Novel Mediastinoscope-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-analysis.

BACKGROUND: Minimally invasive surgery is an expanding field of surgery that has replaced many open surgical techniques. Surgery remains a cornerstone in the treatment of esophageal cancer, yet it is still associated with significant morbidity and technical difficulties. Mediastinoscope-assisted esophagectomy is a promising technique that aims to decrease the surgical burden and enhance recovery. METHODS: PubMed, MEDLINE, and EMBASE databases were searched for publications on mediastinoscope-assisted esophagectomies for esophageal cancer. The primary endpoint was a postoperative anastomotic leak, while secondary endpoints were assessment of harvested lymph nodes (LNs), blood loss, chyle leak, hospital length of stay (LOS), operative (OR) time, pneumonia, wound infection, mortality, and microscopic positive margin (R1). The pooled event rate (PER) and pooled mean were calculated for binary and continuous outcomes respectively. RESULTS: Twenty-six out of the 2274 searched studies were included. The pooled event rate (PER) for anastomotic leak was 0.145 (0.1144; 0.1828). The PERs for chyle leak, recurrent laryngeal nerve injury/hoarseness, postoperative pneumonia, wound infection, early mortality, postoperative morbidity, and microscopically positive (R1) resection margins were 0.027, 0.185, 0.09, 0.083, 0.020, 0.378, and 0.037 respectively. The pooled means for blood loss, hospital stay, operative time, number of total harvested LNs, and number of harvested thoracic LNs were 159.209, 15.187, 311.116, 23.379, and 15.458 respectively. CONCLUSIONS: Mediastinoscopic esophagectomy is a promising minimally invasive technique, avoiding thoracotomy, patient repositioning, and lung manipulation; thus allowing for shorter surgery, decreased blood loss, and decreased postoperative morbidity. It can also be reliable in terms of oncological safety and LN dissection.

Ab initio study of changing the oxygen reduction activity of Co-Fe-based perovskites by tuning the B-site composition.

Perovskite oxides are promising low-cost and stable alternative electrocatalysts for the oxygen reduction reaction (ORR), relative to the precious metal-based electrocatalysts. Despite the experimental research on substituting various transition metals into the B-site of perovskite catalysts to improve the ORR performance, the detailed ORR mechanism due to the substitution process is rarely studied. In this paper, the ORR activity of La0.5Sr0.5CoxFe1-xO3 perovskites (x = 0, 0.25, 0.5, 0.75, and 1) is studied by density functional theory (DFT). The ORR mechanism in alkaline solution is theoretically examined as a function of the Co/Fe composition at different potentials. The substitution of Co for Fe at the B-site of the perovskites dramatically changes the theoretical overpotential and enhances the activity. The HOO* formation is the potential-determining step for all the Co/Fe compositions. In comparison with the other compositions, the Co0.5/Fe0.5 composition exhibits the lowest overpotential and bonding with the reaction intermediates moderately. Furthermore, the oxygen binding energy is correlated with the bulk oxygen p-band center relative to the Fermi level. Among all the Co/Fe compositions, the Co0.5/Fe0.5 composition shows neither too low nor too high oxygen p-band center value. These results provide deep insights into the ORR mechanism on B-site substituted perovskites and guidelines for the design of cost-effective and Pt-free electrocatalysts for oxygen reduction.

Disordered-Layer-Mediated Reverse Metal-Oxide Interactions for Enhanced Photocatalytic Water Splitting.

In heterogeneous catalysts, metal-oxide interactions occur spontaneously but often in an undesired way leading to the oxidation of metal nanoparticles. Manipulating such interactions to produce highly active surface of metal nanoparticles can warrant the optimal catalytic activity but has not been established to date. Here we report that a prior reduced TiO2 support can reverse the interaction with Pt nanoparticles and augment the metallic state of Pt, exhibiting a 3-fold increase in hydrogen production rate compared to that of conventional Pt/TiO2. Spatially resolved electron energy loss spectroscopy of the Ti valence state and the electron density distribution within Pt nanoparticles provide direct evidence supporting that the Pt/TiO2/H2O triple junctions are the most active catalytic sites for water reduction. Our reverse metal-oxide interaction scheme provides a breakthrough in the stagnated hydrogen production efficiency and can be applied to other heterogeneous catalyst systems composed of metal nanoparticles with reducible oxide supports.

