Computed tomography for the prediction of oesophageal variceal bleeding: A surrogate or complementary to the gold standard?

In this editorial we comment on the in-press article in the World Journal of Gastrointestinal endoscopy about the role of computed tomography (CT) for the prediction of esophageal variceal bleeding. The mortality and morbidity are much increased in patients with chronic liver diseases when complicated with variceal bleeding. Predicting the patient at a risk of bleeding is extremely important and receives a great deal of attention, paving the way for primary prophylaxis either using medical treatment including carvedilol or propranolol, or endoscopic band ligation. Endoscopic examination and the hepatic venous pressure gradient are the gold standards in the diagnosis and prediction of variceal bleeding. Several non-invasive laboratory and radiological examinations are used for the prediction of variceal bleeding. The contrast-enhanced multislice CT is a widely used non-invasive, radiological examination that has many advantages. In this editorial we briefly comment on the current research regarding the use of CT as a non-invasive tool in predicting the variceal bleeding.

Turning trash into treasure: Torrefaction of mixed waste for improved fuel properties. A case study of metropolitan city.

Solid waste management is one of the biggest challenges of the current era. The combustible fractions in the waste stream turn out to be a good energy source if converted into refuse-derived fuel. Researchers worldwide are successfully converting it into fuel. However, certain challenges are associated with its application in gasifiers, boilers, etc. to co-fire it with coal. These include high moisture content, low calorific value, and difficulty to transport and store. The present study proposed torrefaction as a pretreatment of the waste by heating it in the range of 200 °C-300 °C in the absence of oxygen at atmospheric pressure. The combustible fraction from the waste stream consisting of wood, textile, paper, carton, and plastics termed as mixed waste was collected and torrefied at 225 °C, 250 °C, 275 °C, and 300 °C for 15 and 30 min each. It was observed that the mass yield and energy yield decreased to 45% and 62.96% respectively, but the energy yield tended to increase by the ratio of 1.39. Proximate analysis showed that the moisture content and volatile matter decreased for torrefied samples, whereas the ash content and fixed carbon content increased. Similarly, the elemental analysis revealed that the carbon content increased around 23% compared to raw samples with torrefaction contrary to hydrogen and oxygen, which decreased. Moreover, the higher heating value (HHV) of the torrefied samples increased around 1.3 times as compared to the raw sample. This pretreatment can serve as an effective solution to the current challenges and enhance refuse-derived fuel's fuel properties.

Fatigue, depression, and sleep disorders are more prevalent in patients with metabolic-associated fatty liver diseases.

AIM: To determine the prevalence and risk factors for depression, sleep disturbances, and exhaustion in MAFLD patients. METHODS: Two hundred twenty-four consecutive patients with MAFLD attending the outpatient clinic from April to October 2023; were subjected to clinical evaluation, laboratory testing including non-invasive laboratory markers, fibroscan (measuring steatosis and fibrosis), and different quantitative and qualitative fatigue scores. A control group including 342 patients without MAFLD was taken. RESULTS: The prevalence of fatigue, depression, and sleeping disorders in the MAFLD group was 67.8%, 75%, 62.5% vs 21%, 16.4%, and 19.5% in the control group respectively ( P = <0.001, P = <0.001 and P = <0.001). MAFLD with fatigue was significantly associated with the presence and severity of steatosis and fibrosis by fibroscan ( P = <0.0001). By univariate and multivariate analysis: age, BMI, waist circumference, T2DM, hypertension, steatosis, fibrosis, and Fib-4 were considered risk factors for fatigue in the MAFLD group. The age, high social level, diabetes, hypertension, steatosis, fibrosis, and fib-4 were considered, by univariate and multivariate analysis, independent risk factors for depression in the MAFLD group. age, BMI, waist circumference, diabetes, hypertension, steatosis, fibrosis, and fib-4 were independent risk factors for sleep disorders in MAFLD. CONCLUSION: Fatigue, sleeping disorders, and depression are more prevalent in MAFLD patients than in the general population. The lower health utility scores in patients with MAFLD are associated with more advanced stages of the disease.

Mitigation of bio-corrosion characteristics of coronary artery stent by optimising fs-laser micromachining parameters.

Cardiovascular diseases, particularly coronary artery disease, pose big challenges to human life. Deployment of the stent is a preferable treatment for the above-mentioned disease. However, stents are usually made up of shape memory alloy called Nitinol. The poorer surface finish on the machined nitinol stents accelerates the migration of Nickel ions from the implanted nitinol stent, which is considered toxic and can lead to stenosis. The current study deals with controlling surface quality by minimising surface roughness and improving corrosion resistance. Femtosecond laser (fs-laser 10-15 s) micromachining was employed to machine the Nitinol surface to achieve sub-micron surface roughness. The Grey relational analysis (GRA)-coupled design of the experimental technique was implemented to determine optimal levels of four micromachining parameters (laser power, pulse frequency, scanning speed, and scanning pattern) varied at three levels to achieve minimum surface roughness and to maximise the volume ablation. The results show that to yield minimum surface roughness and maximum volume ablation, laser power and scanning speed are in a higher range. In contrast, the pulse frequency is lower, and the scanning pattern is in a zig-zag manner. ANOVA results manifest that scanning speed is the predominant factor in minimising surface roughness, followed by pulse frequency. Furthermore, the corrosion behaviour of the machined nitinol specimens was evaluated, and the results show that specimens with lower surface roughness had lower corrosion rates.

