The performance of the supra-annular Top-Hat aortic valves compared to the standard Carbomedics valves

Background: The CarboMedics Top-Hat aortic valve prosthesis was designed to be implanted in a supra-annular position. This study aimed to compare the hemodynamic performance of the Top-Hat aortic prostheses versus the standard CarboMedics aortic valve prostheses. Methods: The study included 98 patients who had aortic valve replacement and were divided into two groups. Group A included 60 patients who had standard aortic valve prostheses, and Group B included 38 patients who had the Top-Hat aortic prostheses. The study endpoints were hospital outcomes, the effective orifice area, and the pressure gradient during a one-year follow-up. Results: There was no significant difference in the baseline echocardiographic data and risk factors between the groups. The patients who had Top-Hat aortic prosthesis were younger, with a mean age of 47.5 (44-55) years, and those who had the standard prosthesis were 53.5 (48-56) years old (P= 0.02). The cardiopulmonary bypass time was significantly less in the Top-Hat prosthesis group with an average of 78 min (75- 81) compared to 88 min (84- 95) in the other group (P ˂0.001). The effective orifice surface area was significantly larger in the group with Top-Hat prosthesis; 0.9 mm/m2 (0.88- 0.92) compared to 0.84 mm/m 2 (0.79- 0.87) for the standard aortic valve prosthesis group (P ˂0.001). The pressure gradient over the aortic valve decreased significantly postoperatively (coefficient -1.98 (-2.21- -1.75); P˂0.001). Patients with Top-Hat valves had significantly lower gradient (coefficient: -4.22 (-6.61- -1.82); P= 0.001), while age had no effect on the pressure gradient (coefficient: 0.1 ( -0.07- 0.27); P= 0.25). Conclusion: The Top-Hat CarboMedics prostheses could be superior to the standard CarboMedics aortic valve prosthesis regarding the effective orifice area and pressure gradient over the valve

Electronic transport in low dimensions: carbon nanotubes and mesoscopic silver wires

This thesis explores the physics of low-dimensional electronic conductors using two materials systems, carbon nanotubes (CNTs) and lithographically-defined silver nanowires. In order to understand the intrinsic electronic properties of CNTs, it is important to eliminate the contact effects from the measurements. Here, this is accomplished by using a conductive-tip atomic force microscope cantilever as a local electrode in order to obtain length dependent transport properties. The CNT-movable electrode contact is fully characterized, and is largely independent of voltage bias conditions, and independent of the contact force beyond a certain threshold. The contact is affected by the fine positioning of the cantilever relative to the CNT due to parasitic lateral motion of the cantilever during the loading cycle, which, if not controlled, can lead to non-monotonic behavior of contact resistance vs. force. Length dependent transport measurements are reported for several metallic and semiconducting CNTs. The resistance versus length R(L) of semiconducting CNTs is linear in the on state. For the depleted state R(L) is linear for long channel lengths, but non-linear for short channel lengths due to the long depletion lengths in one-dimensional semiconductors. Transport remains diffusive under all depletion conditions, due to both low disorder and high temperature. The study of quantum corrections to classical conductivity in mesoscopic conductors is an essential tool for understanding phase coherence in these systems. A long standing discrepancy between theory and experiment regards the phase coherence time, which is expected theoretically to grow as a power law at low temperatures, but is experimentally found to saturate. The origins of this saturation have been debated for the last decade, with the main contenders being intrinsic decoherence by zero-point fluctuations of the electrons, and decoherence by dilute magnetic impurities. Here, the phase coherence time in quasi-one-dimensional silver wires is measured. The phase coherence times obtained from the weak localization correction to the conductivity at low magnetic field show saturation, while those obtained from universal conductance fluctuations at high field do not. This indicates that, for these samples, the origin of phase coherence time saturation obtained from weak localization is extrinsic, due to the presence of dilute magnetic impurities

A multi-sectoral intervention model to scale up family planning services utilization at the primary health care level: evidence from a priority district, Fayoum governorate, Egypt