Survey on serum protein electrophoresis and recommendations for standardised reporting.

INTRODUCTION: Serum protein electrophoresis (SPE) is a well-established laboratory technique. However, reporting of results varies considerably between laboratories. The variation in reporting can cause confusion to the clinician with a potential of adversely impacting patient care. The purpose of the survey was to find out the variation in reporting and to prepare recommendations to the Malaysian laboratories based on the survey to reduce both the variation in reporting between laboratories and the risk of misinterpretation of reports. MATERIALS AND METHODS: To determine the extent of variation in reporting of protein electrophoresis results questionnaires were distributed to the pathologists of various laboratories in Malaysia regarding the method, quantification of paraprotein concentrations and immunoglobulin assays, and information regarding current laboratory electrophoresis practices. RESULTS: Variation was found in the following reporting practices: (a) screening protocol; (b) reporting of serum albumin; (c) numerical reporting of protein fractions and paraprotein; (d) co-migration of a paraprotein with a normal serum protein; (e) reporting of multiple paraprotein bands (f) appearance of small abnormal band and oligoclonal bands and (g) communication about of interferences. CONCLUSION: The pathologists of the country made recommendations on the reporting of protein electrophoresis. Harmonised reporting will reduce inconsistency, variation in reporting, improve the quality of the report and most importantly improve patient care.

Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta-analysis.

OBJECTIVES: To compare the impact of clomiphene citrate (CC) vs other drug regimens on mid-cycle endometrial thickness (EMT), ovulation, pregnancy and live birth rates in women with World Health Organization (WHO) group II ovulatory disorders. METHODS: We searched MEDLINE, EMBASE, Scopus, Web of Science, The Cochrane Central Register of Clinical Trials (CENTRAL) and the non-MEDLINE subset of PubMed from inception to December 2016 and cross-checked references of relevant articles. We included only randomized controlled trials (RCTs) comparing CC used alone vs other drug regimens for ovulation induction in women with WHO group II anovulation. Outcomes were mid-cycle EMT, ovulation, pregnancy and live birth rates. We pooled weighted mean differences (WMD) with 95% confidence intervals (CI) for continuous variables (EMT) and risk ratios (RR) with 95% CI for binary variables (ovulation, pregnancy and live birth rates). RESULTS: We retrieved 1718 articles of which 33 RCTs (4349 women, 7210 ovulation induction cycles) were included. In 15 RCTs that compared CC with letrozole, EMT was lower in the CC group (1957 women, 3892 cycles; WMD, -1.39; 95% CI, -2.27 to -0.51; I2 = 100%), ovulation rates after CC and letrozole were comparable (1710 women, 3217 cycles; RR, 0.97; 95% CI, 0.90-1.04; I2 = 47%), while CC led to a lower pregnancy rate (1957 women, 3892 cycles; RR, 0.78; 95% CI, 0.63-0.95; I2 = 43%) and a lower live birth rate (RR, 0.70; 95% CI, 0.49-0.98; I2 = 35%). In two RCTs that compared CC with CC plus metformin, EMT, ovulation and pregnancy rates were comparable (101 women, 140 cycles; WMD, -0.23; 95% CI, -0.92 to 0.45; I2 = 78%; RR, 0.84; 95% CI, 0.67-1.06; I2 = 0%; and RR, 0.79; 95% CI, 0.33-1.87; I2 = 0%). In three studies that compared CC with CC plus N-acetyl cysteine (NAC), EMT was lower in the CC group (340 women, 300 cycles; WMD, -1.51; 95% CI, -1.98 to -1.04; I2 = 45%). In two studies that compared CC with CC + nitric oxide (NO) donor, EMT was lower in the CC group (120 women, 304 cycles; WMD, -1.75; 95% CI, -2.08 to -1.41; I2 = 0%). Compared with CC plus NO donor or NAC, CC showed statistically significant lower ovulation and pregnancy rates. Compared with tamoxifen in three studies, CC showed a tendency towards lower EMT (571 women, 844 cycles; WMD, -1.34; 95% CI, -2.70 to 0.01; I2 = 96%) with comparable ovulation and pregnancy rates. CONCLUSIONS: In women with WHO group II ovulatory disorders, ovulation induction with CC might result in lower EMT than other ovulation induction regimens. Whether the lower EMT caused the lower pregnancy and live birth rates remains to be elucidated. Letrozole seems to be beneficial for these women. However, our findings should be interpreted with caution as the quality of evidence was very low. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Electronic structure, magnetic properties, and mixed valence character of Ce2 Ni3 Si5 from first principles calculations.

