To Whom Thrombus Aspiration May Concern?

BACKGROUND: Thrombus aspiration for ST-segment elevation myocardial infarction (STEMI) may improve myocardial perfusion. However, these favourable results called into a question by data indicating not only a lack of efficacy but a risk of potentially deleterious complications.AIM: To assess the effect of thrombus aspiration during the primary percutaneous coronary intervention (PPCI) on procedural angiographic results, stent characteristics, and major adverse cardiac and cerebrovascular events (MACCE).METHODS: All consecutive STEMI patients candidate for PPCI and admitted to Critical Care Department, Cairo University hospitals, managed either by thrombectomy before primary PCI (if thrombus score ≥ 3) or conventional PPCI, Six hundred seven subjects were enrolled in the study divided into Group with thrombectomy before PPCI (107 subjects, 18%), and group with Conventional PCI (500 subjects, 82%). ST-segment resolution, peak CK-MB, TIMI score, thrombus score, and MBG were assessed; stent number, diameter, length and stented segment were reported and follow up MACCE was reported (in hospital and 1-year post-intervention).RESULTS: Mean values for peak CKMB were less in thrombectomy group (228 ± 174 I/U vs 269 ± 186 I/U, p = 0.04), ST segment resolution ≥ 70% occurred in {63 subjects (58.9%) vs 233 (46.6%), p = 0.001} in thrombectomy vs conventional group respectively. TIMI score pre procedure was zero in (102 subjects (95%) vs 402 (80.4%), p = 0.001), while TIMI III post procedure was reported in (100 subjects (93.4%) vs 437 (87%), p = 0.06), MBG mean values were (2.4 ± 0.6 vs 2.0 ± 1, p = 0.001), thrombus score was higher in thrombectomy group (4.6 ± 0.4 vs 0.8 ± 1.7, p = 0.001) in thrombectomy vs conventional group respectively .Direct stenting was { 34 patients (31%) vs 102 patients (20%), p = 0.05} , mean stent diameter (2.7 ± 1.3 mm vs 3.5 ± 1.3 mm, p = 0.3), mean stent length was (19.9 mm ± 10 versus 22.7 mm ± 8 in p 0.01). mean stent number was (1.0 ± 0.5 vs 1.2 ± 0.6, p = 0.001), mean stented segment was (22.5 ± 13.5 vs 28.5 ± 15.2 mm, p = 0.001) in thrombectomy vs conventional group respectively. MACCE in hospital were reported in {9 subjects (8.4%) vs 70 (14%), p = 0.07)}. Follow up MACCE after 1 year reported in {6 subjects (5.6 %) vs 80 (16 %), p 0.= 4} in thrombectomy vs conventional group respectively.CONCLUSION: Thrombus aspiration before primary PCI (in a selected group with thrombus score ≥ 3) improves myocardial perfusion, suggested by better ST-segment resolution, TIMI flow, less peak CKMB and MBG, associated with a higher rate of direct stenting, shorter stent length, stented segments and less number of stents. Although thrombus aspiration was done in more risky patients (higher thrombus score) MACCE (in hospital and 1 year follow up) showed no statistical difference

Synthesis and characterization of some new 4-heteroaryl quinazoline and fused triazolo quinazoline derivatives

Treatment of chloroquinazoline (2) with primary amines (2-aminothiazoles and sulpha drugs) and secondary amines (morpholine, piperidine, and piperazine) furnished 4-substituted aminoquinazolines (3a,b and 4a,b), 4-aryl quinazolines (5a,b), and bisquinazoline (6). Hydrazinolysis of compound 2 using hydrazine hydrate, phenyl hydrazine, and sulphonyl hydrazine afforded compound 8 and 9a,b. 1,2,4-Trizolo-quinazoline derivatives (7a-c) were obtained via a one-pot reaction of chloroquinazoline (2), hydrazine hydrate, and aromatic aldehydes. Additionally, 1,2,4-trizolo-quinazoline derivatives (10a,b) were furnished when compound 2 was treated with acid hydrazides like acetyl and benzoyl hydrazides. Pyrimidino quinazoline (13) has been constructed via a three-step conversion of chloroquinazoline 2 using interaction with malononitrile followed by partial hydrolysis and hetero-ring cyclization. All the synthesized compounds were fully characterized using physical and spectral data like, FT-IR, 1H NMR, 13C NMR, and HR-MS

Predicting the properties of concrete incorporating graphene nano platelets by experimental and machine learning approaches

