A Comparative Study of Pedicled Versus Skeletonized Left Internal Mammary Artery Harvesting Techniques Regarding Rate of Mediastinitis Post CABG in Diabetic Patients

Background: For grafting the left anterior descending (LAD) coronary artery, the left internal mammary artery (LIMA) has become the gold standard. Pedicled and skeletonized methods are the two most common harvesting procedures. Objective: In this study we compared between both techniques regarding incidence of postoperative mediastinitis in diabetic patients. Patients and methods: 80 diabetic patients with controlled diabetes i.e. HbA1c below 7 underwent on-pump coronary artery bypass grafting (CABG) surgery were included in this study. The patients were divided into two groups, according to the procedure applied to harvest the LIMA: Group 1: 40 patients underwent pedicled LIMA and Group 2: 40 patients underwent skeletonized LIMA. After CABG surgery, the cases had a 3-month follow-up time. Results: In the pedicled LIMA group, the frequency of excessive intraoperative usage of bone wax was significantly increased. A significant increase was found regarding the occurrence of sternal wound infections (SWI) in the pedicled LIMA group (22.5%) versus (12.5%) within the skeletonized one, (P-value = 0.003). The univariate analysis of the factors related to SWI in all of the studied CABG patients were obesity [OR (95% CI): 15.61 (5.78-42.12), P <0.001], pedicled ITA [OR (95% CI): 4.3(1.4-12.9), P 0.004], intraoperative excessive use of bone wax [OR (95% CI): 14.53(6.48-32.56), P <0.001], and intraoperative excessive use of diathermy [OR (95% CI): 17.31(7.55-39.4), P <0.001]. Conclusion: In comparison to pedicled LIMA, skeletonized LIMA in CABG was correlated to reduced occurrence of superficial as well as deep SWI among diabetic patients

The value of intra-abdominal pressure monitoring through transvesical route in the choice and outcome of management of congenital abdominal wall defects

Introduction Gastroschisis and omphalocele are most common congenital abdominal wall defects (AWDs). Surgical management aims to reduce the evisceration safely, close the defect with a cosmetically acceptable outcome under guidance of intraoperative monitoring of intra-abdominal pressure (IAP). Intravesical pressure monitoring technique recommended by (WSACS) is the most reliable technique for IAP measurement in neonates.Aim The aim of this study is to assess the value of IAP monitoring via vesical pressure measurement in the choice and outcome of management of congenital AWDs.Patients and methods This is a prospective study of 25 cases that suffered congenital anterior AWDs (gastroschisis and omphalocele) admitted to Mansoura University Children Hospital during the period from October 2013 to October 2015. They were all operated upon guided by IVP monitoring during and after repair. Results In our study, 14 (56%) cases presented with gastroschisis and 11 (44%) presented with exomphalos with a median age of 24 h. Males (56%) were slightly more than females (44%). Congenital anomalies were reported in 16 cases (64%). Primary fascial closure was successful in 15 (60%) cases, whereas Silo repair was done in six (24%) cases and skin closure in only four (16%) cases. During the attempts of closure the mean abdominal perfusion pressure was 40.24 ± 5.59, the mean peak inspiratory pressure was 24 ±6.11 and the mean IAP was 22.60± 6.89. Two cases developed intra-abdominal hypertension after abdominal closure (8%) and only one of them needed decompressive laparotomy (4%). Postoperative complications were reported in 15 (60%) cases and mortality occurred in eight (32%) cases.Conclusion Increased IAP secondary to forceful closure of the abdominal defect is associated with the occurrence of complications. IVP monitoring is feasible during closure of AWDs and a threshold of 20cm H2O is  appropriate to decide between primary and staged approach. Keywords: congenital abdominal wall defect, intravesical pressure, intra-abdominal hypertensio

