STN localization using local field potentials based on wavelet packet features and stacking ensemble learning

BACKGROUND

DBS entails the insertion of an electrode into the patient brain, enabling Subthalamic nucleus (STN) stimulation. Accurate delineation of STN borders is a critical but time-consuming task, traditionally reliant on the neurosurgeon experience in deciphering the intricacies of microelectrode recording (MER). While clinical outcomes of MER have been satisfactory, they involve certain risks to patient safety. Recently, there has been a growing interest in exploring the potential of local field potentials (LFP) due to their correlation with the STN motor territory.

METHOD

A novel STN detection system, integrating LFP and wavelet packet transform (WPT) with stacking ensemble learning, is developed. Initial steps involve the inclusion of soft thresholding to increase robustness to LFP variability. Subsequently, non-linear WPT features are extracted. Finally, a unique ensemble model, comprising a dual-layer structure, is developed for STN localization. We harnessed the capabilities of support vector machine, Decision tree and k-Nearest Neighbor in conjunction with long short-term memory (LSTM) network. LSTM is pivotal for assigning adequate weights to every base model.

RESULTS

Results reveal that the proposed model achieved a remarkable accuracy and F1-score of 89.49% and 91.63%.

COMPARISON WITH EXISTING METHODS

Ensemble model demonstrated superior performance when compared to standalone base models and existing meta techniques.

CONCLUSION

This framework is envisioned to enhance the efficiency of DBS surgery and reduce the reliance on clinician experience for precise STN detection. This achievement is strategically significant to serve as an invaluable tool for refining the electrode trajectory, potentially replacing the current methodology based on MER.

Break oily water emulsion during petroleum enhancing production processes using green approach for the synthesis of SnCuO@FeO nanocomposite from microorganisms

The aim of this work was to synthesize a green nanoparticle SnCuO@FeO nanocomposite core-shell to break oily water emulsions during petroleum-enhancing production processes as an alternative to chemical and physical processes. In this study, eight bacterial isolates (MHB1-MHB8) have been isolated from tree leaves, giant reeds, and soil samples. The investigation involved testing bacterial isolates for their ability to make FeO nanoparticles and choosing the best producers. The selected isolate (MHB5) was identified by amplification and sequencing of the 16S rRNA gene as Bacillus paramycoides strain OQ878685. MHB5 produced the FeO nanoparticles with the smallest particle size (78.7 nm) using DLS. XRD, FTIR, and TEM were used to characterize the biosynthesized nanoparticles. The jar experiment used SnCuO@FeO with different ratios of Sn to CuO (1:1, 2:1, and 3:1) to study the effect of oil concentration, retention time, and temperature. The most effective performance was observed with a 1:1 ratio of Sn to CuO, achieving an 85% separation efficiency at a concentration of 5 mg/L, for a duration of 5 min, and at a temperature of 373 K. Analysis using kinetic models indicates that the adsorption process can be accurately described by both the pseudo-first-order and pseudo-second-order models. This suggests that the adsorption mechanism likely involves a combination of film diffusion and intraparticle diffusion. Regarding the adsorption isotherm, the Langmuir model provides a strong fit for the data, while the D-R model indicates that physical interactions primarily govern the adsorption mechanism. Thermodynamic analysis reveals a ∆H value of 18.62 kJ/mol, indicating an exothermic adsorption process. This suggests that the adsorption is a favorable process, as energy is released during the process. Finally, the synthesized green SnCuO@FeO nanocomposite has potential for use in advanced applications in the oil and gas industry to help the industry meet regulatory compliance, lower operation costs, reduce environmental impact, and enhance production efficiency.

Volume outcome relationship in postesophagectomy leak: a systematic review and meta-analysis

BACKGROUND

Anastomotic leak after esophagectomy carries important short- and long-term sequelae. The authors conducted a systematic review and meta-analysis to determine its association with surgical volume.

MATERIALS AND METHODS

A systematic literature review was performed to identify all studies reporting on anastomotic leak after esophagectomy. Studies with less than 100 cases were excluded. The primary outcome was postesophagectomy anastomotic leak, while secondary outcomes were operative mortality overall and after anastomotic leak. Pooled event rates (PER) were calculated, and the association with annual esophagectomy volume by center was investigated.

RESULTS

Of the 3932 retrieved articles, 472 were included ( n =177 566 patients). The PER of anastomotic leak was 8.91% [95% CI=8.32; 9.53%]. The PER of early mortality overall and after an anastomotic leak was 2.49% [95% CI=2.27; 2.74] and 11.39% [95% CI=9.66; 13.39], respectively. Centers with less than 37 annual esophagectomies had a higher leak rate compared to those with greater than or equal to 37 annual esophagectomies (9.58% vs. 8.34%; P =0.040). On meta-regression, surgical volume was inversely associated with the PER of esophageal leak and of early mortality.

CONCLUSIONS

The frequency of anastomotic leaks after esophagectomy, perioperative, and leak associated mortality are inversely associated with esophagectomy volume.

Dry Eye Disease in the Middle East and Northern Africa: A Position Paper on the Current State and Unmet Needs

In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region.

A rare case of 2q37 deletion syndrome presented with patent foramen ovale

This case report presents a 3-year-old female child diagnosed with 2q37 deletion syndrome and patent foramen ovale, and the improvement in hypotonia and gross motor delay after 1 year of physical therapy. This case highlights the importance of thorough examination and diagnostic testing in identifying underlying causes of developmental delays.