Cerium intermetallic compounds exhibit anomalous physical properties such as heavy fermion and Kondo behaviors. Here, an ab initio study of the electronic structure, magnetic properties, and mixed valence character of Ce2 Ni3 Si5 using density functional theory (DFT) is presented. Two theoretical methods, including pure Perdew-Burke-Ernzerhof (PBE) and PBE + U, are used. In this study, Ce3+ and Ce4+ are considered as two different constituents in the unit cell. The formation energy calculations on the DFT level propose that Ce is in a stable mixed valence of 3.379 at 0 K. The calculated electronic structure shows that Ce2 Ni3 Si5 is a metallic compound with a contribution at the Fermi level from Ce 4f and Ni 3d states. With the inclusion of the effective Hubbard parameter (Ueff ), the five valence electrons of 5 Ce3+ ions are distributed only on Ce3+ 4f orbitals. Therefore, the occupied Ce3+ 4f band is located in the valence band (VB) while Ce4+ 4f orbitals are empty and Located at the Fermi level. The calculated magnetic moment in Ce2 Ni3 Si5 is only due to cerium (Ce3+ ) in good agreement with the experimental results. The Ueff value of 5.4 eV provides a reasonable magnetic moment of 0.981 µB for the unpaired electron per Ce3+ ion. These results may serve as a guide for studying present mixed valence cerium-based compounds. © 2017 Wiley Periodicals, Inc.

Characterization of hepatitis B virus surface antigen variability and impact on HBs antigen clearance under nucleos(t)ide analogue therapy.

For hepatitis B virus (HBV)-related chronic infection under treatment by nucleos(t)ide analogues (NUCs), HBsAg clearance is the ultimate therapeutic goal but very infrequent. We investigated how HBV envelope protein variability could lead to differential HBsAg clearance on NUCs. For 12 HBV genotype D patients receiving NUCs, six resolvers (HBsAg clearance) were compared to six matched nonresolvers (HBsAg persistence). PreS/S amino acid (aa) sequences were analysed with bioinformatics to predict HBV envelope antigenicity and aa covariance. To enrich our analyses on very rare resolvers, these were compared with other HBV genotype D strains in three characterized clinical cohorts including common chronically infected patients. The sT125M+sP127T combination was observed in four nonresolvers of six, corroborated by aa covariance analysis, associated with a lower predicted antigenicity than sT125T+sP127P. Concordant features within this HBV key functional domain, at positions 125 and 127, were reported from two of the three comparative cohorts. In our hands, a lower ELISA reactivity of HBV-vaccinated mice sera was observed against the sT125M mutant. In the S gene, 56 aa changes in minor variants were detected in non-resolvers, mainly in the major hydrophilic region, vs 28 aa changes in resolvers. Molecular features in patients showing HBsAg persistence on NUCs argue in favour of a different aa pattern in the HBV S gene compared to those showing HBsAg clearance. In nonresolvers, a decrease in HBs 'a' determinant antigenicity and more frequent mutations in the S gene suggest a role for the HBV envelope characteristics in HBsAg persistence.

