Laparoscopic repair of iatrogenic long ureteral injury

Introduction: Transection of the ureter in laparoscopic retroperitoneal lymph node dissection (RPLND) is a rare iatrogenic complication. Its repair is possible by end-to-end anastomosis when the defect is short, but if there is a long defect, laparoscopic repair is a challenge. Methods: A 30-year-old man underwent modified RPLND of a clinically stage-A mixed germ cell of the left testis. While cutting the gonadal vein, 1.5 cm of the ureter was transected 2 cm below the renal pelvis and clipped by one of our residents. The injury was diagnosed immediately. After the completion of the modified RPLND, the clips were removed and a 20-mm defect of the ureter was seen precluding anastomosis. The kidney was dissected and pulled down 35 mm. The lower pole of the kidney was then fixed to the psoas muscle by a 2-0 vicryl, making anastomosis possible after an 8-mm spatulation of both sides. Anastomosis was done over a stent by interrupted sutures using 4-0 vicryl. Results: Leakage was 400 mL at the first postoperative day and ceased at the 4th day. On the control excretion urography, the kidney function was normal and a fullness of the caliceal system was seen. Conclusion: Long defect of the ureter that may occur in laparoscopic urological surgeries could be manageable laparoscopically using methods for shortening of the interval such as relocation of the kidney. Thus, a same approach as open surgeries can yield acceptable results in laparoscopic surgeries

Overview of electric energy distribution networks expansion planning

Planning of the electric distribution networks is complex and about upgrading the system to satisfy the demand and constraints with the best economic plan. The planning alternatives include the expansion of substations, installing new distributed generation (DG) facilities, upgrading distribution feeders, etc. In the modern networks, distribution planners must gain the confidence of the reversibility of the investment where renewable energy resources (RERs) inject clean and cost-effective electrical power to respond to the rising demand and satisfy environmental standards. This paper is an exhaustive review on the distribution network expansion planning (DEP) including the modelling of DEP (possible objective functions, problem constraints, different horizon time, and problem variables), optimization model (single/multi-objective), the expansion of distributed energy resources (DERs), problem uncertainties, etc. We discuss the requirements of integrated energy district master planning to avoid conflicts between the goal of independence of district planning on energy, e.g. heat and electricity, and that of dependencies on the local electric utilities regarding instant power balance and stability services. Finally, we describe the primary future R&D trends in the field of distribution network planning

Effects of the arteriovenous fistula on pulmonary artery pressure and cardiac output in patients with chronic renal failure

Introduction: Access to the vascular system is necessary in patients with chronic renal failure planned to undergo dialysis. One of the complications of end-stage renal disease patients is pulmonary hypertension (PHT). Temporary arteriovenous access closure and successful kidney transplantation causes a significant fall in cardiac output and pulmonary artery pressure (PAP), indicating the possibility that excessive pulmonary blood flow is involved in the pathogenesis of the disease. We attempted to study the relationship of PHT with arteriovenous fistula (AVF) creation, as well as to assess the relationship between AVF flow and fistula characteristics. Methods: Fifty patients were included in the study. Echocardiography was used to evaluate systolic PAP, cardiac output (CO), and ejection fraction (EF) before creating the AVF. After a follow-up interval of at least 6 months, a second echocardiographic assessment and a Doppler sonographic assessment of their fistula flow were carried out. Complete data were available for 34 patients. Results: Study data were collected from 34 patients, 28 males and 6 females with a mean age of 52 yrs ranging from 15-78 yrs. The data showed a statistically significant positive correlation between fistula flow and PAP2 and PAP changes (p<0.05). Mean fistula flow was 1322 ml/min in patients without PHT and 2750 ml/min in patients with PHT. This difference (1428 ml/min) was statistically significant (p=0.03). We found a significant negative correlation between PAP1 and EF1 and PAP2 and EF2 (p<0.05). In addition, the mean EF2 in patients without PHT was 57 in contrast to 46 in patients with PHT. Mean fistula flow in radial fistulae (mean=422 ml/ min, range: 370-474 ml/min) was significantly less than brachial fistulae (mean=1463 ml, range: 270-3300 ml/min) (p=0.03). Mean systolic PAP2 of 14.8 mmHg in transplanted patients was 5.9 mmHg less than those who were not transplanted (20.7 mmHg). Diabetes was the most common cause of renal failure and diabetics had a significant reduction in their EF (15.5) compared with non-diabetic patients (1 reduction) (p=0.016). Conclusion: Fistula flow, PAP and EF of all patients should be checked at least 6 months after fistula creation. Patients with higher fistula flow rates and patients with diabetes mellitus need to be more closely observed. In addition, elderly patients with significant cardiac and other comorbidities may be more prone to develop symptoms after AVF creation. © 2009 Wichtig Editore