Microplastic sources, formation, toxicity and remediation: a review

Microplastic pollution is becoming a major issue for human health due to the recent discovery of microplastics in most ecosystems. Here, we review the sources, formation, occurrence, toxicity and remediation methods of microplastics. We distinguish ocean-based and land-based sources of microplastics. Microplastics have been found in biological samples such as faeces, sputum, saliva, blood and placenta. Cancer, intestinal, pulmonary, cardiovascular, infectious and inflammatory diseases are induced or mediated by microplastics. Microplastic exposure during pregnancy and maternal period is also discussed. Remediation methods include coagulation, membrane bioreactors, sand filtration, adsorption, photocatalytic degradation, electrocoagulation and magnetic separation. Control strategies comprise reducing plastic usage, behavioural change, and using biodegradable plastics. Global plastic production has risen dramatically over the past 70 years to reach 359 million tonnes. China is the world's top producer, contributing 17.5% to global production, while Turkey generates the most plastic waste in the Mediterranean region, at 144 tonnes per day. Microplastics comprise 75% of marine waste, with land-based sources responsible for 80-90% of pollution, while ocean-based sources account for only 10-20%. Microplastics induce toxic effects on humans and animals, such as cytotoxicity, immune response, oxidative stress, barrier attributes, and genotoxicity, even at minimal dosages of 10 μg/mL. Ingestion of microplastics by marine animals results in alterations in gastrointestinal tract physiology, immune system depression, oxidative stress, cytotoxicity, differential gene expression, and growth inhibition. Furthermore, bioaccumulation of microplastics in the tissues of aquatic organisms can have adverse effects on the aquatic ecosystem, with potential transmission of microplastics to humans and birds. Changing individual behaviours and governmental actions, such as implementing bans, taxes, or pricing on plastic carrier bags, has significantly reduced plastic consumption to 8-85% in various countries worldwide. The microplastic minimisation approach follows an upside-down pyramid, starting with prevention, followed by reducing, reusing, recycling, recovering, and ending with disposal as the least preferable option.

Biogenic synthesis of reduced graphene oxide from Ziziphus spina-christi (Christ's thorn jujube) extracts for catalytic, antimicrobial, and antioxidant potentialities

In the current work, various concentrations of the aqueous extract of Ziziphus spina-christi were employed for the phytoreduction of graphene oxide (GO). The green synthesized reduced graphene oxide (rGO) was characterized through UV-Vis spectrometry, Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy, and energy-dispersive X-ray spectroscopy (SEM-EDX). Gas chromatography-mass spectrometry (GC-MS) denoted the presence of numerous phytoconstituents including ketones, terpenoids, fatty acids, esters, and flavonoids, which acted as reducing and capping agents. The obtained results indicated the increase in rGO yield and shape with increasing the extract concentration. The optimized rGO was instantaneously ~100% removed methylene blue (MB) from the water at 5 mg L^-1. However, the removal efficiency was slightly declined to reach 73.55 and 65.1% at 10 and 15 mg L^-1, respectively. A powerful antibacterial activity for rGO particularly against gram-negative bacteria with a high concentration of 2 × 10⁸ CFU mL^-1 was confirmed. Furthermore, rGO demonstrated promising and comparable antioxidant efficiency with vitamin C against DPPH free radical scavenging. While vitamin C recorded 13.45 and 48.4%, the optimized rGO attained 13.30 and 45.20% at 12 and 50 μg mL^-1, respectively.

Structural, molecular and functional characterization of the aorta in HCM

Introduction

Changes in the Extracellular Matrix (ECM) in Hypertrophic Cardiomyopathy (HCM) is thought to involve the myocardium as well as extracardiac tissues. The extent and significance of extra-myocardial changes has not been adequately studied.

Purpose

To describe the structural, molecular, and functional changes in the aorta of HOCM patients.

Methods

The structural and molecular changes in the aortic wall were studied in a cohort of 102 consecutive patients with hypertrophic obstructive cardiomyopathy undergoing myectomy. The biopsies were examined histologically, immunohistochemically and by Electron microscopy. The findings were compared to 10 normal controls obtained from the homograft bank of the Harefield hospital, following IRB guidelines. Changes in expression were quantified using morphometry and western blotting. For aortic stiffness, pulse wave velocity [PWV] was measured using Cardiac Magnetic Resonance (CMR), in the 102 HCM patients as well as age-matched 166 normal controls.

Results

Specimens from HCM aortas showed a misalignment in collagen and elastin fibres. There was a significant reduction in smooth muscle cells [SMCs] markers; integrin beta1 and smooth muscle actin, and an increase in an apoptosis marker, Caspase3. In addition, there was a significant decrease in the number of lamellae and an increase in the interlamellar distance in HCM aortas. FBLNs 1, 2 and 5 showed a reduction in expression in tunica intima and tunica media of HCM biopsies. PWV was significantly higher in HCM patients compared to healthy controls with the highest levels in patients with LV fibrosis.

Conclusion

This study illustrates the link between functional abnormalities in the aorta of HCM patients with structural and molecular changes. These findings can have a potential value in risk stratification and identify new therapeutic targets in HCM.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): STDF-EgyptMagdi Yacoub Foundation

Homozygosity predominantly affects hypertrophic cardiomyopathy minor genes in an Egyptian clinical cohort

Background

Consanguinity is prevalent in Egypt (35%) resulting in a high incidence of homozygosity. The influence of homozygosity on the genetics of Hypertrophic Cardiomyopathy (HCM) has not been adequately studied.

Purpose

The purpose of this study is to define the genetic architecture of HCM in Egypt using ethnically-matched case and control cohorts.

Methods

Prospective Egyptian patients (n=514) and controls (n=400) were recruited to Aswan Heart Centre for clinical phenotyping and genetic testing for 174 genes implicated in inherited cardiac conditions (Illumina). Rare variation (gnomAD filtering allele frequency ≤4x10–5) in 13 validated HCM genes were classified according to the American College of Medical Genetics (ACMG) guidelines and compared with a prospective HCM cohort of predominantly European ancestry (n=684).

