THE PREDICTED 2020 GLOBAL ECONOMIC CRISIS: CAUSES AND PROSPECTS

While the whole world is awaiting for the expected new economic recession 2020 that might lead to a financial crisis such as the 2008 crisis, this research paper addresses the indicators of this recession and its possible causes as well as the damages resulting from its occurrence and which countries are more affected by it, with a try to reach some recommendations to avoid this recession or dealing with it if it’s actually happens

Sternal healing after bilateral internal mammary arteries use for Coronary artery bypass grafting in diabetic Patients; short-term results

Background:  Bilateral internal mammary artery (BIMA) use may improve long-term outcomes after coronary artery bypass grafting (CABG); however, the risk of infection is high.   Skeletonization of the internal mammary may decrease the risk of infection, especially in patients with diabetes. Our study aimed at evaluation of sternal healing in diabetic patients with different techniques of bilateral internal mammary artery harvesting. Methods: This prospective randomized study included 200 diabetic patients who underwent CABG using BIMA between 2017 and 2019. We divided patients into two groups; Group A had skeletonization of both internal mammary arteries, and Group B had pedicled left mammary and skeletonized right mammary. Patients were observed for three months, post-operatively for any sternal wound problems. Results: There was no significant difference regarding the baseline variables. Type I diabetes mellitus was present in 25% in group A (n= 24) and 13.64% in group B (n= 12) (p= 0.324). There was no difference in harvest time between groups (83 ±4 vs. 81 ±3 minutes in group A vs. B, respectively. P= 0.1). The mean number of grafts was 3± 0.5 in Group A and 3± 0.6 in Group B (p= 0.8). Postoperative drainage was 402.9 ± 174.1 ml in Group A vs. 387.2 ± 153.6 ml in Group B (p= 0.474). The duration of ICU stay did not differ significantly between groups (2± 0.7 in Group A vs. 2± 0.5 in Group B; p= 0.8). Deep sternal wound infection occurred in 4.17% in group A (n= 4) and 4.55% in group B (n= 4) (p= 0.705). Superficial wound infection occurred in eight patients in group A (8.33%) and eight patients in group B (9.1%) (p= 0.59). No patient had sternal dehiscence in group A vs. four patients in group B (4.55%) (p= 0.39). Conclusion: We did not find differences between bilateral mammary artery harvest with skeletonization of both arteries versus skeletonization of the right mammary only on sternal healing nor wound infection in diabetic patients undergoing CABG. A larger study is recommended

An evaluation of secondary prophylaxis for rheumatic heart disease in rural Egypt.

Although essentially disappeared from the industrialized world, rheumatic heart disease (RHD) is still prevalent in developing countries, with 300,000 new cases identified each year. In Aswan, Egypt, RHD affects about 2.3% of children with over 90% of the cases being subclinical. Secondary prophylaxis has proved to be an effective method of preventing the progression of RHD. However, its efficacy is limited by low patient adherence. A systematic, generalizable tool is necessary to outline, and ultimately address these barriers.A 43-item semi-structured questionnaire was developed based on the three domains outlined by Fishbein (capability, intention, and health care barriers). A preliminary evaluation of the barriers to RHD prophylaxis use in Aswan, Egypt was carried out as a pilot study using this tool. Participants were local school children diagnosed with RHD or flagged as high-risk (as per a set of echocardiographic criteria developed by the Aswan Heart Centre) through a previous screening program of randomly selected 3,062 school children in Aswan.29 patients were interviewed (65.5% adherent to RHD prophylaxis). Compared to non-adherent patients, adherent patients had better understanding of the disease (68.4% versus 20% in the non-adherent group, p = 0.021), and were more aware of the consequences of missing prophylaxis doses (79% versus 40% of non-adherent patients, p = 0.005). Furthermore, 90% of non-adherent patients consciously choose to miss injection appointments (as compared to 31.6% of adherent patients, p = 0.005). Clinic wait time was the most frequently reported deterrent for both groups.A standardized tool that systematically outlines barriers to prophylaxis is a necessary first step to improving adherence to penicillin. Although individually developed tools exist for specific populations, a generalizable tool that takes into account the demographic and cultural differences in the populations of interest will allow for more reliable data collection methodology. Application of this tool will be used to further explore barriers to prophylaxis adherence and inform the basis for the design of future KT interventions

