Prevalence, mortality, cost, and disparities in transcatheter mitral valve repair and replacement in cancer patients: Artificial intelligence and propensity score national 5-year analysis of 7495 procedures.

INTRODUCTION: We conducted the first comprehensive evaluation of the therapeutic value and safety profile of transcatheter mitral edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR) in individuals concurrently afflicted with cancer. METHODS: Utilizing the National Inpatient Sample (NIS) dataset, we analyzed all adult hospitalizations between 2016 and 2020 (n = 148,755,036). The inclusion criteria for this retrospectively analyzed prospective cohort study were all adult hospitalizations (age 18 years and older). Regression and machine learning analyses in addition to model optimization were conducted using ML-PSr (Machine Learning-augmented Propensity Score adjusted multivariable regression) and BAyesian Machine learning-augmented Propensity Score (BAM-PS) multivariable regression. RESULTS: Of all adult hospitalizations, there were 5790 (0.004%) TMVRs and 1705 (0.001%) TEERs. Of the total TMVRs, 160 (2.76%) were done in active cancer. Of the total TEERs, 30 (1.76%) were done in active cancer. After the comparable rates of TEER/TMVR in active cancer in 2016, the prevalence of TEER/TMVR was significantly less in active cancer from 2017 to 2020 (2.61% versus 7.28% p < 0.001). From 2017 to 2020, active cancer significantly decreased the odds of receiving TEER or TMVR (OR 0.28, 95%CI 0.13-0.68, p = 0.008). In patients with active cancer who underwent TMVR/TEER, there were no significant differences in socio-economic disparities, mortality or total hospitalization costs. CONCLUSION: The presence of malignancy does not contribute to increased mortality, length of stay or procedural costs in TMVR or TEER. Whereas the prevalence of TMVR has increased in patients with active cancer, the utilization of TEER in the context of active cancer is declining despite a growing patient population.

The Use of a New Safe Angle Concept for Immediate Implant Placement in the Anterior Maxilla: A Cross-sectional Cone Beam Computed Tomography Study.

PURPOSE: The current cross-sectional study aims to introduce a new method for the labiopalatal positioning and angulation of immediately placed dental implants in the anterior maxilla with relation to the type of abutment used (straight/angled abutment). MATERIAL AND METHODS: Cone beam computed tomography scans from the database of a private practice were searched for patients who received immediate implants in anterior maxilla. After superimposition of the initial and post-operative scans, incisal/root angle (IRA), incisal/implant angle (IIA) and the difference between both angles were measured. Furthermore, assessment of whether the implant position would be lying within the safe angle or not. Age, gender, tooth/implant site and type of prosthetic abutment (straight/angled) were retrieved from patients' records. RESULTS: Seventy-four patients with a total of 95 immediate implants were selected for analysis. In regard to the type of abutment, 76 (80%) were straight, while 19 abutments (20%) were angled. Regardless of abutment type, 72 implants (75.8%) lay within the safe angle while 23 implants (24.2%) did not lie within the safe angle. All 19 implants with angled abutments were not lying within the safe angle. There was a statistically significant association between type of abutment, IRA, difference between IIA and IRA, gender and lying within the safe angle (P-value <0.001, OR = 19, P-value <0.001, Effect size = 0.904, P-value <0.001, Effect size = 1.209 and P-value <0.001, OR = 2.995 respectively). There was no statistically significant association between IIA, site or age and lying within the safe angle (P-value = 0.757, Effect size = 0.063, P-value = 0.200, Effect size = 0.184 and P-value = 0.387 Effect size = 0.208, respectively). There was a statistically significant association between IRA, difference between IIA and IRA and type of abutment (P-value = 0.001, Effect size = 0.762, P-value <0.001, Effect size = 1.056, respectively). CONCLUSIONS: The Safe Angle Concept can be used as a reliable planning tool to choose the correct IIP position in the anterior maxilla. Applying the safe angle concept will decrease the use of angled abutment for prosthetic correction.

