A systematic review of ICD complications in randomised controlled trials versus registries: is our 'real-world' data an underestimation?

Implantable cardioverter defibrillator (ICD) implantation carries a significant risk of complications, however published estimates appear inconsistent. We aimed to present a contemporary systematic review using meta-analysis methods of ICD complications in randomised controlled trials (RCTs) and compare it to recent data from the largest international ICD registry, the US National Cardiovascular Data Registry (NCDR). PubMed was searched for any RCTs involving ICD implantation published 1999-2013; 18 were identified for analysis including 6433 patients, mean follow-up 3 months-5.6 years. Exclusion criteria were studies of children, hypertrophic cardiomyopathy, congenital heart disease, resynchronisation therapy and generator changes. Total pooled complication rate from the RCTs (excluding inappropriate shocks) was 9.1%, including displacement 3.1%, pneumothorax 1.1% and haematoma 1.2%. Infection rate was 1.5%.There were no predictors of complications but longer follow-up showed a trend to higher complication rates (p=0.07). In contrast, data from the NCDR ICD, reporting on 356 515 implants (2006-2010) showed a statistically significant threefold lower total major complication rate of 3.08% with lead displacement 1.02%, haematoma 0.86% and pneumothorax 0.44%. The overall ICD complication rate in our meta-analysis is 9.1% over 16 months. The ICD complication reported in the NCDR ICD registry is significantly lower despite a similar population. This may reflect under-reporting of complications in registries. Reporting of ICD complications in RCTs and registries is very variable and there is a need to standardise classification of complications internationally

Spongionella secondary metabolites protect mitochondrial function in cortical neurons against oxidative stress

Accepted: 8 January 2014 This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acknowledgments The research leading to these results has received funding from the following FEDER cofunded-grants: From Ministerio de Ciencia y Tecnología, Spain: AGL2009-13581-CO2-01, AGL2012-40485-CO2-01. From Xunta de Galicia, Spain: 10PXIB261254 PR. From the European Union’s Seventh Framework Programme managed by REA—Research Executive Agency (FP7/2007–2013) under grant agreement Nos. 265896 BAMMBO, 265409 µAQUA, and 262649 BEADS, 315285 CIGUATOOLS and 312184 PHARMASEA. From the Atlantic Area Programme (Interreg IVB Trans-national): 2009-1/117 Pharmatlantic. MER thanks the Government of the Arab Republic of Egypt for a PhD Scholarship. MJ thanks the Scottish University Life Science Alliance which provided funding to set up the compound library.Peer reviewedPublisher PD

Analysis of the filed data of a sample of Egyptian children with bronchial asthma

Background: Identification of the clinical profile of asthma in a community is crucial to the understanding of the growing disease burden. We sought to evaluate the clinical characteristics and management outcome of a sample of asthmatic children from Cairo city and its suburbs. Methods: This retrospective study analyzed the data of 422 consecutively numbered files of asthmatic children from the Pediatric Allergy and Immunology Unit of Ain Shams University Children's Hospital. Data collected included the age at onset, duration of follow up, precipitating factors, feeding history, clinical severity, presence of other allergic diseases and outcome and course of the disease. This is besides the available results of laboratory and imaging studies and the treatment received including the routes and types of therapy. Results: The results revealed that 197 children (46.7%) had bronchial asthma only while 225 (53.3%) had concomitant allergic disorders. Males outnumbered females and urban residents outnumbered suburban and rural residents and all cases belonged to the low and middle social and economic community sectors. A positive family history of allergy in general was evident in about 40% of cases. Viral infection was the most common precipitating factor for exacerbations. Mild and moderate persistent asthma were more frequent than the severe variety (15.10%, 10.20%, and 1.50%). Serum total IgE and peripheral blood eosinophil counts were elevated and atopy was evident in most cases. Inhaled corticosteroid therapy was the most commonly prescribed treatment in the current study but compliance was generally poor. Conclusion: Wider scale multi-center studies in Cairo and other localities of Egypt are needed to outline the profile of childhood asthma in the whole country using a population rather than a referral center-based approach.Keywords: Pediatric asthma, risk factors, asthma grade, asthma triggers, smoking, residenceEgypt J Pediatr Allergy Immunol 2009;7(2):59-6

