Comparison of serum cystatin C and creatinine based methods in detection of early renal dysfunction in critically ill patients

Early detection of renal dysfunction is of importance inthe care of critically ill patients. Cystatin C was proposedto be superior to serum creatinine in estimation of renal function. This work aimed to compare serum cystatin Cto serum creatinine and creatinine based formulae indetection of early decline in renal function at a singlepoint in critically ill patients. Fifty critically ill patientsadmitted to Cairo University Hospitals ICUs - Egypt wereincluded. Patients with chronic renal disease,thyroid disease, malignancy, patients receivingcorticosteroid therapy, with serum creatinine > 1.4 mg/dland patients receiving diuretics or large volumes of IVfluids were excluded. Serum creatinine, serum cystatinC, adjusted creatinine clearance (Adj Ccr), estimatedGFR (eGFR) by modification of diet in renal disease(MDRD), abbreviated MDRD (abb MDRD) andCockcroft-Gault (CG) formulae were measured. Patientswith renal dysfunction (adj Ccr < 80 ml/min/1.73m2)were 26 (52%) in number. Patients with renaldysfunction and high serum creatinine were 12/26(46.2%) while those with high cystatin C were 23/26(88.5%). Cystatin C was found to be significantlycorrelated with serum creatinine, adj Ccr and eGFR by all studied formulae. Using receiver operatingcharacteristic (ROC) analysis; AUC for Cystatin C(0.976) was more than that for eGFR by abb MDRD(AUC=0.839), MDRD (AUC=0.822), CG formulae(AUC=0.808) and serum creatinine (AUC=0.710)respectively. In conclusion; cystatin C was found to bebetter than serum creatinine, eGFR by abb MDRD,MDRD and CG formulae in detection of early renaldysfunction at a single point in critically ill patients

Genetic Algorithm Optimization Model for Determining the Probability of Failure on Demand of the Safety Instrumented System

A more accurate determination for the Probability of Failure on Demand (PFD) of the Safety Instrumented System (SIS) contributes to more SIS realiability, thereby ensuring more safety and lower cost. IEC 61508 and ISA TR.84.02 provide the PFD detemination formulas. However, these formulas suffer from an uncertaity issue due to the inclusion of uncertainty sources, which, including high redundant systems architectures, cannot be assessed, have perfect proof test assumption, and are neglegted in partial stroke testing (PST) of impact on the system PFD. On the other hand, determining the values of PFD variables to achieve the target risk reduction involves daunting efforts and consumes time. This paper proposes a new approach for system PFD determination and PFD variables optimization that contributes to reduce the uncertainty problem. A higher redundant system can be assessed by generalizing the PFD formula into KooN architecture without neglecting the diagnostic coverage factor (DC) and common cause failures (CCF). In order to simulate the proof test effectiveness, the Proof Test Coverage (PTC) factor has been incorporated into the formula. Additionally, the system PFD value has been improved by incorporating PST for the final control element into the formula. The new developed formula is modelled using the Genetic Algorithm (GA) artificial technique. The GA model saves time and effort to examine system PFD and estimate near optimal values for PFD variables. The proposed model has been applicated on SIS design for crude oil test separator using MATLAB. The comparison between the proposed model and PFD formulas provided by IEC 61508 and ISA TR.84.02 showed that the proposed GA model can assess any system structure and simulate industrial reality. Furthermore, the cost and associated implementation testing activities are reduced

PROTECTIVE EFFECTS OF RED PALM OIL AND SUPER RED PALM OLEIN ON HYPERCHOLESTEROLEMIC RATS

The present work was conducted to study the effect of red palm oil (RPO) and super red palm olien (SRPOL) on the nutritional parameters of rats suffering from hypercholesterolemic. The vitamins (E, A, D and K) and β carotene were determinate by HPLC and indicated that RPO and SRPOL are considered the richest vegetable oils of antioxidant specially α- tocopherol and β carotene. Thirty male rats weighting approximately 210 grams were divided into five groups, each group containing six rats. Group G1 fed on basal diet as a control negative group. Group G2 fed on basal diets containing 2% of cholesterol as a control positive group and the other groups G3, G4 and G5 fed on the same diet used in group G2, yet the corn oil was replaced by RPO in G3 and SRPOL in G4, Meanwhile, group G5 was fed on the same diet used in group G2 and supplemented with a drug contained Lipitor Atorvastatin (20 mg/Kg BW rat daily by stomach tube). Concerning biological evaluation all the studied dietary oils compared to positive control group caused an decreases in serum LDL-c and TC and significantly increased HDL-c over the feeding period of experimental rat groups, thereby decreased the TC/HDL-c and LDL-c/HDL-c ratios. Aspartate transaminase (AST), alanine transaminase (ALT) enzymes and albumin in rats serum were generally decreased by RPO, SRPOL and drug Lipitor compared to positive control group.     Also urea, creatnine and uric acid levels in rats serum were significantly decreased by the studied oils and drug. However, a significant increment in the activities of glutathione peroxidase (GPXs), catalase and total antioxidant were observed in blood of hypercholesterolemic rats treated with RPO, SRPOL and drug. As such, the treated groups showed a significant decrement in malondialdehyde (MDA) in plasma

