A new clustering technique based on replication for MANET routing protocols

The cluster head nodes in most mobile ad hoc networks (MANET) clustering protocols take on an extraordinary role in managing routing information. The reliability, efficiency and scalability of the clustering in MANET will ultimately be dramatically impacted. In this work we establish a new approach to form the clusters in MANET called the square cluster-based routing protocol (SCBRP). That protocol is based on the theory of replication. The goal of the protocol is to achieve reliability, availability and scalability with in the MANET. The proposed protocol is evaluated by caring the performance analysis using the NS-3 simulator. The performance shows 50% improvementin data delivering ratio in large network size, also shows an improvement in network stability and availability which is reflected in energy consumption measurements and increase in the system lifetime to 20%

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernia with severe gastroesophageal reflux disease. A retrospective cohort study

Background: Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (> 5 cm) with severe GERD (DeMeester score >100). Materials and methods: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. Results: 360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05). Conclusions: Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint

Hepatobiliary manifestations following two-stages elective laparoscopic restorative proctocolectomy for patients with ulcerative colitis: A prospective observational study

BACKGROUNDHepatobiliary manifestations occur in ulcerative colitis (UC) patients. The effect of laparoscopic restorative proctocolectomy (LRP) with ileal pouch anal anastomosis (IPAA) on hepatobiliary manifestations is debated.AIMTo evaluate hepatobiliary changes after two-stages elective laparoscopic restorative proctocolectomy for patients with UC.METHODSBetween June 2013 and June 2018, 167 patients with hepatobiliary symptoms underwent two-stage elective LRP for UC in a prospective observational study. Patients with UC and having at least one hepatobiliary manifestation who underwent LRP with IPAA were included in the study. The patients were followed up for four years to assess the outcomes of hepatobiliary manifestations.RESULTSThe patients' mean age was 36 +/- 8 years, and males predominated (67.1%). The most common hepatobiliary diagnostic method was liver biopsy (85.6%), followed by Magnetic resonance cholangiopancreatography (63.5%), Antineutrophil cytoplasmic antibodies (62.5%), abdominal ultrasonography (35.9%), and Endoscopic retrograde cholangiopancreatography (6%). The most common hepatobiliary symptom was Primary sclerosing cholangitis (PSC) (62.3%), followed by fatty liver (16.8%) and gallbladder stone (10.2%). 66.4% of patients showed a stable course after surgery. Progressive or regressive courses occurred in 16.8% of each. Mortality was 6%, and recurrence or progression of symptoms required surgery for 15%. Most PSC patients (87.5%) had a stable course, and only 12.5% became worse. Two-thirds (64.3%) of fatty liver patients showed a regressive course, while one-third (35.7%) showed a stable course. Survival rates were 98.8%, 97%, 95.8%, and 94% at 12 mo, 24 mo, 36 mo, and at the end of the follow-up.CONCLUSIONIn patients with UC who had LRP, there is a positive impact on hepatobiliary disease. It caused an improvement in PSC and fatty liver disease. The most prevalent unchanged course was PSC, while the most common improvement was fatty liver disease

Genetic and Morphological Diversity Assessment of Five Kalanchoe Genotypes by SCoT, ISSR and RAPD-PCR Markers

Determining the appropriate parents for breeding programs is the most important decision that plant breeders must make to maximize the genetic variability and produce excellent recombinant genotypes. Several methods are used to identify genotypes with desirable phenotypic features for breeding experiments. In this study, five kalanchoe genotypes were morphologically characterized by assessing plant height, number of inflorescences, number of flowers, flower length, flower diameter and number of petals. The analysis showed the distinction of yellow kalanchoe in the plant height trait, while the orange kalanchoe was distinguished in the number of inflorescences, the number of flowers and flower length traits, whereas the violet kalanchoe possessed the largest flower diameter and the highest number of petals. The molecular profiling was performed by random amplified polymorphism DNA (RAPD), inter-simple sequence repeats (ISSR) and start codon targeted (SCoT)-polymerase chain reaction (PCR) tools. Genomic DNA was extracted from young leaves and the PCR reactions were performed using ten primers for each SCoT, ISSR and RAPD marker. Only four out of ten primers showed amplicon profiles in all PCR markers. A total of 70 bands were generated by SCoT, ISSR and RAPD-PCR with 35 polymorphic bands and 35 monomorphic bands. The total number of bands of RAPD, ISSR and SCoT was 15, 17 and 38, respectively. The polymorphism percentages achieved by RAPD, ISSR and SCoT were 60.25%, 15% and 57%, respectively. The cluster analysis based on morphological data revealed two clusters. Cluster I consisted of violet and orange kalanchoe, and cluster II comprised red, yellow and purple kalanchoe. Whereas the cluster analysis based on molecular data revealed three clusters. Cluster I included only yellow kalanchoe, cluster II comprised orange and violet kalanchoe while cluster III comprised red, and purple kalanchoe. The study concluded that orange, violet and yellow kalanchoe are distinguished parents for breeding economically valued traits in kalanchoe. Also, the study concluded that SCoT and RAPD markers reproduced reliable banding patterns to assess the genetic polymorphism among kalanchoe genotypes that consider the basis stone for genetic improvements in ornamental plants