Results

Significantly fewer rare variants detected in Egyptian patients could be classified as (likely) pathogenic compared to Europeans (40.8% vs. 61.6%, p-value=1.6x10–5). Incorporating analysis from these Egyptian case-control cohorts into the ACMG guidelines increased this yield to 53.8%. Homozygous variants were more frequently observed in Egyptian patients (4.1% vs 0.1%, p-value=2x10–7), with variants in the minor HCM genes MYL2, MYL3 and CSRP3 more likely to present in homozygosity than the major genes (MYH7, MYBPC3 and troponins), suggesting such variants are less penetrant in the heterozygous state.

Conclusions

The integration of Egyptian-specific genetic and phenotypic data significantly improves variant interpretation in HCM and consequently the precision of genetic testing. The observed prevalence of homozygosity and rare variation in minor HCM genes in Egyptian patients provides important insights into its disease-mechanisms and genetics.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Development FundAl Alfi Foundation

Phytofabrication of bimetallic silver-copper/biochar nanocomposite for environmental and medical applications

In the current study, a novel, green, low-cost, and sustainable path for the phyto-fabrication of Ag-Cu biochar nanocomposite (Ag-Cu/biochar) by Atriplex halimus biomass and aqueous extract is described. Surface plasmon resonance peaks were detected at 450 nm and 580 nm signifying the formation of both silver and copper nanoparticles, respectively on the biochar surface. XRD analysis confirmed the crystal structure of the phytosynthesized Ag-Cu/biochar whereas FT-IR, SEM, EDX, and XPS analyses confirmed the successful phytofabrication of the composite. Ag and Cu nanoparticles loaded on the biochar surface were almost spherically-shaped with a particle size ranging from 25 nm to 45 nm. Zeta potential of -25.5 mV showed the stability of Ag-Cu/biochar. The potential of this novel nanocomposite in the removal of doxycycline (DOX) was evident under different conditions as it reached nearly 100% under the optimum reaction conditions (DOX concentration; 50 ppm, pH; 9, a dose of Ag-Cu/biochar; 0.01 g, temperature; 25 °C, and H₂O₂ concentration; 100 mM). The promising regeneration of Ag-Cu/biochar was evident as the removal efficiency was 81% after 6 consecutive cycles. Ag-Cu/biochar was also shown an excellent antimicrobial activity against gram-negative bacteria as well a promising antioxidant activity.

Facial landmark-guided surface matching for image-to-patient registration with an RGB-D camera

BACKGROUND

Fiducial marker-based image-to-patient registration is the most common way in image-guided neurosurgery, which is labour-intensive, time consuming, invasive and error prone.

METHODS

We proposed a method of facial landmark-guided surface matching for image-to-patient registration using an RGB-D camera. Five facial landmarks are localised from preoperative magnetic resonance (MR) images using deep learning and RGB image using Adaboost with multi-scale block local binary patterns, respectively. The registration of two facial surface point clouds derived from MR images and RGB-D data is initialised by aligning these five landmarks and further refined by weighted iterative closest point algorithm.

RESULTS

Phantom experiment results show the target registration error is less than 3 mm when the distance from the camera to the phantom is less than 1000 mm. The registration takes less than 10 s.

CONCLUSIONS

The proposed method is comparable to the state-of-the-arts in terms of the accuracy yet more time-saving and non-invasive.

Green synthesis of bimetallic Ag/ZnO@Biohar nanocomposite for photocatalytic degradation of tetracycline, antibacterial and antioxidant activities

In this work, a simple and green synthesis procedure for phytofabrication Zinc oxide-silver supported biochar nanocomposite (Ag/ZnO@BC) via Persicaria salicifolia biomass is investigated for the first time to uphold numerous green chemistry such as less hazardous chemical syntheses. XRD technique showed the crystal structure of the phytosynthesized Ag/ZnO@BC, whereas UV-visible spectroscopy, FT-IR, SEM, EDX, TEM, and XPS analyses indicated the successful biosynthesis of the nanocomposite. Testing the photocatalytic potential of this novel nanocomposite in the removal of TC under different conditions unraveled its powerful photodegradation efficiency that reached 70.3% under the optimum reaction conditions: TC concentration; 50 ppm, pH; 6, a dose of Ag/ZnO@BC; 0.01 g, temperature; 25 °C, and H₂O₂ concentration; 100 mM. The reusability of Ag/ZnO@BC was evident as it reached 53% after six cycles of regeneration. Ag/ZnO@BC was also shown to be a potent antimicrobial agent against Klebsiella pneumonia as well as a promising antioxidant material. Therefore, the current work presented a novel nanocomposite that could be efficiently employed in various environmental and medical applications.

Sustainable adsorptive removal of antibiotic residues by chitosan composites: An insight into current developments and future recommendations

During COVID-19 crisis, water pollution caused by pharmaceutical residuals have enormously aggravated since millions of patients worldwide are consuming tons of drugs daily. Antibiotics are the preponderance pharmaceutical pollutants in water bodies that surely cause a real threat to human life and ecosystems. The excellent characteristics of chitosan such as nontoxicity, easy functionality, biodegradability, availability in nature and the abundant hydroxyl and amine groups onto its backbone make it a promising adsorbent. Herein, we aimed to provide a comprehensive overview of recent published research papers regarding the removal of antibiotics by chitosan composite-based adsorbents. The structure, ionic form, optimum removal pH and λ_max of the most common antibiotics including Tetracycline, Ciprofloxacin, Amoxicillin, Levofloxacin, Ceftriaxone, Erythromycin, Norfloxacin, Ofloxacin, Doxycycline, Cefotaxime and Sulfamethoxazole were summarized. The development of chitosan composite-based adsorbents in order to enhance their adsorption capacity, reusability and validity were presented. Moreover, the adsorption mechanisms of these antibiotics were explored to provide more information about adsorbate-adsorbent interactions. Besides the dominant factors on the adsorption process including pH, dosage, coexisting ions, etc. were discussed. Moreover, conclusions and future recommendations are provided to inspire for further researches.

