The role of neuromodulation in the management of drug-resistant epilepsy.

Drug-resistant epilepsy (DRE) poses significant challenges in terms of effective management and seizure control. Neuromodulation techniques have emerged as promising solutions for individuals who are unresponsive to pharmacological treatments, especially for those who are not good surgical candidates for surgical resection or laser interstitial therapy (LiTT). Currently, there are three neuromodulation techniques that are FDA-approved for the management of DRE. These include vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). Device selection, optimal time, and DBS and RNS target selection can also be challenging. In general, the number and localizability of the epileptic foci, alongside the comorbidities manifested by the patients, substantially influence the selection process. In the past, the general axiom was that DBS and VNS can be used for generalized and localized focal seizures, while RNS is typically reserved for patients with one or two highly localized epileptic foci, especially if they are in eloquent areas of the brain. Nowadays, with the advance in our understanding of thalamic involvement in DRE, RNS is also very effective for general non-focal epilepsy. In this review, we will discuss the underlying mechanisms of action, patient selection criteria, and the evidence supporting the use of each technique. Additionally, we explore emerging technologies and novel approaches in neuromodulation, such as closed-loop systems. Moreover, we examine the challenges and limitations associated with neuromodulation therapies, including adverse effects, complications, and the need for further long-term studies. This comprehensive review aims to provide valuable insights on present and future use of neuromodulation.

Mud Ring Optimization Algorithm with Deep Learning Model for Disease Diagnosis on ECG Monitoring System.

Due to the tremendous growth of the Internet of Things (IoT), sensing technologies, and wearables, the quality of medical services has been enhanced, and it has shifted from standard medical-based health services to real time. Commonly, the sensors can be combined as numerous clinical devices to store the biosignals generated by the physiological actions of the human body. Meanwhile, a familiar method with a noninvasive and rapid biomedical electrocardiogram (ECG) signal can be used to diagnose and examine cardiovascular disease (CVD). As the growing number of patients is destroying the classification outcome because of major changes in the ECG signal patterns among numerous patients, computer-assisted automatic diagnostic tools are needed for ECG signal classification. Therefore, this study presents a mud ring optimization technique with a deep learning-based ECG signal classification (MROA-DLECGSC) technique. The presented MROA-DLECGSC approach recognizes the presence of heart disease using ECG signals. To accomplish this, the MROA-DLECGSC technique initially preprocessed the ECG signals to transform them into a uniform format. In addition, the Stacked Autoencoder Topographic Map (SAETM) approach was utilized for the classification of ECG signals to identify the presence of CVDs. Finally, the MROA was applied as a hyperparameter optimizer, which assisted in accomplishing enhanced performance. The experimental outcomes of the MROA-DLECGSC algorithm were tested on the benchmark database, and the results show the better performance of the MROA-DLECGSC methodology compared to other recent algorithms.

A White Shark Equilibrium Optimizer with a Hybrid Deep-Learning-Based Cybersecurity Solution for a Smart City Environment.

Smart grids (SGs) play a vital role in the smart city environment, which exploits digital technology, communication systems, and automation for effectively managing electricity generation, distribution, and consumption. SGs are a fundamental module of smart cities that purpose to leverage technology and data for enhancing the life quality for citizens and optimize resource consumption. The biggest challenge in dealing with SGs and smart cities is the potential for cyberattacks comprising Distributed Denial of Service (DDoS) attacks. DDoS attacks involve overwhelming a system with a huge volume of traffic, causing disruptions and potentially leading to service outages. Mitigating and detecting DDoS attacks in SGs is of great significance to ensuring their stability and reliability. Therefore, this study develops a new White Shark Equilibrium Optimizer with a Hybrid Deep-Learning-based Cybersecurity Solution (WSEO-HDLCS) technique for a Smart City Environment. The goal of the WSEO-HDLCS technique is to recognize the presence of DDoS attacks, in order to ensure cybersecurity. In the presented WSEO-HDLCS technique, the high-dimensionality data problem can be resolved by the use of WSEO-based feature selection (WSEO-FS) approach. In addition, the WSEO-HDLCS technique employs a stacked deep autoencoder (SDAE) model for DDoS attack detection. Moreover, the gravitational search algorithm (GSA) is utilized for the optimal selection of the hyperparameters related to the SDAE model. The simulation outcome of the WSEO-HDLCS system is validated on the CICIDS-2017 dataset. The widespread simulation values highlighted the promising outcome of the WSEO-HDLCS methodology over existing methods.

