Conservative management of spontaneous miscarriage

Surgical evacuation of retained products of conception has for many years remained the standard management of spontaneous miscarriage. It is estimated that 80 000 evacuations are performed each year in the United Kingdom for women with early miscarriages (missed abortion and incomplete miscarriages). During the past decade preliminary reports of alternative non-surgical options demonstrated the safety of these options in relation to surgical uterine evacuation. There is still, however, some reluctance among clinicians in offering these alternative options to women. The work in this thesis is mainly focused on the role of conservative management of women with retained products of conception following a spontaneous miscarriage in the first trimester in comparison to the 'gold standard' surgical evacuation of the uterine cavity under general anaesthesia.An extensive review of the literature relevant to the management of these clinical conditions was carried out in the first chapter. It was very clear following the literature review that the lack of randomised trials of appropriate size, power and design has resulted in reluctance from the clinicians' side in adopting these options into routine daily practice.The second chapter in this thesis presents the results of a large randomised trial comparing the safety and efficacy of an expectant approach against those of surgical intervention using suction evacuation under general anaesthetic. This chapter has iv confirmed the safety and the relative effectiveness of conservative management when compared to surgical evacuation.A self-administered questionnaire based study was conducted to investigate the impact of seeing and handling the products of conception on the incidence of psychological adverse reactions in women managed conservatively as compared to the control group (women managed by surgical uterine evacuation). Women managed conservatively seemed to recover psychologically quicker than women managed by surgical evacuation.The impact of conservative management on the reproductive potential of women with retained products of conception was assessed in the fourth chapter. The first part of the fourth chapter studied the return of ovulation in a subgroup of women (n = 30) randomised to conservative management as compared to women (n = 30) randomised to surgical evacuation. The return of normal ovulation was examined by assessing the daily urinary excretion of luteinizing hormone (LH), pregnanediol (P₄) and total urinary oestrogen (E₂), follicular and endometrial development using transvaginal ultrasound. The second part of this chapter concentrated on following up women who desired to become pregnant from the two management groups. Conservative management had similar outcomes to surgical evacuation in relation to the reproductive performance.Finally, a systematic assessment of the cost-effectiveness of conservative management was carried out in comparison with surgical evacuation in the last chapter of the thesis, which revealed a potential for substantial cost savings in NHS resources with the widespread use of conservative management

An investigation on using solid waste materials as aggregate substitute in cementitious concrete composites

The problem of disposing and managing solid waste materials in the United Slates and other industrial countries has become one of the major environmental, economical, and social issues. A complete waste management system including source reduction, reuse, recycling, landfilling, and incineration needs to be implemented to control the increasing waste disposal problems. Of the above options, recycling is the most promising waste management process to the disposal of materials in the waste stream. One of the most promising markets to utilize recycled waste materials successfully on an open-loop basis is the construction industry. The purpose of this research study was to evaluate the possibility of using different granulated solid waste materials (plastics, fiberglass, and glass) from different sources as partial aggregate substitutes to the fine aggregate (sand) in a portland cement concrete mixture to produce new concrete composites. Three different types of concrete composites containing one of these aggregate waste materials were prepared. Four different volume percentages of aggregate substitute (5, 10, 15, and 20%) were utilized for each additive. A control cementitious concrete composite was also prepared as a reference for the new concrete composites. Three different test methods were conducted on these cementitious concrete composites: compression strength test, splitting tensile strength test, and flexure test. Standard ASTM procedures were followed in casting of and testing all the flexural beams and concrete cylinders and the curing of 28-day concrete samples. Statistical procedures of the data obtained were used to determine any significant differences among the values of the mechanical properties of the tested concrete composites. Graphical representation and analysis of the calculated results were also performed to compare the developed cementitious concrete composites with the control specimens. Furthermore, a scanning electron microscope (SEM) was used to study the relationship between these mechanical properties and the microstructure and interfacial features of the new concrete composites. Optical photographs were also obtained to show the general fracture behaviors of these composites. The main findings of this investigation revealed that increasing the volume percentage of plastics aggregate substitute to the cementitious concrete composite led, in general, to a slight reduction of the compressive, splitting tensile, and flexural strengths. On the other hand, the stiffness of these plastics-containing concrete composites was almost the same as that of the control one. In case of glass-containing concrete composites, the average values of compressive and splitting tensile strengths of these composites were comparable to those of the control one. On the other hand, the values of the modulus of rupture and elasticity of all the tested glass-containing concrete composites were almost the same as (and in some cases especially at 20% glass aggregate substitute higher than) those of the control one. In case of fiberglass-containing concrete composites, adding more volume percentages of this aggregate substitute to the cementitious concrete composite led to reducing the compressive, splitting tensile, and flexural strengths of the cementitious concrete composite. On the other hand, adding more volume percentage of fiberglass aggregate substitute to the cementitious concrete composite led to an increase in the stiffness of this composite. Based on the present research study, it is believed that the visual analysis technique should be strongly recommended to compare the properties of different types of concrete composites qualitatively. This technique may also be used to predict whether different concrete composites have the same brittle or ductile fracture modes under different loading systems

Role of machine learning in early diagnosis of kidney diseases.

