Chaotic RIME optimization algorithm with adaptive mutualism for feature selection problems.

The RIME optimization algorithm is a newly developed physics-based optimization algorithm used for solving optimization problems. The RIME algorithm proved high-performing in various fields and domains, providing a high-performance solution. Nevertheless, like many swarm-based optimization algorithms, RIME suffers from many limitations, including the exploration-exploitation balance not being well balanced. In addition, the likelihood of falling into local optimal solutions is high, and the convergence speed still needs some work. Hence, there is room for enhancement in the search mechanism so that various search agents can discover new solutions. The authors suggest an adaptive chaotic version of the RIME algorithm named ACRIME, which incorporates four main improvements, including an intelligent population initialization using chaotic maps, a novel adaptive modified Symbiotic Organism Search (SOS) mutualism phase, a novel mixed mutation strategy, and the utilization of restart strategy. The main goal of these improvements is to improve the variety of the population, achieve a better balance between exploration and exploitation, and improve RIME's local and global search abilities. The study assesses the effectiveness of ACRIME by using the standard benchmark functions of the CEC2005 and CEC2019 benchmarks. The proposed ACRIME is also applied as a feature selection to fourteen various datasets to test its applicability to real-world problems. Besides, the ACRIME algorithm is applied to the COVID-19 classification real problem to test its applicability and performance further. The suggested algorithm is compared to other sophisticated classical and advanced metaheuristics, and its performance is assessed using statistical tests such as Wilcoxon rank-sum and Friedman rank tests. The study demonstrates that ACRIME exhibits a high level of competitiveness and often outperforms competing algorithms. It discovers the optimal subset of features, enhancing the accuracy of classification and minimizing the number of features employed. This study primarily focuses on enhancing the equilibrium between exploration and exploitation, extending the scope of local search.

Tocilizumab for the Treatment of COVID-19-Induced Cytokine Storm and Acute Respiratory Distress Syndrome: A Case Series From a Rural Level 1 Trauma Center in Western Pennsylvania.

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, initially in December 2019 at Wuhan, China, subsequently spread around the world. We describe a case series of COVID-19 patients treated at our academic medical center with focus on cytokine storm and potential therapeutic role of tocilizumab. A 59-year-old female admitted for shortness of breath (SOB), productive cough, fever, and nausea in the setting of COVID-19 pneumonia. Oxygen saturation was 81% necessitating supplemental oxygen. She was transferred to intensive care unit (ICU) for worsening hypoxia; intubated and received tocilizumab following which her oxygen requirements improved. A 52-year-old female admitted from an outside hospital with SOB, intubated for worsening hypoxia, in the setting of COVID-19 pneumonia. She received tocilizumab 400 mg intravenous for 2 doses on ICU admission, with clinical improvement. A 56-year-old female hospitalized with worsening SOB, fever, and cough for 8 days saturating 88% on room air in the setting of COVID-19 pneumonia. Worsening hypoxia necessitated high flow nasal cannula. She was transferred to the ICU where she received 2 doses of tocilizumab 400 mg intravenous. She did not require intubation and was transitioned to nasal cannula. A hyperinflammatory syndrome may cause a life-threatening acute respiratory distress syndrome in patients with COVID-19 pneumonia. Tocilizumab is the first marketed interleukin-6 blocking antibody, and through targeting interleukin-6 receptors likely has a role in treating cytokine storm. We noted clinical improvement of patients treated with tocilizumab.

Seasonal variation in indoor concentrations of air pollutants in residential buildings.