Automated Arrhythmia Classification Using Farmland Fertility Algorithm with Hybrid Deep Learning Model on Internet of Things Environment.

In recent years, the rapid progress of Internet of Things (IoT) solutions has offered an immense opportunity for the collection and dissemination of health records in a central data platform. Electrocardiogram (ECG), a fast, easy, and non-invasive method, is generally employed in the evaluation of heart conditions that lead to heart ailments and the identification of heart diseases. The deployment of IoT devices for arrhythmia classification offers many benefits such as remote patient care, continuous monitoring, and early recognition of abnormal heart rhythms. However, it is challenging to diagnose and manually classify arrhythmia as the manual diagnosis of ECG signals is a time-consuming process. Therefore, the current article presents the automated arrhythmia classification using the Farmland Fertility Algorithm with Hybrid Deep Learning (AAC-FFAHDL) approach in the IoT platform. The proposed AAC-FFAHDL system exploits the hyperparameter-tuned DL model for ECG signal analysis, thereby diagnosing arrhythmia. In order to accomplish this, the AAC-FFAHDL technique initially performs data pre-processing to scale the input signals into a uniform format. Further, the AAC-FFAHDL technique uses the HDL approach for detection and classification of arrhythmia. In order to improve the classification and detection performance of the HDL approach, the AAC-FFAHDL technique involves an FFA-based hyperparameter tuning process. The proposed AAC-FFAHDL approach was validated through simulation using the benchmark ECG database. The comparative experimental analysis outcomes confirmed that the AAC-FFAHDL system achieves promising performance compared with other models under different evaluation measures.

Sodium Alginate- and Cationic Cellulose-Functionalized Polycaprolactone Nanofibers for In Vitro and Antibacterial Applications.

The use of polyelectrolytes is emerging as a fascinating strategy for the functionalization of biomedical membranes, due to their ability to enhance biological responses using the interaction effect of charged groups on multiple interface properties. Herein, two different polyelectrolytes were used to improve the antibacterial properties of polycaprolactone (PCL) nanofibers fabricated via electrospinning. First, a new cationic cellulose derivative, cellulose-bearing imidazolium tosylate (CIMD), was prepared via the nucleophilic substitution of the tosyl group using 1-methylimidazole, as confirmed by NMR analyses, and loaded into the PCL nanofibers. Secondly, sodium alginate (SA) was used to uniformly coat the fibers' surface via self-assembly, as remarked through SEM-EDX analyses. Polyelectrolyte interactions between the CIMD and the SA, initially detected using a FTIR analysis, were confirmed via Z potential measurements: the formation of a CMID/SA complex promoted a substantial charge neutralization of the fibers' surfaces with effects on the physical properties of the membrane in terms of water adsorption and in vitro degradation. Moreover, the presence of SA contributed to the in vitro response of human mesenchymal stem cells (hMSCs), as confirmed by a significant increase in the cells' viability after 7 days in the case of the PCL/CMID/SA complex with respect to the PCL and PCL/CMID membranes. Contrariwise, SA did not nullify the antibacterial effect of CMID, as confirmed by the comparable resistance exhibited by S. mutans, S. aureus, and E. coli to the PCL/CIMD and PCL/CIMD/SA membranes. All the reported results corroborate the idea that the CIMD/SA functionalization of PCL nanofibers has a great potential for the fabrication of efficient antimicrobial membranes for wound healing.

Mineralized Polyvinyl Alcohol/Sodium Alginate Hydrogels Incorporating Cellulose Nanofibrils for Bone and Wound Healing.