High-performance biosensors based on angular plasmonic of a multilayer design: new materials for enhancing sensitivity of one-dimensional designs.

In this study, a theoretical examination is conducted to investigate the biosensing capabilities of different surface plasmon resonance (SPR) based hybrid multilayer structures, which are composed of two-dimensional (2D) materials. The transfer matrix formulation is implemented to calibrate the results of this study. A He-Ne laser of wavelength = 632.8 nm is used to simulate the results. Many permutations and combinations of layers of silver (Ag), aluminum oxynitride (AlON), and 2D materials were utilized to obtain the optimized structure. Ten dielectrics and twelve 2D materials were tested for a highly sensitive multilayer hybrid sensing design, which is composed of the prism (Ohara S-FPL53)/Ag/AlON/WS2/AlON/sensing medium. The optimized biosensing design is capable of sensing and detecting analytes whose refractive variation is limited between 1.33 and 1.34. The maximum sensitivity, which is achieved by using the proposed design is 488.2° per RIU. Additionally, the quality factor, figure of merit, detection limit, and qualification limit values of the optimized design were also calculated to obtain a true picture of the sensing capabilities. The designing approach based on the multilayer hybrid SPR biosensors has the potential to develop various plasmonic biosensors that are related to food, chemical, and biomedical engineering fields.

ANN-Based Intelligent Secure Routing Protocol in Vehicular Ad Hoc Networks (VANETs) Using Enhanced AODV.

A vehicular ad hoc network (VANET) is a sophisticated wireless communication infrastructure incorporating centralized and decentralized control mechanisms, orchestrating seamless data exchange among vehicles. This intricate communication system relies on the advanced capabilities of 5G connectivity, employing specialized topological arrangements to enhance data packet transmission. These vehicles communicate amongst themselves and establish connections with roadside units (RSUs). In the dynamic landscape of vehicular communication, disruptions, especially in scenarios involving high-speed vehicles, pose challenges. A notable concern is the emergence of black hole attacks, where a vehicle acts maliciously, obstructing the forwarding of data packets to subsequent vehicles, thereby compromising the secure dissemination of content within the VANET. We present an intelligent cluster-based routing protocol to mitigate these challenges in VANET routing. The system operates through two pivotal phases: first, utilizing an artificial neural network (ANN) model to detect malicious nodes, and second, establishing clusters via enhanced clustering algorithms with appointed cluster heads (CH) for each cluster. Subsequently, an optimal path for data transmission is predicted, aiming to minimize packet transmission delays. Our approach integrates a modified ad hoc on-demand distance vector (AODV) protocol for on-demand route discovery and optimal path selection, enhancing request and reply (RREQ and RREP) protocols. Evaluation of routing performance involves the BHT dataset, leveraging the ANN classifier to compute accuracy, precision, recall, F1 score, and loss. The NS-2.33 simulator facilitates the assessment of end-to-end delay, network throughput, and hop count during the path prediction phase. Remarkably, our methodology achieves 98.97% accuracy in detecting black hole attacks through the ANN classification model, outperforming existing techniques across various network routing parameters.

Internet of Vehicles (IoV)-Based Task Scheduling Approach Using Fuzzy Logic Technique in Fog Computing Enables Vehicular Ad Hoc Network (VANET).

