Vaginal Vault Prolapse

Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future

Evaluation of Flashover Voltage Levels of Contaminated Hydrophobic Polymer Insulators Using Regression Trees, Neural Networks, and Adaptive Neuro-Fuzzy

Polluted insulators at high voltages has acquired considerable importance with the rise of voltage transmission lines. The contamination may lead to flashover voltage. As a result, flashover voltage could lead to service outage and affects negatively the reliability of the power system. This paper presents a dynamic model of ac 50Hz flashover voltages of polluted hydrophobic polymer insulators. The models are constructed using the regression tree method, artificial neural network (ANN), and adaptive neuro-fuzzy (ANFIS). For this purpose, more than 2000 different experimental testing conditions were used to generate a training set. The study of the ac flashover voltages depends on silicone rubber (SiR) percentage content in ethylene propylene diene monomer (EPDM) rubber. Besides, water conductivity (μS/cm), number of droplets on the surface, and volume of water droplet (ml) are considered. The regression tree model is obtained and the performance of the proposed system with other intelligence methods is compa ed. It can be concluded that the performance of the least squares regression tree model outperforms the other intelligence methods, which gives the proposed model better generalization ability

Improving robotic grasping system using deep learning approach

Traditional robots can only move according to a pre-planned trajectory which limits the range of applications that they could be engaged in. Despite their long history, the use of computer vision technology for grasp prediction and object detection is still an active research area. However, the generating of a full grasp configuration of a target object is the main challenge to plan a successful robotic operation of the physical robotic grasp. Integrating computer vision technology with tactile sensing feedback has given rise to a new capability of robots that can accomplish various robotic tasks. However, the recently conducted studies had used tactile sensing with grasp detection models to improve prediction accuracy, not physical grasp success. Thus, the problem of detecting the slip event of the grasped objects that have different weights is addressed in this research. This research aimed to develop a Deep Learning grasp detection model and a slip detection algorithm and integrating them into one innovative robotic grasping system. By proposing a four-step data augmentation technique, the achieved grasping accuracy was 98.2 % exceeding the best-reported results by almost 0.5 % where 625 new instances were generated per original image with different grasp labels. Besides, using the twostage- transfer-learning technique improved the obtained results in the second stage by 0.3 % compared to the first stage results. For the physical robot grasp, the proposed sevendimensional grasp representations method allows the autonomous prediction of the grasp size and depth. The developed model achieved 74.8 milliseconds as prediction time, which makes it possible to use the model in real-time robotic applications. By observing the real-time feedback of a force sensing resistor sensor, the proposed slip detection algorithm indicated a quick response within 86 milliseconds. These results allowed the system to maintain holding the target objects by an immediate increase of the grasping force. The integration of the Deep Learning and slip detection models has shown a significant improvement of 18.4% in the results of the experimental grasps conducted on a SCARA robot. Besides, the utilized Zerocross-Canny edge detector has improved the robot positioning error by 0.27 mm compared to the related studies. The achieved results introduced an innovative robotic grasping system with a Grasp-NoDrop-Place scheme

The association between right ventricular function and exercise capacity for hypertensive patients

Background: Transthoracic echocardiography (TTE) would be used to evaluate right ventricular (RV) function in patients with arterial hypertension, and the link between RV dysfunction and exercise capacity was studied in the study population.Objective: To establish a correlation with exercise capability in the study group by using transthoracic echocardiography (TTE) to evaluate RV function in patients with arterial hypertension.Patients and Methods: Patients with hypertension were surveyed in a cross-sectional research; those known and treated; whether controlled or not and patients who were recently discovered to be hypertensive. Ninety patients were included; gender and age were taken into account. A thorough examination was performed on each patient (TTE) as well as six minute walking distance (6MWD). For all we had a written informed consent prior to enrollment. Results: Patients with untreated and uncontrolled hypertension showed significantly reduced right ventricular systolic and diastolic functions compared to those with well-controlled hypertension. Patients with untreated or uncontrolled hypertension had significant (P <0.001) deterioration on S', wave and diastolic dysfunction parameters (E/A, DTt, E/e t and IVRT). Untreated and uncontrolled hypertension patients showed a significant decrease in 6MWD compared to the well-controlled individuals (P <0.001). Conclusion: Untreated or ineffectively treated hypertension individuals had considerably reduced right ventricular function and exercise capacity, according to our findings. In the entire research population, right ventricular functions are strongly linked to exercise ability

Pretransplant HLA typing revealed loss of heterozygosity in the major histocompatibility complex in a patient with acute myeloid leukemia

Introduction Chromosomal abnormalities are frequent events in hematological malignancies. The degree of HLA compatibility between donor and recipient in hematopoietic stem cell transplantation is critical. Purpose of the study In this report, we describe an acute myeloid leukemia case with loss of heterozygosity (LOH) encompassing the entire HLA. Materials and methods HLA molecular typing was performed on peripheral blood (PB) and buccal swabs (BS). Chromosomal microarray analysis (CMA) was performed using a whole genome platform. Results Typing results on PB sample collected during blast crisis demonstrated homozygosity at the -A, -B, -C, -DR, and -DQ loci. A BS sample demonstrated heterozygosity at all loci. A subsequent PB sample drawn after count recovery confirmed heterozygosity. The CMA performed on PB samples collected during and after blast crisis revealed a large terminal region of copy-neutral LOH involving chromosome region 6p25.3p21.31, spanning approximately 35.9 Mb. The results of the CMA assay on sample collected after count recovery did not demonstrate LOH. Conclusions LOH at the HLA gene locus may significantly influence the donor search resulting in mistakenly choosing homozygous donors. We recommend confirming the HLA typing of recipients with hematological malignancies when homozygosity is detected at any locus by using BS samples, or alternatively from PB when remission is achieved