Background: Egypt is one of the most populous countries in the Middle East and Africa. Evidence from developing countries revealed that increasing family planning use is associated with substantial declines in fertility and population growth. The objective of this study was to assess the impact of implementing a multisectoral intervention model on the family planning utilization at the Primary Health Care (PHC) level in a priority district, Fayoum governorate, Egypt.  Methods: A quasi-experimental design was conducted from July 2016 to September 2016. The model targeted 10 PHC units out of 23 at Tamia district, with two types of interventions; health sector and non-health sector related interventions carried out in the intervention units and their catchment areas. The family planning utilization of the intervention units (n=10) was compared to the control units (n=13). Additionally, the overall family planning utilization at the district level was measured.  Results: Following the implementation of the interventions, the overall family planning utilization at the district level showed a significant increase in mean ± Standard Error of the Mean (SEM) of new family planning clients (44.4±11.0vs. 63.3±13.8; P= 0.006) recording 43% change. The mean ± SEM of intrauterine devices dispensed from the intervention units significantly increased by 391% (3.5±1.0 vs. 17.2±3.3; P=0.002). Findings from the control units didn't reveal significant increase regarding the dispense of any family planning method.  Conclusion: Mobilizing and optimizing resources use, empowering district authorities and strengthening collaboration across sectors were key drivers of the success of this model in scaling up family planning services utilization.  &nbsp

Formulation, evaluation and optimization of miconazole nitrate tablet prepared by foam granulation technique

The aim of our study was to utilize novel foam granulation technique in formulation of miconazole nitrate; a model hydrophobic drug as oral disintegrating tablets "ODT" particularly to enhance its bioavailability. Foam granulation technique has additional advantages over the other traditional granulation technique since; it enhances the granulation process and produce acceptable tablets. Fractional factorial design was used to investigate the effect of formulation and processing variables on the prepared miconazole ODT. The prepared granules were evaluated by measuring their density, flowability, granules size and shape, and granules wetting time. The quality attributes of the prepared tablets; drug content, tablet thickness, uniformity of weight, tablet tensile strength, friability, disintegration, and dissolution were also evaluated. The results indicated that, the prepared granules showed acceptable characteristics and is significantly affected by the disintegrant type, urea concentration, and the lubricant type. The quality attributes of the tablets were not affected by the processing parameters. From the prepared formulas; F20, F19, F12, and F20 displayed 18, 35, 35, and 40 seconds disintegration time respectively and the percent of dissolution after 15 minutes ranged from 94.4-100%. These results ascertained that foam granulation technique fulfill the requirement in preparation of miconazole ODT. Key words: miconazole nitrate, foam granulation, oral disintegrating tablet

Učinak zamjene obroka od pšeničnih mekinja obrokom sa sjemenkama kima na nesenje, kvalitetu jaja i masnokiselinski profil u kokoši nesilica

The objective of the present study was to investigate the effect of substituting wheat bran (WB) with cumin seed meal (CSM) on laying performance, egg quality characteristics and egg-yolk fatty acids profile in laying hens. A total of 180 Bovans hens at 55 weeks of age were divided randomly into three treatments. The CSM was incorporated into a standard corn- and soybean meal-based diet by replacing 0, 50, and 100% of WB [i.e., 100% WB (control), 50% WB+50% CSM and 100% CSM] from 55 to 61 weeks of age. Body weight was measured at the beginning and end of the experiment. Feed intake, hen-day egg production and egg weight were recorded daily. At 61 weeks of age, 30 eggs were taken at random from each treatment group to determine the egg quality characteristics. Replacing 100% of WB by CSM did not affect body weight, however, hen-day egg production, egg weight and egg mass significantly increased, while feed conversion ratio significantly decreased (P<0.05). Haugh unit, shell thickness and yolk color significantly increased by CSM substitution in comparison with 100% WB. Plasma concentrations of total cholesterol, triglycerides, LDL-cholesterol and glutamic oxalacetic transaminase (GOT) significantly decreased by replacing WB with CSM, while, plasma HDL-cholesterol significantly increased. Furthermore, the liver malondialdehyde (MDA) concentration significantly decreased, while vitamin E, linoleic acid and alpha-linolenic acid significantly increased (P<0.05) due to CSM inclusion. Therefore, it could be concluded that substitution of WB with CSM could improve laying performance and egg quality characteristics, and reduce lipid peroxidation in laying hens.Cilj ovoga rada bio je istražiti učinak zamjene obroka s pšeničnim mekinjama (WB) obrokom sa sjemenkama kima (CSM) na nesenje, kvalitetu jaja te profil masnih kiselina u žumanjku jajeta kokoši nesilica. Ukupno je 180 Bovans kokoši u dobi od 55 tjedana slučajnim odabirom podijeljeno u tri pokusne skupine, u kojima su sjemenke kima dodane u standardni obrok s kukuruzom i sojom zamjenjujući 0, 50 i 100 % pšeničnih mekinja. Tako je kontrolna skupina hranjena obrocima sa 100 % pšeničnih mekinja, druga skupina s 50 % obroka s pšeničnim mekinjama i 50 % obroka sa sjemenkama kima, a treća skupina obrokom koji je sadržavao 100 % sjemenki kima. Pokusno razdoblje je trajalo od 55. do 61. tjedna starosti nesilica. Tjelesna je masa mjerena na početku i na kraju pokusa. Unos hrane, dnevna proizvodnja jaja i njihova masa bilježili su se svaki dan. U dobi od 61 tjedna iz svake je skupine slučajnim odabirom uzeto 30 jaja kako bi se odredila njihova kvaliteta. zamjenjujući 100 % obrok od pšeničnih mekinja sjemenke kima nisu utjecale na tjelesnu masu, no ipak su dnevna proizvodnja, težina i masa jaja znakovito porasle, dok se stopa konverzije hrane znakovito smanjila (P<0,05). Haugh-ova jedinica, debljina ljuske i boja žumanjka znakovito su porasle u skupinama u kojima su pšenične mekinje zamijenjene sjemenkama kima u odnosu na kontrolnu skupinu. Ukupni kolesterol, trigliceridi, LDL-kolesterol i glutaminska oksalooctena transaminaza (GOT) znakovito su sniženi u skupinama u kojima su pšenične mekinje zamijenjene sjemenkama kima, dok je HDL-kolesterol znakovito povišen. nadalje, koncentracija malondialdehida (MDA) u jetri znakovito je snižena, dok su vitamin E, linolna i alfa-linolna kiselina znakovito porasli (P<0,05) uslijed dodanih sjemenki kima. Može se zaključiti da zamjena obroka s pšeničnim mekinjama obrokom sa sjemenkama kima može poboljšati nesenje i kvalitetu jaja te smanjiti lipidnu peroksidaciju u kokoši nesilica