Novel Biogenic Synthesis of a Ag@Biochar Nanocomposite as an Antimicrobial Agent and Photocatalyst for Methylene Blue Degradation

The conventional synthesis of nanomaterials employing physical and chemical methods usually requires high cost and toxic chemicals. Thus, a facile, ecofriendly, cost-effective, novel, and sustainable route for the synthesis of a silver-loaded biochar nanocomposite (Ag@biochar) using Chenopodium ambrosioides leaf extract and biomass is reported for the first time in this study to advocate many of the principles of green chemistry such as safer solvents and auxiliaries. UV spectroscopic analysis at 420 nm indicated the formation of silver nanoparticles (AgNPs). The band gap energy of Ag@biochar was 1.9 eV, confirming its potential use as a photocatalyst. Ag@biochar was found to be photoluminescent at 425 nm. AgNPs on the surface of biochar were predominantly spherical with a size range of 25-35 nm and a surface area of 47.61 m²/g. A zeta potential of -5.87 mV designated the stability of Ag@biochar. Testing the photocatalytic potential of Ag@biochar to remove methylene blue from wastewater demonstrated its high removal efficiency that reached 88.4% due to its high efficiency of electron transfer confirmed via electrochemical impedance spectroscopy analysis and retained 70.65% after six cycles of reuse. Ag@biochar was shown to be a powerful broad-spectrum antimicrobial agent as it completely prevented the growth of Escherichia coli and also inhibited the growth of Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus subtilis, and Candida albicans with the inhibition zones of 19, 18, 22, and 16 mm, respectively.

Recent developments in alginate-based adsorbents for removing phosphate ions from wastewater: a review

The huge development of the industrial sector has resulted in the release of large quantities of phosphate anions which adversely affect the environment, human health, and aquatic ecosystems. Naturally occurring biopolymers have attracted considerable attention as efficient adsorbents for phosphate anions due to their biocompatibility, biodegradability, environmentally-friendly nature, low-cost production, availability in nature, and ease of modification. Amongst them, alginate-based adsorbents are considered one of the most effective adsorbents for removing various types of pollutants from industrial wastewater. The presence of active COOH and OH^- groups along the alginate backbone facilitate its physical and chemical modifications and participate in various possible adsorption mechanisms of phosphate anions. Herein, we focus our attention on presenting a comprehensive overview of recent advances in phosphate removal by alginate-based adsorbents. Modification of alginate by various materials, including clays, magnetic materials, layered double hydroxides, carbon materials, and multivalent metals, is addressed. The adsorption potentials of these modified forms for removing phosphate anions, in addition to their adsorption mechanisms are clearly discussed. It is concluded that ion exchange, complexation, precipitation, Lewis acid-base interaction and electrostatic interaction are the most common adsorption mechanisms of phosphate removal by alginate-based adsorbents. Pseudo-2^nd order and Freundlich isotherms were figured out to be the major kinetic and isotherm models for the removal process of phosphate. The research findings revealed that some issues, including the high cost of production, leaching, and low efficiency of recyclability of alginate-based adsorbents still need to be resolved. Future trends that could inspire further studies to find the best solutions for removing phosphate anions from aquatic systems are also elaborated, such as the synthesis of magnetic-based alginate and various-shaped alginate nanocomposites that are capable of preventing the leaching of the active materials.

Facile Synthesis of Gold Nanoparticles for Anticancer, Antioxidant Applications, and Photocatalytic Degradation of Toxic Organic Pollutants

In the current study, a facile, rapid, and ecologically safe photosynthesis of gold nanoparticles (AuNPs) that remained stable for 3 months is reported to advocate the main aspects of green chemistry, such as safer solvents and auxiliaries, and the use of renewable feedstock. Zi-AuNPs were phytosynthesized by the aqueous extract of Ziziphus spina-christi leaves, and numerous techniques were employed for their characterization. The results demonstrated the successful phytofabrication of crystalline AuNPs with brownish-black color, spherical nanoparticles with a size between 0 and 10 nm, a plasmon peak at 540 nm, and a surface charge of -25.7 mV. Zi-AuNPs showed an effective photodegradation efficiency (81.14%) against malachite green and a good recycling capacity of 69.2% after five cycles of regeneration. The cytotoxicity test by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay signified a high anticancer efficiency for both Zi-AuNPs and Z. spina-christi extract against human breast cancer cells (MCF7 cell line) with IC₅₀'s of 48 and 40.25 μg/mL, respectively. Highly efficient antioxidant capabilities were proven with 2,2-diphenyl-1-picrylhydrazyl (DPPH) removal percentages of 67.5% for Zi-AuNPs and 92.34% for Z. spina-christi extract.

Catalytic and Medical Potential of a Phyto-Functionalized Reduced Graphene Oxide-Gold Nanocomposite Using Willow-Leaved Knotgrass

In the current study, a simple, environmentally friendly, and cost-effective reduced graphene oxide-gold nanoparticle (rGO-AuNP) nanocomposite was successfully phytosynthesized using the aqueous leaf extract of a common weed found on the Nile banks, Persicaria salicifolia, for the first time. The phytosynthesis of rGO-AuNPs was first confirmed via the color transformation from brown to black as well as throughvarious techniques such as transmission electron microscopy (TEM) and Raman spectroscopy. Two UV-vis peaks at 275 and 530 nm were observed for the nanocomposite with a typical particle size of mostly spherical AuNPs of 15-20 nm. However, other shapes were occasionally detected including rods, triangles, and rhomboids. Existing phytoconstituents such as flavonoids and glycosides in the plant extract were suggested to be responsible for the phytosynthesis of rGO-AuNPs. The excellent catalytic efficacy of rGO-AuNPs against MB degradation was confirmed, and a high antibacterial efficiency against Escherichia coli and Klebsiella pneumonia was also confirmed. Promising antioxidant performance of rGO-AuNPs was also proved. Furthermore, it was concluded that rGO-AuNPs acquired higher efficiency than AuNPs synthesized from the same plant extract in all of the studied applications.

Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema

Background

There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema.

Results

Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping < 60 ms). No statistical significance was found between the TIRM and the T2 mapping neither in the total amount of edema (p = 0.79), nor in the LV basal, mid, and apical segments’ edema (p = 0.69, 0.5, and 0.8 respectively). The upper and lower limits of agreements were tested between the TIRM and the T2 mapping of total edema mass, basal segments, mid, and apical ventricular segments were = 18 and − 7.7 g, 11.3 and − 5.1 g, 12.3 and − 5.2 g, and 15.5 and − 7.8 g respectively.

Conclusion

This study supports the proof of the principle that there is no statistical significant difference per myocardial segments between the T2 mapping and routine edema’s sequences. Larger studies are recommended to assess the impact in clinical outcome.

Incidence of maternal and fetal complications in pregnant with mechanical prosthetic cardiac valves: a cohort study

Background

In developing countries, an unusually large number of women of childbearing age have mechanical valves because rheumatic fever and concomitant valvular heart disease are still common and most severely affect the young. Managing anticoagulation during pregnancy is challenging, and the rate of complications is relatively high.

Purpose

The aim of this study was to detect the incidence of maternal and fetal complications in pregnant women with prosthetic valve in a high-risk pregnancy unit in one of the developing countries.

Methods

This study included 106 pregnant women with prosthetic heart valves on oral anticoagulant therapy. Excluded from the study were patients with low ejection fraction (&lt;50%), patients with other comorbidities that may affect the pregnancy outcomes and patients who were not willing to share their data. Patients were followed up since presentation to the high-risk pregnancy unit till delivery. At each visit, women were clinically assessed for the occurrence of complications (heart failure, infective endocarditis, prosthetic valve dysfunction, systemic emboli, new onset arrhythmia, antepartum hemorrhage, or death). Babies were evaluated by an Obstetrician for intrauterine growth retardation or fetal death, abortion, oligo or polyhydramnios, and congenital heart diseases.

Results

The mean age was 28.5±4.2 years, 58 patients (54.7%) had mitral valve prothesis, 34 (32.1%) had aortic valve prosthesis and 14 patients (13.2%) had double valve prothesis. Fifty-three patients (50%) received warfarin throughout pregnancy and the rest switched to heparin in the first trimester. Cerebrovascular stroke occurred in 4 patients (3.8%), all were on the 1st trimester and all were taking heparins. The mean gestational age at delivery was 36.2±4.8 weeks and the mean fetal birth weight was 2435±791.5 gm. Thirty-three abortions were reported and the mean gestational age for abortion was 13 weeks±6 days while the mean gestational age for intrauterine fetal death was 29±4 weeks, table. Two babies had congenital heart diseases (ventricular septal defect and patent ductus arteriosus) and in both, the mothers were taking warfarin &gt;5 mg/day during the second and third trimesters.

Conclusion

In this tertiary care centre, the incidence of maternal complications was relatively small while the incidence of fetal complications was high, especially in mothers taking higher warfarin doses. Switching to heparin in the first trimester increased the risk of systemic embolization.

Funding Acknowledgement

Type of funding sources: None.

Evaluation of secondary prevention in Egyptian patients after primary percutaneous coronary intervention

Funding Acknowledgements

Type of funding sources: None.

Background

Effective secondary prevention after acute coronary syndromes is critical to reducing the risk of a subsequent cardiovascular event.  Adherence to secondary prevention is disappointingly low worldwide, with no data in Upper Egypt. 

Purpose and methods

 We sought to determine the prevalence of adherence to secondary preventive among patients who underwent primary percutaneous coronary intervention (PPCI) in a tertiary centre in Upper Egypt from 2014-2016 (n = 468).

Results

 Our cohort included 468 patients, mean age  at STEMI was 55.7 ± 11.2 years; 79% males. Smoking, diabetes mellitus (DM), dyslipidemia, obesity and hypertension were 62%, 42%, 39%, 38% and 34% respectively. Median follow-up duration (IQR) was 703 (613-830) days. Table 1 shows the prevalence of adherence secondary prevention. Re-myocardial infarction, unstable angina, repeated hospital admission was 4.9%, 5.1%, 14% respectively.  Revascularizations were 8.1% and total ischemic complications  were 18%. The major adverse cardiac events MACEs were 24%. DM and hypertension were significant predictors of MACEs on univariable and multivariable analysis (multivariable ORs [95% CIs]: 1.685 [1.002 -2.833] and 1.764 [1.033-3.012], respectively). 

Conclusion

 Adherence to secondary prevention after PPCI is sub-optimal in Upper Egypt. We need to raise the standard of preventive cardiology care through more effective primary and secondary prevention programs, to reduce morbidity and mortality.

Risk factor Target level Number (%) Diabetes HbA1c &lt;7% 280(62) Blood pressure &lt;140/90 295(63) Smoking cessation in smokers Complete cessation 122 (43) Smoking status No smoking 301(65) Physical activity Walking at least 30 minutes 5 days/week 301(60) Body mass index &lt;25 kg/m2 101(22) Waist circumference &lt;102 cm in males, &lt;88 cm in females 164(36) Diet Low salt and fat, adequate fruits and vegetables 268 (57) Lipids LDL &lt; 70 gm/dL 93(26)

Contralateral Eye Study of Topography Guided versus Q Value Adjusted Photorefractive Keratectomy in Myopia and Myopic Astigmatism

Purpose of the Study

To compare visual outcome, higher order aberrations (HOAs) of topography guided and Q value adjusted ablation in the fellow eye of patients undergoing photorefractive keratectomy (PRK) for the correction of myopia and myopic astigmatism.

