Effect of nitric oxide donors on uterine and sub-endometrial blood flow in patients with unexplained infertility: a randomized controlled trial

Background: Impaired sub-endometrial perfusion might reduce endometrial receptivity and possibly contribute to unexplained infertility. A favorable effect on sub-endometrial blood flow has been demonstrated with nitric oxide.Methods: This randomized controlled trial evaluated the effect of nitroglycerine on uterine and sub-endometrial blood flow in women with unexplained infertility. Sixty women were randomized into 2 equal groups. The study group received 5mg nitroglycerine patch daily from day 2 of the cycle till the evaluation day and the control group received no treatment. Independent of the study arms, 30 parous women were included as the fertile group. Six to eight days after detecting luteinizing hormone surge, women were assessed for endometrial thickness, uterine artery blood flow with color Doppler and sub-endometrial blood flow with three-dimensional power Doppler.Results: Compared to fertile women, cases with unexplained infertility (control group) had a significantly thinner endometrium, higher uterine artery Doppler indices and lower sub-endometrial blood flow. Women who received nitroglycerin showed a significant improvement in sub-endometrial blood flow while uterine artery blood flow did not show a significant difference; however, the values were also comparable to fertile women. In addition, no effect on endometrial thickness was found with nitroglycerin treatment. Nitroglycerin treatment side effects were headache, blurring of vision and hypotension. These adverse effects were not significant compared to controls.Conclusions: In women with unexplained infertility, nitroglycerin significantly improved the sub-endometrial blood flow but did not affect the endometrial thickness

QoS Categories Activeness-Aware Adaptive EDCA Algorithm for Dense IoT Networks

IEEE 802.11 networks have a great role to play in supporting and deploying of the Internet of Things (IoT). The realization of IoT depends on the ability of the network to handle a massive number of stations and transmissions, and to support Quality of Service (QoS). IEEE 802.11 networks enable the QoS by applying the Enhanced Distributed Channel Access (EDCA) with static parameters regardless of existing network capacity or which Access Category (AC) of QoS is already active. Our objective in this paper is to improve the efficiency of the uplink access in 802.11 networks; therefore we proposed an algorithm called QoS Categories Activeness-Aware Adaptive EDCA Algorithm (QCAAAE) which adapts Contention Window (CW) size, and Arbitration Inter-Frame Space Number (AIFSN) values depending on the number of associated Stations (STAs) and considering the presence of each AC. For different traffic scenarios, the simulation results confirm the outperformance of the proposed algorithm in terms of throughput (increased on average 23%) and retransmission attempts rate (decreased on average 47%) considering acceptable delay for sensitive delay services.Comment: 17 pages, 10 figure

Neutrophil-surface antigens CD11b and CD64 expression: a potential predictor of early-onset neonatal sepsis

Background: CD11b, an α subunit of the β2 integrin adhesion molecule, and CD64, the high affinity Fcγ receptor I, are specific neutrophil-surface antigens activated in response to systemic inflammation and, hence, they might potentially help identifying neonatal infections. Objective: We sought to evaluate the time course of expression and diagnostic and prognostic utility of CD11b and CD64 in early-onset sepsis in the suspected newborn. Methods: Sixty newborn infants (28-40 weeks gestation) with antenatal risk factors for sepsis were enrolled and subjected to sepsis work-up including complete blood count, quantification of serum C reactive protein (CRP) and flow cytometric analysis of CD11b and CD64 in cord blood (0 h). These tests were repeated at 8, 24 and 48 h postnatally. Neonates were defined, retrospectively, in two groups: sepsis and no infection, on basis of clinical observation over their first five postnatal days and sepsis work-up results. Results: A significant enhancement of neutrophil CD11b and CD64 expression was demonstrated in the sepsis group as compared to the non-infected group. CD11b over-expression had an onset at 0 h. Its mean value approached two-fold mean level of non-infected neonates by 8-24 h, and declined thereafter. CD64 rising onset was detectable at 8 h and its mean percentage reached four-fold mean value of the non-infected group at 24 h. At 24 h, an optimal cut-off value for CD11b expression of 35% (sensitivity 80%, and specificity 100%), and for CD64 expression of 17% (sensitivity 88%, and specificity 90.3%) had the best performance for prediction of sepsis. Combined use of both markers at 24 h yielded 90% sensitivity and 95% specificity for sepsis prediction. Sepsis survivors showed significantly lower mean expression for CD11b and CD64 as compared to those with fatal outcome. At 24 h, a cut-off value of 88% expression for CD11b and 50% expression for CD64 predicted mortality with sensitivity and specificity of 100%. Conclusion: Enhanced expression of neutrophil-surface antigens CD11b and CD64 could be a promising tool for prediction and therapeutic decision-making in early-onset sepsis indicating the necessity of initiation of antimicrobial therapy and reduction of its unnecessary use in non-infected neonates even before definitive microbiologic identification.Keywords: sepsis, neonate, early-onset, neutrophil activation, surface antigen, CD11b, CD64Egypt J Pediatr Allergy Immunol 2004; 2(2): 90-10

Placental pouch closure: a novel, safe and effective surgical procedure for conservative management of placenta accreta