The intelligent transportation system (ITS) relies heavily on the vehicular ad hoc network (VANET) and the internet of vehicles (IoVs), which combine cloud and fog to improve task processing capabilities. As a cloud extension, the fog processes' infrastructure is close to VANET, fostering an environment favorable to smart cars with IT equipment and effective task management oversight. Vehicle processing power, bandwidth, time, and high-speed mobility are all limited in VANET. It is critical to satisfy the vehicles' requirements for minimal latency and fast reaction times while offloading duties to the fog layer. We proposed a fuzzy logic-based task scheduling system in VANET to minimize latency and improve the enhanced response time when offloading tasks in the IoV. The proposed method effectively transfers workloads to the fog computing layer while considering the constrained resources of car nodes. After choosing a suitable processing unit, the algorithm sends the job and its associated resources to the fog layer. The dataset is related to crisp values for fog computing for system utilization, latency, and task deadline time for over 5000 values. The task execution, latency, deadline of task, storage, CPU, and bandwidth utilizations are used for fuzzy set values. We proved the effectiveness of our proposed task scheduling framework via simulation tests, outperforming current algorithms in terms of task ratio by 13%, decreasing average turnaround time by 9%, minimizing makespan time by 15%, and effectively overcoming average latency time within the network parameters. The proposed technique shows better results and responses than previous techniques by scheduling the tasks toward fog layers with less response time and minimizing the overall time from task submission to completion.

Hard and soft tissue alterations using dual-zone concept versus connective tissue graft at maxillary immediate implant placement: A 1-year randomized clinical and volumetric trial.

OBJECTIVES: To evaluate the esthetic outcome, as well as clinical, radiographic, and volumetric tissue alterations 1 year after immediate implant placement (IIP) with connective tissue grafting (CTG) versus dual-zone concept (DZ) at sites with thin labial bone in the esthetic zone. MATERIALS AND METHODS: This randomized clinical trial included 30 patients treated with IIP simultaneous with either CTG or DZ (n = 15 each). Pink esthetic score (PES) was assessed 6 months after crown placement as the primary outcome. Amount of bone labial to the implant, labio-palatal ridge reduction, and crestal bone changes were measured via CBCT after 1 year. Volumetric analysis of linear labial soft tissue contour, interdental, and mid-facial soft tissue level changes, and total volume loss (mm3) were measured after 1 year. RESULTS: Similar PES was observed in the CTG (12.53 ± 1.13) and DZ (12.13 ± 1.55) groups, with no significant difference (p = 0.42). Likewise, there were no statistically significant differences found between the two groups in labio-palatal bone reduction (mm&%), interdental papillae, and mid-facial gingival levels (p > 0.05). However, the mean vertical crestal bone changes in the CTG and DZ groups were -1.1 ± 0.6 mm and 0.2 ± 1.0 mm, respectively, with a statistically significant difference (p = 0.0002). Moreover, CTG revealed less linear and total volume (mm3) loss in the labial soft tissue which was statistically significant compared to DZ (p = 0.007). CONCLUSION: Both groups demonstrated the same PES, nevertheless, volumetric analysis revealed twice total labial volume loss in DZ compared to CTG. It might be concluded that the use of CTG with IIP caused less horizontal reduction in the supra-implant complex compared to the DZ.

A Novel Dental Implant Approach for Crestal Sinus Elevation: A Case Series Study.

The aim of this study was to evaluate the radiographic and clinical outcomes of patients undergoing sinus membrane elevation via a minimally invasive crestal approach utilizing the dental implant. Twenty patients having 1 or more missing posterior teeth were included. The maxillary sinus membrane was elevated using dental implant via a crestal approach in areas with insufficient residual bone. CBCT scans were used to measure the amount of newly formed bone, implant length inside the sinus, bucco-palatal sinus width, and bone thickness. Surgical and postsurgical complications along with implant survival were also measured. The mean (±SD) values for the newly formed bone after 1 year were 2.4 (±1.87) mm, while values for implant length inside the sinus were 4 (±1.49) mm. The results showed that percentage of implant length inside the sinus and the palatal bone thickness were statistically significant positive predictors of the newly formed bone. Higher percentage of implant length inside the sinus and increased palatal bone thickness were associated with larger amounts of newly formed bone. A high patient satisfaction was reported along with a 100% implant survival. The utilization of the novel dental implant approach for crestal sinus elevation demonstrated predictable clinical and radiographic outcomes. This novel technique is simple to both patients and clinicians, rendering it a promising and cost-efficient procedure.

