Modified Koyanagi Technique in Management of Proximal Hypospadias

Background/Purpose: One stage urethroplasty with parameatal foreskin flap (OUPF) applicable to all types of hypospadias was first described by Tomohiko Koyanagi, however high complication rates were reported.The aim of this study is to analyze the results of a modification of the Koyanagi technique as a one-stage repair of proximal hypospadias. Patients and Methods: During the period of from March 2008 to March 2009, 30 patients underwent treatment of proximal hypospadias using the modified Koyanagi technique. Patient age at the time of surgery ranged from 6 to 24 months. In all cases, the urethral opening was at or just proximal to the penoscrotal junction. Follow up ranged from 3 months to 1 year. Results: Primary success occurred in 27 cases (90%) with accepted cosmetic appearance. Complications occurred in 3 cases (10%). Urethrocutaneous fistula occurred in 2 cases (6.7%). Meatal recession occurred in 1 case (3.3%). There was no incidence of meatal stenosis, urethral stricture, residual chordee or complete flap necrosis. Conclusion: The modified technique permits one-stage repair of proximal hypospadias with low complication rates. Keywords: Hypospadias, Koyanagi, One stage urethroplasty

Near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy (nesidioblastosis): Mansoura experience

Background/purpose Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of persistent hypoglycemia in infancy with consequences such as seizures and brain damage. Treatment that prevents the occurrence of these sequele is essential. When medical therapy fails or complications are anticipated, early pancreatectomy is recommended to maintain euglycemia. The aim of this study was short-term evaluation of near-total pancreatectomy for PHHI after failure of medical treatment in patients in Mansoura, Egypt.Patients and methods During May 2002 to May 2010, 33 patients suffering from persistent hyperinsulinemic hypoglycemia were admitted to Mansoura university child hospital. Twenty patients responded to medical treatment and 13 patients (eight girls and five boys) were treated by near-total (90–95%) pancreatectomy after failure of medical treatment. Their ages at the time of surgery ranged from 20 days to 27 months. Only patients who were surgically managed were included in this study. All of them suffered from symptoms of PHHI: thermoregulatory problems in five cases, tremors in five cases, seizures in three, irritability in five, respiratory distress in eight, apnea in four, hypotonia in four, lethargy in five, and feeding difficulty in four cases. All cases were diagnosed following strict criteria that included bouts of hypoglycemia without acidosis coinciding with increased insulin level. Follow-up ranged from 3 months to 8 years.Results Primary success occurred in two cases (15%); four more cases (31%) developed temporary diabetes mellitus, and one case (8%) had a temporary pancreatic fistula. Eventually, total cure occurred in seven cases (54%); six cases (46%) developed a variety of complications; and persistent hypoglycemia was seen in two. Persistent diabetes mellitus was observed in three patients, developmental delay in one, and persistent neurological deficit in two patients; there was one case of mortality.Conclusion Near-total (90–95%) pancreatectomy is a suitable procedure for treatment of nesidioblastosis not responding to medical treatment and should be performed as early as possible. Keywords: Mansoura, near-total pancreatectomy, persistent hyperinsulinemic hypoglycemi

Modeling and Optimization of Microwave Devices and Circuits Using Genetic Algorithms

Abstract-This paper presents a new approach for the simulation and optimization of microwave devices using a genetic algorithm (GA). The proposed technique solves the equations that describe the semiconductor transport physics in conjunction with Poisson's equation, employing an adaptive real-coded GA. An objective function is formulated, and most of the GA parameters are recommended to change during the simulation. In addition, different methods for describing the way the GA parameters change are developed and studied. The effect of GA parameters including the mutation value, number of crossover points, selection criteria, size of population, and probability of mutation is analyzed. The technique is validated by simulating a submicrometer field-effect transistor, and then compared to successive over relaxation, showing the same degree of accuracy along with a moderate speed of convergence. The purpose of this paper is to introduce a new vision for a GA capable of optimizing real value functions with a considerably large number of variables. This paper also represents a fundamental step toward applying GAs to Maxwell's equations in conjunction with the hydrodynamic model, aiming to develop an optimized and unconditionally stable global-modeling simulator

Measurements and Theoretical Predictions of Charge Exchange Cross Sections and Emission Spectra for O6+ with H2O, CO, CO2, CH4, N2, NO, N2O and Ar

Article reports absolute CE cross sections for up to three exchanges of the O6+ ion with electrons from the comet/planetary gases H2O, CO, CO2, CH4, N2, NO, N2O and Ar

Anti-tumour activity of a first-in-class agent NUC-1031 in patients with advanced cancer: results of a phase I study

Background Gemcitabine is used to treat a wide range of tumours, but its efficacy is limited by cancer cell resistance mechanisms. NUC-1031, a phosphoramidate modification of gemcitabine, is the first anti-cancer ProTide to enter the clinic and is designed to overcome these key resistance mechanisms. Methods Sixty-eight patients with advanced solid tumours who had relapsed after treatment with standard therapy were recruited to a dose escalation study to determine the recommended Phase II dose (RP2D) and assess the safety of NUC-1031. Pharmacokinetics and anti-tumour activity was also assessed. Results Sixty-eight patients received treatment, 50% of whom had prior exposure to gemcitabine. NUC-1031 was well tolerated with the most common Grade 3/4 adverse events of neutropaenia, lymphopaenia and fatigue occurring in 13 patients each (19%). In 49 response-evaluable patients, 5 (10%) achieved a partial response and 33 (67%) had stable disease, resulting in a 78% disease control rate. Cmax levels of the active intracellular metabolite, dFdCTP, were 217-times greater than those reported for equimolar doses of gemcitabine, with minimal toxic metabolite accumulation. The RP2D was determined as 825 mg/m2 on days 1, 8 and 15 of a 28-day cycle. Conclusions NUC-1031 was well tolerated and demonstrated clinically significant anti-tumour activity, even in patients with prior gemcitabine exposure and in cancers not traditionally perceived as gemcitabine-responsive

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030