Effect of Levosimendan Compared to Conventional Inotropic Agents on Hemodynamics and Outcome in Patient with Poor LV Function Undergoing Cardiac Surgery

BACKGROUND: Patients undergoing heart surgery involving cardiopulmonary bypass (CPB) experience global myocardial ischemia with subsequent reperfusion which, despite cardioplegic protection, may result in different degrees of transient ventricular dysfunction. Levosimendan is a “calcium sensitisersâ€, it improves myocardial contractility by sensitising troponin C to calcium without increasing myocardial oxygen consumption and without impairing relaxation and diastolic function. AIM: To evaluate the adding effect of a calcium sensitiser (levosimendan) compared to the conventional inotropic and vasoactive agent used in the patient with poor left ventricular function undergoing cardiac surgery on different measured hemodynamic variables and the effect on the outcome. METHODS: It is prospective observational studies were patients were divided into 2 groups of 30 patients each. The first Group received conventional inotropic and vasoactive treatment at different doses, while the other group received levosimendan additionally at a loading dose of 6-12mic/kg according to mean arterial pressure over 0.5 hr followed by 24 hrs infusion at 0.05 to 0.2 mic/kg/min. Hemodynamic data were collected at the end and 30 minutes after CPB, after that at 6, 12, 24, and 36 hours post CPB. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), mixed venous saturation (Svo2), and base deficit (BD) were measured. RESULTS: Levosimendan had significantly improved postoperative hemodynamic values as in the mixed venous pressure at different times postoperative (p < 0.05), also the base deficit at different times postoperative (p < 0.05), while there was a significant reduction in systemic vascular resistance as decreased mean arterial pressure in levosimendan group compared to conventional group at 6hrs postoperative mean 77.50 ± 10.81 vs 83.73 ± 10.81 with (p = 0.029), and at 12 hrs postoperative mean 77.37 ± 10.10vs 84.23 ± 13.81 with (p = 0.032), and there was no significant difference in heart rate at different times postoperative between both groups (p > 0.05), while there was no significant effect on mortality between both groups (p = 0.781). CONCLUSION: Levosimendan had improved hemodynamic parameters significantly with no effect on mortality compared to conventional inotropic agents in a patient with poor left ventricular function undergoing cardiac surgery

PSO-SVM hybrid system for melanoma detection from histo-pathological images

This paper introduces an automated system for skin cancer (melanoma) detection from Histo-pathological images sampled from microscopic slides of skin biopsy. The proposed system is a hybrid system based on Particle Swarm Optimization and Support Vector Machine (PSO-SVM). The features used are extracted from the grayscale image histogram, the co-occurrence matrix and the energy of the wavelet coefficients resulting from the wavelet packet decomposition. The PSO-SVM system selects the best feature set and the best values for the SVM parameters (C and γ) that optimize the performance of the SVM classifier.   The system performance is tested on a real dataset obtained from the Southern Pathology Laboratory in Wollongong NSW, Australia. Evaluation results show a classification accuracy of 87.13%, a sensitivity of 94.1% and a specificity of 80.22%.The sensitivity and specificity results are comparable to those obtained by dermatologists

Transvenous Lead Extraction of Cardiac Implantable Electronic Devices Indications, Complications and Outcome: An Egyptian Two Years' Experience

BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed

Enhancing image captioning with depth information using a Transformer-based framework