Proportion and Risk Factors of Silent Vertebral Fractures Among Egyptian Females With Fragility Hip Fracture Presenting to the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures caused by osteoporosis are known to increase the risk of further fragility fractures. Also, several factors have been associated with an increasing risk of fracture in postmenopausal women with osteoporosis, as prior fracture, advancing age, low bone mineral density (BMD), greater risk or history of falls certain, pharmacologic therapies such as glucocorticoids, and medical conditions increase the risk of secondary osteoporosis and related fractures through their direct impact on bone density or structure. Menstrual history including age at menarche menopause and a history of amenorrhea is documented as a predicting osteoporotic fracture. Objective The aim of the current study is to find the proportion of hidden vertebral fractures among Egyptian females with fragility hip fracture. Patients and methods A cross-sectional study was conducted on patients who presented to the orthopedic emergency room (ER) of Ain Shams University Hospitals in Cairo, Egypt, from September 2020 to September 2021. Our inclusion criteria include females aged 40 years or older, who presented to the ER with fragility hip fractures. A simple random sample of females fulfilling our inclusion criteria for osteoporotic hip fracture was thoroughly investigated. Conventional lateral and anteroposterior radiographs of the dorsolumbar spine were obtained excluding those with high-impact fractures or pathological fractures. Results During the study period, a total of 43,935 persons presented to the orthopedic ER, of whom 30,901 were females, comprising 70.03% of total orthopedic ER visits. A sample of 150 females met our inclusion criteria. Results showed that 16 of our 150 cases had concomitant vertebral fracture, meaning that 10.7% of cases had hidden vertebral fracture at the time of osteoporotic hip fracture, as diagnosed by the screening lumbosacral plain X-rays. Older age at menarche, younger age at menopause, and amenorrhea are shown to be risk factors for hidden vertebral fracture in Egyptian females. Conclusion Osteoporosis is a complex and costly disease. Osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. Concomitant hidden vertebral fracture is prevalent among females with osteoporotic hip fractures, and those who had later menarche, earlier menopause, and menstrual irregularities have a higher incidence of developing associated vertebral fracture, which warrants identification and management to evade complications and mortality.

A promising ultra-sensitive CO2 sensor at varying concentrations and temperatures based on Fano resonance phenomenon in different 1D phononic crystal designs.

Detecting of the levels of greenhouse gases in the air with high precision and low cost is a very urgent demand for environmental protection. Phononic crystals (PnCs) represent a novel sensor technology, particularly for high-performance sensing applications. This study has been conducted by using two PnC designs (periodic and quasi-periodic) to detect the CO2 pollution in the surrounding air through a wide range of concentrations (0-100%) and temperatures (0-180 °C). The detection process is physically dependent on the displacement of Fano resonance modes. The performance of the sensor is demonstrated for the periodic and Fibonacci quasi-periodic (S3 and S4 sequences) structures. In this regard, the numerical findings revealed that the periodic PnC provides a better performance than the quasi-periodic one with a sensitivity of 31.5 MHz, the quality factor (Q), along with a figure of merit (FOM) of 280 and 95, respectively. In addition, the temperature effects on the Fano resonance mode position were examined. The results showed a pronounced temperature sensitivity with a value of 13.4 MHz/°C through a temperature range of 0-60 °C. The transfer matrix approach has been utilized for modeling the acoustic wave propagation through each PnC design. Accordingly, the proposed sensor has the potential to be implemented in many industrial and biomedical applications as it can be used as a monitor for other greenhouse gases.

The effect of high oral loading dose of cholecalciferol in non-alcoholic fatty liver disease patients. A randomized placebo controlled trial.