Bio sustainable hydrogels including tunable morphological and/or chemical cues currently offer a valid strategy of designing innovative systems to enhance healing/regeneration processes of damaged tissue areas. In this work, TEMPO-oxidized cellulose nanofibrils (T-CNFs) were embedded in alginate (Alg) and polyvinyl alcohol (PVA) solution to form a stable mineralized hydrogel. A calcium chloride reaction was optimized to trigger a crosslinking reaction of polymer chains and mutually promote in situ mineralization of calcium phosphates. FTIR, XRD, SEM/EDAX, and TEM were assessed to investigate the morphological, chemical, and physical properties of different mineralized hybrid hydrogels, confirming differences in the deposited crystalline nanostructures, i.e., dicalcium phosphate dehydrate (DCPDH) and hydroxyapatite, respectively, as a function of applied pH conditions (i.e., pH 4 or 8). Moreover, in vitro tests, in the presence of HFB-4 and HSF skin cells, confirmed a low cytotoxicity of the mineralized hybrid hydrogels, and also highlighted a significant increase in cell viability via MTT tests, preferentially, for the low concentration, crosslinked Alg/PVA/calcium phosphate hybrid materials (<1 mg/mL) in the presence of hydroxyapatite. These preliminary results suggest a promising use of mineralized hybrid hydrogels based on Alg/PVA/T-CNFs for bone and wound healing applications.

A Simplified Quantum Walk Model for Predicting Missing Links of Complex Networks.

Prediction of missing links is an important part of many applications, such as friends' recommendations on social media, reduction of economic cost of protein functional modular mining, and implementation of accurate recommendations in the shopping platform. However, the existing algorithms for predicting missing links fall short in the accuracy and the efficiency. To ameliorate these, we propose a simplified quantum walk model whose Hilbert space dimension is only twice the number of nodes in a complex network. This property facilitates simultaneous consideration of the self-loop of each node and the common neighbour information between arbitrary pair of nodes. These effects decrease the negative effect generated by the interference effect in quantum walks while also recording the similarity between nodes and its neighbours. Consequently, the observed probability after the two-step walk is utilised to represent the score of each link as a missing link, by which extensive computations are omitted. Using the AUC index as a performance metric, the proposed model records the highest average accuracy in the prediction of missing links compared to 14 competing algorithms in nine real complex networks. Furthermore, experiments using the precision index show that our proposed model ranks in the first echelon in predicting missing links. These performances indicate the potential of our simplified quantum walk model for applications in network alignment and functional modular mining of protein-protein networks.

Heat stress affects some physiological and productive variables and alters metabolism in dairy ewes.

Heat stress (HS) has a significant economic impact on the global dairy industry. However, the mechanisms by which HS negatively affects metabolism and milk synthesis in dairy ewes are not well defined. This study evaluated the production and metabolic variables in dairy ewes under controlled HS conditions. Eight Lacaune ewes (75.5 ± 3.2 kg of body weight; 165 ± 4 d of lactation; 2.31 ± 0.04 kg of milk per day) were submitted to thermoneutral (TN) or HS conditions in a crossover design (2 periods, 21 d each, 6-d transition). Conditions (day-night, 12-12 h; relative humidity; temperature-humidity index, THI) were: TN (15-20°C; 50 ± 5%; THI = 59-65) and HS (28-35°C; 45 ± 5%; THI = 75-83). Ewes were fed ad libitum and milked twice daily. Rectal temperature, respiratory rate, feed intake, water consumption, and milk yield were recorded daily. Milk and blood samples were collected weekly. Additionally, TN and HS ewes were exposed to glucose tolerance test, insulin tolerance test, and epinephrine challenge. Heat stress reduced feed intake (-11%), and increased rectal temperature (+0.77°C), respiratory rate (+90 breaths/min), and water consumption (+28%). Despite the reduced feed intake, HS ewes produced similar milk to TN ewes, but their milk contained lower fat (-1.7 points) and protein (-0.86 points). Further, HS milk tended to contain more somatic cells (+0.23 log points). Blood creatinine was greater in HS compared with TN, but no differences in blood glucose, nonesterified fatty acids, or urea were detected. When glucose was infused, TN and HS had similar insulin response, but higher glucose response (+85%) was detected in HS ewes. Epinephrine infusion resulted in lower nonesterified fatty acids response (-215%) in HS than TN ewes. Overall, HS decreased feed intake, but milk production was not affected. Heat stress caused metabolic adaptations that included increased body muscle degradation and reduced adipose tissue mobilization. These adaptations allowed ewes to spare glucose and to avoid reductions in milk yield.