Methods

Prospective randomized controlled interventional clinical study. The eyes of 52 patients undergoing PRK for myopia and astigmatism were included, that is, 104 eyes in total. In each patient, eyes were randomly allocated to group I: one eye received topography guided PRK using Contoura ablation software, or group II: the other eye received Q value adjusted PRK using Custom Q ablation software.

Follow-Up

Six months.

Results

At the end of 6 months, LogMAR UDVA was -0.04 ± 0.12 and -0.05 ± 0.11 (p = 0.688), while LogMAR CDVA was -0.06 ± 0.09 and -0.06 ± 0.1 in group I and group II, respectively (p = 0.972). Both groups showed a progressive oblate shift with time. This oblate shift was insignificantly less in group I by Topolyzer at 6mm, 15° and 30° at 6 months (p = 0.102, p = 0.138, p = 0.245, respectively). Topolyzer identified a significant difference between the change in coma and trefoil in both groups at 6 months (p<0.001 and p = 0.001, respectively). This was caused by the significant worsening of coma in group II (p<0.001) and the significant improvement of trefoil in group I (p = 0.007). No significant difference was found between groups in the change of ISV or ABR (p = 0.955 and 0.982, respectively). Ablation depth is a significant predictor of ΔQ at 6mm, 15° and 30° (p = 0.009, 0.039 and 0, respectively). No significant difference was found in the Strehl ratio or contrast sensitivity, although they were insignificantly better in group I (p = 0.785 and p = 0.745, respectively).

Conclusion

TG PRK and CQ PRK yielded similar results regarding UDVA, CDVA, MRSE, safety, predictability and contrast sensitivity. Both groups showed a progressive oblate shift, which was less in the TG group but the difference was statistically insignificant. TG PRK showed significantly improved trefoil HOA as compared to CQ PRK.

Deep convolutional neural network for the automated detection of Subthalamic nucleus using MER signals

BACKGROUND

Deep brain stimulation (DBS) surgery has been extensively conducted for treating advanced Parkinson's disease (PD) patient's symptoms. DBS hinges on the localization of the subthalamic nucleus (STN) in which a permanent electrode should be accurately placed to produce electrical current. Microelectrode recording (MER) signals are routinely recorded in the procedure of DBS surgery to validate the planned trajectories. However, manual MER signals interpretation with the goal of detecting STN borders requires expertise and prone to inter-observer variability. Therefore, a computerized aided system would be beneficial to automatic detection of the dorsal and ventral borders of the STN in MER.

NEW METHOD

In this study, a new deep learning model based on convolutional neural system for automatic delineation of the neurophysiological borders of the STN along the electrode trajectory was developed.

COMPARISON WITH EXISTING METHODS

The proposed model does not involve any conventional standardization, feature extraction or selection steps.

RESULTS

Promising results of 98.67% accuracy, 99.03% sensitivity, 98.11% specificity, 98.79% precision and 98.91% F1-score for subject based testing were achieved using the proposed convolutional neural network (CNN) model.

CONCLUSIONS

This is the first study on the analysis of MER signals to detect STN using deep CNN. Traditional machine learning (ML) algorithms are often cumbersome and suffer from subjective evaluation. Though, the developed 10-layered CNN model has the capability of extracting substantial features at the convolution stage. Hence, the proposed model has the potential to deliver high performance on STN region detection which shows perspective in aiding the neurosurgeon intraoperatively.

Primary Topography-Guided LASIK: A Comparative Study Comparing Treating the Manifest versus the Topographic Astigmatism

Purpose

To investigate if topography-guided laser in situ keratomileusis (LASIK) depending on the topographic astigmatism which is measured using the Topolyzer leads to a better refractive outcome when compared to treatment of the manifest refractive astigmatism in cases of myopic astigmatism.

Methods

This was a prospective non-masked, randomized study (block randomization) of postoperative vision and refraction of patients with myopic astigmatism that had LASIK using Contoura vision software. They were divided into three groups according to the treatment strategy, treating the manifest astigmatism in one group, the topographic astigmatism with compensation for the spherical power in the second group and treating the topographic astigmatism without changing the spherical power in the third group. It was conducted at Kasr Alainy Hospital and Dar Eloyon Hospital.

Results

The postoperative uncorrected distant visual acuity (UDVA) in each group separately was better than the preoperative corrected distant visual acuity (CDVA) (58% (n=35) had UDVA better than 20/20 and gained 1 line or more); however, eyes treated with the topographic astigmatism without changing the spherical power showed the statistically best results (75% (n=15) had UDVA better than 20/20). The residual anterior corneal astigmatism was lower in this group (the mean 0.47 vs 0.95 and 0.59). No significant difference was noted in the residual refractive astigmatism, but it was also the least in that group.

Conclusion

Topography-guided LASIK is a safe and effective ablation profile for treatment of myopic astigmatism. Treating according to the topographic astigmatism shows the best outcome as regards the vision and residual astigmatism.

Contribution of Posterior Corneal Astigmatism to Total Corneal Astigmatism in a Sample of Egyptian Population

Purpose

To determine the percentage of contribution of the magnitude of posterior corneal astigmatism to total corneal astigmatism using Scheimpflug imaging.

Methods

This prospective cross-sectional study was conducted on 356 eyes of 356 patients, where the total corneal astigmatism was calculated by addition of anterior and posterior corneal astigmatism using vector analysis and then the percentage of posterior to total corneal astigmatism was calculated.