Indoor concentrations of PM10, PM2.5, CO, and CO2 were measured in 25 naturally ventilated urban residences during the winter and summer seasons in Alexandria, Egypt. Ambient air samples were also collected simultaneously for comparison to indoor measurements. Furthermore, data for air exchange rates, home characteristics, and indoor activities during sampling were collected. It was found that the average indoor PM10, PM2.5, CO, and CO2 concentrations for all homes in winter were 119.4 ± 30.9 µg/m3, 85.2 ± 25.8 µg/m3, 1.6 ± 0.8 ppm, and 692.4 ± 144.6 ppm, respectively. During summer, the average indoor levels were 98.8 ± 21.8 µg/m3, 67.8 ± 14.9 µg/m3, 0.5 ± 0.5 ppm, and 558.2 ± 66.2 ppm, respectively. The results indicate that the indoor daily averages of PM10 and PM2.5 concentrations were higher than the World Health Organization (WHO) guidelines for all selected homes in the two sampling periods. For CO and CO2 levels, the indoor daily averages for all monitored homes were less than the WHO guideline and the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ANSI/ASHRAE) Standard 62.1, respectively. A strong seasonal variability was observed, with air quality being particularly poor in winter. Due to increased ventilation rates in summer, indoor levels of air pollutants were strongly dependent on ambient levels, while in winter the indoor concentrations were more strongly affected by indoor sources due to increased human activities and poor ventilation. In addition, stronger indoor/outdoor correlation of air pollutants' levels was found in summer than in winter probably due to higher ventilation and infiltration in the summer. The study also attempted to understand the potential sources and the various determinants that influence indoor PM, CO, and CO2 concentrations in the two seasons. The findings can assist policymakers to better understand the indoor air pollution problem and to provide a sound basis for the development of proper national IAQ standards in Egypt.Implications: Personal exposure is considerably influenced by indoor air pollution which increases health risks. Assessment of indoor air quality has become a more significant issue in Egypt as people tend to spend most of their time inside buildings, especially in their homes. Currently, there is a lack of research on residential indoor air quality in Egyptian cities in terms of the spatial and temporal variation which prevents an accurate assessment of the current situation to develop effective mitigation measures and to establish national indoor air quality standards. This article is considered the first research studying the effect of seasonality on indoor concentrations of PM10, PM2.5, CO, and CO2 in urban residences in Alexandria. It also studies the indoor/outdoor relationship of air pollutants' levels and identifies their major sources as well as the various determinants that influence their indoor concentrations.

Outdoor and indoor factors influencing particulate matter and carbon dioxide levels in naturally ventilated urban homes.

The present study investigated indoor and outdoor concentrations of two particulate matter size fractions (PM10 and PM2.5) and CO2 in 20 urban homes ventilated naturally and located in one congested residential and commercial area in the city of Alexandria, Egypt. The results indicate that the daily mean PM2.5 concentrations measured in the ambient air, living rooms, and kitchens of all sampling sites exceeded the WHO guideline by 100%, 65%, and 95%, respectively. The daily mean outdoor and indoor PM10 levels in all sampling sites were found to exceed the WHO guideline by 100% and 80%, respectively. The indoor PM10 and PM2.5 concentrations were significantly correlated with their corresponding outdoor levels, as natural ventilation through opening doors and windows allowed direct transfer of outdoor airborne particles into the indoor air. Most of the kitchens investigated had higher indoor concentrations of PM2.5 and CO2 than in living rooms. The elevated levels of PM2.5 and CO2 in domestic kitchens were probably related to inadequate ventilation. The current study attempted to understand the sources and the various indoor and outdoor factors that affect indoor PM10, PM2.5 and CO2 concentrations. Several domestic activities, such as smoking, cooking, and cleaning, were found to constitute important sources of indoor air pollution. The indoor pollution caused by PM2.5 was also found to be more serious in the domestic kitchens than in the living rooms and the results suggest that exposure to PM2.5 is high and highlights the need for more effective control measures. Implications: Indoor air pollution is a complex problem that involves many determinant factors. Understanding the relationships and the influence of various indoor and outdoor factors on indoor air quality is very important to prioritize control measures and mitigation action plans. There is currently a lack of research studies in Egypt to investigate determinant factors controlling indoor air quality for urban homes. The present study characterizes the indoor and outdoor concentrations of PM10, PM2.5, and CO2 in residential buildings in Alexandria city. The study also determines the indoor and outdoor factors which influence the indoor PM and CO2 concentrations as well as it evaluates the potential indoor sources in the selected homes. This research will help in the development of future indoor air quality standards for Egypt.

Effects of microstructure and alloy composition on hydroxyapatite precipitation on alkaline treated α/ß titanium alloys.

The current work aims at exploring the effects of the microstructure and alloy composition on enhancing the bone osseointegration in Ti-6Al-4V (Ti64) and Ti-6Al-7Nb (Ti67) alloys. This was revealed by investigating the alloy susceptibility to grow hydroxyapatite (HA) on their surfaces after immersion in simulated body fluid (SBF). The specimens were produced by two methods: forging and casting in order to study the influence of the microstructure on the precipitation process. The surface conditions investigated were the polished, alkaline and the hydrothermally treated. It was found that precipitation on both of Ti64 and Ti67 occurs after about 4 weeks and considerably dissolve back with further immersion. Precipitation process is enhanced at some pH levels lower than the neutral level. Forged Ti67 has less reactivity with Hank solution than Ti64 specimens; the reverse is true for cast specimens. In case of the alkaline treated specimens, precipitations on cast specimens were denser than on the forged ones. For the hydrothermally treated specimens, high amounts of Ca and P were observed on cast Ti67 indicating that hydrothermal treatment is considered the best surface modification treatment for alloy Ti67.

