The Outcome of Congenital Cardiac Surgery in Patients with Down Syndrome: Single-Center Experience.

OBJECTIVES: This study aimed to describe the outcomes of Down syndrome patients who underwent cardiac surgery for congenital heart defects and to develop risk prediction models for in-hospital mortality, recurrent hospital admission, and the need for catheter intervention among a cohort of patients. METHODS: This single-centre retrospective cohort study included consecutive Down syndrome patients who underwent cardiac surgery for congenital heart defects between January 2018 and December 2021. We reviewed the electronic medical records. Two hundred patients fulfilled the eligibility criteria with complete data reporting. The patients' perioperative data and outcomes were recorded. RESULTS: Females constituted 56.5%. Most (78.5%) patients showed accepted recovery. The incidence of all-cause in-hospital mortality was 3.0%. The rates of the need for a second operation, heart failure management, and permanent pacemaker insertion were 3.0%, 2.0%, and 2.5%, respectively. Only 8 (4.0%) patients stayed in the hospital for a long duration after chylothorax or tracheostomy (if intubated more than 2 weeks). The model had an accuracy of 99% and included the intraoperative transesophageal echocardiography (TEE) abnormalities (residual heart lesions) (adjusted odds ratio [AOR]: 26.541, p = 0.033), the duration of mechanical ventilation following the operation (AOR: 1.152, p = 0.009), and the occurrence of postoperative heart block (AOR: 76.447, p = 0.005). CONCLUSION: Surgical treatment of congenital heart defects in Down syndrome patients had good outcomes with accepted recovery (without intra-hospital or during follow-up mortality or morbidity) of 78.5% and a 3% incidence of in-hospital mortality. Though, the occurrence of chylothorax was considerably high, and resulted in a long hospital stay (more than 10 days). Repair of tetralogy of Fallot and coarctation of the aorta were associated with an increased likelihood of catheter intervention following the operation.

Efficacy and toxicity of plasmonic photothermal therapy (PPTT) using gold nanorods (GNRs) against mammary tumors in dogs and cats.

Plasmonic photothermal therapy (PPTT) was introduced as a promising treatment of cancer. This work was conducted to evaluate the cytotoxic effect of intratumoral (IT) injection of 75µg gold nanorods (GNRs)/kg of body weight followed by direct exposure to 2 w/cm2 near infra-red laser light for 10min on ablation of mammary tumor in 10 dogs and 6 cats. Complete blood count (CBC), liver and kidney function were checked before the start of treatment and one month after injection of GNRs. Results showed that 62.5% (10/16), 25% (4/16) and 12.5% (2/16) of treated animals showed complete remission, partial remission and no response, respectively. Tumor was relapsed in 4 cases of initially responding animals (25%). Overall survival rate was extended to 315.5±20.5days. GNRs have no toxic effect on blood profile, liver or kidney functions. In conclusion, GNRs can be safely used for treatment of mammary tumors in dogs and cats.

Surface Treatment by Physical Irradiation for Antifouling, Chlorine-Resistant RO Membranes.

Reverse osmosis (RO) membranes represent a strategic tool for the development of desalination and water treatment processes. Today's global needs for clean water supplies show stressing circumstances to secure this supply, relying upon desalination and wastewater treatment and reuse, especially in Egypt and the Middle East. However, chlorine attack and fouling of polyamide layers, the active (selective) layers of RO membranes, are representing a great obstacle to seriously spreading the use of this technology. One promising way of fouling control and chlorine resistance is surface modification using grafting by plasma or vacuum ultraviolet (VUV) irradiation as a layer-by-layer assembly on polyamide membranes. Several studies have shown the effect of grafting by plasma using methacrylic acid (atmospheric pressure plasma) and showed that grafted coatings can improve PA membranes toward permeation compared with commercial ones with fouling behavior but not chlorine resistance. In this work, the techniques of layer-by-layer (LBL) assembly for previously prepared PA RO membranes (3T) using a mixed-base polymer of polysulfone and polyacrylonitrile in the presence of nanographene oxide (GO) without chemical grafting and with chemically grafted poly-methacrylic acid (3TG) were used. Membranes 3T, 3TG, a blank one (a base polymer membrane only was surface modified using VUV activation (AKT), and one with a grafted layer with polyethylene glycol (VUV-PEG) were prepared. These were then compared with polydimethylsiloxane (VUV-PDMS) and another surface modification with low-pressure plasma using acrylic acid (acryl) and hexadimethyl siloxane (GrowPLAS). The tested membranes were evaluated by short-term permeation and salt rejection experiments together with fouling behavior and chlorine resistance. A clear improvement of chlorine resistance and antifouling was observed for 3T membranes under plasma treatment, especially with the grafting with polyacrylic acid. Better antifouling and antichlorine behaviors were achieved with the vacuum UV treatment.