Productivity of sodic soils can be enhanced through the use of salt tolerant rice varieties and proper agronomic practices.

Regaining the agricultural potential of sodic soils in the Indo-Gangetic plains necessitates the development of suitable salt tolerant rice varieties to provide an entry for other affordable agronomic and soil manipulation measures. Thus selection of high yielding rice varieties across a range of sodic soils is central. Evaluation of breeding lines through on-station and on-farm farmers' participatory varietal selection (FPVS) resulted in the identification of a short duration (110-115 days), high yielding and disease resistant salt-tolerant rice genotype 'CSR-89IR-8', which was later released as 'CSR43' in 2011. Several agronomic traits coupled with good grain quality and market value contributed to commercialization and quick adoption of this variety in the sodic areas of the Indo-Gangetic plains of eastern India. Management practices required for rice production in salt affected soils are evidently different from those in normal soils and practices for a short duration salt tolerant variety differ from those for medium to long duration varieties. Experiments were conducted at the Indian Council of Agricultural Research-Central Soil Salinity Research Institute (ICAR-CSSRI), Regional Research Station, Lucknow, Uttar Pradesh, India during 2011 and 2013 wet seasons, to test the hypothesis that combining matching management practices (Mmp) with an improved genotype would enhance productivity and profitability of rice in sodic soils. Mmp were developed on-station by optimizing existing best management practices (Bmp) recommended for the region to match the requirements of CSR43. The results revealed that transplanting 4 seedlings hill-1 at a spacing of 15 × 20 cm produced significantly higher yield over other treatments. The highest additional net gain was US$ 3.3 at 90 kg ha-1 N, and the lowest was US$ 0.4 at 150 kg ha-1 N. Above 150 kg ha-1, the additional net gain became negative, indicating decreasing returns from additional N. Hence, 150 kg N ha-1 was considered the economic optimum N application rate for CSR43 in these sodic soils. Using 150-60-40-25 kg N-P2O5-K2O-ZnSO4·7H2O ha-1 in farmers' fields grown to CSR43 produced an average of 5.5 t ha-1 grain. The results of on-farm evaluation trials of CSR43 showed that matching management practices (Mmp) increased yield by 8% over existing best management practices (Bmp) recommended by ICAR-CSSRI for sodic soils and by 16% over framers' management practices; however, combining Mmp with CSR43 resulted in 35% higher yields over farmers' current varieties and management. This approach of combining cost effective crop and nutrient management options and a salt-tolerant variety can maximize the productivity and profitability of sodic soils in the alluvial Indo-Gangetic plains and in neighboring salt-affected areas of the Ganges mega delta in South Asia.

Fungal Planet description sheets: 371-399.

Novel species of fungi described in the present study include the following from Australia: Neoseptorioides eucalypti gen. & sp. nov. from Eucalyptus radiata leaves, Phytophthora gondwanensis from soil, Diaporthe tulliensis from rotted stem ends of Theobroma cacao fruit, Diaporthe vawdreyi from fruit rot of Psidium guajava, Magnaporthiopsis agrostidis from rotted roots of Agrostis stolonifera and Semifissispora natalis from Eucalyptus leaf litter. Furthermore, Neopestalotiopsis egyptiaca is described from Mangifera indica leaves (Egypt), Roussoella mexicana from Coffea arabica leaves (Mexico), Calonectria monticola from soil (Thailand), Hygrocybe jackmanii from littoral sand dunes (Canada), Lindgomyces madisonensis from submerged decorticated wood (USA), Neofabraea brasiliensis from Malus domestica (Brazil), Geastrum diosiae from litter (Argentina), Ganoderma wiiroense on angiosperms (Ghana), Arthrinium gutiae from the gut of a grasshopper (India), Pyrenochaeta telephoni from the screen of a mobile phone (India) and Xenoleptographium phialoconidium gen. & sp. nov. on exposed xylem tissues of Gmelina arborea (Indonesia). Several novelties are introduced from Spain, namely Psathyrella complutensis on loamy soil, Chlorophyllum lusitanicum on nitrified grasslands (incl. Chlorophyllum arizonicum comb. nov.), Aspergillus citocrescens from cave sediment and Lotinia verna gen. & sp. nov. from muddy soil. Novel foliicolous taxa from South Africa include Phyllosticta carissicola from Carissa macrocarpa, Pseudopyricularia hagahagae from Cyperaceae and Zeloasperisporium searsiae from Searsia chirindensis. Furthermore, Neophaeococcomyces is introduced as a novel genus, with two new combinations, N. aloes and N. catenatus. Several foliicolous novelties are recorded from La Réunion, France, namely Ochroconis pandanicola from Pandanus utilis, Neosulcatispora agaves gen. & sp. nov. from Agave vera-cruz, Pilidium eucalyptorum from Eucalyptus robusta, Strelitziana syzygii from Syzygium jambos (incl. Strelitzianaceae fam. nov.) and Pseudobeltrania ocoteae from Ocotea obtusata (Beltraniaceae emend.). Morphological and culture characteristics along with ITS DNA barcodes are provided for all taxa.