Machine learning (ML) and deep learning (DL) approaches have been used as indispensable tools in modern artificial intelligence-based computer-aided diagnostic (AIbased CAD) systems that can provide non-invasive, early, and accurate diagnosis of a given medical condition. These AI-based CAD systems have proven themselves to be reproducible and have the generalization ability to diagnose new unseen cases with several diseases and medical conditions in different organs (e.g., kidneys, prostate, brain, liver, lung, breast, and bladder). In this dissertation, we will focus on the role of such AI-based CAD systems in early diagnosis of two kidney diseases, namely: acute rejection (AR) post kidney transplantation and renal cancer (RC). A new renal computer-assisted diagnostic (Renal-CAD) system was developed to precisely diagnose AR post kidney transplantation at an early stage. The developed Renal-CAD system perform the following main steps: (1) auto-segmentation of the renal allograft from surrounding tissues from diffusion weighted magnetic resonance imaging (DW-MRI) and blood oxygen level-dependent MRI (BOLD-MRI), (2) extraction of image markers, namely: voxel-wise apparent diffusion coefficients (ADCs) are calculated from DW-MRI scans at 11 different low and high b-values and then represented as cumulative distribution functions (CDFs) and extraction of the transverse relaxation rate (R2*) values from the segmented kidneys using BOLD-MRI scans at different echotimes, (3) integration of multimodal image markers with the associated clinical biomarkers, serum creatinine (SCr) and creatinine clearance (CrCl), and (4) diagnosing renal allograft status as nonrejection (NR) or AR by utilizing these integrated biomarkers and the developed deep learning classification model built on stacked auto-encoders (SAEs). Using a leaveone- subject-out cross-validation approach along with SAEs on a total of 30 patients with transplanted kidney (AR = 10 and NR = 20), the Renal-CAD system demonstrated 93.3% accuracy, 90.0% sensitivity, and 95.0% specificity in differentiating AR from NR. Robustness of the Renal-CAD system was also confirmed by the area under the curve value of 0.92. Using a stratified 10-fold cross-validation approach, the Renal-CAD system demonstrated its reproduciblity and robustness with a diagnostic accuracy of 86.7%, sensitivity of 80.0%, specificity of 90.0%, and AUC of 0.88. In addition, a new renal cancer CAD (RC-CAD) system for precise diagnosis of RC at an early stage was developed, which incorporates the following main steps: (1) estimating the morphological features by applying a new parametric spherical harmonic technique, (2) extracting appearance-based features, namely: first order textural features are calculated and second order textural features are extracted after constructing the graylevel co-occurrence matrix (GLCM), (3) estimating the functional features by constructing wash-in/wash-out slopes to quantify the enhancement variations across different contrast enhanced computed tomography (CE-CT) phases, (4) integrating all the aforementioned features and modeling a two-stage multilayer perceptron artificial neural network (MLPANN) classifier to classify the renal tumor as benign or malignant and identify the malignancy subtype. On a total of 140 RC patients (malignant = 70 patients (ccRCC = 40 and nccRCC = 30) and benign angiomyolipoma tumors = 70), the developed RC-CAD system was validated using a leave-one-subject-out cross-validation approach. The developed RC-CAD system achieved a sensitivity of 95.3% ± 2.0%, a specificity of 99.9% ± 0.4%, and Dice similarity coefficient of 0.98 ± 0.01 in differentiating malignant from benign renal tumors, as well as an overall accuracy of 89.6% ± 5.0% in the sub-typing of RCC. The diagnostic abilities of the developed RC-CAD system were further validated using a randomly stratified 10-fold cross-validation approach. The results obtained using the proposed MLP-ANN classification model outperformed other machine learning classifiers (e.g., support vector machine, random forests, and relational functional gradient boosting) as well as other different approaches from the literature. In summary, machine and deep learning approaches have shown potential abilities to be utilized to build AI-based CAD systems. This is evidenced by the promising diagnostic performance obtained by both Renal-CAD and RC-CAD systems. For the Renal- CAD, the integration of functional markers extracted from multimodal MRIs with clinical biomarkers using SAEs classification model, potentially improved the final diagnostic results evidenced by high accuracy, sensitivity, and specificity. The developed Renal-CAD demonstrated high feasibility and efficacy for early, accurate, and non-invasive identification of AR. For the RC-CAD, integrating morphological, textural, and functional features extracted from CE-CT images using a MLP-ANN classification model eventually enhanced the final results in terms of accuracy, sensitivity, and specificity, making the proposed RC-CAD a reliable noninvasive diagnostic tool for RC. The early and accurate diagnosis of AR or RC will help physicians to provide early intervention with the appropriate treatment plan to prolong the life span of the diseased kidney, increase the survival chance of the patient, and thus improve the healthcare outcome in the U.S. and worldwide

A non-invasive diagnostic system for early assessment of acute renal transplant rejection.