Insulin sensitizing agent improves clinical pregnancy rate and insulin resistant parameters in polycystic ovarian syndrome patients with acanthosis nigricans: a randomized controlled study

Objective: To investigate the effect of adding metformin to clomiphene citrate (CC) in polycystic ovarian syndrome (PCOS) patients with acanthosis nigricans (AN) who were previously not responding to CC. Material and Methods: A double blinded randomized controlled trial (NCT02562664) included 66 PCOS women with acanthosis nigricans who were CC resistant (at least 3 months). Day 3 follicle stimulating hormone (FSH) level, fasting insulin, fasting glucose and homeostatic model assessment were used to quantify insulin resistance. Participants were randomly assigned to either group I (CC with placebo tablets) or group II (CC with metformin) for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi- square and Fischer exact tests. Results: The demographic data was comparable in both groups, however; there was higher cumulative pregnancy rate after three cycles of stimulation in group II (18/33) (54.5%) in comparison with group I (7/33) (21.1%) (P=0.03). There was a significant improvement in the insulin resistance parameters after three months of combining clomiphene citrate with metformin as compared with CC alone. Conclusion: Adding metformin to CC in clomiphene citrate resistant PCOS patients who have acanthosis nigricans improves the pregnancy rate and insulin resistant parameters

Formulation, evaluation and optimization of miconazole nitrate tablet prepared by foam granulation technique

The aim of our study was to utilize novel foam granulation technique in formulation of miconazole nitrate; a model hydrophobic drug as oral disintegrating tablets "ODT" particularly to enhance its bioavailability. Foam granulation technique has additional advantages over the other traditional granulation technique since; it enhances the granulation process and produce acceptable tablets. Fractional factorial design was used to investigate the effect of formulation and processing variables on the prepared miconazole ODT. The prepared granules were evaluated by measuring their density, flowability, granules size and shape, and granules wetting time. The quality attributes of the prepared tablets; drug content, tablet thickness, uniformity of weight, tablet tensile strength, friability, disintegration, and dissolution were also evaluated. The results indicated that, the prepared granules showed acceptable characteristics and is significantly affected by the disintegrant type, urea concentration, and the lubricant type. The quality attributes of the tablets were not affected by the processing parameters. From the prepared formulas; F20, F19, F12, and F20 displayed 18, 35, 35, and 40 seconds disintegration time respectively and the percent of dissolution after 15 minutes ranged from 94.4-100%. These results ascertained that foam granulation technique fulfill the requirement in preparation of miconazole ODT. Key words: miconazole nitrate, foam granulation, oral disintegrating tablet