Modern infrastructure requirements necessitate structural components with improved durability and strength properties. The incorporation of nanomaterials (NMs) into concrete emerges as a viable strategy to enhance both the durability and strength of the concrete. Nevertheless, the complexities inherent in these nanoscale cementitious composites are notably intricate. Traditional regression models face constraints in comprehensively capturing these intricate compositions. Thus, posing challenges in delivering precise and dependable estimations. Therefore, the current study utilized three machine learning (ML) methods, including artificial neural network (ANN), gene expression programming (GEP), and adaptive neuro-fuzzy inference system (ANFIS), in conjunction with experimental investigation to study the effect of the integration of graphene nanoplatelets (GNPs) on the electrical resistivity (ER) and compressive strength (CS) of concrete containing GNPs. Concrete containing GNPs demonstrated an improved fractional change in resistivity (FCR) and strength. The experimental measures depict that strength enhancement was notable at GNP concentrations of 0.05% and 0.1%, showcasing increases of 13.23% and 16.58%, respectively. Simultaneously, the highest observed FCR change reached −12.19% and −13%, respectively. The prediction efficacy of the three models proved to be outstanding in forecasting the characteristics of concrete containing GNPs. For CS, the GEP, ANN, and ANFIS models demonstrated impressive correlation coefficient (R) values of 0.974, 0.963, and 0.954, respectively. For electrical resistivity, the GEP, ANN, and ANFIS models exhibited high R-values of 0.999, 0.995, and 0.987, respectively. The comparative analysis of the models revealed that the GEP model delivered precise predictions for both ER and CS. The mean absolute error (MAE) of the GEP-CS model demonstrated a 14.51% reduction compared to the ANN-CS model and a substantial 48.15% improvement over the ANFIS-CS model. Similarly, the ANN-CS model displayed an MAE that was 38.14% lower compared to the ANFIS-CS model. Moreover, the MAE of the GEP-ER model demonstrated a 56.80% reduction compared to the ANN-CS model and a substantial 82.47% improvement over the ANFIS-CS model. The Shapley Additive explanation (SHAP) analysis provided that curing age exhibited the highest SHAP score. Thus, indicating its predominant contribution to CS prediction. In predicting ER, the graphene content exhibited the highest SHAP score, signifying its predominant contribution to ER estimation. This study highlights ML's accuracy in predicting the properties of concrete with graphene nanoplatelets, offering a fast and cost-effective alternative to time-consuming experiments.Validerad;2024;Nivå 2;2024-04-03 (joosat);Funder: Prince Sattam bin Abdulaziz University (PSAU/2023/01/206862);Full text license: CC BY</p

Forecasting the strength of graphene nanoparticles-reinforced cementitious composites using ensemble learning algorithms

Integrating nanomaterials into concrete is a promising solution to improve concrete strength and durability. However, the intricacies of such nanoscale cementitious composites are highly complex. Traditional regression models encounter limitations in capturing these intricate compositions to provide accurate and reliable estimations. This study focuses on developing robust prediction models for the compressive strength (CS) of graphene nanoparticle-reinforced cementitious composites (GrNCC) through machine learning (ML) algorithms. Three ML models, bagging regressor (BR), decision tree (DT), and AdaBoost regressor (AR), were employed to predict CS based on a comprehensive dataset of 172 experimental values. Seven input parameters, including graphite nanoparticle (GrN) diameter, water-to-cement ratio (wc), GrN content (GC), ultrasonication (US), sand content (SC), curing age (CA), and GrN thickness (GT), were considered. The models were trained with 70 % of the data, and the remaining 30 % of the data was used for testing the models. Statistical metrics such as mean absolute error (MAE), root mean square error (RMSE) and correlation coefficient (R) were employed to assess the predictive accuracy of the models. The DT and AR models demonstrated exceptional accuracy, yielding high correlation coefficients of 0.983 and 0.979 for training, and 0.873 and 0.822 for testing, respectively. Shapley Additive exPlanation (SHAP) analysis highlighted the influential role of curing age and GrN thickness (GT), positively impacting CS, while an increased water-to-cement ratio (w/c) negatively affected CS. This study showcases the efficacy of ML techniques in accurately predicting CS of graphene nanoparticle-modified concrete, offering a swift and cost-effective approach for assessing nanomaterial impact on concrete strength and reducing reliance on time-consuming and expensive experiments.Validerad;2024;Nivå 1;2024-04-08 (marisr);Full text license: CC BY</p

Estimating compressive strength of concrete containing rice husk ash using interpretable machine learning-based models