Results

The percentage of contribution of posterior to total corneal astigmatism was about 30% in patients with With The Rule astigmatism and about 8% in patients with Against The Rule astigmatism.

Conclusion

Posterior corneal astigmatism should not be neglected during calculation of total corneal astigmatism as neglecting posterior corneal astigmatism can result in errors during calculation and correction of astigmatism.

Evaluation of Environmental Pollution and Microbial Treatment of Shallow Groundwater in El Omayed Area, Egypt

In the last few years, the northwestern coastal zone of Egypt has been affected by many stresses that impact its water resources, leading to undesirable consequences related to water quantity and quality. This paper aims to evaluate the possible contamination sources of shallow aquifers in the El-Omayed area, Egypt, that are causing its deterioration; this was achieved through an integration of hydrochemical and isotopic techniques, an assessment of the undesirable consequences of potential toxic metals (PTMs) on human health risk as a result of direct water consumption, and finally, the application of biological treatment in the remediation of some metal contamination. The chemical composition, environmental isotopes (δ¹⁸ O and δ² H), and microbial analyses were analyzed from 13 collected water samples. Approximately 20% of the groundwater samples were classified as fresh water, and the rest were classified as slightly saline to moderately saline. Stable isotopes proved the contribution of the El Sheikh Zoied canal (which is mainly recharged from the Nile system) as a recharge source. The toxicity of PTMs (Cd, Cu, Co, Cr, Pb, Zn, B, and Fe) was evaluated on the basis of their exceedance values. It was proven that the majority of the groundwater samples were contaminated, which might be attributed to natural and anthropogenic actions in the study area; however, according to human health risk exposure assessment calculations, there is no human cancer risk posed via ingestion of drinking groundwater. The total bacterial count was determined for all water samples; autochthonous microorganisms were capable of removing heavy metals in the polluted water sample. The bacterial strain M52, which was identified by 16S rRNA sequencing as Stenotrophomonas rhizophila, showed the best results, by removing 75% and 65% of the initial concentrations of Fe and B, respectively. The results indicate that this bacterial strain may be useful and represents an environmentally friendly method to remove pollutants and heavy metals from contaminated water. Integr Environ Assess Manag 2020;16:461-471. © 2020 SETAC.

Molecular epidemiology of Clostridium neonatale and its relationship with the occurrence of necrotizing enterocolitis in preterm neonates

Clostridia—especially Clostridium butyricum—are among the taxa most frequently identified from stool samples of preterm neonates with necrotizing enterocolitis (NEC). Recently, Clostridium neonatale has also been detected from epidemic cases, but using a culture-based approach we were unable to confirm this discovery in a local cohort. In order to investigate this link by a molecular approach, a specific rpoB-based quantitative real-time PCR was developed to detect C. neonatale directly from patients' stool specimens. Design of this rpoB-based quantitative real-time PCR was based on the genomic analysis of seven clinical isolates of C. neonatale. It was tested on stool samples from 88 preterm neonates with necrotizing enterocolitis and 71 matched controls. C. neonatale was significantly more prevalent in stools from preterm neonates with necrotizing enterocolitis than in controls (respectively 30/88 (34%) versus 9/71 (13%); p 0.003). Whole-genome analysis also allowed the identification of three genomic clusters of C. neonatale. This clustering was associated with a geographical location regardless of isolation from the NEC or control, suggesting asymptomatic carriage. Although less prevalent than C. butyricum in our cohort, C. neonatale is significantly associated with the occurrence of necrotizing enterocolitis.

Verification and measurement of the side-cut angle of corneal flap in patients undergoing LASIK surgery using FS 200 kHz femtosecond laser system versus conventional mechanical microkeratome

Introduction: This is a prospective nonrandomized interventional clinical trial conducted to measure and verify the intended versus the achieved LASIK flap side-cut angle in two groups of patients, Femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) using Wavelight FS200 (Alcon Laboratories Inc. Fort Worth, TX, USA) and the conventional mechanical microkeratme (Moria M₂ 90).

Methods: This prospective clinical trial was conducted on 40 eyes of 20 patients (20 eyes in each group) in the interval between December 2017 and August 2018. Heidelberg anterior segment OCT was done for the patients 2 weeks postoperatively to measure the corneal flap side cut angle.

Results: The achieved side-cut angles of all the patients in the first group (the femtosecond laser-assisted in-situ keratomileusis group) were equal to or more inverted than the intended angle (110–115°) in all the study candidates with a minimum angle (110°) and maximum angle (155°). Unlike the achieved side-cut angle in the second group (the mechanical microkeratome group) in which all the achieved side-cut angle were acute with a minimum angle (30°) and maximum angle (65°) which is more acute than the intended side-cut angle (70°).

Conclusion: In our study we found that the femtoLASIK technology was capable of making the flap side-cut angle more obtuse than the intended angle, unlike the achieved flap side-cut angle done using the mechanical microkeratome which was more acute than the intended angle in 100% of cases.

Clostridium pacaense: a new species within the genus Clostridium

Using the strategy of taxonogenomics, we described Clostridium pacaense sp. nov. strain Marseille-P3100^T, a Gram-variable, nonmotile, spore-forming anaerobic bacillus. This strain was isolated from a 3.3-month-old Senegalese girl with clinical aspects of marasmus. The closest species based on 16S ribosomal RNA was Clostridium aldenense, with a similarity of 98.4%. The genome length was 2 672 129 bp, with a 50% GC content; 2360 proteins were predicted. Finally, predominant fatty acids were hexadecanoic acid, tetradecanoic acid and 9-hexadecenoic acid.