Modeling of Effect of Infill Density Percentage on Rotating Bending Fatigue Behavior of Additive-Manufactured PLA Polymers.

Nowadays, 3D PLA-printed parts are widely used in many applications, essentially using the fused filament fabrication technique. While the influence of printing parameters on quasi-static mechanical characterization has been extensively considered within the literature, there are limited accounts of this effect on fatigue performance. The two main aims of this research are first to investigate the effects of the infill density percentage on the fatigue life of dog-bone samples under rotating bending cycling loads, and second to model the fatigue life using Wöhler and Basquin models. The experiments exhibit a high variability of results, especially for low cyclic loads. The S-N curves show that the number of cycles at failure increases with the increase in the infill density percentage and decreases with the increase in loads. Investigations allow the formulation of each constant model as a function of the infill density percentage. The new fatigue model formulations exhibit good agreement with the experimental data. As an outcome of this study, the fatigue model for 3D-printed parts may be expressed as a function of the infill density percentage using fewer tests in the future and for other polymers used in fused filament fabrication.

The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity.

AIM OF WORK: The aim of this study is to present a new technique of using spreader grafts in the correction of crooked nose deformity with C-shaped deviation of the middle third of the nose. PATIENTS AND METHODS: This is a prospective case series study conducted on 18 patients with crooked nose deformity with C-shaped deviation of the middle third of the nose. All of the patients were managed by open septorhinoplasty. During surgery, a curved spreader graft was harvested from the nasal septum and placed on the convex side of the C-shaped deviation of the dorsal part of the nasal septum. Objective measurements of the angles of external nasal deviation (END) and the internal nasal valve (INV) angles were performed before and 6 months after the surgery. Subjective assessment of aesthetic satisfaction by the visual analog scale and nasal function by the nasal obstruction symptom evaluation scale was also performed before and 6 months after surgery. RESULTS: Eighteen patients were enrolled in the study and completed the minimum follow-up period of 6 months. The mean follow-up period was 17.3 months. Objectively, there was highly significant ( P < 0.00001) improvement of the END angle and INV angle. Subjectively, there was also highly significant ( P < 0.00001) improvement of both the nasal obstruction symptom evaluation score and the visual analog scale score for aesthetic satisfaction. CONCLUSIONS: The insertion of a curved unilateral spreader graft over the convexity of the deviated nasal dorsum can correct the END, improve the collapsed INV on both sides, and consequently achieve satisfactory aesthetic and functional outcomes.

Recompensation in cirrhosis: unravelling the evolving natural history of nonalcoholic fatty liver disease.

Recompensation has gained increasing attention in the field of cirrhosis, particularly in chronic liver disease with a definite aetiology. The current global prevalence of obesity and nonalcoholic fatty liver disease (NAFLD) is increasing, but there is currently a lack of a clear definition for recompensation in NAFLD-related cirrhosis. Here, we provide an up-to-date perspective on the natural history of NAFLD, emphasizing the reversible nature of the disease, summarizing possible mechanisms underlying recompensation in NAFLD, discussing challenges that need to be addressed and outlining future research directions in the field. Recompensation is a promising goal in patients with NAFLD-related cirrhosis, and further studies are needed to explore its underlying mechanisms and uncover its clinical features.

Experimental and Simulation Study of Solar-Powered Air-Gap Membrane Distillation Technology for Water Desalination.

This work aimed to investigate temperature polarization (TP) and concentration polarization (CP), which affect solar-powered air-gap membrane distillation (SP-AGMD) system performance under various operating conditions. A mathematical model for the SP-AGMD system using the experimental results was performed to calculate the temperature polarization coefficient (τ), interface temperature (Tfm), and interface concentration (Cfm) at various salt concentrations (Cf), feed temperatures (Tf), and flow rates (Mf). The system of SP-AGMD was simulated using the TRNSYS program. An evacuated tube collector (ETC) with a 2.5 m2 surface area was utilized for solar water heating. Electrical powering of cooler and circulation water pumps in the SP-AGMD system was provided using a photovoltaic system. Data were subjected to one-way analysis of variance (ANOVA) and Spearman's correlation analysis to test the significant impact of operating conditions and polarization phenomena at p < 0.05. Statistical analysis showed that Mf induced a highly significant difference in the productivity (Pr) and heat-transfer (hf) coefficients (p < 0.001) and a significant difference in τ (p < 0.05). Great F-ratios showed that Mf is the most influential parameter. Pr was enhanced by 99% and 146%, with increasing Tf (60 °C) and Mf (12 L/h), respectively, at a stable salt concentration (Cf) of 0.5% and a cooling temperature (Tc) of 20 °C. Also, the temperature increased to 85 °C when solar radiation reached 1002 W/m2 during summer. The inlet heat temperature of AGMD increased to 73 °C, and the Pr reached 1.62 kg/(m2·h).