Early diagnosis of acute renal transplant rejection (ARTR) is of immense importance for appropriate therapeutic treatment administration. Although the current diagnostic technique is based on renal biopsy, it is not preferred due to its invasiveness, recovery time (1-2 weeks), and potential for complications, e.g., bleeding and/or infection. In this thesis, a computer-aided diagnostic (CAD) system for early detection of ARTR from 4D (3D + b-value) diffusion-weighted (DW) MRI data is developed. The CAD process starts from a 3D B-spline-based data alignment (to handle local deviations due to breathing and heart beat) and kidney tissue segmentation with an evolving geometric (level-set-based) deformable model. The latter is guided by a voxel-wise stochastic speed function, which follows from a joint kidney-background Markov-Gibbs random field model accounting for an adaptive kidney shape prior and for on-going visual kidney-background appearances. A cumulative empirical distribution of apparent diffusion coefficient (ADC) at different b-values of the segmented DW-MRI is considered a discriminatory transplant status feature. Finally, a classifier based on deep learning of a non-negative constrained stacked auto-encoder is employed to distinguish between rejected and non-rejected renal transplants. In the “leave-one-subject-out” experiments on 53 subjects, 98% of the subjects were correctly classified (namely, 36 out of 37 rejected transplants and 16 out of 16 nonrejected ones). Additionally, a four-fold cross-validation experiment was performed, and an average accuracy of 96% was obtained. These experimental results hold promise of the proposed CAD system as a reliable non-invasive diagnostic tool

Effect of Life Style Modification's Nursing Program on Post-operative Outcomes of Patients with Selected Benign Perianal Diseases

Benign perianal diseases are common pathologic lesions affecting millions worldwide which lead to significant morbidity and representing major medical and socioeconomic problems . This study aiming to evaluate the effect of life style modification's nursing program on post-operative outcomes of patients with selected benign perianal diseases. Subjects: A purposive sample of 100 adult patients undergoing a surgical procedure for hemorrhoid or/and anal fissure. Setting: The study was conducted at the general surgery department and general surgery out patient's clinics of Menoufia University hospital and Shebien El- kom Teaching hospital. Tools of the study: Four tools were utilized. Tool I: An interviewing questionnaire includes three parts: Personal data, medical data and patient's knowledge about diet and behavioral modification. Tool II: Post-operative complications assessment sheet. Tool III: Kegel exercise's performance checklist Tool IV: Self reported compliance assessment sheet. Results: There was statistically significant difference between study and control group regarding total means of knowledge, behavioral and exercises performance after intervention. There was statistically significant difference between study group and control group regarding post- operative complication. There were statistically significant differences regarding compliance about diet, behavioral modification and exercises in the study group than control group.  Also, there was statistically significant reduction of recurrent manifestation of study group and control group after and six months. Conclusion: The implementation of lifestyle modifications program had led to improve healthy habits regarding diet, behavior and exercise practice that leading to reduce postoperative complication and also, is more effective on prevent the recurrence of manifestation after six months of follow up. Recommendations: Generalizing dietary and behavioral life style modifications among patients to prevent diseases initiation / symptoms aggravation reduce the incidence of surgery and disease recurrence after surgery. Keywords: Life Style Modification's nursing program, Post-operative outcomes &Selected benign perianal diseases. DOI: 10.7176/JHMN/60-10 Publication date:March 31st 201

Reduced erbium-doped ceria nanoparticles: one nano-host applicable for simultaneous optical down- and up-conversions

This paper introduces a new synthesis procedure to form erbium-doped ceria nanoparticles (EDC NPs) that can act as an optical medium for both up-conversion and down-conversion in the same time. This synthesis process results qualitatively in a high concentration of Ce(3+) ions required to obtain high fluorescence efficiency in the down-conversion process. Simultaneously, the synthesized nanoparticles contain the molecular energy levels of erbium that are required for up-conversion. Therefore, the synthesized EDC NPs can emit visible light when excited with either UV or IR photons. This opens new opportunities for applications where emission of light via both up- and down-conversions from a single nanomaterial is desired such as solar cells and bio-imaging

Evaluation of Pregnant Women's Knowledge and Attitude Toward Banking of Stem Cells from the Umbilical Cord Blood Before and After Counseling