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

Deciphering the therapeutic potential of trimetazidine in rheumatoid arthritis via targeting mi-RNA128a, TLR4 signaling pathway, and adenosine-induced FADD-microvesicular shedding: In vivo and in silico study

Rheumatoid arthritis (RA) is a debilitating autoimmune condition characterized by chronic synovitis, joint damage, and inflammation, leading to impaired joint functionality. Existing RA treatments, although effective to some extent, are not without side effects, prompting a search for more potent therapies. Recent research has revealed the critical role of FAS-associated death domain protein (FADD) microvesicular shedding in RA pathogenesis, expanding its scope beyond apoptosis to include inflammatory and immune pathways. This study aimed to investigate the intricate relationship between mi-RNA 128a, autoimmune and inflammatory pathways, and adenosine levels in modulating FADD expression and microvesicular shedding in a Freund’s complete adjuvant (FCA) induced RA rat model and further explore the antirheumatoid potency of trimetazidine (TMZ). The FCA treated model exhibited significantly elevated levels of serum fibrogenic, inflammatory, immunological and rheumatological diagnostic markers, confirming successful RA induction. Our results revealed that the FCA-induced RA model showed a significant reduction in the expression of FADD in paw tissue and increased microvesicular FADD shedding in synovial fluid, which was attributed to the significant increase in the expression of the epigenetic miRNA 128a gene in addition to the downregulation of adenosine levels. These findings were further supported by the significant activation of the TLR4/MYD88 pathway and its downstream inflammatory IkB/NFB markers. Interestingly, TMZ administration significantly improved, with a potency similar to methotrexate (MTX), the deterioration effect of FCA treatment, as evidenced by a significant attenuation of fibrogenic, inflammatory, immunological, and rheumatological markers. Our investigations indicated that TMZ uniquely acted by targeting epigenetic miRNA128a expression and elevating adenosine levels in paw tissue, leading to increased expression of FADD of paw tissue and mitigated FADD microvesicular shedding in synovial fluid. Furthermore, the group treated with TMZ showed significant downregulation of TLR4/MYD88 and their downstream TRAF6, IRAK and NF-kB. Together, our study unveils the significant potential of TMZ as an antirheumatoid candidate, offering anti-inflammatory effects through various mechanisms, including modulation of the FADD-epigenetic regulator mi-RNA 128a, adenosine levels, and the TLR4 signaling pathway in joint tissue, but also attenuation of FADD microvesicular shedding in synovial fluid. These findings further highlight the synergistic administration of TMZ and MTX as a potential approach to reduce adverse effects of MTX while improving therapeutic efficacy.Peer Reviewe

Expression of FGFR3 Protein and Gene Amplification in Urinary Bladder Lesions in Relation to Schistosomiasis

BACKGROUND: Bladder cancer represents the fifth most common malignancy worldwide and a major cause of cancer-related morbidity and death. Incidence and mortality rates have remained relatively constant over the past four decades. Urothelial bladder cancers have identified multiple risk factors.AIM: We aimed at evaluating the expression of the FGFR3 protein and gene amplification in the urothelial cells of neoplastic and non-neoplastic urothelial lesions of the urinary bladder, and correlation with tumour grade, stage and associated bilharziasis.MATERIAL AND METHODS: One hundred and five different urinary bladder lesions were studied, including 15 cystitis cases (9 bilharzial and 6 non-bilharzial cystitides), 75 urothelial carcinoma cases (18 bilharzial associated and 57 non-bilharzial associated) and 15 squamous cell carcinoma associated with bilharziasis, beside 5 control cases. Data concerning age, sex, tumour grade, stage, and associated bilharziasis were obtained. Each case was studied for FGFR3 expression, and FISH technique was applied on forty malignant cases that show high protein expression.RESULTS: The highest incidence of cystitis was in the fourth decade while of bladder cancer was in the seventh decade. Tumour grade was correlated significantly with tumour stage. FGFR3 correlates significantly with tumour grade, stage and with a bilharzial infestation. FGFR3 gene amplification was reported mainly in low grade and NNMBIC tumours.CONCLUSIONS: FGFR3 overexpression in malignant cases was significantly higher than in chronic cystitis. FGFR3 gene amplification was reported mainly in low grade and NNMBIC tumours. FGFR3 may be further studied as a subject for target therapy of bladder cancer