Mitigating mutual coupling effects on circular polarization for improved bandwidth in MIMO systems: A novel approach.

An improved mutual coupling compensation in circularly polarized (CP) multi-input multi-output (MIMO) dielectric resonator antenna (DRA) is presented in this paper. Using trimming approach, the mutual coupling (MC) between closely spaced DRA units at 0.3λ has been significantly reduced while axial ratio performance has been maintained. Mutual coupling reduction is obtained by trimming the DRA to ensure low mutual coupling below -20dB. The exclusive features of the proposed MIMO DRA include wide impedance matching bandwidth (BW), triple band circular polarization, and suppressed MC between the radiating elements. The impedance bandwidth matches perfectly with a triple band's 3 dB axial ratio (AR). It is designed with characteristic mode analysis with good agreement of the measurement that has been obtained. Using the probe feed method, the DRA and patch strip are coupled together to allow bandwidth widening of the pro-posed DRA. An impedance bandwidth of 34% at a lower frequency to around 2% at a higher frequency was achieved in all resonance frequencies. Thus, we refer to our newly designed DRA as a proposed method for effectively reducing the mutual coupling between DRAs. Additionally, the 3 dB AR bandwidth matched at 3.3 GHz, 4.6 GHz, and 6.3 GHz with a percentage of 11.66%, 3.04%, and 2.22% obtained at the three different frequencies. Note that the proposed DRA exhibits low mutual coupling (below -20 dB) at the targeted frequencies, which is suitable for better signal reception for MIMO applications. By computing, the metrics envelop correlation coefficient, diversity gain, channel capacity loss, and total active reflection coefficient, the MIMO performance of the proposed antenna is verified. The experiments show a close result between simulated and computed validation of the proposed DRA.

Survival difference among adult and pediatric mediastinal yolk sac tumors cases: A meta-analysis of case reports.

BACKGROUND: Mediastinal Yolk sac tumors (YST) are rare and highly malignant extragonadal germ cell tumors with rapid growth and early metastases. We sought to conduct a meta-analysis of published case reports/case series to compare differences in survival, demographics, and treatment modalities between adult and pediatric patients with YST. METHODS: Ovid Embase, Cochrane, and Ovid Medline databases were searched for primary mediastinal pure YST cases. The primary outcome was overall survival (OS). Log-rank and Cox regression were used. This study is registered on PROSPERO (CRD42022367586). RESULTS: Among 846 studies, 87 met our inclusion criteria including 130 patients (Adults: 90 and Pediatrics: 40). About 41.5% of the patients were from the United States. The median age was 23.0 (Q1-Q3: 17.0-30.0), 88.5% were males, and (32.3%) were Asian. Stage II represented almost 40%. AFP was elevated in 96.9%. Respiratory distress was the presenting symptom in 65.4%. Chemotherapy, radiotherapy, and surgery were utilized in 84.6, 23.1, and 64.7% respectively. Median OS was 24 months (Adults: 23 months, Pediatrics: 25 months, P = 0.89). 3- and 5-year OS were 34.4% and 22.9% in adults and 41.5% and 41.5% in pediatrics, respectively. On multivariate analysis, anterior location of tumors, receipt of chemotherapy, and undergoing surgery were associated with better OS. CONCLUSION: Primary mediastinal YSTs are rare, but lethal neoplasms. Our meta-analysis showed that mediastinal YSTs mimic other non-seminomatous mediastinal GCTs in terms of clinical characteristics and available treatment options. Early diagnosis, neoadjuvant chemotherapy, and surgical resection are the key points for effective management and improved outcomes.