Financial and food security challenges of Egyptian women undergoing breast cancer treatment.

BACKGROUND: Breast cancer treatment is an established cause of financial toxicity, and associated costs may contribute to higher mortality and morbidity rates. In Egypt, breast cancer incidence and mortality rates are among the highest in the Middle East. Late-stage diagnosis is common, and disease occurs at an earlier age than in Europe and North America. Out-of-pocket payments are the primary means of financing healthcare in Egypt, and socioeconomic factors have been shown to significantly impact access to cancer screening and treatment. METHODS: An observational cross-sectional study was conducted among breast cancer patients at Ain Shams University Hospitals in Cairo from 2013 to 2015. RESULTS: One hundred women with breast cancer participated. There was a high need for financial assistance (66.0%) and patients with financial needs had great difficulty affording medications (80.0%). A number of patients had lost their jobs following diagnosis, with 32.7% employed prior to diagnosis and 15.3% afterwards. Nearly one-half of participants were classified as food insecure, and nearly one-third reported difficulty affording transportation costs. CONCLUSIONS: This is the first study to describe socioeconomic needs and financial impact among a cohort of Egyptian women undergoing breast cancer treatment. The findings highlight the financial impact of breast cancer treatment on a cohort of Egyptian breast cancer patients and the need for a multidisciplinary approach to help them access and mitigate the costs of treatment. Recommendations include implementing patient financial navigation services and producing printed materials to inform patients of resources to help mitigate the treatment's financial impact.

Sensing solutions for improving the performance, health and wellbeing of small ruminants.

Diversity of production systems and specific socio-economic barriers are key reasons explaining why the implementation of new technologies in small ruminants, despite being needed and beneficial for farmers, is harder than in other livestock species. There are, however, helpful peculiarities where small ruminants are concerned: the compulsory use of electronic identification created a unique scenario in Europe in which all small ruminant breeding stock became searchable by appropriate sensing solutions, and the largest small ruminant population in the world is located in Asia, close to the areas producing new technologies. Notwithstanding, only a few research initiatives and literature reviews have addressed the development of new technologies in small ruminants. This Research Reflection focuses on small ruminants (with emphasis on dairy goats and sheep) and reviews in a non-exhaustive way the basic concepts, the currently available sensor solutions and the structure and elements needed for the implementation of sensor-based husbandry decision support. Finally, some examples of results obtained using several sensor solutions adapted from large animals or newly developed for small ruminants are discussed. Significant room for improvement is recognized and a large number of multiple-sensor solutions are expected to be developed in the relatively near future.

Incremental value of three-dimensional transthoracic echocardiography over the two-dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum.

The usefulness of two-dimensional transthoracic echocardiography (2DTTE) in the assessment of right heart compression and dysfunction produced by pectus excavatum chest wall deformity has been well described in the literature by several investigators. However, there is a paucity of reports describing incremental value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over the two-dimensional technique in the evaluation of right heart function in these patients. We present a severe case of pectus excavatum chest wall deformity in a young male, in whom 3DTTE provided incremental value over standard 2DTTE in assessing compression of the right heart before surgery and marked improvement in right heart function parameters following surgical repair. In addition, an updated summary of salient features of this deformity, including 2D and 3DTTE findings as well as right heart echocardiographic parameters by both 2D and 3DTTE in normal/healthy subjects summarized from the literature have been provided in a tabular form for comparison.