Novel resonant and light-guiding phenomena in photonics

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Physics, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 100-109).We investigate theoretically five novel resonant and light-guiding photonics phenomena. First, we develop a universal coupled mode theory (CMT) treatment of the freespace scattering of waves from resonant objects. This analytical framework very accurately models the scattering and absorption cross sections, as long as the resonant scatterer has spherical/cylindrical symmetry, or is sufficiently smaller than the resonant wavelength of the incident wave. We apply it to study the scattering of light from spherically symmetrical resonant objects and atoms, and also the neutron scattering off nuclei. Then, we propose an efficient weakly-radiative Wireless Energy Transfer (WET) scheme between two identical classical resonant objects, strongly coupled to an intermediate one having the same resonance frequency. The transfer mechanism, analyzed by CMT, relies on the adiabatic evolution of a dark eigenstate of the 3-object system. We explore its performance in various parameter regimes, and illustrate it by witricity-type WET between resonant inductively-coupled capacitively-loaded metallic loops. Third, we develop an analytical CMT model for the electric field generated by an arbitrary polarization source in a general photonic structure (that could involve loss, gain and/or nonlinearities). Based on this model, we investigate the criteria for enhancing the efficiency of nonlinear effects, and produce efficient terahertz sources. The results, validated by Finite-Difference Time-Domain (FDTD) calculations, suggest that this approach could potentially be a substitute for the more numerically intensive FDTD method. Next, we propose a 2D PhC structure that supports super-collimation over a large frequency range. We theoretically and numerically investigate the collimation mechanism in this 2D structure, in comparison to that of two other frequently used related PhC structures. We also point out the potential importance of this structure in designing super-collimation-based devices for monochromatic and polychromatic light. Finally, we present numerical simulations of anisotropic multilayers that strongly discriminate certain incidence angles of light, over a broad range of frequencies and irrespective of polarization. Such systems could improve the efficiency of solar cells.by Rafif E. Hamam.Ph.D

Serum OX40 ligand: a potential marker of atopic dermatitis disease severity in children

Background: OX40 ligand (OX40L) and OX40 are members of the tumor necrosis factor (TNF) and TNF receptor (TNFR) super families respectively. Recent studies have indicated the critical involvement of OX40/OX40L interaction in the pathogenesis of atopic dermatitis. To our knowledge, no data could be cited in literature concerning OX40L levels in serum or in other biological fluids of atopic dermatitis children. Objective: This study was done to explore the expression of OX40L in the serum of atopic dermatitis children with respect to disease activity and severity. Methods: This follow-up, case-control longitudinal study was conducted on 64 children as a stratified non-random sample; 34 with atopic dermatitis and 30 healthy children. Serum concentrations of OX40L were measured by sandwich enzyme immunoassay. The severity of atopic dermatitis was assessed according to the Leicester Sign Score (LSS), Simple Scoring System (SSS), Scoring Atopic Dermatitis (SCORAD) index, and Objective SCORAD. Results: Serum OX40L levels (pg/ml) in atopic dermatitis patients were significantly elevated as compared to controls (176.6 ± 45.9) whether during flare (1007 ± 241.5) or quiescence (699 ± 198.5). There were significant positive correlations between serum OX40L levels and each of the LSS, SSS and SCORAD indices of atopic dermatitis disease severity, while it was insignificant regarding the objective SCORAD. However, when atopic dermatitis children were classified according to the objective SCORAD index of severity into mild, moderate and severe, it was found that the mean serum level in the severe group was significantly higher than the corresponding values of the mild or the moderate group. OX40L levels did not correlate with serum total IgE or absolute eosinophils count. Serum total LDH levels correlated positively with each of the serum OX40L levels and the LSS and SCORAD indices of severity. Conclusions: Serum OX40L level is an objective reliable marker of atopic dermatitis severity in children. It may be useful for follow up and may help to improve research and management of this disease. Blockade of interactions between OX40 on Th2 cells and OX40L on activated dendritic cells using an OX40L-specific monoclonal antibody could represent a novel strategy for the treatment of atopic dermatitis.Keywords: Atopic dermatitis, LSS, OX40, OX40L, SCORAD, SSS, TNFEgypt J Pediatr Allergy Immunol 2009;7(1):15-2

TRA-954: SOLUTION MODEL FOR URBAN TRAFFIC CONGESTION: EGYPTIAN CASE STUDY

Traffic congestion is a major problem in many cities around the world resulting in massive delays, increased fuel wastage, environmental impact and other negative consequences affecting the daily life of each individual. From a transportation engineering point of view, making the correct decision to eliminate such congestion problems can be very difficult for decision-makers who carry the burden of analyzing large quantities of data which could be vague and conflicting in nature. Therefore, an effective and consistent system is required to simplify the decision-making process of the traffic congestion control. Traffic simulation could be that tool. The seriousness of traffic congestion in Egypt is the main motive for the study presented herein. The study aims at developing a model that sets guidelines on how to approach an urban congested traffic area, be able to tackle the problem and choose the effective engineering solution in terms of either geometry and/or structure. Sectors of El Nasr Road, Cairo with a total length of 2.4 km is chosen as a typical example of an urban area with traffic congestion hotspots. It serves as an excellent location to implement the traffic solution model on. The model is developed and implemented as follows: collection of traffic data, diagnosis of the congestion problems in terms of social, commercial, cultural, and behavioral aspects. The analysis of the data finger points out the flag areas by conducting total and peak traffic volume counts, simulation of the existing traffic conditions to get the delayed travel times of vehicles in that area. The analysis of the output would finally help decide whether such problem would be solved by geometric adjustments of the surface or the problem requires a multi-layered intersection