Facile assembly of flexible quaternary SnO2/SrSnO3/Fe3O4/PVDF nanocomposites with tunable optical, electrical, and magnetic properties for promising magneto-optoelectronic applications.

Facile assembly, co-precipitation, and drop casting procedures have been used to construct SnO2/SrSnO3/Fe3O4/PVDF flexible nanocomposites. SnO2/SrSnO3/Fe3O4 nanocomposites (TSF NCs') have been successfully incorporated into polyvinylidene fluoride polymers (PF), according to the microstructural exploration of the systems, which was revealed by XRD, EDX, and ATR-FTIR analysis. The FESEM and cross-section areas demonstrated that the addition of TSF NCs' to PF porous material enhanced its surface characteristics and decreased its surface roughness. The optical gap was lowered from 3.90 to 3.07 eV, and it was discovered that both the refractive index and optical conductivity had improved when TSF NCs' were incorporated into PF. According to the observations, the supplement ratios have a profound influence on the dielectric properties of the nanocomposites. Moreover, the electrical parameters of TSF/PF nanocomposite are significantly modified. The TSF/PF magnetic nanocomposite has good magnetic reactivity and can be easily extracted from the aqueous solution using an external magnetic field, as demonstrated by VSM. This research has been conducted to obtain TSF/PF nanocomposites to be used in promising magno-optoelectronic applications.

Lung Cancer as a Leading Cause among Paraneoplastic Non-Bacterial Thrombotic Endocarditis: A Meta-Analysis of Individual Patients' Data.

Hypercoagulability is strongly associated with cancer and may result in non-bacterial thrombotic endocarditis (NBTE). The aim of our meta-analysis was to explore the demographics and characteristics of this condition in cancer. Databases were systematically searched. The outcomes were to identify the annual trend in premortem diagnosis among the entire cohort and different subgroups and to identify differences in characteristics and survival in the considered population. A total of 121 studies with 144 patients were included. The proportion of marantic endocarditis associated with lung cancer was 0.29 (95% CI, 0.21-0.37; p < 0.001), that associated with pancreatic cancer was 0.19 (95% CI, 0.13-0.27; p < 0.001), that associated with advanced cancer stage (metastasis) was 0.69 (95% CI, 0.61-0.76; p < 0.001), and that associated with adenocarcinoma was 0.65 (95% CI, 0.56-0.72; p < 0.001). Median and 6-month overall survival (OS) were 1.3 months and 32.3%, respectively, with 6-month OS of 20.8% vs. 37.0% in lung vs. other cancers, respectively (p = 0.06) and 42.9% vs. 31.1% among those who underwent intervention vs. those who did not (p = 0.07). Cases discovered in recent years had better survival (HR = 0.98 (95% CI, 0.96-0.99; p = 0.003). While cancer-associated NBTE is a rare entity, lung cancers were the most common tumor site and are frequently associated with more advanced and metastatic cancer stages. The prognosis is dismal, especially among lung cancers.

Antiviral resistance mutations and genotype-associated amino acid substitutions in treatment-naïve hepatitis B virus-infected individuals from the Indian subcontinent.