Background: Nowadays the collection of stem cells from the umbilical cord blood is one of the most important topics of health sciences. Pregnant women need to understand or at the very least know about stem cells researches so they can preserve their babies' future health. Purpose: This study was conducted with the purpose of evaluating the pregnant women's knowledge and attitude toward banking of stem cells from the umbilical cord blood before and after counseling. Methods: Research Design: A quasi-experimental design (with pre and post test).  Tools: Three instruments were used throughout the course of this study: (I) interviewing questionnaire, (II) women's knowledge assessment sheet and (III) women's attitude scale. Main results: There was a highly statistically significant difference between knowledge and attitude scores at the pre and post test. Conclusion: both study hypotheses were accepted. Pregnant women's score of knowledge about banking of stem cells from the umbilical cord blood was increased after counseling as compared to before. Pregnant women's score of attitude about banking of stem cells from the umbilical cord blood was increased after counseling as compared to before. Recommendations: The current study can be replicated on a larger sample and on a national base in country to serve as a base for antenatal educational program to raise women's awareness about cord blood banking. The current studied topic should be included in the antenatal education at the third trimester of pregnancy. The study booklet can be handed to women during their antenatal visits. In-service training programs about new trends in nursing care and practices must be developed to enhance nurses' knowledge so become able to properly counsel pregnant women. Keywords: knowledge, attitude, stem cells banking and umbilical cord blood and counseling

Wound Surface Area and Colony Count of Various Modes of Phototherapy

Background: The degree of tissue damage caused by related inflammatory and immunological sequelae poses a major therapeutic treatment problem in burn wounds. Chronic wounds frequently have a significant bioburden and pathogens that are resistant to antibiotics. This review article discusses present research on phototherapy, which is believed to be useful in managing wound bioburden and promoting healing.Objective: To evaluate the wound healing efficacy of polarized light therapy (BLT) against low-level laser therapy (GaAs laser) in order to determine which is more efficient and successful at speeding burn healing.Subject and methods: The current study enrolled thirty patients having partial thickness thermal burn on the forearm (dermal burn). They were selected from Burn Unit at Legislation Association Hospital for Burns & Oncology. They were randomly assigned into two equal groups: Group (A) that included fifteen patients who received the BLT with mean age of 28.8 ± 2.51 years old and group (B) that enrolled fifteen patients who received LLLT with mean age of 29.6 ± 2.79 years old. Both groups also received traditional physical therapy and conservative treatment for the burn site three times weekly for four weeks.Results: Group A and B showed a significant reduction in colony count and wound surface area after treatment in comparison to that before treatment (p > 0.001). In group A, the colony count and wound surface area decreased by 38.63% and 55.1% respectively, but in group B, by 15.6% and 37.92% respectively.Conclusion: Both polarized light therapy and low-level laser therapy had a therapeutic efficiency on wound healing, but BLT is more efficient and more successful in the acceleration of the burned wounds healing

Smart Touch Radiofrequency Catheter Ablation versus Cryoballoon Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

AIM: Evaluation of the safety and efficacy of pulmonary veins isolation in patients with paroxysmal atrial fibrillation (AF) using two new different technologies, cryoballoon (CB) ablation and radiofrequency ablation with contact force (CF)-sensing catheters. METHODS: Prospective single-center evaluation, carried out from January 2016 to June 2018 in Critical Care Medicine Department – Cairo University, comparing CF radiofrequency (Thermocool® SmartTouch, Biosense Webster, Inc.) (CF group) with CB ablation (Arctic Front Advance 28 mm CB, Medtronic, Inc.) (CB group), in regards to procedural safety and efficacy, as well as recurrence at 12 months. Overall, 50 consecutive patients were enrolled (25 in each group). RESULTS: The characteristics of patients of both the groups were similar (46.9 ± 11.2 years, the proportion of women 36%, mean documented AF duration 3 ± 2.3 years, mean CHA2DS2-VASc score 1.4 ± 1.3, and mean HAS-BLED 1.4 ± 0.6). Duration of the procedure was significantly lower in the CB group (171.7 ± 15.24 vs. 199.3 ± 18.94 min, p = 0.002), with a longer duration of fluoroscopy and X-ray exposure in the CB group than the CF group but statistically non-significant difference (58.60 ± 11.57 vs. 48.7 ± 13.86 min and 6273 ± 4934 cGy cm² vs. 6853 ± 5069 cGy cm², p = 0.1 and p = 0.2, respectively). Overall complication rate was similar in both groups: 2 (8%) in each group. At 12 months, AF recurrence occurred in 7 patients (28%) in the CF group and in 9 patients (36%) in the CB group (log rank p = 0.682). CONCLUSION: Pulmonary vein isolation using CF-guided RF and second-generation CB leads to comparable single-procedure arrhythmia-free survival at up to 12 months with similar overall complication rate