Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature.

Introduction: We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy). Methods: A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification. Results: Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% (95% confidence interval [CI]: 7.4%-13.1%). For types A and B, the successful recanalization rate was 95.4% (95% CI: 86.5%-100%), with a 13.7% (95% CI: 2.3%-27.4%) complication rate. For type C, the success rate for ET was 45.7% (95% CI: 17.8%-70.7%), with a complication rate of 46.0% (95% CI: 20.0%-71.4%) for ET and for the HS technique 87.6% (95% CI: 80.9%-94.4%), with a complication rate of 14.0% (95% CI: 7.0%-21.8%). For type D, the success rate of recanalization was 29.8% (95% CI: 7.8%-52.8%), with a 29.8% (95% CI: 6.1%-56.3%) complication rate. Successful recanalization resulted in a symmetrical perfusion between both cerebral hemispheres, resolution of penumbra, normalization of the mean transit time, and improvement in Montreal Cognitive Assessment (MoCA) score (ΔMoCA = 9.80 points; P = 0.004). Conclusions: Type A and B occlusions benefit from ET, especially in the presence of a large penumbra. Type C occlusions can benefit from HS. Unfortunately, we did not identify an intervention to help patients with type D occlusions. A phase 2b randomized controlled trial is needed to confirm these findings

Behavior of corroded bonded fully prestressed and conventional concrete beams

AbstractPrestressed concrete is widely used in the construction buildings. And corrosion of steel is one of the most important and prevalent mechanisms of deterioration for concrete structures. Consequently the capacity of post-tension elements decreased after exposure to corrosion. This study presents results of the experimental investigation of the performance/behavior of bonded fully prestressed and conventional concrete beams, with 40MPa compressive strength exposed to corrosion. The experimental program of this study consisted of three fully prestressed and two conventional concrete beams with overall dimensions equal to 150×400×4500mm. The variables were considered in terms of corrosion exposure effect, prestressed level, and corrosion location effect for fully prestressed beams. Mode of failure, cracking width/distribution, ultimate load and the corresponding deflection of each beam were recorded. The results showed that the fully prestressed beam in comparison with conventional beam was considered to be even more resistance to corrosion because it was perceived to be crack-free as a result of prestressing. Also the mention deterioration incident in fully prestressed beams fully corrosion exposure level unnoticed that deterioration incident in partially corrosion exposure level. The most of deterioration incident in fully prestressed beam acts on compression of non-prestressed steel reinforcement. Because the bonded tendons are less likely to corrode. Cement grout/duct is a barrier to moisture and chloride penetration, especially plastic duct without splices. The theoretical analysis based on strain compatibility and force equilibrium gave a good prediction of the deformational behavior for fully prestressed beams

Focal High Intensity Focused Ultrasound for Prostate Cancer

Chapter Bookinfo:eu-repo/semantics/nonPublishe

International logistic

1 online resource (52 leaves) : ill.Includes abstract.Includes bibliographical references (leaf 52).The business case subject of this project is the international trade of a Canadian product in a way to reduce the cost of the logistic system. The goal of the paper is to provide the highest profit per unit of investment. This project consists of an investment which results in spending money either by paying to the suppliers or the cost of the logistic system (Transportation – Inventories). That being said, the analysis should be based on a strategy to control the risk. Creating the logistic system and analyzing it from suppliers to customers in addition to choosing the product and the locations either for the manufactures or the target market are important deliverables of the project. This paper can be used as a guide for international trade. It studies the entire steps necessary to trade a product internationally, from the selection of the product to the assembling of the logistic system and from the Supply/demand concept to the logistic cost calculation. The paper shows how to calculate the cost per item including transportation cost. Also, it shows how to predict the quantity demanded to see if the project breakeven

Plasma Soluble Human Elastin Fragments as an Intra-Aneurysmal Localized Biomarker for Ruptured Intracranial Aneurysm

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of elastin fragments were measured using an ELISA-based method. Mean plasma level of soluble human elastin fragments was significantly greater in ruptured aneurysms when compared with nonruptured aneurysms (102.0±15.5 versus 39.3±9.6 ng/mL; P\u3c0.001). Mean plasma level of soluble human elastin fragments did not have significant correlation with age, sex, size, or aneurysm location. Conclusions—The present study revealed that a significantly higher concentration of soluble human elastin fragments in the lumen of ruptured intracranial aneurysms when compared with nonruptured ones. © 2018 The Authors

Cerebral Arteriovenous Malformations: Evaluation and Management.