Captioning images is a challenging scene-understanding task that connects computer vision and natural language processing. While image captioning models have been successful in producing excellent descriptions, the field has primarily focused on generating a single sentence for 2D images. This paper investigates whether integrating depth information with RGB images can enhance the captioning task and generate better descriptions. For this purpose, we propose a Transformer-based encoder-decoder framework for generating a multi-sentence description of a 3D scene. The RGB image and its corresponding depth map are provided as inputs to our framework, which combines them to produce a better understanding of the input scene. Depth maps could be ground truth or estimated, which makes our framework widely applicable to any RGB captioning dataset. We explored different fusion approaches to fuse RGB and depth images. The experiments are performed on the NYU-v2 dataset and the Stanford image paragraph captioning dataset. During our work with the NYU-v2 dataset, we found inconsistent labeling that prevents the benefit of using depth information to enhance the captioning task. The results were even worse than using RGB images only. As a result, we propose a cleaned version of the NYU-v2 dataset that is more consistent and informative. Our results on both datasets demonstrate that the proposed framework effectively benefits from depth information, whether it is ground truth or estimated, and generates better captions. Code, pre-trained models, and the cleaned version of the NYU-v2 dataset will be made publically available.Comment: 19 pages, 5 figures, 13 table

Autologous Pericardial Band for Tricuspid Valve Annuloplasty: Midterm Results

Background: Even though tricuspid regurgitation (TR) is a frequent cardiac valve disorder, and tricuspid valve annuloplasty (TVA) has been evolved to manage TR for more than 50 years, there is still a substantial controversy regarding the best durable method for TVA. We reported our midterm (3 years) outcomes of TVA using autologous pericardial (AP) band comparing it with DeVega annuloplasty for the management of functional TR. Methods: Between January 2017 and November 2018, about 175 cases with moderate or more TR underwent TVA as a part of primary left-sided valve replacement surgery. Autologous pericardial (AP) TVA was performed in 100 patients, and DeVega TVA in 75 patients. Results: Both groups are comparable as regards preoperative characteristics. Immediate postoperatively, regarding NYHA class, degree of TR, ejection fraction, and pulmonary artery systolic pressure, there was a marked improvement within the 2 groups compared to the preoperative values, without a significant difference between both groups. 94% of patients completed the follow-up period. In hospital death was 2% in the AP group, and 1% in the DeVega group. The AP group showed a marked improvement in the mean degree of TR at the same follow-up period compared to the DeVega group, 12% patients of the AP group and 21% patients of the De Vega group had 3+ or 4+ TR at 3 years postoperative follow up. There was a marked improvement in the Diastolic tricuspid annuloplasty diameter in the AP group compared to the DeVega group. There were 6.3% late deaths in our study. Conclusion:  TVA with an AP was more durable than the DeVega in avoiding postoperative TR progression on the midterm results

The Diagnostic accuracy of transvaginal ultrasonography, magnetic resonance imaging and diffusion weighted image in female patients with endometrial carcinoma

Aim of work: To evaluate the efficacy of transvaginal ultrasonography (TVUS), magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) in presurgical staging of endometrial cancer.Methodology: This work included 35 female patients. Thirty patients were diagnosed to have endometrial carcinoma.Results: The sensitivity, specificity, predictive values, accuracy of transvaginal ultrasound in detection of invasion of myometrial cavity were 67.25%, 75.0%, 90.00%, 30.00% and in distant metastasis were 77.78%, 80.95%, 63.64%, 89.47% and %80. These variables for MRI were 88.89%, 100.0%, 100%, 66.67% and 91% in myometrial invasion and in distant metastasis were 100.0%, 100.0%, 100.0%, 100% and 100.0%. There was an inversely proportional relationship between ADC values and the tumor grading. Apparent diffusion coefficient (ADC) magnitude of 0.77 ± 0.21 x 10-3 mm2/s was associated with endometrial cancer while normal endometrial cavity showed ADC value of 1.31 ± 0.11 x 10-3 mm2/s).Conclusion: Conventional MRI, diffusion weighted imaging and contrast enhanced MR images are superior to TVUS in patients with endometrial cancer and ADC values help to differentiate between normal and endometrial cancer which may replace MR contrast enhanced images.Keywords: Transvaginal ultrasound, MRI, DWI, Endometrial carcinom

Preparation of La0.7Ca0.3Mn0.95Fe0.05O3 perovskites by different methods: Catalytic activity towards the hydroxylation of benzene