A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step

Background This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh. Methods Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck’s first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study. Results The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level < 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh. Conclusion Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117

Demographic and clinical characteristics of pulmonary hypertension cases and the awareness of the disease among chest physicians in Abassia Chest Hospital

Rational: To date in Egypt there is no available national registry for PH cases therefore this study had two objectives, first to record the clinical characteristics and demographics of PH cases in a single center study that hopefully could be a stepping stone in the development of a national registry. The second objective was to assess the awareness of the physicians of the disease. Methods: It included two parts, the first a retrospective descriptive study of 52 patients diagnosed as PH who were admitted to Abassia Chest Hospital in the period between January 2011 and December 2012. The second part comprised a prospective assessment of the awareness of 40 specialized chest physicians who worked in Abassia Chest Hospital using a questionnaire. Results: Among the 52 patients the mean age was 55.8 ± 13.25 years, 28 females (53.8%) and 24 males (46.2%) and a mean cigarette smoking index of 78.5 (±33.3). The patients suffered from slight respiratory acidosis with a mean pH of 7.3 (±0.03) explained by the elevated mean PaCO2 of 49.9 (±8.6) mmHg and hypoxemia explained by a mean PaO2 of 73.6 (±12.7) mmHg, and a mean SO2 of 83.9 (±5)%. According to NYHA, 40 (76.9%) presented in FC III and 12 (23.1%) FC IV. ECHO assessment records revealed an elevated right ventricular systolic pressure (RVSP) with an estimated mean of 61.4 (±12.4) mmHg, tricuspid regurge was the most common valve affection in 38 (73%) of the cases while 18 (34.6%) had left ventricular diastolic dysfunction and left ventricular hypertrophy. Almost all of the diagnosed patients with PH 43/52 (82.6%) were classified as group 3 that is PH due to lung diseases and/or hypoxemia. COPD contributed to slightly more than half of the 29 (55.7%) cases meanwhile the other half was shared between variable lung diseases. PH due to left sided heart failure (group 2) was the second common cause 5/52 (9.6%) followed equally by patients with chronic thromboembolism (CTEPH) (group 4) 2/52 (3.8%) and patients with idiopathic pulmonary hypertension (group 1) 2/52 (3.8%). Among the 40 physicians enrolled in the survey only 15 (37.5%) acknowledged that they found PH a commonly diagnosed disease in their practice. As regards the method of investigation; 34 (85%) decided on ECHO only but 5 (12.5%) recommended both ECG and ECHO. To reach a confirmed diagnosis of PH only 2 (5%) selected right heart catheterization while 35 (87.5%) chose elevated RVSP > 25 mmHg and 3 (7.5%) didn’t know. None of the physicians conducted clinical trials on PH medications also none of them have previously referred any of the PH cases for heart and lung transplant and only 1 physician referred 1 case for thrombo-endarterectomy. Lastly 34 (85%) of the physicians didn’t attend any educational meeting concerning PH, the remaining 4 (10%) attended one meeting and 2 (5%) attended two meetings. Conclusion: In conclusion the study provides information on the clinical and epidemiological features of PH in Egypt as a primary pilot study. It highlights the fact that awareness about the disease is still lacking among physicians and/or health care providers and late detection continues to be a threat for optimum management of PH. Clinical impact: It unveiled the urgent need for a large scale registry not only national but also regional using uniform diagnostic criteria based on the latest published guidelines

Comparison of Presepsin (CD14), Procalcitonin (PCT) and C- Reactive Protein (CRP) at Different SOFA and APACHE II Scores in Sepsis Patients

Sepsis remains a major challenge in clinical practice with considerable morbidity and mortality despite modern treatments. Clinicians need good diagnostic and prognostic markers to identify infected patients who would rapidly benefit from prompt, empirical antibiotic therapy and other supportive treatment. to comparison of Presepsin (CD14), Procalcitonin (PCT) and C- reactive protein (CRP) at different SOFA and APACHE II scores in sepsis patients. A prospective cohort observational study was conducted in Critical Care Medicine Department, Faculty of medicine, Cairo University, Egypt recruiting admitted adult critically ill patients diagnosed. All subjects were recruited during the period from December 2013 to November 2015. All subjects were subjected to complete history taking, clinical examination, Complete blood count, Kidney and Liver function, Coagulation profiles, blood, urine, and sputum cultures ± wound or drain culture, presepsin, PCT and CRP plasma concentrations. Mean age of our study group was 49.8±16.05 years and mean APACHE II score 14±4.4 with mean length of ICU stay was 13.6±7.06 days.There was significantly higher frequency of DM and HTN in Non- survivors group than Survivors.SOFA score was significantly higher at all assessments in Non- survivors as compared to survivors on admission and at day 1, 3,7 and 15