Background and Aim: Non-alcoholic fatty liver (NAFLD) is one of the most common progressive metabolic disorders worldwide. There are increasing scientific interests nowadays for the association between vitamin D status and Non-alcoholic fatty liver. Earlier studies have revealed that vitamin D deficiency is highly prevalent in Non-alcoholic fatty liver patients that contributes to poor outcomes. Hence, the present study aimed to assess the efficacy and safety of oral cholecalciferol on Non-alcoholic fatty liver patients. Subjects and Methods: This study was conducted on 140 patients that were randomized either to group 1 that received the standard conventional therapy in addition to placebo or group 2 that received the standard conventional therapy in addition to cholecalciferol during the 4 months study period. Results: At the end of the study group 2 revealed significant decrease (p < 0.05) in the mean serum level of TG, LDL-C, TC, hsCRP as compared to their baseline results and group 1 results. Additionally, a significant improvement in the serum levels of ALT (p = 0.001) was seen in group 2 at the end of the study when compared to group 1. Whereas group 1 did not show any change in these parameters when compared to group 2 and their baseline results. Conclusion: Cholecalciferol was shown to have beneficial effects on serum ALT levels, hsCRP levels and lipid profile of NAFLD patients. Clinical Trial Registration: https://prsinfo.clinicaltrials.gov/prs-users-guide.html, identifier NCT05613192.

Bone dimensional changes after flapless immediate implant placement with and without bone grafting: Randomized clinical trial.

INTRODUCTION: Immediate implant in postextraction sockets requires managing the postextraction alveolar resorption. This randomized clinical trial examined vertical and horizontal changes 1-year following flapless immediate implant with and without xenograft at sites with thin labial plate. METHODS: Forty patients with hopeless teeth in maxillary esthetic zone were randomly assigned to receiving either one immediate implant without bone graft (control) or with bone graft (intervention). Cone beam computed tomography (CBCT) scans were obtained pre-extraction and 1-year postoperatively to measure thickness and dimensional changes of the labial bone. RESULTS: Cone beam computed tomography measurements revealed that a xenograft, when compared to no xenograft, led to 0.2 mm increased fill of the horizontal gap (95% confidence interval (CI): -1.1, 0.7). In both groups, there was a significant reduction in the labio-palatal bone width after 1 year compared to baseline (P ≤ 0.05). There was no significant difference (P > 0.05) between the xenograft when compared to no xenograft regarding the labio-palatal bone collapse % at 0 mm (-0.2, 95% CI: -4.8, 4.5) and 2 mm apical to the labial crest (1.9, 95% CI: -1.8, 5.6). While at 5 mm the ridge was significantly reduced (P ≤ 0.05) in the no xenograft when compared to xenograft (4.5, 95% CI: 0.7, 8.2). The xenograft when compared to no xenograft, led to 1.1 mm less vertical bone changes (95% CI: 0.4, 1.9). Both groups revealed significant positive correlation between labio-palatal socket dimension and bone formed labial to the implant (P ≤ 0.05). [Correction added on 7 February 2023, after first online publication: In the 8th line of this section, the word "collapse" was changed to "ridge" in this version.] CONCLUSION: This investigation suggested that immediate implants with or without grafting the labial gap preserved alveolar bone dimension and that bone formation labial to the implant was related to initial labio-palatal socket dimension.

Association of TLR7 and TLR9 genes polymorphisms in Egyptian patients with systemic lupus erythematosus.

Introduction: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, multiorgan, systemic autoimmune disease. It is characterized by the high production of autoantibodies against nuclear compounds. TLRs (toll-like receptors 7/9) are pattern-recognition receptors that recognize nucleic acids and induce proinflammatory responses by activating NF-kB and producing type I interferon, which play a role in eliciting innate/adaptive immune responses and developing chronic inflammation. TLR7 and TLR9 single nucleotide polymorphisms (SNPs) have been linked to systemic lupus erythematosus in numerous studies (SLE). In this work, we wanted to evaluate and analyze single nucleotide polymorphisms (SNPs) in the TLR7 (rs3853839) and TLR9 (rs187084) genes among Egyptian SLE patients and healthy controls. Method: Whole blood samples were taken from 100 SLE patients and 100 controls; DNA was extracted and then processed for TLR7 rs3853839 and TLR9 rs187084 single nucleotide polymorphisms analysis by real-time polymerase chain reaction technology and restriction fragment-length polymorphism. We also assessed the association between TLR 7 and TLR 9 genes polymorphism with SLE clinical parameters. Results: Our results showed that TLR7 rs3853839 CG genotypes and G allele were significantly associated with SLE. Also, TLR7 rs3853839 genotypes and alleles were significantly associated with nephritis, arthritis, oral ulcers, and thrombocytopenia.Whereas genotypes and alleles of TLR9 were not significantly associated with the risk nor the clinical characteristics of SLE except for malar rash. Conclusion: In the investigated Egyptian cohort, our findings suggest that TLR7 rs3853839 gene polymorphisms increase the risk for SLE development and play a role in developing clinical characteristics, especially nephritis.