A mathematical model for SARS-CoV-2 in variable-order fractional derivative

A new coronavirus mathematical with hospitalization is considered with the consideration of the real cases from March 06, 2021 till the end of April 30, 2021. The essential mathematical results for the model are presented. We show the model stability when $${\mathcal {R}}_0<1$$ in the absence of infection. We show that the system is stable locally asymptotically when $${\mathcal {R}}_0<1$$ at infection free state. We also show that the system is globally asymptotically stable in the disease absence when $${\mathcal {R}}_0<1$$. Data have been used to fit accurately to the model and found the estimated basic reproduction number to be $${\mathcal {R}}_0= 1.2036$$. Some graphical results for the effective parameters are drawn for the disease elimination. In addition, a variable-order model is introduced, and so as to handle the outbreak effectively and efficiently, a genetic algorithm is used to produce high-quality control. Numerical simulations clearly show that decision-makers may develop helpful and practical strategies to manage future waves by implementing optimum policies

Amyloid fibril inhibition, acceleration, or fragmentation; Are nano-based approaches advance in the right direction?

Nanotechnology-based approaches have shown promising potential to overcome the challenges associated with current therapeutic/diagnostic approaches and offer exciting solutions to improve the quality of life of Alzheimer's Disease (AD) patients. Unfortunately, thus far they have failed in clinical translation. These disappointing results question whether nanotechnology-based therapeutic strategies are heading in the right direction. Here, we re-consider the problems and current therapeutic approaches from new angles and suggest what might have been overlooked in advanced AD therapy

Inhibitors of α-Synuclein Fibrillation and Oligomer Toxicity in Rosa damascena: The All-Pervading Powers of Flavonoids and Phenolic Glycosides

There is an intense search for natural compounds that can inhibit the oligomerization and fibrillation of α-synuclein (α-Syn), whose aggregation is key to the development of Parkinson’s disease (PD). Rosa damascena is a medicinal herb widely used in Middle Eastern food, ceremonies, and perfumes. The herb is known to contain many different polyphenols. Here we investigated the existence of α-Syn fibrillation inhibitors in R. damascena extract. Different HPLC fractions of the extract were assessed in α-Syn fibrillation and toxicity assays. The most active fractions led to the formation of more α-Syn oligomers but with less toxicity to SH-SY5Y cells, according to MTT and LDH assays. LC–MS analysis identified gallic acid, kaempferol 3-glucoside, kaempferol-3-O-β-rutinoside, and quercetin which were subsequently shown to be strong α-Syn fibrillation inhibitors. Our results highlight the benefits of R. damascena extract to combat PD at the population level

Photoluminescent carbon quantum dot/poly-L-Lysine core-shell nanoparticles: A novel candidate for gene delivery

Cationic polymers such as poly-L-lysine (PLL) are able to interact electrostatically with DNA to produce polymeric systems with nanometric diameters due to the neutralization and accumulation of DNA. This study integrates the outstanding properties of carbon quantum dots (CQDs) with PLL to develop a novel gene delivery vehicle with a core-shell hybrid nanostructure. The CQD/PLL core-shell nanoparticles (NPs) were, therefore, synthesized in such a way that they had narrow size distribution and an average diameter under 10 nm, both of which were confirmed by dynamic light scattering (DLS) and transmission electron microscopy (TEM). Fourier transform infrared (FTIR) spectroscopy exhibited that the PLL passivation agents were formed on the CQDs through releasing amine groups on their surface. The positive charge of the CQD/PLL core-shell NPs reduced from +15 to nearly zero mV after being loaded with DNA at the weight ratio of 2:1. These traceable, water-soluble, biocompatible, and tunable photoluminescent NPs demonstrated a quantum yield of around 12 and a cellular uptake of nearly 70. The NPs also showed no considerable toxicity to the human embryonic kidney (HEK)-293T cells. Hence, these novel CQD/PLL core-shell NPs hold great promise as a non-toxic and efficient gene delivery vector. © 2020 Elsevier B.V

The potential of zwitterionic nanoliposomes against neurotoxic alpha-synuclein aggregates in Parkinson's Disease.

The protein α-synuclein (αSN) aggregates to form fibrils in neuronal cells of Parkinson's patients. Here we report on the effect of neutral (zwitterionic) nanoliposomes (NLPs), supplemented with cholesterol (NLP-Chol) and decorated with PEG (NLP-Chol-PEG), on αSN aggregation and neurotoxicity. Both NLPs retard αSN fibrillization in a concentration-independent fashion. They do so largely by increasing lag time (formation of fibrillization nuclei) rather than elongation (extension of existing nuclei). Interactions between neutral NLPs and αSN may locate to the N-terminus of the protein. This interaction can even perturb the interaction of αSN with negatively charged NLPs which induces an α-helical structure in αSN. This interaction was found to occur throughout the fibrillization process. Both NLP-Chol and NLP-Chol-PEG were shown to be biocompatible in vitro, and to reduce αSN neurotoxicity and reactive oxygen species (ROS) levels with no influence on intracellular calcium in neuronal cells, emphasizing a prospective role for NLPs in reducing αSN pathogenicity in vivo as well as utility as a vehicle for drug delivery