Endocrine and Targeted Therapy for Hormone-Receptor-Positive, HER2-Negative Advanced Breast Cancer: Insights to Sequencing Treatment and Overcoming Resistance Based on Clinical Trials.

Background: Advanced hormone-receptor positive HER2 negative breast cancer is a common and a very heterogeneous disease. Hormone therapy is the main first line treatment of choice, given alone or in combination with other agents that have shown to improve patient outcomes, Nevertheless, treatment remains generally palliative rather than curative. Sequencing of such treatment remains challenging, especially with resurgence of variable resistance patterns. Multiple attempts have been made to overcome resistance and improve patient survival, yet resistance remains not very well understood and metastatic cancer remains a disease with dismal prognosis. Methods: In this paper, we searched pubmed database as well as local and international meetings for all studies discussing advanced and metastatic hormone-receptor-positive, her2-negative breast cancer, hormonal treatment, resistance to hormonal treatment, mechanism of resistance, and means to overcome such resistance. Conclusion: There does not exist an optimal treatment sequence for hormone-receptor-positive, her2-negative advanced breast cancer. However, after review of literature, a reasonable approach may be starting with tamoxifen, aromatase inhibitors, or fulvestrant in absence of visceral crisis, in addition to ensuring adequate ovarian function suppression in pre/peri-menopausal women. Aromatase inhibitors and fulvestrant seem to be superior. Resistance to such agents is increasing, mostly attributed to genetic and molecular changes. Multiple modalities are addressed to overcome such resistance including use of CKD4/6 inhibitors, mTOR inhibitors and PI3K inhibitors in addition to other agents under study, all with promising results. CDK4/6 inhibitors work best when used in frontline setting. Finally, treatment of breast cancer remains a growing field, and more studies are to be awaited.

Investigation of PM2.5 and carbon dioxide levels in urban homes.

PM2.5 (particulate matter with an aerodynamic diameter <2.5 µm) samples were collected in the indoor environments of 15 urban homes and their adjacent outdoor environments in Alexandria, Egypt, during the spring time. Indoor and outdoor carbon dioxide (CO2) levels were also measured concurrently. The results showed that indoor and outdoor PM2.5 concentrations in the 15 sites, with daily averages of 45.5 ± 11.1 and 47.3 ± 12.9 µg/m³, respectively, were significantly higher than the ambient 24-hr PM2.5 standard of 35 µg/m³ recommended by the U.S. Environmental Protection Agency (EPA). The indoor PM2.5 and CO2levels were correlated with the corresponding outdoor levels, demonstrating that outdoor convection and infiltration could lead to direct transportation indoors. Ventilation rates were also measured in the selected residences and ranged from 1.6 to 4.5 hr⁻¹ with median value of 3.3 hr⁻¹. The indoor/outdoor (I/O) ratios of the monitored homes varied from 0.73 to 1.65 with average value of 0.99 ± 0.26 for PM2.5, whereas those for CO2ranged from 1.13 to 1.66 with average value of 1.41 ± 0.15. Indoor sources and personal activities, including smoking and cooking, were found to significantly influence indoor levels.

Indoor particulate matter in urban residences of Alexandria, Egypt.

UNLABELLED: Indoor particulate matter samples were collected in 17 homes in an urban area in Alexandria during the summer season. During air measurement in all selected homes, parallel outdoor air samples were taken in the balconies of the domestic residences. It was found that the mean indoor PM2.5 and PM10 (particulate matter with an aerodynamic diameter < or = 2.5 and < or = 10 microm, respectively) concentrations were 53.5 +/- 15.2 and 77.2 +/- 15.1 microg/m3, respectively. The corresponding mean outdoor levels were 66.2 +/- 16.5 and 123.8 +/- 32.1 microg/m3, respectively. PM2.5 concentrations accounted, on average, for 68.8 +/- 12.8% of the total PM10 concentrations indoors, whereas PM2.5 contributed to 53.7 +/- 4.9% of the total outdoor PM10 concentrations. The median indoor/outdoor mass concentration (I/O) ratios were 0.81 (range: 0.43-1.45) and 0.65 (range: 0.4-1.07) for PM2.5 and PM10, respectively. Only four homes were found with I/O ratios above 1, indicating significant contribution from indoor sources. Poor correlation was seen between the indoor PM10 and PM2.5 levels and the corresponding outdoor concentrations. PM10 levels were significantly correlated with PM2.5 loadings indoors and outdoors and this might be related to PM10 and PM2.5 originating from similar particulate matter emission sources. Smoking, cooking using gas stoves, and cleaning were the major indoor sources contributed to elevated indoor levels of PM10 and PM2.5. IMPLICATIONS: The current study presents results of the first PM2.5 and PM10 study in homes located in the city of Alexandria, Egypt. Scarce data are available on indoor air quality in Egypt. Poor correlation was seen between the indoor and outdoor particulate matter concentrations. Indoor sources such as smoking, cooking, and cleaning were found to be the major contributors to elevated indoor levels of PM10 and PM2.5.