Use of echocardiography as an essential tool for targeted transcatheter biopsy of cardiac masses.

Echocardiography has emerged as an essential tool to guide targeted, transcatheter biopsy of cardiac masses. Options for imaging include transthoracic or transesophageal echocardiography and intracardiac echocardiography, with appropriate use being dictated by specific patient characteristics and institutional experience. The authors present a case of three-dimensional (3-D) transesophageal echocardiography-guided transcatheter biopsy of a right ventricular mass and review the current use of echocardiography to guide these procedures.

Usefulness of right ventricular strain assessment in submassive pulmonary thromboembolism undergoing ultrasound-facilitated thrombolysis.

Massive and submassive pulmonary thromboembolism carry significant morbidity and mortality. We present an elderly female who was diagnosed with a submassive pulmonary embolism by computed tomographic angiography and treated with ultrasound-facilitated thrombolysis (UFT). This case demonstrates the usefulness of right ventricular longitudinal strain measurements by two-dimensional speckle tracking echocardiography in the evaluation of right ventricular function before and after UFT. Evaluation of right ventricle longitudinal strain by speckle tracking echocardiography may supplement other parameters in the assessment of right ventricular function in these patients.

Comparing the efficiency of Fib-4, Egy-score, APRI, and GUCI in liver fibrosis staging in Egyptians with chronic hepatitis C.

Assessment of hepatic fibrosis in chronic hepatitis C virus patients by liver biopsy is not widely accepted despite its accuracy, being invasive, carrying complications, and adding cost. This paved the way to development and use of non-invasive markers of fibrosis in diagnosis of hepatic fibrosis. We aimed at evaluating the efficiency of Fib-4, Egy-score, Aspartate-to-platelet ratio index (APRI), and Göteborg University Cirrhosis Index (GUCI) in comparison to liver biopsy, in the assessment of hepatic fibrosis in chronic hepatitis C patients. This was a cross sectional study including 200 chronic HCV patients were divided into two groups according to stage of fibrosis (Metavir score) into non-significant fibrosis (1.27, APRI >0.48, Egy-score >0.73, and GUCI >0.57 significantly predict significant fibrosis (P < 0.01). Fib-4 carries the best performance and significant reliability with AUROC 0.783, sensitivity 74%, specificity 69%, PPV 0.55, and NPV 0.86. The addition of BMI to Fib-4 improved the significant fibrosis AUROC curve performance but did not reach statistical significant improvement. We concluded that age and BMI are good predictors of hepatic fibrosis. Fib-4 (>1.27) is the best method of prediction of significant fibrosis compared to Egy-score, APRI, and GUCI. Addition of BMI to Fib-4 did not improve diagnostic value of Fib-4.

Assessment of tricuspid valve by two- and three-dimensional echocardiography with special reference to percutaneous repair and prosthetic valve implantation procedures.

Moderate-to-severe tricuspid regurgitation affects approximately 1.6 million people in the United States. An estimated 8000 patients will undergo tricuspid surgery annually, leaving a large number of patients with this condition untreated. Many of these individuals who are not referred for surgery engender a large unmet clinical need; this may be primarily due to the surgical risk involved. In persons who are categorized as high-risk surgical candidates, percutaneous procedures present a viable alternative. The majority of developmental attention as regards percutaneous approaches has been focused on the aortic and mitral valves recently, but few data are available about the feasibility and efficacy of minimally invasive tricuspid valve treatment. We review the usefulness of two- and three-dimensional echocardiography in the assessment of the tricuspid valve with special reference to recent interest in percutaneous repair and prosthetic valve implantation procedures for severe functional tricuspid regurgitation.

Incremental benefit of three-dimensional transthoracic echocardiography in the assessment of left atrial appendage aneurysm leading to severe extrinsic compression of a coronary artery.