Timing of Coronary Artery Bypass Grafting Surgery after Acute Myocardial Infarction

Background: Optimal timing for CABG surgery after myocardial infarction remains a matter of debate. The aim of our study was to analyze the effect of timing of CABG after acute myocardial infarction on operative mortality and morbidity. Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction over 20 months (from the first of November 2014 till the end of June 2016) in Kasr Al-Ainy University Hospitals. Patients were divided into two groups; the early group (0 – 3 days) included 14 patients (23.3%) and the late group (4 – 30 days) included 46 patients (76.7%). The primary outcome was all-cause hospital mortality. Results: Our study included 43 males (71.7%) and 17 females (28.3%). The mean age was 58.4 ± 7.3 years. The total mortality rate was 8.3%. Patients undergoing early CABG experienced a higher mortality rate than those undergoing late CABG (21.4% vs 4.3%, P = 0.043). Also, early CABG was associated with more postoperative complications. Cardiogenic shock and early CABG were independent risk factors of mortality. Conclusion: CABG in the first 3 days after acute myocardial infarction was associated with high mortality and morbidity in comparison with late CABG. This suggests that CABG may best be deferred for more than 3 days after acute MI in non-urgent cases

The Tectonics of the Double Skin:: Green Building or Just more Hi-Tech Hi-Jinx?

Double skin façade systems are employed increasingly in high profile buildings, designed by famous Architects, using acclaimed engineering consultants, and being touted as an exemplary "green” building strategy. It is a new technology that is more often found in high-end European and Pacific Rim architecture, and far less often in North American building. For the majority of mainstream architects, double skin technology remains elusive. From perspectives of both knowledge and budget, double skin systems are often beyond the scope of most commercially driven, North American projects. The question arises as to whether or not double skin buildings truly are more environmentally responsible and sustainable. Is North American commercial architecture missing out on potential energy and environmental savings? The Double Skin Façade is based on the notion of exterior walls that respond dynamically to varying ambient conditions, and that can incorporate a range of integrated sun-shading, natural ventilation, and thermal insulation devices or strategies. Early modern architects such as Le Corbusier, with his "mur-neutralisant”7, and Alvar Aalto, in the window design of the Paimio Sanitorium, explored this new building technology. Early solar passive design exemplified in the "trombe” wall, is also viewed as a precursor to modern double skin systems.8 Only recently has double skin technology become analogous with explorations in transparent and glass architecture, and moreover, acclaimed as environmentally "responsible” design. This paper represents the findings of a team of upper level B.Arch. and Masters students who have conducted an initial investigation into double skin cladding systems. The study has allowed us to begin to ascertain whether or not these systems represent a valid approach to energy efficient and environmentally responsible design or are, as they might appear, just another "cool” high-tech style. Does this type of skin system represent environmentally "responsible' versus "responsive” design? The end result of the research will be posted on the School website so that it can be shared with others interested in the findings.

Modelling Machining-induced Residual Stresses after Laser-assisted Turning of Steels

Abstract. The current study examines the effects of laser assistance on machining-induced residual stresses (RS), using finite element modelling, during turning of AISI 4340 steel at different feed rates. Dry orthogonal cutting was modelled, along with the pre-heating effect of the laser beam. Laser-assisted machining (LAM) resulted in higher surface tensile RS compared to conventional machining, with more pronounced effects at lower feed rates. This is basically because the assisted material experienced higher plastic deformation, due to thermal softening, as well as higher temperatures, which are both attributed to the pre-heating effect of LAM

Investigation of surface integrity in laser-assisted machining of nickel based superalloy

While laser-assisted machining can significantly improve the machinability of nickel-based superalloy, the mechanism of surface integrity evolution and its influence on the material functional performance is still not clear. The present study gives a comprehensive investigation on the surface integrity of laser-assisted milling (LAMill) process with an in-depth study of the mechanism of chip formation, microstructural and mechanical alternations, supported by key outcomes from the two constitutive processes, conventional milling (CMill) and single laser scanning (LS). Although the high thermal affected layer in LAMill process has been removed through the cutting chips, a significant bending effect has been found in both the LAMill and LS workpiece. More interestingly, a combined impact of the residual stress from LS and CMill has been found on LAMill workpiece while a lattice evolution has been revealed regarding both the thermal and mechanical influence. Specifically, inadequate fatigue performance on LAMill and LS workpiece has been found due to the high thermal effect in the superficial layer regarding the residual tensile stress distribution and microstructure variation. While LAMill is generally considered as a promising machining method with improved machinability of difficult-to-cut materials, this research shows a poor workpiece functional performance (fatigue) and justifies its application prospect