Cytokines in response to proteins predicted in genomic regions of difference of Mycobacterium tuberculosis.

Cellular immune responses are responsible for both protection and pathogenesis in tuberculosis, and are mediated/regulated by a complex network of pro-inflammatory, T helper (Th) type 1 and type 2 cytokines. In this study, the secretion of pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8 and IL-1ß; Th1 cytokines interferon-gamma (IFN-γ), IL-2 and tumor necrosis factor-beta (TNF-ß); and Th2 cytokines IL-4, IL-5 and IL-10 by the peripheral blood mononuclear cells (PBMCs) of pulmonary tuberculosis patients was studied. PBMCs were cultured in vitro in the absence and presence of complex mycobacterial antigens and peptides corresponding to 11 regions of difference (RD) of Mycobacterium tuberculosis that are deleted/absent in all vaccine strains of Mycobacterium bovis bacillus Calmette-Guérin (BCG). The culture supernatants were tested for secreted cytokines by FlowCytomix assay. PBMCs from the majority of patients (53-100%) spontaneously secreted detectable concentrations of all cytokines tested, except for IL2 (29%) and IL-10 (41%). The profiles of proinflammatory cytokines were largely similar for various complex antigens or RD peptides. However, with respect to Th1 and Th2 cytokines, the antigens could be divided into three groups; the first with Th1-bias (culture filtrate of M. tuberculosis, RD1, RD5, RD7, RD9 and RD10), the second with Th2-bias (whole cells and cell walls of M. tuberculosis, RD12, RD13 and RD15), and the third without Th1/Th2-bias (M. bovis BCG, RD4, RD6 and RD11). Complex mycobacterial antigens and RD proteins with Th1- and Th2-biases may have roles in protection and pathogenesis of tuberculosis, respectively.

Laparoscopic versus open cholecystectomy in patients with liver cirrhosis: a prospective, randomized study.

BACKGROUND: Gallstones are more common in patients with liver cirrhosis than in healthy individuals. Higher morbidity and mortality were reported in cirrhotic patients with either laparoscopic or open cholecystectomy. The aim of this study was to compare laparoscopic and open cholecystectomy in cirrhotic patients with symptomatic cholelithiasis in a prospective, randomized manner. MATERIALS AND METHODS: Thirty patients with symptomatic cholelithiasis associated with Child-Pugh class A or B liver cirrhosis were prospectively and randomly grouped equally to either laparoscopic or open cholecystectomy. The two groups were compared regarding operative time, morbidity, mortality, postoperative liver function, and hospital stay. RESULTS: The two groups were comparable regarding demographic data, preoperative and postoperative Child-Pugh scoring, mean operative time (57.3 minutes for laparoscopic and 48.5 for open), and complications (33.3% for each). Hospital stay was shorter for the laparoscopic group. One conversion (6.7%) to open surgery was reported. No periopertive mortality occurred in either group. CONCLUSIONS: For Child-Pugh class A and B cirrhotics, laparoscopic cholecystectomy is comparable to the open approach regarding operative time, morbidity, mortality, and effect on liver function, but with shorter hospital stay. Considering the other well-documented advantages of the laparoscopic approach, namely, less pain, earlier mobilization and feeding, and better cosmoses, laparoscopic cholecystectomy would be the first choice in cirrhotic patients.

Aerosol sampling methods in workplace and ambient environments.

Aerosols are emitted into the workplace atmosphere and the ambient environment through a variety of processes. Aerosol particles are known to have significant effects on both human health and the ambient environment. For this reason, monitoring aerosol concentrations in the atmosphere by aerosol sampling is undertaken in workplace and ambient environments. A wide range of aerosol sampling methods using different collection mechanisms has been used for collecting representative aerosol samples using either a collecting or sensing medium. This paper shows the existing and commonly used aerosol sampling methods based on aerosol collection and real-time measurements. The method of choice for aerosol sampling will ultimately depend on a variety of factors, such as purpose of sampling, type of aerosol, analysis requirements, and available budget.