Acute compartment syndrome of the forearm as a rare complication of toxic epidermal necrolysis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Toxic epidermal necrolysis lies within the spectrum of severe cutaneous adverse reactions induced by drugs, affecting skin and mucous membranes. Toxic epidermal necrolysis is considered a medical emergency as it is considered to be potentially fatal and carries a high mortality rate. To the best of our knowledge the association of toxic epidermal necrolysis and compartment syndrome has been rarely mentioned in the literature. In this case we treated the compartment syndrome promptly despite the poor general condition and skin status of our patient. Despite the poor skin condition, wound healing was uneventful with no complications.</p> <p>Case presentation</p> <p>A 62-year-old Caucasian man with a generalized macular-vesicular rash involving 90% of his body surface area and mucous membranes, as well as impaired renal and hepatic functions following ingestion of allopurinol for treatment of gout, was admitted to our hospital. Skin biopsies were taken and he was started on a steroid infusion. Within hours of admission, he developed acute compartment syndrome of the dominant forearm and hand.</p> <p>Conclusions</p> <p>Despite its rare incidence, toxic epidermal necrolysis is a condition with a high incidence of complications and mortality. Patients with severe conditions affecting a large degree of the skin surface area should be treated as promptly and effectively as patients with burns, with close monitoring and the anticipation that rare musculoskeletal complications might arise. The association of compartment syndrome and toxic epidermal necrolysis might lead to a rapid deterioration and fatal systemic involvement and multiple organ failures.</p

Evaluation of laparoscopic-assisted anorectoplasty for the management of intermediate and high anorectal malformations in boys: Mansoura experience

Introduction: Laparoscopic-assisted anorectoplasty (LAARP) has been gaining great popularity for management of imperforate anus. This study aims to evaluate the use of this technique for high and intermediate anorectal malformations in boys.Patients and methods: From December 2012 to December 2016, we performed LAARP on 20 boys, all of which were colostomized at birth. Findings regarding the patients’ age at operation, type of anomaly, associated morbidities, sacral ratios, operative time, intraoperative complications, hospital stay, immediate/long-term postoperative complications, and reoperations were noted. Postoperatively, we evaluated the patients using barium enema, an ascending and voiding cystourethrogram, pelvic MRI, and a functional continence evaluation questionnaire.Results: A total of 11 patients presented with rectourethral bulbar fistula (RBF), seven with rectourethral prostatic fistula (RPF), one with rectovesical fistula, and one with no fistula. Mean sacral ratio was 0.82 ± 0.19. Mean age at time of LAARP was 236 ± 77 days. Mean operative time was 152 ± 32 min. Our most common intraoperative complication was peritoneal contamination (20%). Incidence of rectal mucosal prolapse was 40%. Barium enema revealed a mean rectoanal angle of 107 ± 13°. Ascending and voiding cystourethrogram revealed a residual urethral diverticulum in seven cases, six of which had RBFs. Mean MRI placement score obtained was 0.76± 0.51 denoting excellent rectal position.Conclusion: Usage of LAARP to manage high and intermediate anorectal malformations in boys is feasible, allowing accurate rectal placement within the muscle complex and with good postoperative functional results. Residual urethral diverticulum occurred more frequently in patients with RBF. Incidence of mucosal prolapse is high after LAARP and should be avoided.Keywords: laparoscopic-assisted anorectoplasty, anorectal malformations, residual urethral diverticulum post LAAR

Microwave Assisted Synthesis Of Binary Metallic Oxides For Catalysis Applications

Herein, versatile, and reproducible method to prepare binary metal oxides via microwave assisted synthesis. Catalysts are substances that basically speeds up chemical reactions. Ideally, bonds are formed between the catalysts and the reactants. Also, catalysts permit formation of products from the reactants. These formed products, splits off the catalyst without affecting or changing it. Catalytic kinetics studies the correlate chemical reaction rate with some properties of reactants and/or products for instance, temperature, concentration and pressure. The aim of the project is to prepare pure and bi-metal iron-based catalyst by co-precipitation method and to characterize the prepared sample using X-ray diffraction. Metal oxides nanoparticles is a field of interest in catalysis, such that these oxides are used to oxidize carbon monoxide. The samples were prepared through co-precipitation method in laboratory scale. The metals used was copper, iron and cobalt. After preparing pure sample of each metal a mix of two metals were introduced in different ratios. The samples were characterized via X-ray diffraction (XRD) and then the results were compared to exist data introduced from others research, the prepared samples XRD was having a great matching with the data retrieved from internet and we found that the metal could exist in two form of oxides and even could exist as pure metal. Each peak in the XRD figure could indicate one or more phase of the metal

Contact osteogenesis by biodegradable 3D-printed poly(lactide-co-trimethylene carbonate)