BACKGROUND/AIMS: Antiviral resistance is a major challenge to the treatment currently available for hepatitis B virus (HBV). In this study, mutations that may affect the antiviral efficacy in treatment-naïve HBV-infected individuals were analyzed. METHODS: Ninety-seven treatment-naïve HBV-infected individuals were included in this study. HBV reverse transcriptase (rt) domains were sequenced and nucleotide differences were compared to GenBank wild-type sequences. Furthermore, HBV genotypes, subgenotypes and subtypes were determined by analyzing surface gene sequences. RESULTS: An adefovir-related rtI233V mutation was identified in 4 subjects. The rtS213T lamivudine and entecavir refractory mutant was presented in 3 individuals. Altogether, drug-related, atypical and novel HBVrt amino acid substitutions were seen in 73 positions. The HBV genotypes A, C, D and G were depicted in 15, 21, 60 and 1 individuals, respectively. There were 17 HBVrt amino acid substitutions that are associated with certain genotypes of HBV. Mutations in HBVrt corresponded to established surface gene mutations in 9 patients. CONCLUSION: This data shows that antiviral-resistant HBV strains do exist in treatment-naïve individuals in this region. Further studies are essential to characterize the role of HBVrt amino acid substitutions in response to anti-HBV therapy.

Iatrogenic illness in the paediatric intensive care unit at Gharian teaching hospital, Libya.

The aim of this prospective follow-up study wasto determine the incidence and risk factors of iatrogenic illness and the outcome among cases admitted to the paediatric intensive care unit in ateaching hospital in Libya. The incidence of iatrogenic complications was 22.9% among 423 cases admitted over a 1-year period. Human error (18.4%) followed by machine defects (4.5%) were the most common causes of complications. The overall mortality rate was 7.6% and was significantly higher in iatrogenic cases than others (13.4% versus 5.8%). Paediatric risk of mortality (PRISM) score was a good predictor of risk of iatrogenic illness. Both mortality and occurrence of iatrogenic illness were significantly associated with: higher PRISM score, use of mechanical ventilation, higher bed occupancy rate in the unit, presence of respiratory and neurological diseases, prolonged duration of stay in the intensive care unit and younger age of the child.

Effect of Benson's relaxation therapy alone or combined with aerobic exercise on cortisol, sleeping quality, estrogen, and severity of dyspeptic symptoms in perimenopausal women with functional dyspepsia.

OBJECTIVE: Besides repeated stress exposure, a sedentary lifestyle and low estrogen levels are risk factors for the development of functional dyspepsia (FD). The aim of this study was to find out the effect of adding aerobic exercise (5 sessions per week) to the daily application of a 40-minute Benson's relaxation therapy (BRT) (diaphragmatic breathing and progressive muscle relaxation applied for 20 minutes in the morning and evening) on Glasgow dyspepsia severity score (GDSS), cortisol, visual analogue scale (VAS) (for abdominal symptoms), estradiol (one of the endogenous estrogens), Pittsburgh sleep quality index (PSQI), and 42-item depression, anxiety, and stress scales (DASS-42) in 60 perimenopausal women with FD. PATIENTS AND METHODS: Women who consumed a daily dose of pantoprazole (40 mg tablet administered as a proton pump inhibitor drug) were randomly assigned to an 8-week study group (this group received aerobic exercise plus BRT, N=30) or an 8-week control group (this group received BRT only, N=30). RESULTS: Significant improvements were reported in all measured variables within women groups (except estradiol of the control group). Compared to the control group, the reported within-group significant improvements in GDSS, cortisol, VAS, PSQI, and DASS-42 were higher in the study group. CONCLUSIONS: Significant improvements in GDSS, cortisol, VAS, PSQI, and DASS-42 could be achieved after adding adjunctive therapies - aerobic exercise and BRT - to the medications of FD in perimenopausal women. Compared to BRT alone, physical exercise plus BRT significantly increases the levels of estradiol in perimenopausal women with FD.

Hazards of Radioactive Mineralization Associated with Pegmatites Used as Decorative and Building Material.

