DL Multi-sensor information fusion service selective information scheme for improving the Internet of Things based user responses

Multi-sensor information fusion aids different services to meet the application requirements through independent and joint data assimilation. The role of multiple sensors in smart connected applications helps to improve their efficiency regardless of the users. However, the assimilation of different information is subject to resource and time constraints at the time of application response. This results in partial fulfillment of the application services, and hence, this article introduces a service selective information fusion processing (SSIFP) scheme. The proposed scheme identifies service-specific sensor information for satisfying the application service demands. The identification process is eased with deep recurrent learning in determining the level of sensor information fusion. This level identification reduces the unavailability of services (resource constraint) and delays in application services (time constraint). Through this identification, the applications\u27 precise demands are detected, and selective fusion is performed to mitigate the issues above. The proposed system\u27s performance is verified using the metrics delay, fusion rate, service loss, and backlogs

the Effects of Training Program based on Auditory Perception Skills in Enhancing Phonological Awareness among Learning Disability Students in Aseer Region

This study aimed to explore the effect of a training program based on auditory perception  skills in enhancing phonological awareness  among learning disability students in the Aseer region. The sample of the study consisted of forty students from grades 3, 4, 5 and 6 in the Aseer directorate of education. Students were diagnosed by the resources room teacher as learning disability students. The researchers used the semi-experimental design which consists of experimental and control groups. Results showed mean significant difference in the phonetic sequential-memorization skill between the experimental and control groups on the post-test, in favor of the experimental group. There was no significant difference in the auditory perception skills that could be attributed to grade level. The results showed a continuous effect for the phonological awareness development program in developing auditory perception skills among learning disability students in the Aseer area

Computed tomography scans image processing for nasal symptoms severity prediction

This paper aims to use a new technique of computed tomography (CT) scan image processing to correlate the image analysis with sinonasal symptoms. A retrospective cross-sectional study is conducted by analyzing the digital records of 50 patients who attended the ear, nose and throat (ENT) clinics at King Abdullah University Hospital, Jordan. The coronal plane CT scans are analyzed using our developed software. The purposes of this software are to calculate the surface area of the nasal passage at three different levels visible on coronal plane CT scans: i) the head of the inferior turbinate, ii) the head of the middle turbinate, and iii) the tail of the inferior turbinate. We employ image processing techniques to correlate the narrowing of nasal surface area with sinonasal symptoms. As a consequence, obstruction in the first level is correlated significantly with the symptoms of nasal obstruction while the narrowing in the second level is related to frontal headache. No other significant correlations are found with nasal symptoms at the third level. In our study, we find that image processing techniques can be very useful to predict the severity of common nasal symptoms and they can be used to suggest treatment and to follow up on the case progression

Baseline characteristics and treatment pattern of type 2 diabetes patients in Jordan: analysis from the DISCOVER patient population

Introduction: Jordan has limited published data on T2DM and its treatment patterns. This analysis of the DISCOVER study, focusing on Jordan, is aimed at describing the characteristics of patients and treatment patterns according to the real-world setting in T2DM patients initiating a second-line antidiabetic treatment Methods: The DISCOVER study is an ongoing, multi-country, multicenter, observational, prospective, and longitudinal cohort study. The baseline data of patients’ characteristics, clinical and laboratory variables, micro- and macro-complications, and treatment choices were captured on a standardized case report form. Results: Two hundred and seventy-one patients were enrolled from 13 different clinical sites in Jordan. Sixty percent of the patients were male. The participants overall mean age was 53.8 ± 11.3 years with a mean BMI 30.8 ± 5.0 kg/m 2. The mean duration of T2DM was almost 6 years and the mean documented HbA1c and fasting plasma glucose were e 8.4% ± 1.6 and 180.9 ± 63.7 mg/dL, respectively, at the initiation of second-line antidiabetic treatment. Almost 25% of the participants were reported to be either current smokers or ex-smokers. More than 40% of patients had comorbidities such as hypertension or dyslipidemia. Diabetes related microvascular and macrovascular complications were documented in 10.3% and 12.5% of patients, respectively. Metformin (MET) alone was used as a first-line therapy in almost one-half of the patients and in combination with sulfonylurea (SU) in approximately one-third of the patients. The most commonly used second-line therapy was the combination of MET and dipeptidyl peptidase-4 inhibitors (DPP-4i) with 29.9% followed by the triple therapy of MET, SU, and DPP-4i with 28%. Conclusion: A substantial number of patients were young with uncontrolled diabetes and at high risk for micro- and macrovascular complications. Therefore, a comprehensive management with early treatment intensification and risk factors modifications are required to achieve target goals

A large gastrointestinal stromal tumor of the duodenum: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gastrointestinal stromal tumors of the duodenum are uncommon. They can reach a large size. Diagnosis can be elusive and managing them can be difficult. Our case report aims to increase awareness and highlight some issues related to the diagnosis and management of duodenal gastrointestinal stromal tumors.</p> <p>Case presentation</p> <p>We present the case of a 38-year-old Middle Eastern woman with a large, slowly-growing gastrointestinal stromal tumor of the duodenum. Her complaints were minor epigastric discomfort and swelling. A pancreaticoduodenectomy with complete tumor excision was performed. She was doing very well with no evidence of disease recurrence when she was last seen 34 months after her operation.</p> <p>Conclusion</p> <p>Gastrointestinal stromal tumors of the duodenum should be suspected in any patient with a duodenal wall mass. Extramural growth and central ulceration with or without bleeding should alert the endoscopist to the possibility of a duodenal gastrointestinal stromal tumor diagnosis. There is more than one surgical approach available; however, complete surgical excision, with negative margins, is the absolute requirement. Preoperative imatinib mesylate can be considered in unresectable or borderline resectable cases.</p

Docking, synthesis, and anticancer assessment of novel quinoline-amidrazone hybrids

A group of new amidrazone compounds that include a quinoline component was produced through the reaction of hydrazonyl chloride, derived from 6-aminoquinoline, with appropriate secondary cyclic amines. The new compounds were confirmed through 1H-NMR, 13C-NMR, FTIR, and HRMS, and further verified by single-crystal X-ray diffraction. The antitumor potential of the synthesized compounds was tested against lung cancer (A549) and breast cancer (MCF-7) cell lines. Among the compounds, the ethyl carboxylate and o-hydroxy phenyl piperazine derivatives (10d and 10g) exhibited the strongest activity against both cell lines, with IC50 values of 43.1 and 59.1 μM for the lung and breast cancer cell lines, respectively. Moreover, the most potent compounds were subsequently docked into the c-Abl kinase binding site (PDB code: 1IEP) as a possible anticancer mechanism. In-silico ADMET study shows acceptable pharmacokinetic properties, and the toxicity profile for the most potent compounds is non-carcinogenic

Popliteal lymph node dissection for metastatic squamous cell carcinoma: a case report of an uncommon procedure for an uncommon presentation

Lymph node metastasis from cutaneous squamous cell carcinoma is uncommon. The popliteal fossa is rarely involved with metastasis. Popliteal lymph node dissection is uncommonly performed and not frequently discussed in the literature. We present a case of squamous cell carcinoma of the heel with popliteal and inguinal metastasis. This is followed by a description of the relevant anatomy of the popliteal fossa and the technique of popliteal lymphadenectomy

Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease

Background: Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). Objectives: The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD. Methods: A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles. Results: PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001). Conclusions: In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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

Summary 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 middleincome 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 lowincome 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 lowincome, 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