Priabonian Sharks and Rays (Late Eocene: Neoselachii) From Minqar Tabaghbagh In The Western Qattara Depression, Egypt

http://deepblue.lib.umich.edu/bitstream/2027.42/90948/1/Contributions32no06-c04-30-2012.pd

Corallivory in the Anthropocene: Interactive Effects of Anthropogenic Stressors and Corallivory on Coral Reefs

Corallivory is the predation of coral mucus, tissue, and skeleton by fishes and invertebrates, and a source of chronic stress for many reef-building coral species. Corallivores often prey on corals repeatedly, and this predation induces wounds that require extensive cellular resources to heal. The effects of corallivory on coral growth, reproduction, and community dynamics are well-documented, and often result in reduced growth rates and fitness. Given the degree of anthropogenic pressures that threaten coral reefs, it is now imperative to focus on understanding how corallivory interacts with anthropogenic forces to alter coral health and community dynamics. For example, coral bleaching events that stem from global climate change often reduce preferred corals species for many corallivorous fishes. These reductions in preferred prey may result in declines in populations of more specialized corallivores while more generalist corallivores may increase. Corallivory may also make corals more susceptible to thermal stress and exacerbate bleaching. At local scales, overfishing depletes corallivorous fish stocks, reducing fish corallivory and bioerosion, whilst removing invertivorous fishes and allowing population increases in invertebrate corallivores (e.g., urchins, Drupella spp.). Interactive effects of local stressors, such as overfishing and nutrient pollution, can alter the effect of corallivory by increasing coral-algal competition and destabilizing the coral microbiome, subsequently leading to coral disease and mortality. Here, we synthesize recent literature of how global climate change and local stressors affect corallivore populations and shape the patterns and effect of corallivory. Our review indicates that the combined effects of corallivory and anthropogenic pressures may be underappreciated and that these interactions often drive changes in coral reefs on scales from ecosystems to microbes. Understanding the ecology of coral reefs in the Anthropocene will require an increased focus on how anthropogenic forcing alters biotic interactions, such as corallivory, and the resulting cascading effects on corals and reef ecosystems

Did salvage ICE chemotherapy improve the outcome in primary resistant/relapsing stage III/IV neuroblastoma?

AbstractBackground and purposeNeuroblastoma is the most common extracranial and deadly solid tumor in children. It accounts for 15% of the deaths from cancer in the pediatric age group. Approximately half of the newly diagnosed children are at “high risk” of treatment failure.The aim of this study is to evaluate the response rate of salvage chemotherapy by the ICE (Ifosfamide, Carboplatin, and Etoposide) regimen when administered to previously treated primary refractory or progressive high risk neuroblastoma patients.Patients and methodsSixty-six patients from the National Cancer Institute (NCI), Cairo University and the Children Cancer Hospital Egypt (CCHE) received salvage chemotherapy (ICE) either due to primary resistance in 51/66 (77.2%) or due to disease progression on primary chemotherapy in 15/66 (22.8%).ResultsThey were 40 males (60.6%) and 26 females (39.4%). Patients’ age ranged between 3months and 12.5years. The most common tumor site was suprarenal, followed by retroperitoneal mass. Two patients (3%) died from chemotherapy toxicity during ICE administration. Evaluation of tumor response in the remaining 64 patients showed the following: CR/PR in 24 patients (36.5%), SD in 11 patients (16.6%), and PD in 29 patients (43.9%).Fourteen patients (21.2%) were considered eligible for auto BMT, while 50/64 patients (78.8%) failed this second line (salvage) chemotherapy and had palliative lines of therapy.By the end of the study (May 2010), 47/66 (71.2%) of the patients were still alive, while 19/66 (28.8%) were dead. Two out of 14 patients (14.2%) who underwent HSCT died from post transplantation disease progression, while 12/14 (85.8%) were in CCR.ConclusionChemotherapy by ICE for primary resistant or progressive stage III/IV NB seems well tolerated. With a 36.6% response rate, 18% CCR, and 3% treatment mortality rate, it could be considered a good salvage therapy in the category of patients who are condemned for palliation