The construction sector is a major contributor to global greenhouse gas emissions. Using recycled and waste materials in concrete is a practical solution to address environmental challenges. Currently, agricultural waste is widely used as a substitute for cement in the production of eco-friendly concrete. However, traditional methods for assessing the strength of such materials are both expensive and time-consuming. Therefore, this study uses machine learning techniques to develop prediction models for the compressive strength (CS) of rice husk ash (RHA) concrete. The ML techniques used in the present study include random forest (RF), light gradient boosting machine (LightGBM), ridge regression, and extreme gradient boosting (XGBoost). A total of 348 values of CS were collected from the experimental studies, and five characteristics of RHA concrete were taken as input variables. For the performance assessment of the models, multiple statistical metrics were used. During the training phase, the correlation coefficients (R) obtained for ridge regression, RF, XGBoost, and LightGBM were 0.943, 0.981, 0.985, and 0.996, respectively. In the testing set, the developed models demonstrated even higher performance, with correlation coefficients of 0.971, 0.993, 0.992, and 0.998 for ridge regression, RF, XGBoost, and LightGBM, respectively. The statistical analysis revealed that the LightGBM model outperformed other models, whereas the ridge regression model exhibited comparatively lower accuracy. SHapley Additive exPlanation (SHAP) method was employed for the interpretability of the developed model. The SHAP analysis revealed that water-to-cement is a controlling parameter in estimating the CS of RHA concrete. In conclusion, this study provides valuable guidance for builders and researchers to estimate the CS of RHA concrete. However, it is suggested that more input variables be incorporated and hybrid models utilized to further enhance the reliability and precision of the models.Validerad;2024;Nivå 2;2024-03-25 (joosat);Funder: Gulf University for Science and Technology (32093); Najran University (NU/NRP/SERC/12/6);Full text license: CC BY 4.0;</p

Strategy for Nasal Reconstruction in Atypical Facial Clefts

Summary:. It is difficult to put forward a strategy for the treatment of nasal clefts due to the rarity and diversity of anatomical aberrations of these cases contrary to the common nasal affection in cleft lip and palate patients, which differ in severity rather than differing in the morbid anatomy. This simple strategy for correction of these nasal clefts will hopefully help surgeons to achieve better results. In the mean time I intended to describe the morbid anatomy of these cases by choosing examples of each morbid anatomy

The link between the fibroblast growth factor-23-klotho-vitamin D3 axis and the renin-angiotensin-aldosterone axis in the development and progression of obesity-related kidney disease

Introduction and aim of the workObesity is established as an important contributor of increased diabetes mellitus, hypertension and cardiovascular disease, all of which can promote chronic kidney disease (CKD). Recently, there is a growing appreciation that even in the absence of these risks, obesity itself significantly increases CKD and accelerates its progression. The aim of this work is to evaluate the link between Renin-Angiotensin-Aldosterone System (RAAS) and FGF23-Klotho-1,25D3 axis and their impact in obese and non-obese CKD patients. Patients and methods In a cross sectional randomized multi centers study, two hundred twenty six CKD patients stage III and IV (eGFR20-60 ml/min/m2) have enrolled in this study as follows: group I; 87 non diabetic CKD patients aged 20-40 years with body mass index (BMI) between 20-25 kgm/m2; group II; 130 non diabetic CKD patients aged 20-40 years with (BMI) >30 kgm/m2 and group III; 89 CKD patients aged >60 years. All patient have been tested for plasma leptinlevels, 1,25-dihydrocholicalciferole (1,25D3), plasmaparathormone (PTH) Serum calcium (Ca), serum phosphorus (PO4), and plasma FGF-23 , plasma renin activity (PRA), plasma angiotensinogen receptor 1 &2 (AT1 & AT2) and plasma aldosterone (ALD) and pulse wave velocity (PWV). Results The eGFR was significantly reduced in the obese group II (eGFR=37.7±13.6) when compared with eGFR of the lean group I (eGFR=49.3±7.51) were P<0.001, but not significant when compared with the old age group III (eGFR=41.0±13.47). The obese group II shows significant increase in the ALD/PRA ratio when compared with the lean group I and old age group III (43.23±14.9) for group II vs 11.29±4.1 for group I, P<0.001 and 24.91±12.1 for group III, P<0.05 ). Regarding the FGF23-Klotho-vitD3 axis, its components of the obese group II (FGF23 259.55±138.6 Ru/ml; PTH 77.63±X32.4 pg/ml; S.PO 4.74±1.61 mg/dl) were significantly elevated when compared to the lean group I (FGF23 132.81±126.1 Ru/ml; PTH 59.18±24.7 pg/ml; S.PO4 3.85±0.92 mg/dl); the P values were <0.001, <0.01 and <0.05 respectively , while when compared with the old age group III (FGF23 179.33±237.4 Ru/ml; PTH 70.94±15.26 pg/ml; S.PO4 4.09±0.42 mg/dl), values were of less significance. Plasma insulin levels were significantly high in the obese group II (insulin=13.73±2.38fg/l) than the lean group I (insulin=5.59±2.31 fg/l) and P<0.001 and in group III p. insulin level was 10.7±1.68 (P<0.05). Conclusion Obesity per se is an independent risk factor in the development and progression of chronic kidney disease specially in young age patients