Simultaneous intratunnel cross-linking with intrastromal corneal ring segment implantation versus simultaneous epithelium-off cross-linking with intrastromal corneal ring segment implantation for keratoconus management

Purpose

The purpose of this study is to compare the efficacy of intratunnel cross-linking combined with intrastromal corneal ring segment (ICRS) implantation versus combined epithelium-off (epi-off) cross-linking and ICRS implantation for the management of keratoconus.

Methods

Our study included 20 eyes of 12 patients with moderate-to-severe keratoconus. Group A included 10 eyes that underwent simultaneous ICRS implantation with intratunnel cross-linking. Group B included 10 eyes that underwent simultaneous ICRS implantation with epi-off cross-linking. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere and cylinder, mean and maximum keratometric readings, corneal thickness at pachy apex and thinnest location, as well as corneal hysteresis (CH) and corneal resistance factor (CRF) were compared preoperatively and at 6 months postoperatively.

Results

The mean UDVA and CDVA improved significantly in both groups with a statistically nonsignificant difference between the groups (P=0.798 and 0.126, respectively). The manifest cylinder decreased significantly in both groups, while the manifest sphere decreased significantly in Group A but nonsignificantly in Group B with a statistically nonsignificant difference between the groups (P=0.773 and 0.111, respectively). Both techniques led to significant flattening of the cornea and a significant decrease of K_m and K_max with a statistically nonsignificant difference between the groups (P=0.312 and 0.857, respectively). There was a statistically significant decrease in CH in both groups postoperatively; however, there was a statistically nonsignificant increase in CRF after both techniques with a statistically nonsignificant difference between the groups in the mean change of CH and CRF (P=0.633 and 0.313, respectively). No intraoperative or postoperative complications were observed in both groups.

Conclusion

Both techniques improved the visual and refractive outcomes in cases of moderate and severe keratoconus with no statistically significant difference between the groups; however, simultaneous intratunnel cross-linking and ICRS implantation showed early visual rehabilitation due to the absence of epithelial defect.

Effect of adjunctive use of systemic antioxidant therapy (N-acetylcysteine) on soluble receptor activator nuclear factor κB ligand levels in gingival crevicular fluid following surgical periodontal treatment for chronic periodontitis

N-acetylcysteine (NAC) is an anti-oxidant drug that has been used as a mucolytic agent and a paracetamol antidote for many years. This study was designed to determine the efficacy of the adjunctive use of NAC for periodontal treatment. Thirty subjects with moderate-to-severe chronic periodontitis were randomized to surgery with NAC (600 mg; S-NAC), surgery only (S-nonNAC), and healthy control groups. Gingival crevicular fluid (GCF) samples were obtained from all patients and sRANKL levels were determined by enzyme-linked immunosorbent assay at baseline, and 1, 3, and 7 months post-surgery. Plaque and gingival indices, probing depths, and clinical attachment levels were recorded at the same time. There was a significant reduction in probing depth at 3 months in the S-NAC group when compared to the S-nonNAC group (P < 0.05). However, no statistically significant differences in plaque and gingival indices, probing depths, clinical attachment levels, and sRANKL levels in GCF were noted between the surgical treatment groups at the end of 7 months. Hence, the use of adjunctive NAC resulted in a significant reduction in probing depths in the S-NAC group when compared to the S-nonNAC group at 3 months, but no statistically significant differences in GCF sRANKL levels were observed in the sites that underwent surgical treatment with or without NAC at different time intervals.

Comparison of different intraocular pressure measurement techniques in normal eyes and post small incision lenticule extraction

Purpose

The purpose of the study was to determine the accuracy of intraocular pressure (IOP) measurement after small incision lenticule extraction (SMILE) using Goldmann applanation tonometry (GAT) and ocular response analyzer (ORA).

Methods

This is a prospective clinical study that was conducted on 30 eyes in the interval between February 2016 and September 2016. The age of the patients ranged between 19 and 40 years. The patients underwent SMILE surgery using the femto laser. IOP was measured preoperatively and 1 month postoperatively by both techniques, the GAT and the ORA.

Results

GAT recorded lower values than ORA values (IOPcc) preoperatively and postoperatively and the difference was statistically significant. Both GAT and ORA IOP measurements decreased after SMILE. There was no statistically significant correlation between the changes in the GAT and ORA readings and the postoperative corneal pachymetry or the lenticule thickness. Both corneal hysteresis and corneal resistance factor showed significant decline after the procedure, which correlated with the lenticule thickness.

Conclusion

SMILE causes significant reduction in IOP measurement by ORA and GAT. Corneal biomechanics decreases following SMILE and this correlates with lenticule thickness.

Description of Clostridium phoceensis sp. nov., a new species within the genus Clostridium

Clostridium phoceensis sp. nov., strain GD3^T (= CSUR P1929 = DSM 100334) is the type strain of C. phoceensis sp. nov., a new species within the genus Clostridium. This strain was isolated from the gut microbiota of a 28-year-old healthy French man. C. phoceensis is a Gram-negative, spore-forming, nonmotile, strictly anaerobic bacterium. We describe its complete genome sequence and annotation, together with its phenotypic characteristics.

An interatrial tunnel: a rare form of atrial septal defects

Atrial septal defects (ASDs) account for approximately 6%-10% of congenital heart defects. The well-known types of atrial septal communications are the ostium secundum, ostium primum, sinus venosus types, and coronary sinus defects. A 50-year-old female was referred for TEE for better assessment of MR severity and mechanism. 2D/3D-TEE showed a rare combination of different abnormalities; bi-leaflet mitral valve prolapse, cleft P2, cor triatriatum sinister, and a tunnel-shaped IAS communication. To the best of our knowledge, this is a very rare case with a rare form of atrial septal defect that was not described before. We named this defect an interatrial tunnel.