Left atrial appendage aneurysm (LAA AN) is a rare disease entity, which can be congenital or acquired in nature. We report an adult patient with LAA AN presenting with anginal chest pain in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over the two-dimensional (2D) technique in providing a more comprehensive assessment of the lesion. A literature review of the salient features of LAA AN is also provided in a tabular form.

Effects of chronic heat stress on lactational performance and the transcriptomic profile of blood cells in lactating dairy goats.

High temperature is a major stress that negatively affects welfare, health, and productivity of dairy animals. Heat-stressed animals are more prone to disease, suggesting that their immunity is hindered. Although productive and physiologic responses of dairy animals to heat stress are well known, there is still limited information on the response at the transcriptome level. Our objective was to evaluate the changes in performance and blood transcriptomics of dairy goats under heat stress. Eight multiparous Murciano-Granadina dairy goats in mid-lactation were assigned to 1 of 2 climatic treatments for 35 d. Treatments and temperature-humidity index (THI) were: (1) thermal neutral (TN: n = 4; 15-20 °C, 40-45%, THI = 59-65), and (2) heat stress (HS: n = 4; 12 h at 37 °C-40%, THI = 86; 12 h at 30 °C-40%, THI = 77). Rectal temperature, respiratory rate, feed intake and milk yield were recorded daily. Additionally, milk composition was evaluated weekly. Blood samples were collected at d 35 and RNA was extracted for microarray analyses (Affymetrix GeneChip Bovine Genome Array). Differences in rectal temperature and respiratory rate between HS and TN goats were maximal during the first 3 d of the experiment, reduced thereafter, but remained significant throughout the 35-d experimental period. Heat stress reduced feed intake, milk yield, milk protein and milk fat contents by 29, 8, 12, and 13%, respectively. Microarray analysis of blood revealed that 55 genes were up-regulated, whereas 88 were down-regulated by HS. Bioinformatics analysis using the Dynamic Impact Approach revealed that 31 biological pathways were impacted by HS. Pathways associated with leukocyte transendothelial migration, cell adhesion, hematopoietic cell lineage, calcium signaling, and PPAR signaling were negatively impacted by HS, whereas nucleotide metabolism was activated. In conclusion, heat stress not only negatively affected milk production in dairy goats, but also resulted in alterations in the functionality of immune cells, which would make the immune system of heat-stressed goats less capable of fending-off diseases.

Prosthetic mitral inflow mimicking severe aortic regurgitation (revisited). An echocardiographic challenge.

Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame-by-frame analysis of two-dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR.

Prominent pulmonary venous flow mimicking mitral regurgitation.

The present case highlights a potential pitfall in assessing mitral regurgitation severity due to the presence of similar colored prominent pulmonary vein signals in the left atrium during color Doppler examination.

Remediation of lead and cadmium-contaminated soils.

The research was designated to study the ability of plants to bio-accumulate, translocate and remove the heavy metals, lead and cadmium from contaminated soil. The herbal plant ryegrass, Lolium multiflorum was investigated as a bio-accumulator plant for these metals. The translocation of these heavy metals in the herbal plant was compared considering root to shoot transport and redistribution of metals in the root and shoot system. The trace metal contents from root and shoot parts were determined using atomic absorption spectrometer. The results showed that the percent of lead and cadmium transferred to ryegrass plant were averaged as 51.39, and 74.57%, respectively, while those remained in the soil were averaged as 48.61 and 25.43% following 60 days of treatment. The soil-plant transfer index in root and shoot system of ryegrass was found to be 0.32 and 0.20 for lead, and 0.50 and 0.25 for cadmium. These findings indicated that the herbal plant ryegrass, Lolium multiflorum is a good accumulator for cadmium than lead. The soil-plant transfer factor (the conc. of heavy metal in plant to the conc. in soil) indicated that the mechanism of soil remedy using the investigated plant is phytoextraction where the amounts of heavy metals transferred by plant roots into the above ground portions were higher than that remained in the soil. The method offers green technology solution for the contamination problem since it is effective technology with minimal impact on the environment and can be easily used for soil remedy.