Trends of elevated parathormone serum titers in hemodialysis patients on intensive therapy for bone disease: A multicenter study

To determine the prevalence of controlled parathyroid hormone (PTH) serum levels with intensified therapy for chronic kidney disease mineral and bone disorder (CKD-MBD) in the dialysis population, we studied 563 chronic hemodialysis patients recruited from three different dialysis centers from three different major cities in the Kingdom of Saudi Arabia. The trend of the routine monthly chemistries related to CKD-MBD was evaluated besides the whole-molecule PTH serum levels over 28 months (January 2011 to April 2013). The cost ratios of the medications to the estimated dialysis total cost were calculated. There were 323 (57.4%) males in the study, and the mean age of the patients was 50.2 ± 15.2 years; 371 (65.9%) patients were initiated on dialysis before 2011. The causes of the original kidney disease included diabetes mellitus in 163 (29%) patients. Parathyroidectomy was performed in 23 (4.1%) patients and only six (23%) patients underwent the operation during the study period; most of the parathyroidectomies (69%) were performed before 2011. The trend of the medians of monthly serum levels of calcium, phosphorus, albumin, bicarbonate, alkaline phosphatase, serum levels of PTH and vitamin D25 assays showed better control of the levels with time. The added cost of cinacalcet was more significant than the other drugs, including vitamin D and phosphate binders, but the cost was minimal in comparison with the whole dialysis bill. The ratios of the discontinuation rates to the total patient-months of treatment for the different drugs were in the range of 3-4% and mostly due to transient overdosing of medications. We conclude that the trends of the median serum levels of PTH and related minerals in the CKD patients in our dialysis patients suggested a good inclination toward control and prevention of the vascular calcifications prevalent in the CKD-MBD. The popularity of use of new drugs such as cinacalcet is promising and does not seem to add much to the current out-patient cost of chronic dialysis

The potential ameliorative impacts of cerium oxide nanoparticles against fipronil-induced hepatic steatosis

Abstract Fipronil (FIP) is a phenylpyrazole insecticide that is commonly used in agricultural and veterinary fields for controlling a wide range of insects, but it is a strong environmentally toxic substance. Exposure to FIP has been reported to increase the hepatic fat accumulation through altered lipid metabolism, which ultimately can contribute to nonalcoholic fatty liver disease (NAFLD) development. The present study aimed to examine the function of cerium oxide nanoparticles (CeNPs) in protecting against hepatotoxicity and lipogenesis induced by FIP. Twenty-eight male albino rats were classified into four groups: FIP (5 mg/kg/day per os), CTR, CeNPs (35 mg/kg/day p.o.), and FIP + CeNPs (5 (FIP) + 35 (CeNPs) mg/kg/day p.o.) for 28 consecutive days. Serum lipid profiles, hepatic antioxidant parameters and pathology, and mRNA expression of adipocytokines were assessed. The results revealed that FIP increased cholesterol, height-density lipoprotein, triacylglyceride, low-density lipoprotein (LDL-c), and very-low-density lipoprotein (VLDL-c) concentrations. It also increased nitric oxide (NO) and malondialdehyde (MDA) hepatic levels and reduced glutathione peroxidase (GPx) and superoxide dismutase (SOD) enzyme activities. Additionally, FIP up-regulated the fatty acid-binding protein (FABP), acetyl Co-A carboxylase (ACC1), and peroxisome proliferator-activated receptor-alpha (PPAR-α). Immunohistochemically, a strong proliferation of cell nuclear antigen (PCNA), ionized calcium-binding adapter molecule 1 (Iba-1), cyclooxygenase-2 (COX-2) reactions in the endothelial cells of the hepatic sinusoids, and increased expression of caspase3 were observed following FIP intoxication. FIP also caused histological changes in hepatic tissue. The CeNPs counteracted the hepatotoxic effect of FIP exposure. So, this study recorded an ameliorative effect of CeNPs against FIP-induced hepatotoxicity