The present study aimed to assess the radiological hazards associated with applying the investigated granite in the building materials and the infrastructures applications. The investigated granites are classified into four categories: El-Urf, barren, colourful and opaque. El Urf monzogranite intrudes metagabbro diorite complex with sharp contacts. Based on the activity concentrations, the environmental parameters such as absorbed dose rate (Dair), annual effective dose (AED), radium equivalent activity (Raeq), external (Hex) and internal (Hin) hazard indices were measured. The mineralized pegmatite is located in the southwestern foothill of the Gabal El Urf younger granite. It displays well-defined zonation of three zones: outer, middle and inner zones represented by potash feldspar, quartz and mica, respectively. The isorad map showed that El Urf monzogranite is barren (Up to 100 cps) surrounding an excavation of the studied pegmatite that exhibits moderate colorful mineralization (phase-I = 500-1500 cps) and anomalous opaque mineralization (phase-II = 1500-3500 cps) pegmatites. The obtained results of radionuclides activity concentrations illustrated that the Opaque granites have the highest values of 238U (561 ± 127 Bq kg-1), 232Th (4289 ± 891 Bq kg-1) and 40K (3002 ± 446 Bq kg-1) in the granites, which are higher than the recommended worldwide average. Many of the radiological hazard parameters were lesser than the international limits in the younger granites and barren pegmatites. All of these parameters were higher in the colorful and opaque mineralized pegmatites. The high activity and the elevated radiological hazard parameters in the mineralized pegmatites are revised to the presence of radioactive and radioelements bearing minerals, such as thorite, meta-autunite, kasolite, phurcalite, columbite, fergusonite, Xenotime and fluorapatite. Other instances of mineralization were also recorded as cassiterite, atacamite, galena, pyrite and iron oxide minerals. Thus, the granites with high radioactivity concentration cannot be applied in the different applications of building materials and ornamental stones.

Learning curve and volume outcome relationship of endoscopic trans-oral versus trans-axillary thyroidectomy; A systematic review and meta-analysis.

BACKGROUND: In the modern era, minimally invasive surgery is rapidly evolving and even replacing conventional open techniques in many surgical fields. Thyroidectomy was not an exception, with the introduction of multiple endoscopic thyroidectomy techniques. Trans-oral endoscopic trans-vestibular thyroidectomy (TOT) is a novel technique with promising outcomes. We conducted this meta-analysis to compare surgical outcomes and learning curves for TOT and other endoscopic thyroidectomy techniques. METHODS: A systematic review in PubMed, MEDLINE, and EMBASE databases was conducted searching for publications on TOT versus trans-axillary thyroidectomy (TAT). The primary endpoint was operative (OR) time. Secondary endpoints were number of harvested lymph nodes (LNs), estimated blood loss (EBL), recurrent laryngeal nerve (RLN) injury, hoarseness, seroma, infection, chyle leak, hypocalcemia, hospital length of stay (LOS), and Cost. We also investigated the learning curve for each technique. Leave-out-out analysis, meta-regression, and subgroup analysis were used. Random effect inverse variance method was utilized. RESULTS: Among 3820 retrieved studies, 15 studies (10 unmatched and 5 matched), with 2173 (TOT: 1024(47.12%) and TAT:1149(52.87%)) patients, met the inclusion criteria. The operative time and harvested L. Ns number were higher in TOT versus TAT (standard mean difference (SMD) = 0.72 [95%CI 0.07; 1.37], P = 0.029 and SMD = 0.32 [95%CI 0.02; 0.62], P = 0.036 respectively) while less EBL in TOT versus TAT (SMD = -0.26 [-0.43; -0.09], P = 0.0018). All other outcomes showed no significant difference between both groups. Weighted mean values for TOT and TAT were 158.03 vs 144.97 min for OR time, 6.33 vs 5.16 for harvested LNs, and $5,919.05 vs $6,253.79 for the cost. Statistical significance in learning curve development was noticed ranging between 6 and 15 annual cases. CONCLUSION: Trans-oral thyroidectomy is a safe and reliable technique with outcomes comparable to other endoscopic techniques. It provides better access to the central compartment with a more feasible LN dissection. Improvement in surgical outcomes is expected with growing learning curve and technique mastery.