In silico analysis of missense variants of the C1qA gene related to infection and autoimmune diseases.

Objectives: C1q is a key activator of the classical pathway of the complement system and exerts consequences relating to opsonization and phagocytosis. The C1qA gene is one of three genes encoding the C1q molecule. Defects in C1q, and especially in C1qA, have been linked to an increased susceptibility to infection, sepsis, and systemic lupus erythematosus. These defects could arise from missense single nucleotide polymorphisms (SNPs) and their deleterious impacts on protein structure and function. Thus, identifying high-risk missense SNPs in C1qA has become a necessity if we are to identify appropriate measures for prevention and management of affected patients. Methods: A comprehensive in silico study was conducted to screen the 184 missense SNPs in the C1qA gene using different tools with different algorithms and approaches. We investigated the impact of SNPs on protein function, stability, and structure. In addition, we identified the location of the SNPs on protein domains, secondary structure alignment, and the phylogenetic conservation of their positions. Results: Of the 184 missense SNPs, 10 SNPs were predicted to be the most damaging to protein function and structure. Conclusion: Ten missense SNPs were predicted to have the highest risk of damaging protein function and structure, thus leading to infection, sepsis, and systemic lupus erythematosus. These 10 SNPs constitute the best candidates for further experimental investigations.

Investigation of TLR2 and TLR4 Polymorphisms and Sepsis Susceptibility: Computational and Experimental Approaches.

Toll-like receptors (TLR) play an eminent role in the regulation of immune responses to invading pathogens during sepsis. TLR genetic variants might influence individual susceptibility to developing sepsis. The current study aimed to investigate the association of genetic polymorphisms of the TLR2 and TLR4 with the risk of developing sepsis with both a pilot study and in silico tools. Different in silico tools were used to predict the impact of our SNPs on protein structure, stability, and function. Furthermore, in our prospective study, all patients matching the inclusion criteria in the intensive care units (ICU) were included and followed up, and DNA samples were genotyped using real-time polymerase chain reaction (RT-PCR) technology. There was a significant association between TLR2 Arg753Gln polymorphisms and sepsis under the over-dominant model (p = 0.043). In contrast, we did not find a significant difference with the TLR4 Asp299Gly polymorphism with sepsis. However, there was a significant association between TLR4 Asp299Gly polymorphisms and Acinetobacter baumannii infection which is quite a virulent organism in ICU (p = 0.001) and post-surgical cohorts (p = 0.033). Our results conclude that the TLR2 genotype may be a risk factor for sepsis in adult patients.

Characterization of enterohemorrhagic Escherichia coli from diarrhoeic patients with particular reference to production of Shiga-like toxin.