The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms.

INTRODUCTION: Troublesome voiding lower urinary tract symptoms (LUTS) are a common problem in men, particularly with ageing. Implicitly, management of voiding LUTS can be guided by accurate determination of underlying mechanisms, distinguishing men with voiding symptoms caused by outlet obstruction from those with reduced bladder contractility. METHODS: A PubMed search of the published literature on invasive and non-invasive methods used to assess lower urinary tract function was carried out. RESULTS: A multitude of methods have been applied to assess LUTS. Multichannel pressure flow studies (PFS) are the standard for diagnosing bladder outlet obstruction and underlying mechanisms of LUTS, though their invasive nature can be difficult to tolerate, and improved prediction of treatment outcome is disputed. Uroflowmetry and post void residual measurement are insufficient to make a definitive diagnosis. Ultrasound-derived measurements of bladder wall thickness and estimated bladder weight offer a potential non-invasive alternative to PFS, but their diagnostic parameters are still under evaluation. Non-invasive methods that measure isovolumetric bladder pressure by interrupting the urinary stream can reproducibly measure pressure and urinary flow, but are unable to determine the effects of abdominal straining during voiding and give no insight into urine storage symptoms. Doppler ultrasound during urethral flow is informative, but it is an expensive approach whose clinical utility has yet to be established. CONCLUSION: A variety of non-invasive urodynamic and non-urodynamic techniques have been used to evaluate LUTS and some show great promise. However, there is as yet, insufficient evidence to justify replacement of invasive voiding cystometry by these investigational approaches.

Percutaneous nephrolithotomy in horseshoe kidneys: is rigid nephroscopy sufficient tool for complete clearance? A case series study.

BACKGROUND: this study represents a case series to evaluate how successful is the rigid percutaneous nephroscopy as a tool for clearance of all stones in various locations in horseshoe kidneys. METHODS: Between 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy) for calculi in horseshoe kidneys in 21 renal units (17 patients) in our department. The indications were large stone burden in 18 units and failed SWL(shock wave lithotripsy) in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location. RESULTS: The procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal) were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy) drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7% at discharge. CONCLUSION: Percutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.

Botulinum toxin treatment for overactive bladder: risk of urinary retention.

In recent years, botulinum-A neurotoxin has increasingly been used to manage lower urinary tract symptoms, including overactive bladder and detrusor overactivity (DO), either due to neurogenic or idiopathic etiology. Techniques, doses, and preparation vary. Although many studies have reported promising results regarding efficacy, potential adverse effects, particularly urinary retention, have been less comprehensively reported. We performed a critical review of published studies evaluating botulinum treatment for overactive bladder and its reported effects on voiding function. Acute urinary retention is recognized, though rare. Chronic urinary retention is inconsistently reported; it appears to be more common in neurogenic DO, but it can occur in idiopathic DO. Increased postvoid residuals have been reported by several studies, but the clinical significance that investigators attach to the observation varies. The detrimental effect of retention on quality of life can be considerable. Accordingly, patients should be fully counseled on the risks of urinary retention and trained in intermittent catheterization before the procedure. Postvoid residual assessment should be part of follow-up and patients should be warned of possible presentations.

Wastewater treatment by membrane ultrafiltration enhanced with ultrasound: Effect of membrane flux and ultrasonic frequency.

Membrane ultrafiltration is increasingly applied for wastewater treatment and reuse, even though membrane fouling still represents one of the main drawbacks of this technology. In the last years, innovative strategies for membrane fouling control have been developed, such as the combination of membrane processes with ultrasound (US). In present work, the application of membrane ultrafiltration and its combination with US were studied, evaluating the influence on the performance of the treatment and membrane fouling formation of two membrane fluxes, 75 and 150L/m2h, along with two US frequencies, 35 and 150kHz. The results observed showed that the combination of membrane ultrafiltration with US, respect to the filtration process alone, reduced membrane fouling rates to a greater extent at the higher membrane flux and lower US frequency applied, reaching a reduction of 57.33% at 150L/m2h and 35kHz. Furthermore, higher organic matter and turbidity removals were observed at higher frequency (130kHz). The results obtained highlights the applicability of this combined process for the upgrading of membrane ultrafiltration and as an alternative option to conventional tertiary wastewater treatments.