Upregulation of Trem2 expression occurs exclusively on microglial contact with plaques

Using spatial cell-type-enriched transcriptomics, we compare plaque-induced gene (PIG) expression in microglia touching plaques, neighboring plaques, and far from plaques in 18-month-old APPNLF/NLF knock-in mice with and without the Alzheimer’s disease risk mutation Trem2R47H/R47H. We report that, in AppNLF/NLF mice, expression of 35/55 PIGs, is exclusively upregulated in microglia that are touching plaques. In 7 PIGs including Trem2 this upregulation is prevented by the Trem2R47H/R47H mutation. Unlike in young mice, knockin of the Trem2R47H/R47H mutation does not significantly decrease the Trem2 expression but decreases protein levels by 20% in the absence of plaques. On plaques, despite the mutation preventing increased gene expression, TREM2 protein levels increased by 1.6-fold (compared to 3-fold with Trem2WT/WT) and microglial density increased 20-fold compared to 30-fold. Hence microglia must touch plaques before Trem2 gene expression is increased but small changes in protein expression can increase microglia density without a change in gene expression

Plaque contact and unimpaired Trem2 is required for the microglial response to amyloid pathology

Using spatial cell-type-enriched transcriptomics, we compare plaque-induced gene (PIG) expression in microglia-touching plaques, neighboring plaques, and far from plaques in an aged Alzheimer’s mouse model with late plaque development. In 18-month-old APPNL-F/NL-F knockin mice, with and without the Alzheimer’s disease risk mutation Trem2R47H/R47H, we report that expression of 38/55 PIGs have plaque-induced microglial upregulation, with a subset only upregulating in microglia directly contacting plaques. For seven PIGs, including Trem2, this upregulation is prevented in APPNL-F/NL-FTrem2R47H/R47H mice. These TREM2-dependent genes are all involved in phagocytic and degradative processes that we show correspond to a decrease in phagocytic markers and an increase in the density of small plaques in Trem2-mutated mice. Furthermore, despite the R47H mutation preventing increased Trem2 gene expression, TREM2 protein levels and microglial density are still marginally increased on plaques. Hence, both microglial contact with plaques and functioning TREM2 are necessary for microglia to respond appropriately to amyloid patholog

Prognostic value of B-cell maturation antigen, CD56 expression and neutrophil lymphocyte ratio in patients with multiple myeloma

Introduction: B-cell maturation antigen (BCMA) plays a critical role in regulating B-cell proliferation and differentiation into plasma cells. CD56 is involved in the adhesion of myeloma cells to the bone marrow matrix. Thus, lack of CD56 expression is associated with a higher incidence of extramedullary disease. An elevated neutrophil-lymphocyte ratio (NLR) has been recognized as a poor prognostic factor in various hematological malignancies.The aim of this study was to evaluate the role of BCMA, CD56 and NLR as novel prognostic markers in multiple myeloma (MM).Material and methods: The study included 80 subjects, 40 MM patients, and 40 normal healthy age- and sex-matched controls. BCMA was analyzed by enzyme-linked immune sorbent assay. Flow cytometry was used for the determination of CD56 expression. NLR was calculated from the complete blood count differential count. All patients received six cycles of bortezomib, cyclophosphamide and dexamethasone (VCD). Treatment outcome was assessed and progression-free survival (PFS) was estimated using Kaplan-Meier survival analysis.Results: Patients who achieved complete remission showed lower BCMA levels, positive CD56 expression, and lower NLR. Moreover, higher BCMA levels and CD56 negative expression were significantly associated with shorter PFS.Conclusions: Our study emphasizes the importance of BCMA, CD56 and   NLR to predict the clinical outcome in MM patients. This could help in better risk stratification and tailored clinical management of MM patients