Enterohemorrhagic Escherichia coli (EHEC) is a subtype of pathogenic E. coli that causes diarrhea or hemorrhagic colitis in humans, which can progresses to hemolytic uremic syndrome (HUS), a leading cause of acute renal failure in children, and morbidity and mortality in adults. Stool samples (n = 273) of patients (1 day-40 years old) suffered from bloody diarrhea and abdominal cramps, were examined bacteriologically and molecularly for the presence and pathogenicity of EHEC with phylogenetic analysis of the obtained stx1, stx2, and eaeA virulence genes' sequences. Overall, 71 (26.01%) E. coli isolates were identified as EHEC with the following serogroupes: O1:H11 (3), O128:H2 (9), O26:H11 (6), O157:H7 (3), O25:H2 (7), O145:H328 (2), O125:H6 (9), O86:H8 (5), O18:H15 (11) and untypable (16). The highest isolation rate were in samples belonged to infants below two years old (42.25%). Antimicrobial susceptibility testing showed that all isolates were highly sensitive to ciprofloxacin, nitrofurantoin, gentamycin, imipenem and vancomycin (100% each), however, they were resistant to ampicillin, cephalexin, penicillin and tetracycline (100% each). In-vitro pathogenicity testing of the isolates revealed that 67 (94.37%) isolates were positive for Congo red test, 47 (66.20%) isolates possessed P fimbriae (MRHA) and 17 (23.94%) possessed type 1 fimbriae (MSHA). Moreover, 46 (64.79%) isolates exhibited hemolysis and 42 (59.15%) isolates showed distinct cytopathic effect to Vero cells. Molecular detection of enterohemorrhagic E. coli (EHEC) pathotype virulence genes, confirmed the presence of stx1 gene in O157:H7 (MA2), O26:H11, O145:H328 and O125:H6 serogroups; stx2 gene in (O157:H7 (MA1), O128:H2 and O25:H2; while all serogroups except (O125:H6) carried the eaeA intimin virulence gene. A phylogenetic tree, based on the nucleotide sequences of toxin-encoding genes, demonstrates that Shiga toxin E. coli (STEC) isolates have considerable genetic variation and belong to various phylogenetic groupings.

Role of MBL2 Polymorphisms in Sepsis and Survival: A Pilot Study and In Silico Analysis.

Sepsis is a serious infection-induced syndrome with serious ramifications, especially in intensive care units. Global concern motivated the investigation of the role of related genes' polymorphism in predicting the liability to infection, sepsis, septic shock and survival. Among these genes is the gene encoding mannose-binding lectin (MBL), with its remarkable importance in the immune system. However, the previous studies showed conflicting results and ambiguity that urged us to engage with this issue in the Egyptian population. Prediction of functional and structural impacts of single nucleotide polymorphisms (SNPs) was done using in silico methods. A prospective observational study was conducted in intensive care units; one hundred and thirty patients were followed up. Genotyping was performed using real-time polymerase chain reaction (RT-PCR) technology. MBL SNPs showed a remarkable high frequency in our population, as well. No significant association was found between MBL2 genotypes and any of our analyses (sepsis, septic shock and survival). Only septic shock and age were independently associated with time of survival by Cox regression analysis. Our study may confirm the redundancy of MBL and the absence of significant impact on sepsis liability and mortality in adult patients.

The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes?

INTRODUCTION: One anastomosis gastric bypass (OAGB) has become one of the most commonly performed gastric bypass procedures in some countries. OBJECTIVES: To assess how surgeons viewed the OAGB, perceptions, indications, techniques, and outcomes, as well as the incidence of short- and long-term complications and how they were managed worldwide. METHODS: A questionnaire was sent to all IFSO members in all 5 chapters to study the pattern of practice and outcomes of OAGB. RESULTS: Seven hundred and forty-two surgeons responded. The most commonly performed procedures were sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and OAGB. Preoperatively, 70% of the surgeons performed endoscopy routinely. In regards to weight loss, 83% (570 surgeons) responded that OAGB produces better weight loss than SG, and 49% (342 surgeons) responded that OAGB produces better weight loss than RYGB. The most common length of the biliopancreatic limb (BPL) utilized was 200 cm. Sixty-seven percent of surgeons did not measure the total length of the small bowel. In patients with reflux disease and history of smoking, 53% and 22% of surgeons respectively still offered OAGB as a treatment option. Postoperatively, leak was documented in 963 patients, and it was the leading cause for mortality. Leak management was conservative in 35%. Conversion to RYGB was performed in 31%. In 16% the anastomosis was reinforced, 6% of the patients were reversed, and other procedures were performed in 12%. Revision of OAGB for malnutrition/steatorrhea or severe bile reflux was reported at least once by 37% and 45% of surgeons, respectively (200 cm was the most commonly encountered biliopancreatic limb BPL in those revised for malnutrition). Most common strategy for revision was conversion to RYGB (43%), reversal to normal anatomy (32%), shortening of the BPL (20%), and conversion to SG (5%). Nevertheless, 5 out of 98 mortalities (5%) were due to liver failure/malnutrition. CONCLUSION: There are infrequent but potentially severe specific complications including malnutrition, liver failure, and bile reflux that may require surgical correction after OAGB.

Antimicrobial activities encountered by sulfur nanoparticles combating Staphylococcal species harboring sccmecA recovered from acne vulgaris.

Over decades, sulfur has been employed for treatment of many dermatological diseases, several skin and soft tissue, and Staphylococcus infections. Because of its abuse, resistant bacterial strains have emerged. Nanotechnology has presented a new horizon to overcome abundant problems including drug resistance. Nano-sized sulfur has proven to retain bactericidal activity. Consequently, the specific aims of this study are exclusively directed to produce various sulfur nanoparticles formulations with control of particle size and morphology and investigate the antibacterial activity response specifically classified by the category of responses of different formulations, for the treatment of acne vulgaris resistant to conventional antibiotics. In this study, we produced uncoated sulfur nanoparticles (SNPs), sulfur nano-composite with chitosan (CS-SNPs), and sulfur nanoparticles coated with polyethylene glycol (PEG-SNPs) and evaluate their bactericidal impact against Staphylococcus aureus and Staphylococcus epidermidis isolated from 173 patients clinically diagnosed acne vulgaris. Accompanied with molecular investigations of ermB and mecA resistance genes distribution among the isolates. Sulfur nanoparticles were synthesized using acid precipitation method and were characterized by scanning electron microscope (SEM), transmission electron microscopy (TEM), energy dispersed x-ray spectroscopy (EDX), and Fourier transform infrared spectroscopy (FTIR). Moreover, agar diffusion and broth micro-dilution methods were applied to determine their antibacterial activity and their minimum inhibitory concentration. PCR analysis for virulence factors detection. Results: TEM analysis showed particle size of SNPs (11.7 nm), PEG-SNPs (27 nm) and CS-SNPs (33 nm). Significant antibacterial activity from nanoparticles formulations in 100% dimethyl sulfoxide (DMSO) with inhibition zone 30 mm and MIC at 5.5 µg/mL. Furthermore, the prevalence of mecA gene was the most abundant among the isolates while ermB gene was infrequent. Conclusions: sulfur nanoparticles preparations are an effective treatment for most Staphylococcus bacteria causing acne vulgaris harboring multi-drug resistance virulence factors.

New findings on the significance of Jebel Moya in the eastern Sahel.

This paper presents new excavation data and new radiometric dates for Jebel Moya, south-central Sudan. These data suggest revisions to previous chronological understandings of the site. New excavations, initiated in 2017, show a longer, more continuous occupation of the site than has been previously recognised. Archaeozoological and archaeobotanical analyses provide evidence for domesticated taxa. Archaeobotanical evidence is dominated by domesticated sorghum (Sorghum bicolor), radiocarbon dated to c. 2550-2210 BC. Faunal remains include cattle and goat/sheep. A late third-millennium BC date on the human skeleton excavated in the 2017 season also shows that mortuary activity began early in the site's history, contemporary with domesticated faunal and botanical remains. These initial results indicate the long-term association of the site with pastoralism and agriculture and with environmental change. Jebel Moya's continued potential to serve as a chronological and cultural reference point for future studies in south-central Sudan and the eastern Sahel is reinforced.