CIFAR-10: KNN-based Ensemble of Classifiers

In this paper, we study the performance of different classifiers on the CIFAR-10 dataset, and build an ensemble of classifiers to reach a better performance. We show that, on CIFAR-10, K-Nearest Neighbors (KNN) and Convolutional Neural Network (CNN), on some classes, are mutually exclusive, thus yield in higher accuracy when combined. We reduce KNN overfitting using Principal Component Analysis (PCA), and ensemble it with a CNN to increase its accuracy. Our approach improves our best CNN model from 93.33% to 94.03%

MicroRNA Modulate Alveolar Epithelial Response to Cyclic Stretch

Background MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression implicated in multiple cellular processes. Cyclic stretch of alveoli is characteristic of mechanical ventilation, and is postulated to be partly responsible for the lung injury and inflammation in ventilator-induced lung injury. We propose that miRNAs may regulate some of the stretch response, and therefore hypothesized that miRNAs would be differentially expressed between cyclically stretched and unstretched rat alveolar epithelial cells (RAECs). Results RAECs were isolated and cultured to express type I epithelial characteristics. They were then equibiaxially stretched to 25% change in surface area at 15 cycles/minute for 1 hour or 6 hours, or served as unstretched controls, and miRNAs were extracted. Expression profiling of the miRNAs with at least 1.5-fold change over controls revealed 42 miRNAs were regulated (34 up and 8 down) with stretch. We validated 6 of the miRNAs using real-time PCR. Using a parallel mRNA array under identical conditions and publicly available databases, target genes for these 42 differentially regulated miRNAs were identified. Many of these genes had significant up- or down-regulation under the same stretch conditions. There were 362 down-regulated genes associated with up-regulated miRNAs, and 101 up-regulated genes associated with down-regulated miRNAs. Specific inhibition of two selected miRNAs demonstrated a reduction of the increased epithelial permeability seen with cyclic stretch. Conclusions We conclude that miRNA expression is differentially expressed between cyclically stretched and unstretched alveolar epithelial cells, and may offer opportunities for therapeutic intervention to ameliorate stretch-associated alveolar epithelial cell dysfunction

Laparoscopic Hernia Repair in Infancy and Childhood; Evaluation of Two Different Techniques

Background/Purpose: There are many techniques available for laparoscopic hernia repair in infancy and childhood. The objective of this study is to compare two different laparoscopic techniques as regards operative time, recurrence rate, hydrocele formation and post operative cosmetic results. Materials & Methods: A prospective randomized controlled study was carried out in the Pediatric Surgery Unit of Al- Azhar University Hospitals, over three years period. ne-hundred and fifty patients with congenital inguinal hernia were randomized into two equals groups; (n = 75). Group A was subjected to purse-string suture around the internal inguinal ring (IIR) using two needle holders (TNH). Group B was subjected to laparoscopic hernia repair of inguinal hernia by Reverdin Needle (RN). Inclusion criteria included; bilateral inguinal hernia, recurrent hernia, hernia in obese child, incarcerated hernia and hernia on ipsilateral with questionable contralateral side. Exclusion criteria included; unilateral inguinal hernia, and hernia with undescended testicles. The main outcome measurements were; operative time, hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results. Results: There were no significant differences as regard age, sex and mode of presentation between both groups. All cases were completed successfully without conversion. There were significant statistical differences in the operative time between the studied groups, while there were no significant statistical differences in the hospital stay, post operative hydrocele formation and recurrence rate. The cosmetic result is excellent in group B. Conclusion: Laparoscopic hernia repair by RN is an effective line of hernia repair in infancy and childhood. It resulted in marked reduction of operative time and excellent cosmetic results with low recurrence. Index Word: Laparoscopic, Reverdin Needle, Purse-string, Intracorporeal sutures

Angiogenesis: Managing the Culprits behind Tumorigenesis and Metastasis

Deregulated angiogenesis has been identified as a key contributor in a number of pathological conditions including cancer. It is a complex process, which involves highly regulated interaction of multiple signalling molecules. The pro-angiogenic signalling molecule, vascular endothelial growth factor (VEGF) and its cognate receptor 2 (VEGFR-2), which is often highly expressed in majority of human cancers, plays a central role in tumour angiogenesis. Owing to the importance of tumour vasculature in carcinogenesis, tumour blood vessels have emerged as an excellent therapeutic target. The anti-angiogenic therapies have been shown to arrest growth of solid tumours through multiple mechanisms, halting the expansion of tumour vasculature and transient normalization of tumour vasculature which help in the improvement of blood flow resulting in more uniform delivery of cytotoxic agents to the core of tumour mass. This also helps in reduction of hypoxia and interstitial pressure leading to reduced chemotherapy resistance and more uniform delivery of cytotoxic agents at the targeted site. Thus, complimentary combination of different agents that target multiple molecules in the angiogenic cascade may optimize inhibition of angiogenesis and improve clinical benefit in the cancer patients. This review provides an update on the current trend in exploitation of angiogenesis pathways as a strategy in the treatment of cancer.Ashwaq H. S. Yehya is funded by TWAS (The Academy of Sciences for the Developing World, Italy). Chern Ein Oon is supported by L’Oréal-UNESCO for Women in Science National Fellowship (304/CIPPM/650806/L117) and MAKNA Cancer Research Award (304/CIPPM/650859/M122)

Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients

Background: Obesity and intraoperative (IO) opioid are risk-factors during bariatric surgery and require certain manipulations to deal with. Enhanced recovery after surgery (ERAS) and spare-opioid use protocol (SOUP) might aid to bypass these risk factors Objectives: Evaluation of the outcomes of ERAS protocol with SOUP application for morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). Patients and methods: 60 obese patients were allocated into Group-C received conventional opioid-based anaesthesia and postoperative (PO) analgesia and Group-E received the ERAS protocol with SOUP application. All patients received balanced sevoflurane anesthesia 2% in oxygen 100% and rocuronium and 4-ports LSG. The study outcome is the efficacy of the applied protocol to provide IO and PO opioid-free analgesia during major surgeries for risky patients. Results: All surgeries were conducted without a shift to laparotomy or conventional opioid-based anesthesia. Group-E patients had significantly shorter PACU stays (P=0.035) and higher Aldrete scores at time of PACU discharge (P=0.023). Among Group-E patients, 5 required IO fentanyl shots and 3 patients received PO morphine shots. Group-E patients showed significantly lower PO nausea (P=0.032) and need for antiemetic therapy (P=0.005), earlier ambulation (P=0.020) and oral intake (P=0.034) and hospital discharge (P=0.014). Conclusion: Implementation of ERAS with SOUP protocols is a feasible, effective and safe anesthetic policy for high-risk patients undergoing major surgeries. The applied SOUP spared the need for opioid analgesia in about 90% of patients. The applied anesthetic policy improved immediate surgical outcomes, and reduced times for PACU discharge, ambulation, oral intake and PO hospital stay with cost reductions

Optimisation of arsenic adsorption from water by carbon nanofibres grown on powdered activated carbon impregnated with nickel

Contamination of water due to arsenic (As) is increasing in many parts of the world. The removal of As from aqueous solution by using impregnated carbon nanofibres (CNFs) as the adsorbent is reported in this paper. The effects of pH, CNFs dosage, contact time and initial concentration of arsenic were studied at room temperature (±25°C). The interactions among the parameters were also investigated. The data obtained from the adsorption experiment were analysed using statistical software in order to develop a regression equation to represent the optimum operating conditions. The interactions of each parameters were considered during this analysis and the result indicated that the highest removal (97.25%) of As can be attained at pH 6, initial concentration of arsenic of 0.08 mg L-1, contact time of 60 min and CNF dosage of 200 mg L-1. Comparison between impregnated CNF and Powdered Activated Carbon (PAC) were also done and it is determined that impregnated CNF has better removal compared to PAC alone. The final concentration of As after the treatment using CNFs was about 8 ~ 10 times less than that of using PAC. Therefore, it can be concluded that CNFs are highly potential for the adsorption of As from water

Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome:A PARDIE Study

Rationale: Few data exist to guide early adjunctive therapy use in pediatric acute respiratory distress syndrome (PARDS). Objectives: To describe contemporary use of adjunctive therapies for early PARDS as a framework for future investigations. Methods: This was a preplanned substudy of a prospective, international, cross-sectional observational study of children with PARDS from 100 centers over 10 study weeks. Measurements and Main Results: We investigated six adjunctive therapies for PARDS: continuous neuromuscular blockade, corticosteroids, inhaled nitric oxide (iNO), prone positioning, high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation. Almost half (45%) of children with PARDS received at least one therapy. Variability was noted in the median starting oxygenation index of each therapy; corticosteroids started at the lowest oxygenation index (13.0; interquartile range, 7.6–22.0) and HFOV at the highest (25.7; interquartile range, 16.7–37.3). Continuous neuromuscular blockade was the most common, used in 31%, followed by iNO (13%), corticosteroids (10%), prone positioning (10%), HFOV (9%), and extracorporeal membrane oxygenation (3%). Steroids, iNO, and HFOV were associated with comorbidities. Prone positioning and HFOV were more common in middle-income countries and less frequently used in North America. The use of multiple ancillary therapies increased over the first 3 days of PARDS, but there was not an easily identifiable pattern of combination or order of use. Conclusions: The contemporary description of prevalence, combinations of therapies, and oxygenation threshold for which the therapies are applied is important for design of future studies. Region of the world, income, and comorbidities influence adjunctive therapy use and are important variables to include in PARDS investigations

Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome:A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study

OBJECTIVES: Pediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist with trial design. We aimed to develop and validate mortality prediction models for patients with pediatric acute respiratory distress syndrome. DESIGN: Leveraging additional data collection from a preplanned ancillary study (Version 1) of the multinational Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology study, we identified predictors of mortality. Separate models were built for the entire Version 1 cohort, for the cohort excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths. Models were externally validated in a cohort of intubated pediatric acute respiratory distress syndrome patients from the Children's Hospital of Philadelphia. SETTING: The derivation cohort represented 100 centers worldwide; the validation cohort was from Children's Hospital of Philadelphia. PATIENTS: There were 624 and 640 subjects in the derivation and validation cohorts, respectively. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The model for the full cohort included immunocompromised status, Pediatric Logistic Organ Dysfunction 2 score, day 0 vasopressor-inotrope score and fluid balance, and PaO2/FIO2 6 hours after pediatric acute respiratory distress syndrome onset. This model had good discrimination (area under the receiver operating characteristic curve 0.82), calibration, and internal validation. Models excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths also demonstrated good discrimination (all area under the receiver operating characteristic curve ≥ 0.84) and calibration. In the validation cohort, models for intubated pediatric acute respiratory distress syndrome (including and excluding neurologic deaths) had excellent discrimination (both area under the receiver operating characteristic curve ≥ 0.85), but poor calibration. After revision, the model for all intubated subjects remained miscalibrated, whereas the model excluding neurologic deaths showed perfect calibration. Mortality models also stratified ventilator-free days at 28 days in both derivation and validation cohorts. CONCLUSIONS: We describe predictive models for mortality in pediatric acute respiratory distress syndrome using readily available variables from day 0 of pediatric acute respiratory distress syndrome which outperform severity of illness scores and which demonstrate utility for composite outcomes such as ventilator-free days. Models can assist with risk stratification for clinical trials