Stress and Burnout among Preretirement Employee in Hospital at 10th of Ramadan City

Employees are at high risk for stress and burnout. The aim of this study was to assess job stressors and burnout among employees in hospital at Tenth of Ramadan city. Design: cross-sectional descriptive design. Setting: the National Health Insurance Hospital at 10th of Ramadan city. Samples: convenience sample consisted of 100 employees. Tools: a self-administered questionnaire including scales for job stress and strain, burnout, and coping strategies, in addition to socio-demographic data was used in data collection. Results: the majority of the nurses were younger than 30 years (78%), with diploma degree (93%), and insufficient income (69%). More nurses had high exposure to stressors (49%), than strains (19%), and 20% had high burnout. Conclusion: the coping strategy most commonly used was effective behavioral confrontation. Nurses’ stress, strain, and burnout are strongly correlated and are influenced by personal factors such as age, qualification, experience, and residence, as well as job factors such as work hours, income, and the use of ineffective coping. Recommendations: the hospital administration should deal with and periodic assess the job factors underlying nurses’ stress and burnout. Further research is proposed to investigate the effectiveness of changing work environment factors and nursing care system on nurses’ burnout

Contemporary outcomes of continuous-flow biventricular assist devices.

BACKGROUND: Significant right ventricular failure (RVF) complicating left ventricular assist device (LVAD) placement has been reported at 10–30%. Although primarily indicated for left ventricular failure, ventricular assist devices (VADs) have become utilized in a biventricular setup to combat right ventricular failure (RVF) following LVAD implantation. With the advent of continuous-flow LVADs (CF-LVADs) superseding their pulsatile predecessors, the shift towards CF-biventricular assist devices (CF-BiVADs) come with the prospect of improved outcomes over previous pulsatile BiVADs. We aim to review the literature and determine the outcomes of CF-BiVAD recipients. METHODS: A systematic review was performed to determine the outcomes of CF-BiVADs. Pre-operative demographics and device configuration data was collected. Primary outcomes evaluated were short-term survival, long-term survival, duration of support, and survival to transplant. Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (ICU-LOS and HLOS, respectively), pump thrombosis, pump exchange. Median and interquartile range was reported where appropriate. A major limitation was the likely overlap of cohorts across publications, which may have contributed to some selection bias. RESULTS: Of 1,282 screened, 12 publications were evaluated. Sample size ranged from 4 to 93 CF-BiVAD recipients, and follow-up ranged from 6 to 24 months. Mean age ranged from 34 to 52 years old. Forty-five percent of CF-BiVADs had right atrial (RA-) inflow cannulation, with the remaining being right ventricular (RV). Thirty-day survival was a median of 90% (IQR 82–97.8%) and 12-month survival was a median of 58.5% (IQR 47.5–62%). Where reported, rate of pump thrombosis (predominantly the right VAD) was a median of 31% (IQR 14–36%), although pump exchange was only 9% (IQR 1.5–12.5%). CONCLUSIONS: RVF post-LVAD implantation is a high morbidity and mortality complication. There is no on-label continuous-flow RVAD currently available. Thus, the modifications of LVADs for right ventricular support to combat pump thrombosis has resulted in various techniques. BiVAD recipients are predominantly transplant candidates, and complications of pump thrombosis and driveline infection whilst on wait-list are of great consequence. This study demonstrates the need for an on-label CF-BiVAD

Effect of energy window width on planer and SPECT image uniformity

AbstractTo detect radiopharmaceutical distribution in patient organs and avoid interpretation mistakes, due to the protocol errors, a gamma camera must work in optimum conditions. One such error is camera non-uniformity. Baron and Chouraqui[Baron, J.M., Chouraqui, P., 1996. Myocardial single-photon emission computed tomographic quality assurance. J. Nucl. Cordial. 3(2), 157–166] have reported the need to ensure consistently high image quality and accuracy using an optimally chosen standardized protocol. It has been reported that single photon emission computed tomography (SPECT) significantly improved contrast over the planer image and has the ability to separate overlapping structures[Critchly, M., 1993. Nuclear Medicine Pocket Handbook, Amersham International Plc, pp. 6–7]. Window width of energy is considered as one of the most important physical parameters affecting the quality of planer and SPECT images. Thus, the effect of widow widths of energy 5%, 10%, 15%, 20% and 25% on planer and SPECT images were investigated using a Tc-99m source at 140keV. Tc-99m is the most common isotope in nuclear medicine and has one well-defined peakT in comparison with thallium, which has three peaks. In the present study, it was evident that energy window width played a prominent role in flood images uniformity using the Tc-99m source. The calculated integral uniformity percentage (IU%) and differential uniformity percentage (DU%) values of center field of view (CFOV) and useful field of view (UFOV) were markedly changed with a change of energy window width. The optimum energy window width was in the range from 15% to 20%. Moreover, the effect of window widths of energy 5%, 10%, 15%, 20% and 25% on SPECT image on a heart phantom with an artificial defect performed at the anterior wall of the heart was investigated. The SPECT images were clinically examined by a physician who reported a different diagnosis for each energy window width due to vertical long axis cuts, which, in turn, were due to the change in the collected counts. We concluded that the optimum energy window width was also in the range 15–20% for the Tc-99m isotope, which confirmed previous planer results