There has been increased detection of incidental AVMs as result of the frequent use of advanced imaging techniques. The natural history of AVM is poorly understood and its management is controversial. This review provides an overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management of AVMs. The authors discussed the imaging techniques available for detecting AVMs with regard to the advantages and disadvantages of each imaging modality. Furthermore, this review paper discusses the factors that must be considered for the most appropriate management strategy (based on the current evidence in the literature) and the risks and benefits of each management option

Role of Assistive Devices on Gait in Patients with Incomplete Spinal Cord Injury: Systematic Review

Background: People with incomplete spinal cord injury disabilities can be able to live a healthy, productive, and dignified life by using Assistive devices as their role in improving gait. Facilitate locomotion rehabilitation. And enable people with incomplete SCI to ambulate in an upright position. Objective: This systematic review aimed to examine the effectiveness of the role of using assistive devices in gait rehabilitation in patients with incomplete SCI. Material and Methods: Studies were identified from 2000 to 2020 by electronic search using PubMed, Cochrane Database of Systematic Reviews, Google Scholar, and Physiotherapy Evidence Database (Pedro). They were reviewed if they were randomized control trials focused on the effectiveness of Assistive Devices on Gait in Patients in age more than 18 years with incomplete Spinal Cord Injury being published in English. Eight studies were selected according to inclusive and exclusive criteria and descriptive analysis was conducted due to heterogeneity. Results: Eight trials were identified with good quality methodology. Descriptive analysis was applied for three studies that supported the use of assistive devices for those patients and meta-analysis was applied for five studies. The mean difference across all the five studies is -0.69 (95% CI -0.93, -0.45). According to AACPDM, there is level II evidence that supports the use of the assistive device as a method to be able to live a healthy, productive, and dignified life. Conclusion: The current level of evidence supports the effectiveness of assistive devices in improving gait in patients with incomplete spinal cord injury

THE EFFECTS OF DIABETES MELLITUS ON THE RESPONSE TO PEGINTERFERON-ALPHA IN COMBINATION WITH RIBAVIRIN THERAPY IN EGYPTIAN CHRONIC HEPATITIS C PATIENTS

Objective:The present study aimed to determine whether type 2 diabetes mellitus influences the response to antiviral therapy with peg-interferon alpha plus ribavirin in Egyptian patients with chronic hepatitis C. Methods:All patients were treated with peginterferon alpha 2 b (1.5 μg/Kg/body weight) subcutaneously plus oral ribavirin application in a dose ranging from 800-1200 mg/day and followed after 12 w of therapy. Results: The present study indicated that, non-significant changes were observed in liver function, kidney function, thyroid function tests, tumor marker, immunological analysis, hematological parameters, viral load and degree of cirrhosis between both groups’ baselines, while the only significant difference was regarded in glucose level. However, diabetic group showed a significant decrease in response to antiviral therapy as compared to non-diabetic hepatitis C virus (HCV) patients. Furthermore, significant decrease in serum liver enzymes activity and total bilirubin level as compared to baseline levels in both groups, while there were a significant increase in alanine transaminase (ALT) activity and total bilirubin level in diabetic group as compared to non-diabetic HCV group after treatment. Also, significant decreases in hemoglobin concentration, white blood cells and platelet counts, in both groups after treatment as compared to there before treatment while diabetic group showed significant decreases in hemoglobin concentration and white blood cells count when compared with non-diabetic HCV group after treatment. Conclusion: Type 2 diabetes mellitus influence the response to antiviral therapy with peginterferon plus ribavirin in Egyptian patients with chronic hepatitis C