External Auditory Canal: Computed Tomography Analysis and Classification.

Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CT scans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ± 0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ± 1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ± 0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.

Experimental and numerical assessment of the flexural response of banana fiber sandwich epoxy composite.

Recently, most service or product-oriented industries have been focusing on their activities to uphold the green and sustainable environment protocol owing to the increased environmental pollution. Concerning this issue, industries are now concentrating on developing recyclable or waste materials products. This research advocates developing and validating a banana fiber sandwich composite to promote the beneficial usage of bio-waste. The composite sandwich specimens were fabricated with resin-impregnated woven banana fiber mat as a skin, and the core was reinforced with three different weight percentages (5, 7.5 and 10%) of chopped banana fiber. The sandwich specimens were pressed into a three-point bending test to validate the structural integrity. The flexural characteristics like flexural strength and modulus were examined experimentally, whereas the key strength indices like flexural stiffness and core shear modulus were evaluated analytically. Post-fracture surfaces were studied through a scanning electron microscope to investigate the failure mechanism. The experimental and analytical results indicate that 10% banana fiber content in the sandwich core increases the flexural strength and flexural modulus to 225% and 147%, respectively, compared to the neat epoxy core. The numerical simulation was also performed through FEA to validate the experimental findings. The numerical results are in good concurrence with the experimental one.

An international Delphi consensus statement on metabolic dysfunction-associated fatty liver disease and risk of chronic kidney disease.

Background: With the rising global prevalence of fatty liver disease related to metabolic dysfunction, the association of this common liver condition with chronic kidney disease (CKD) has become increasingly evident. In 2020, the more inclusive term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace the term non-alcoholic fatty liver disease (NAFLD). The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD. However, to date, there is no appropriate guidance on CKD in individuals with MAFLD. Furthermore, there has been little attention paid to the link between MAFLD and CKD in the Nephrology community. Methods and Results: Using a Delphi-based approach, a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD. Conclusions: This Delphi-based consensus statement provided guidance on the epidemiology, mechanisms, management and treatment of MAFLD and CKD, as well as the relationship between the severity of MAFLD and risk of CKD, which establish a framework for the early prevention and management of these two common and interconnected diseases.

Metabolic-associated fatty liver disease: New nomenclature and approach with hot debate.

An international panel recently proposed an update to the terminology and diagnostic criteria for fatty liver disease. The experts proposed a change in the nomenclature from non-alcoholic fatty liver disease (NAFLD) to metabolic (dysfunction)-associated fatty liver disease (MAFLD). This single-letter change, we believe, heralds the dawn of a new era in clinical practice and in clinical and basic research as well. The new nomenclature with the easily applicable approach has stimulated the enthusiasm of the researchers worldwide, resulting in a large number of publications over the past two years. Several recent studies have provided tremendous evidence of the superiority of the MAFLD criteria over the NAFLD criteria. Many studies in different geographic areas of the world including the United States, Europe, and Asia on a large number of patients proved that the utility of MAFLD criteria was higher than that of the NAFLD criteria in different aspects of fatty liver diseases. Consequently, many societies, physician and nurse groups, health stakeholders, representatives of regulatory sciences, and others endorsed the new nomenclature. Here we highlight the endorsement of the new name by different societies and groups and the outcome of different studies on the new nomenclature in addition to a short discussion of the debate by some experts.

Clinical study on the efficacy of hepatitis B vaccination in hepatitis C virus related chronic liver diseases in Egypt.

BACKGROUND: Chronic hepatitis B (HBV) and C virus (HCV) infections represent significant public health issues internationally. HBV vaccination has high sero-conversion rates in patients with mild to moderate chronic liver disease but has reduced efficacy in advanced stages. AIM: to evaluate the efficacy of hepatitis B vaccination in HCV-related chronic liver disease and identify possible factors that may contribute to hypo-responsiveness in those patients. METHODS: Our study was a retrospective observational clinical study carried out at the tropical medicine department. It was conducted on 500 individuals (400 chronic HCV patients and 100 healthy controls). Individuals were divided into 5 groups: A (control group), B (cirrhotic patient not receiving treatment), C (chronic hepatitis patients receiving treatment), D (cirrhotic patients receiving treatment), and E (HCC patients receiving treatment). All individuals were subjected for comprehensive history taking, clinical examination, laboratory investigations, and assessment of anti-HBs titer. RESULTS: There is an inverse relationship between the level of anti-HBs Abs and the duration of vaccine. Diabetes and presence of cirrhosis have statistically significant relationship with serum anti-HBs Abs titer (P = 0.007). Oral DAAs therapy is associated with reduced response to HBV vaccine (only 31.75% of the patients were protected). CONCLUSION: HCV infection and its complications significantly impair HBV vaccine response. Levels of anti-HBs Abs decline progressively with increasing duration from the last dose in immunization schedule of HBV vaccine. Diabetes and presence of cirrhosis being the main risk factors for vaccine hypo-responsiveness, also oral DAAs therapy is associated with reduced response to HBV vaccine.

External Auditory Canal: Computed Tomography Analysis and Classification

Abstract Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CTscans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ±0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ±1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ±0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.