Nanoparticles of the La0.7Ca0.3Mn0.95Fe0.05O3 perovskites were synthesized by various wet chemical routes, namely, co-precipitation, oxalate-gel and citrate-gel methods. Phase formation and crystal structure of the synthesized powders were examined by the X-ray diffraction (XRD). The morphology was evaluated by the scan electron microscopy (SEM). Infrared transmission spectroscopy revealed that stretching and bending modes were influenced by the preparation methods. The citrate gel method yielded better powder properties. The prepared perovskite samples were used in the oxidation of benzene. The highest activity for the catalytic oxidation of benzene to phenol in presence of hydrogen peroxide (H2O2) was obtained with the citrate-gel prepared sample

Anti-apolipoprotein A-I antibodies and paraoxonase 1 activity in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) patients have an increased risk of atherosclerosis. Identification of at-risk patients and the pathogenesis of atherosclerosis in SLE remain elusive. Paraoxonase 1 (PON1) and anti-apolipoprotein A-I antibody (anti-Apo A-I) appear to have a potential role in premature atherosclerosis in SLE. The aim of this work was to study PON1 activity and anti-Apo A-I antibody in SLE female patients and to demonstrate their relations to disease activity as well as disease related damage. Forty SLE female patients and 40 apparently healthy volunteers were included. Anti-Apo A-I antibodies levels and PON1 activity levels were assessed. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and systemic Lupus International Collaboration Clinics (SLICC)/American College of Rheumatology (ACR) damage index were preformed in all patients. Compared with controls, SLE patients showed significantly lower PON1 activity and significantly higher titers of anti-Apo A-I. Anti-Apo A-I antibody titers correlated inversely with PON1 activity. Elevated titers of anti-Apo A-I antibody and reduced PON activity were related to increased SLEDAI and (SLICC/ACR) damage index scores. We concluded that there is decreased PON1 activity and formation of anti-Apo A-I antibodies in female patients with SLE. SLE-disease activity assessed by SLEDAI and SLE disease related organ damage assessed by SLICC/ACR damage index are negatively correlated with PON1 activity and positively correlated with anti-Apo A-I antibodies. PON1 activity and anti-Apo A-I antibodies might be involved in the pathogenesis of atherosclerosis in SLE patients

Visual image and expression directed to the child in Media Age

Abstract:Designing the visual image directed to the child is considered to be a big challenge for the artist or designer who is forming it, as the visual image is the strongest communication channel in the age of media because it carries meaning smoothly through expressive content. The artists or designer uses the design theories of visual image to form its elements expressing the message carried to children actively.The research contains the definition of visual image and how to form it based on art composition forming theories of the visual image, the study of the meaning definition and expressive characteristics that are in the children drawings and wording shapes for knowing the best ways to communicate with their sentiment. Keywords:Visual image – expression – children drawings characteristics Research Aims:1. Studying the dimensions of the visual image directed to the Pre-adolescent child (9 to 12 years old) contributes to activating the elements of his visual culture.2. Study of the basic formative construction of expression in child’s drawings achieves the target of communication message carried to him.Research Methodology:• The researcher uses the descriptive method followed by an analytical study to identify the concept of the visual image and expression addressed to the "Pre-adolescent" child (9 to 12 years old) to identify the set standards or the necessary ones of it.Research Results:1- That the formative elements of the visual image has to match the expressive content of the message carried.2- Design theories adds an aesthetic and expressive values to the visual image.3- The child has his own way of expressing that the artist needs to study to find the best way to communicate with his sentiment.4- The visual image and expression are considered to be the most powerful way to influence child’s perception.Most important references:1- Dr Ahmed Hamdy Mahmoud- Ma Wara’ Al Fen - General Egyptian Book Organization - 19932- Malameh Wa Qadaya Al Fen Al Tashkily Al Mo’aser - Dr Saleh Reda - Maktabet Al Osra - 200