Background: Placenta accreta spectrum (PAS) has become a global problem secondary to the high rate of cesarean delivery (CD). The current study presents an effective surgical procedure (placental pouch closure) for uterine preservation in patients with PAS. Methods: We applied this procedure in sixty cases at a tertiary university hospital between September 2017 and January 2019. We included women who were diagnosed as PAS based on preoperative ultrasound and Doppler evaluation, and who had the desire for uterine preservation. Results: The procedure was successful in almost all cases; the uterus was conserved 98.33 % of participants, with no associated severe maternal morbidities or mortality. In all cases, no additional surgical procedures were needed. The mean blood loss was 1263 ml, and the mean number of units of blood required for transfusion was 2.31 units. Conclusion: Identifying and meticulously closing the placental pouch is a novel surgical procedure for conservative management of PAS. In well-selected cases with the availability of facilities and expertise, the technique could have a place as a safe and effective surgical technique in women presenting with placenta accreta who desire uterine preservation. Trial registration number: NCT03241849. Registered on August 8, 201

From PET Bottles Waste to N-Doped Graphene as Sustainable Electrocatalyst Support for Direct Liquid Fuel Cells

Direct liquid fuel cells represent one of the most rapidly emerging energy conversion devices. The main challenge in developing fuel cell devices is finding low-cost and highly active catalysts. In this work, PET bottle waste was transformed into nitrogen-doped graphene (NG) as valuable catalyst support. NG was prepared by a one-pot thermal decomposition process of mineral water waste bottles with urea at 800 °C. Then, NG/Pt electrocatalysts with Pt loadings as low as 0.9 wt.% and 1.8 wt.% were prepared via a simple reduction method in aqueous solution at room temperature. The physical and electrochemical properties of the NG/Pt electrocatalysts are characterized and evaluated for application in direct borohydride peroxide fuel cells (DBPFCs). The results show that NG/Pt catalysts display catalytic activity for borohydride oxidation reaction, particularly the NG/Pt_1, with a number of exchanged electrons of 2.7. Using NG/Pt composite in fuel cells is anticipated to lower prices and boost the usage of electrochemical energy devices. A DBPFC fuel cell using NG/Pt_1 catalyst (1.8 wt.% Pt) in the anode achieved a power density of 75 mW cm−2 at 45 °C. The exceptional performance and economic viability become even more evident when expressed as mass-specific power density, reaching a value as high as 15.8 W mgPt−1

Exercise-induced bronchoconstriction and atopy in Tunisian athletes

<p>Abstract</p> <p>Background</p> <p>This study is a cross sectional analysis, aiming to evaluate if atopy is as a risk factor for exercise induced bronchoconstriction (EIB) among Tunisian athletes.</p> <p>Methods</p> <p>Atopy was defined by a skin prick test result and EIB was defined as a decrease of at least 15% in forced expiratory volume in one second (FEV1) after 8-min running at 80–85% HRmaxTheo. The study population was composed of 326 athletes (age: 20.8 ± 2.7 yrs – mean ± SD; 138 women and 188 men) of whom 107 were elite athletes.</p> <p>Results</p> <p>Atopy was found in 26.9% (88/326) of the athletes. Post exercise spirometry revealed the presence of EIB in 9.8% of the athletes including 13% of the elite athletes. Frequency of atopy in athletes with EIB was significantly higher than in athletes without EIB [62.5% vs 23.1%, respectively].</p> <p>Conclusion</p> <p>This study showed that atopic Tunisian athletes presented a higher risk of developing exercise induced bronchoconstriction than non-atopic athletes.</p

Modelling urban growth evolution and land-use changes using GIS based cellular automata and SLEUTH models: the case of Sana'a metropolitan city, Yemen.

An effective and efficient planning of an urban growth and land use changes and its impact on the environment requires information about growth trends and patterns amongst other important information. Over the years, many urban growth models have been developed and used in the developed countries for forecasting growth patterns. In the developing countries however, there exist a very few studies showing the application of these models and their performances. In this study two models such as cellular automata (CA) and the SLEUTH models are applied in a geographical information system (GIS) to simulate and predict the urban growth and land use change for the City of Sana’a (Yemen) for the period 2004–2020. GIS based maps were generated for the urban growth pattern of the city which was further analyzed using geo-statistical techniques. During the models calibration process, a total of 35 years of time series dataset such as historical topographical maps, aerial photographs and satellite imageries was used to identify the parameters that influenced the urban growth. The validation result showed an overall accuracy of 99.6 %; with the producer’s accuracy of 83.3 % and the user’s accuracy 83.6 %. The SLEUTH model used the best fit growth rule parameters during the calibration to forecasting future urban growth pattern and generated various probability maps in which the individual grid cells are urbanized assuming unique “urban growth signatures”. The models generated future urban growth pattern and land use changes from the period 2004–2020. Both models proved effective in forecasting growth pattern that will be useful in planning and decision making. In comparison, the CA model growth pattern showed high density development, in which growth edges were filled and clusters were merged together to form a compact built-up area wherein less agricultural lands were included. On the contrary, the SLEUTH model growth pattern showed more urban sprawl and low-density development that included substantial areas of agricultural lands

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially