released from dopaminergic cells (such as PC12) was realized. The NLF electrode was used to detect MANTs from its sources (PC12), and it could be used for clinical diagnosis

General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial

BACKGROUND: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. METHODS: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. RESULTS: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4-13] to 5 [0-11] vs 8 [3-13] to 7 [3-12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0-3] to 1 [0-2] vs 1 [0-2] to 1 [0-3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of - £229.0 (95% CI - 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI - 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). CONCLUSION: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498

Assessment of genetic diversity of zoonotic Brucella spp. recovered from livestock in Egypt using multiple locus VNTR analysis

Brucellosis is endemic in most parts of Egypt, where it is caused mainly by Brucella melitensis biovar 3, and affects cattle and small ruminants in spite of ongoing efforts devoted to its control. Knowledge of the predominant Brucella species/strains circulating in a region is a prerequisite of a brucellosis control strategy. For this reason a study aiming at the evaluation of the phenotypic and genetic heterogeneity of a panel of 17 Brucella spp. isolates recovered from domestic ruminants (cattle, buffalo, sheep, and goat) from four governorates during a period of five years (2002-2007) was carried out using microbiological tests and molecular biology techniques (PCR, MLVA-15, and sequencing). Thirteen strains were identified as B. melitensis biovar 3 while all phenotypic and genetic techniques classified the remaining isolates as B. abortus (n = 2) and B. suis biovar 1 (n = 2). MLVA-15 yielded a high discriminatory power (h = 0.801), indicating a high genetic diversity among the B. melitensis strains circulating among domestic ruminants in Egypt. This is the first report of the isolation of B. suis from cattle in Egypt which, coupled with the finding of B. abortus, suggests a potential role of livestock as reservoirs of several zoonotic Brucella species in the region

HER2/neu expression status of post BCG recurrent non-muscle-invasive bladder urothelial carcinomas in relation to their primary ones

Background: Transurethral resection (TUR) followed by adjuvant therapy is still the treatment of choice of Non-Muscle-Invasive Bladder Urothelial Carcinoma (NMIBUC). However, recurrence is one of the most troublesome features of these lesions. Early second resection and adjuvant BCG therapy has been shown to improve the outcome. Objective: To evaluate the prognostic value of C-erbB-2 (HER2/neu) expression status in Non-Muscle-Invasive Bladder Urothelial Carcinoma cases, before and after intravesical Bacillus Calmette Guerin (BCG immunotherapy). Materials and methods: HER2/neu expression was studied in 120 (Ta-T1) Non-Muscle-Invasive Urothelial Carcinoma cases. The expression was evaluated and compared to the expression after Bacillus Calmette Guerin (BCG) immunotherapy. Results: HER2/neu expression in low and high grade of the Non- Muscle-Invasive Urothelial Carcinoma was (38%) and (83%) respectively. The difference of the expression rates by tumor grade was statistically significant. In recurring lesions post BCG therapy, C-erbB-2 expression was markedly decreased (31.6%) when compared to its expression before therapy (65%). Conclusions: The HER2/neu expression increased as the tumor grade rose. The reduction in expression following BCG treatment in Non-Invasive transitional cell carcinoma cases could reflect a reduction of the potential malignancy of the tumor

Assessment of platelet function in patients with stroke using multiple electrode platelet aggregometry: a prospective observational study

Background There is a link between high on-treatment platelet reactivity (HPR) and adverse vascular events in stroke. This study aimed to compare multiple electrode platelet aggregometry (MEA), in healthy subjects and ischaemic stroke patients, and between patients naive to antiplatelet drugs (AP) and those on regular low dose AP. We also aimed to determine prevalence of HPR at baseline and at 3–5 days after loading doses of aspirin. Methods Patients with first ever ischaemic stroke were age and sex-matched to a healthy control group. Three venous blood samples were collected: on admission before any treatment given (baseline); at 24 h and 3–5 days after standard treatment. MEA was determined using a Mutliplate® analyser and agonists tested were arachidonic acid (ASPI), adenosine diphosphate (ADP) and collagen (COL). Results Seventy patients (mean age 73 years [SD 13]; 42 men, 28 women) were age and sex-matched to 72 healthy subjects. Thirty-three patients were on antiplatelet drugs (AP) prior to stroke onset and 37 were AP-naive. MEA results for all agonists were significantly increased in AP-naive patients compared to healthy subjects: ADP 98 ± 31 vs 81 ± 24, p < 0.005; ASPI 117 ± 31 vs 98 ± 27, p < 0.005; COL 100 ± 25 vs 82 ± 20, p < 0.005. For patients on long term AP, 33% (10/30) of patients were considered aspirin-resistant. At 3–5 days following loading doses of aspirin, only 11.1% were aspirin resistant based on an ASPI cut-off value of 40 AU*min. Conclusions Many patients receiving low dose aspirin met the criteria of aspirin resistance but this was much lower at 3–5 days following loading doses of aspirin. Future studies are needed to establish the causes of HPR and potential benefits of individualizing AP treatment based on platelet function testing

Prevalence of asthma-triggering drug use in adults and its impact on asthma control

BackgroundThe use of asthma-triggering drugs (ATDs) is a major factor in poor asthma control (PAC), which can be either uncontrolled or partially controlled. ATDs include angiotensin-converting enzyme (ACE) inhibitors, β-blockers, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).AimsTo measure the prevalence of ATD use in adult asthmatics and their control levels.MethodsThis is a one-year cross-sectional study (starting March 2016). A sample of 173 adult asthmatics (mean age: 44±16 years) was enrolled from five primary care centres in Jeddah city (Saudi Arabia). Asthmatics were clinically diagnosed according to the British Thoracic Society’s asthma guidelines. Chronic obstructive pulmonary disease was excluded by reversibility (i.e., symptom improvement after using asthma drugs). The four questions about asthma control from the Global Initiative for Asthma’s 2016 guidelines were translated to Arabic, photos and names of ATDs available in local pharmacies were collected, and a questionnaire was drafted. The questionnaire was presented to adult asthmatics by medical students during a personal interview. Data were statistically analysed using SPSS.ResultsFifty percent of the adult asthmatics who used ATDs had badly controlled asthma: 31 per cent uncontrolled and 19 per cent partially controlled. Of the patients who took ATDs, 97 per cent had used several ATDs for extended periods of time without any warnings from health professionals. In order of prevalence, aspirin, ACE inhibitors, other NSAIDs, and β-blockers were the most common ATDs used.ConclusionATDs are a major cause of PAC. ATD use is extensive and often goes unnoticed. The present findings highlight the low awareness of health professionals about the undesirable effects of ATDs on asthma control. This problem needs to be resolved by regular and continuous asthma health educational courses. During clinic visits, health professionals should inquire about ATD use, discontinue them, and offer an alternative. This simple action could markedly improve asthma control

The effect of radio-adaptive doses on HT29 and GM637 cells

<p>Abstract</p> <p>Background</p> <p>The shape of the dose-response curve at low doses differs from the linear quadratic model. The effect of a radio-adaptive response is the centre of many studies and well known inspite that the clinical applications are still rarely considered.</p> <p>Methods</p> <p>We studied the effect of a low-dose pre-irradiation (0.03 Gy – 0.1 Gy) alone or followed by a 2.0 Gy challenging dose 4 h later on the survival of the HT29 cell line (human colorectal cancer cells) and on the GM637 cell line (human fibroblasts).</p> <p>Results</p> <p>0.03 Gy given alone did not have a significant effect on both cell lines, the other low doses alone significantly reduced the cell survival. Applied 4 h before the 2.0 Gy fraction, 0.03 Gy led to a significant induced radioresistance in GM637 cells, but not in HT29 cells, and 0.05 Gy led to a significant hyperradiosensitivity in HT29 cells, but not in GM637 cells.</p> <p>Conclusion</p> <p>A pre-irradiation with 0.03 Gy can protect normal fibroblasts, but not colorectal cancer cells, from damage induced by an irradiation of 2.0 Gy and the application of 0.05 Gy prior to the 2.0 Gy fraction can enhance the cell killing of colorectal cancer cells while not additionally damaging normal fibroblasts. If these findings prove to be true in vivo as well this may optimize the balance between local tumour control and injury to normal tissue in modern radiotherapy.</p