Background To support bone regeneration, 3D-printed templates function as temporary guides. The preferred materials are synthetic polymers, due to their ease of processing and biological inertness. Poly(lactide-co-trimethylene carbonate) (PLATMC) has good biological compatibility and currently used in soft tissue regeneration. The aim of this study was to evaluate the osteoconductivity of 3D-printed PLATMC templates for bone tissue engineering, in comparison with the widely used 3D-printed polycaprolactone (PCL) templates. Methods The printability and physical properties of 3D-printed templates were assessed, including wettability, tensile properties and the degradation profile. Human bone marrow-derived mesenchymal stem cells (hBMSCs) were used to evaluate osteoconductivity and extracellular matrix secretion in vitro. In addition, 3D-printed templates were implanted in subcutaneous and calvarial bone defect models in rabbits. Results Compared to PCL, PLATMC exhibited greater wettability, strength, degradation, and promoted osteogenic differentiation of hBMSCs, with superior osteoconductivity. However, the higher ALP activity disclosed by PCL group at 7 and 21 days did not dictate better osteoconductivity. This was confirmed in vivo in the calvarial defect model, where PCL disclosed distant osteogenesis, while PLATMC disclosed greater areas of new bone and obvious contact osteogenesis on surface. Conclusions This study shows for the first time the contact osteogenesis formed on a degradable synthetic co-polymer. 3D-printed PLATMC templates disclosed unique contact osteogenesis and significant higher amount of new bone regeneration, thus could be used to advantage in bone tissue engineering.publishedVersio

Enhancement of nitrogen prediction accuracy through a new hybrid model using ant colony optimization and an Elman neural network

Advanced human activities, including modern agricultural practices, are responsible for alteration of natural concentration of nitrogen compounds in rivers. Future prediction of nitrogen compound concentrations (especially nitrate-nitrogen and ammonia-nitrogen) are important for countries where household water is obtained from rivers after treatment. Increased concentrations of nitrogen compounds result in the suspension of household water supplies. Artificial Neural Networks (ANNs) have already been deployed for the prediction of nitrogen compounds in various countries. But standalone ANN have several limitations. However, the limitations of ANNs can be resolved using hybrid models. This study proposes a new ACO-ENN hybrid model developed by integrating Ant Colony Optimization (ACO) with an Elman Neural Network (ENN). The developed ACO-ENN hybrid model was used to improve the prediction results of nitrate-nitrogen and ammonia-nitrogen prediction models. The results of new hybrid models were compared with multilayer ANN models and standalone ENN models. There was a significant improvement in the mean square errors (MSE) (0.196→0.049→0.012, i.e. ANN→ENN→Hybrid), mean absolute errors (MAE) (0.271→0.094→0.069) and Nash–Sutcliffe efficiencies (NSE) (0.7255→0.9321→0.984). The hybrid model had outstanding performance compared with the ANN and ENN models. Hence, the prediction accuracy of nitrate-nitrogen and ammonia-nitrogen has been improved using new ACO-ENN hybrid model

Optimised neural network model for river nitrogen prediction utilizing a new training approach

In the past few decades, there has been a rapid growth in the concentration of nitrogenous compounds such as nitrate-nitrogen and ammonia-nitrogen in rivers, primarily due to increasing agricultural and industrial activities. These nitrogenous compounds are mainly responsible for eutrophication when present in river water, and for ‘blue baby syndrome’ when present in drinking water. High concentrations of these compounds in rivers may eventually lead to the closure of treatment plants. This study presents a training and a selection approach to develop an optimum artificial neural network model for predicting monthly average nitrate-N and monthly average ammonia-N. Several studies have predicted these compounds, but most of the proposed procedures do not involve testing various model architectures in order to achieve the optimum predicting model. Additionally, none of the models have been trained for hydrological conditions such as the case of Malaysia. This study presents models trained on the hydrological data from 1981 to 2017 for the Langat River in Selangor, Malaysia. The model architectures used for training are General Regression Neural Network (GRNN), Multilayer Neural Network and Radial Basis Function Neural Network (RBFNN). These models were trained for various combinations of internal parameters, input variables and model architectures. Post-training, the optimum performing model was selected based on the regression and error values and plot of predicted versus observed values. Optimum models provide promising results with a minimum overall regression value of 0.92