Electrical tunability of terahertz nonlinearity in graphene

Graphene is conceivably the most nonlinear optoelectronic material we know. Its nonlinear optical coefficients in the terahertz frequency range surpass those of other materials by many orders of magnitude. Here, we show that the terahertz nonlinearity of graphene, both for ultrashort single-cycle and quasi-monochromatic multicycle input terahertz signals, can be efficiently controlled using electrical gating, with gating voltages as low as a few volts. For example, optimal electrical gating enhances the power conversion efficiency in terahertz third-harmonic generation in graphene by about two orders of magnitude. Our experimental results are in quantitative agreement with a physical model of the graphene nonlinearity, describing the time-dependent thermodynamic balance maintained within the electronic population of graphene during interaction with ultrafast electric fields. Our results can serve as a basis for straightforward and accurate design of devices and applications for efficient electronic signal processing in graphene at ultrahigh frequencies.D.T. and H.A.H. acknowledge funding from the European Union’s Horizon 2020 Framework Programme under grant agreement no. 964735 (EXTREME-IR). M.G. and B.G. acknowledge support from the European Cluster of Advanced Laser Light Sources (EUCALL) project that has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 654220. K.-J.T. acknowledges funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 804349 (ERC StG CUHL) and financial support through the MAINZ Visiting Professorship. ICN2 was supported by the Severo Ochoa program from Spanish MINECO (grant no. SEV-2017-0706). Parts of this research were carried out at ELBE at the Helmholtz-Zentrum Dresden-Rossendorf e.V., a member of the Helmholtz Association. F.H.L.K. acknowledges support from the Government of Spain (FIS2016-81044; Severo Ochoa CEX2019-000910-S), Fundació Cellex, Fundació Mir-Puig, and Generalitat de Catalunya (CERCA, AGAUR, and SGR 1656). Furthermore, the research leading to these results has received funding from the European Union’s Horizon 2020 under grant agreement no. 881603 (Graphene Flagship Core 3)

Evaluating the Feasibility of Pro-Neurotensin and 25-Hydroxyvitamin D3 as Possible Indicators for Type 2 Diabetes Mellitus and Its Complications

(1) Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome are associated with decreased vitamin D. In contrast, high pro-neurotensin (pro-NT) levels are linked with an increased risk of T2DM and cardiovascular disease. We aimed to determine the validity of pro-NT and 25-dihydroxy vitamin D3 levels as predictors for T2DM complications; (2) Methods: One hundred T2DM, and one hundred healthy volunteers participated in this case-control study. Their Pro-NT and 25-hydroxyvitamin D3 levels were evaluated using the ELISA technique; (3) Results: Pro-NT and 25 (OH) vitamin D3 have significant validity and accuracy in T2DM prediction, 84.5%, and 90.5%, respectively (p = 0.001). At a value of \u3c29.5, 25-Hydroxy vitamin D3 showed 88% sensitivity and 93% specificity in predicting T2DM. At a value of \u3e124 Pmol/L, Pro-NT showed 81% sensitivity and 88% specificity in predicting T2DM. At a value of 16.5, 25-Hydroxy vitamin D3 had 78.4% sensitivity and 68.3% specificity in predicting T2DM complications. At a value of \u3e158 pmol/L, Pro-NT predicted T2DM complications with 67.6% sensitivity and 56.0% specificity; (4) Conclusions: 25 (OH) Vit D3 and Pro-NT could identify T2DM patients and predict T2DM complications. More extensive research is required to adequately validate this novel perspective with a large population study

Grating-graphene metamaterial as a platform for terahertz nonlinear photonics

Nonlinear optics is an increasingly important field for scientific and technological applications, owing to its relevance and potential for optical and optoelectronic technologies. Currently, there is an active search for suitable nonlinear material systems with efficient conversion and small material footprint. Ideally, the material system should allow for chip-integration and room-temperature operation. Two-dimensional materials are highly interesting in this regard. Particularly promising is graphene, which has demonstrated an exceptionally large nonlinearity in the terahertz regime. Yet, the light-matter interaction length in two-dimensional materials is inherently minimal, thus limiting the overall nonlinear-optical conversion efficiency. Here we overcome this challenge using a metamaterial platform that combines graphene with a photonic grating structure providing field enhancement. We measure terahertz third-harmonic generation in this metamaterial and obtain an effective third-order nonlinear susceptibility with a magnitude as large as 3$\cdot$10$^{-8}$m$^2$/V$^2$, or 21 esu, for a fundamental frequency of 0.7 THz. This nonlinearity is 50 times larger than what we obtain for graphene without grating. Such an enhancement corresponds to third-harmonic signal with an intensity that is three orders of magnitude larger due to the grating. Moreover, we demonstrate a field conversion efficiency for the third harmonic of up to $\sim$1% using a moderate field strength of $\sim$30 kV/cm. Finally we show that harmonics beyond the third are enhanced even more strongly, allowing us to observe signatures of up to the 9$^{\rm th}$ harmonic. Grating-graphene metamaterials thus constitute an outstanding platform for commercially viable, CMOS compatible, room temperature, chip-integrated, THz nonlinear conversion applications

Synchronization of Boron application methods and rates is environmentally friendly approach to improve quality attributes of Mangifera indica L. on sustainable basis

Micronutrient deficiency in the soil is one of the major causes of mango fruit and yield's poor quality. Besides, the consumption of such a diet also causes a deficiency of micronutrients in humans. Boron deficiency adversely affects the flowering and pollen tube formation, thus decreasing mango yield and quality attributes. Soil and foliar application of B are considered a productive method to alleviate boron deficiency. A field experiment was conducted to explore the Boron most suitable method and application rate in mango under the current climatic scenario. There were nine treatments applied in three replications. The results showed that application of T8 = RD + Borax (75 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) and T9 = RD + Borax (150 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) significantly enhanced the nitrogen, potassium, proteins, ash, fats, fiber, and total soluble solids in mango as compared to the control. A significant decrease in sodium, total phenolics contents, antioxidant activity, and acidity as citric acid also validated the effective functioning of T8 = RD + Borax (75 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) and T9 = RD + Borax (150 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) as compared to control. In conclusion, T8 = RD + Borax (75 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) and T9 = RD + Borax (150 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) is a potent strategy to improve the quality attributes of mango under the changing climatic situation

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication