Tadalafil versus tamsulosin as combination therapy with 5-alpha reductase inhibitors in benign prostatic hyperplasia, urinary and sexual outcomes.

PURPOSE: To compare the urological and sexual outcomes of using either tamsulosin/finateride or tadalafil/finasteride as combination therapies in patients with large prostate. PATIENTS AND METHODS: Selection criteria included prostate volume > 40 ml and IPSS > 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were excluded. Patients were randomized into group I (tamsulosin/finasteride) and group II (tadalafil/finasteride). The primary endpoint was to define urinary and sexual function changes (IPSS, IPSS-quality of life, urinary flow rates and IIEF domains) within each group. The secondary endpoint was to compare the treatment induced changes between both groups. RESULTS: At 4th and 12th weeks, 131 and 127 patients were available in both groups, respectively. Both groups showed significant LUTS improvement (IPSS changes: - 4.9 ± 2.7 and - 4.3 ± 2.9 at 4th week and - 6.1 ± 3 and - 5.4 ± 2.8 points by the 12th week in both groups, respectively). Group I had better average flow rates at both follow-up visits. Meanwhile, maximum flow rates were comparable in both groups at 12th week (13.5 ± 3.9vs. 12.6 ± 3.7, p > 0.05). In group I, all IIEF domains were significantly lowered at both visits (p < 0.05). Group II showed significant increase in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2 at the 4th and 12th weeks) with a transient significant reduction of IIEF-orgasm and sexual desire noted only by the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively). CONCLUSION: Within three months, both combinations are comparably effective in improving BPH related LUTS. Tamsulosin/finasteride provided significantly better Qmax only at 4th week. Tadalafil/finasteride had the advantage of improving sexual performance over the other combination.

Evaluation of clinical performance of additively manufactured and milled polyetheretherketone (PEEK) inlays compared with indirect composite resin inlays over a one-year follow-up: A randomized clinical trial.

STATEMENT OF PROBLEM: Data on polymer materials, particularly polyetheretherketone (PEEK) used in restorative dentistry, are scarce, as is knowledge concerning the clinical efficacy of PEEK restorations produced through additive manufacturing when compared with existing indirect materials and techniques. PURPOSE: The purpose of this randomized clinical trial was to evaluate the clinical performance of additively manufactured and milled PEEK inlays compared with composite resin inlays according to modified United State Public Health Service (USPHS) criteria over a 1-year follow- up. MATERIAL AND METHODS: Participants were allocated into 3 distinct categories based on the materials and techniques used: R1 denoting teeth restored with 3 dimensionally (3D) printed PEEK inlays (N=16), R2 representing teeth restored with milled PEEK inlays (N=16), and R3 indicating the comparator group comprising teeth restored with milled composite resin inlays (N=16). After the placement of inlay restorations, evaluations were conducted at 3 time points (T): baseline (T0), 6 months (T1), and 12 months (T2) by using the modified USPHS criteria for assessing anatomic form, color match, marginal discoloration, marginal adaptation, surface texture, secondary caries, retention, and postoperative sensitivity. Ordinal data were analyzed using the Kruskal-Wallis test, followed by the Dunn post hoc test for between group comparisons, as well as the Friedman test, followed by the Nemenyi post hoc test for within group comparisons (α=.05). RESULTS: Across all parameters and intervals, most of the restorations within each group exhibited an alfa score, with no statistically significant differences noted (P>.05). However, concerning color match, all restorations within the PEEK groups received a bravo score, indicating a statistically significant difference in intergroup comparison between the milled composite resin groups and the PEEK group (P<.001). However, no significant variances were noted in the scores evaluated across different follow-up periods (P>.05). CONCLUSIONS: Subtractive and additive manufacturing techniques, as well as PEEK and composite resin materials together, offer clinically acceptable functioning restorations over 1 year. PEEK material can be used as a suitable alternative to commonly used indirect composite resin intracoronal restorations in posterior areas. Improvements in terms of surface texture and esthetics are required.

Effect of authentic leadership on work readiness: the mediating role of nurses' agility.

BACKGROUND: The dynamic and demanding nature of healthcare environments necessitates that nurses not only possess clinical proficiency but also exhibit high levels of work readiness to adapt swiftly to changes. Authentic leadership has been recognized as a critical factor influencing various organizational outcomes. AIM: Investigating the mediating role of nurses' agility in the relation between authentic leadership and nurses' work readiness. DESIGN AND METHOD: A correlational analytical research design was utilized following STROBE guidelines, and data were collected from 249 nurses at a hospital affiliated with Beni-Suef University, Egypt. Instruments included authentic leadership Questionnaire, work readiness scale, and workforce agility scale. Data was collected from the beginning of March to the end of April 2024. RESULTS: The findings indicate that authentic leadership was notably strong regarding morality/ethics dimension (mean score: 15.81), and nurses demonstrated relatively high agility levels, particularly in proactivity (mean score: 29.16). Organizational acumen scored highest in work readiness dimensions (mean score: 53.94). Nurses' overall scores for study variables ranged from 72 to 80% of the maximum, with agility scoring highest (mean score: 85.77). Significant positive correlations were found between variables, especially between nurses' agility and authentic leadership (r = 0.362). CONCLUSION: Path analysis reveals nurses' agility as a paramount mediator between authentic leadership and nurses' work readiness, indicating its vital role in transmitting the positive effects of authentic leadership. Practical implications include establishing authentic leadership programs that foster nurses' agility especially proactive behaviors. That in turn improve nurses' readiness for various work responsibilities.

Mediation of psychological ownership between green human resources management and nursing faculty's green behavior.

BACKGROUND: Greening organizations have become a top priority for decision-makers in the 21st century. Psychological ownership can be improved through responsible administration, which, in turn, improves green behavior. AIM: Investigating the mediating role of psychological ownership in the relationship between green human resources management (HRM) and green behavior among nursing faculty. DESIGN AND METHOD: A correlational analytical research design was utilized to conduct the study following the STROBE guidelines. A convenience sample of 204 academic staff was used. Four data collection tools were used: sociodemographic characteristics, the green HRM questionnaire, the Psychological Ownership Scale, and the Green Behaviour Scale. RESULTS: Faculty members who perceive strong green HRM practices are more likely to have heightened psychological ownership, positively influencing their engagement in green behavior. Conversely, weaker perceptions of green HRM are associated with lower levels of green behavior. Psychological ownership was found to act as a partial mediator between green HRM and green behavior. Even when considering the influence of psychological ownership, green HRM has a significant and direct impact on green behavior. CONCLUSION: Faculty members who perceive a high level of green HRM practices are more likely to have a high level of psychological ownership that, in turn, influences their green behavior. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Workshops on psychological ownership and green behavior can foster environmental sustainability. Policies should integrate green HRM practices into nursing education and healthcare facilities, recognizing psychological ownership's role. Incentivizing green initiatives can motivate staff, aligning with broader conservation goals. Encouraging an ethos of environmental stewardship benefits both the healthcare and sustainable development agendas.

Exploring Ventilator-Associated Pneumonia: Microbial Clues and Biomarker Insights from a Retrospective Study.

Background and Objectives: Ventilator-associated pneumonia (VAP) is a common complication in critically ill patients receiving mechanical ventilation. The incidence rates of VAP vary, and it poses significant challenges due to microbial resistance and the potential for adverse outcomes. This study aims to explore the microbial profile of VAP and evaluate the utility of biomarkers and illness severity scores in predicting survival. Materials and Methods: A retrospective cohort study was conducted involving 130 patients diagnosed with VAP. Microbial analysis of bronchoalveolar lavage (BAL) fluid, as well as measurements of C-reactive protein (CRP) and procalcitonin (PCT) levels, were performed. Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated to assess illness severity. Statistical analyses were conducted to determine correlations and associations. Results: The study revealed that Klebsiella pneumoniae (K. pneumoniae) (50.7%) and Pseudomonas aeruginosa (P. aeruginosa) (27.69%) were the most identified microorganisms in VAP cases. SOFA (p-value < 0.0001) and APACHE II (p-value < 0.0001) scores were effective in assessing the severity of illness and predicting mortality in VAP patients. Additionally, our investigation highlighted the prognostic potential of CRP levels (odds ratio [OR]: 0.980, 95% confidence interval [CI] 0.968 to 0.992, p = 0.001). Elevated levels of CRP were associated with reduced survival probabilities in VAP patients. Conclusion: This study highlights the microbial profile of VAP and the importance of biomarkers and illness severity scores in predicting survival. Conclusions: The findings emphasize the need for appropriate management strategies to combat microbial resistance and improve outcomes in VAP patients.

Preoperative localisation of parathyroid adenomas using ultrasound-guided methylene blue dye injection.

Purpose: Primary hyperparathyroidism is mainly caused by parathyroid adenomas. Preoperative imaging can be performed using different imaging modalities, e.g. ultrasound (US), radionuclide scanning, magnetic resonance imaging, and computed tomography, often used in combination. Currently, US-guided blue dyes, especially methylene blue (MB) injection, are used to identify parathyroid tumours. Material and methods: This was a retrospective study of 228 patients. Preoperative ultrasound, scintigraphy, and bio-chemistry were performed on all patients, and fine-needle aspiration procedures were performed on suspected patients. Using preoperative US-G injection with MB dye, target tumours were injected in all cases. Results: A total of 163 patients were female and 65 were male. The mean age was 42.5 years. US was positive in 203 (89%) cases, 25 (11%) were negative, and all had a positive sestamibi scan (100%). US-G needle injections with MB dye of target tumours were successful in all cases. The average diameter of the lesions was 18 mm. All had positive intraoperative identification of parathyroid adenoma and MB staining (100% accuracy, 100% sensitivity, and 100% specificity). Operating time (min ± SD) was 22.7 ± 11.5 minutes, and the success rate was 100%. All were parathyroid adenomas histologically. Intraoperative parathormone hormone decreased in all patients. In postoperative follow-up, all were normocalcaemic with no local or systemic complications. Conclusions: Localisation of small parathyroid adenomas by US-guided blue dye injection is a safe, simple, and useful tool when performing parathyroidectomy with no complications.

Mediation of Bacterial Interactions via a Novel Membrane-Based Segregator to Enhance Biological Nitrogen Removal.

The regulation of microbial subpopulations in wastewater treatment plants (WWTPs) with desired functions can guarantee nutrient removal. In nature, "good fences make good neighbors," which can be applied to engineering microbial consortia. Herein, a membrane-based segregator (MBSR) was proposed, where porous membranes not only promote the diffusion of metabolic products but also isolate incompatible microbes. The MBSR was integrated with an anoxic/aerobic membrane bioreactor (i.e., an experimental MBR). The long-term operation showed that the experimental MBR exhibited higher nitrogen removal (10.45 ± 2.73 mg/L total nitrogen) than the control MBR (21.68 ± 4.23 mg/L) in the effluent. The MBSR resulted in much lower oxygen reduction potential in the anoxic tank of the experimental MBR (-82.00 mV) compared to that of the control MBR (83.25 mV). The lower oxygen reduction potential can inevitably aid in the occurrence of denitrification. The 16S rRNA sequencing showed that the MBSR significantly enriched acidogenic consortia, which yielded considerable volatile fatty acids by fermenting the added carbon sources and allowed efficient transfer of these small molecules to the denitrifying community. Moreover, the sludge communities of the experimental MBR harbored a higher abundance of denitrifying bacteria than those of the control MBR. Metagenomic analysis further corroborated these sequencing results. The spatially structured microbial communities in the experimental MBR system demonstrate the practicability of the MBSR, achieving nitrogen removal efficiency superior to that of mixed populations. Our study provides an engineering method for modulating the assembly and metabolic division of labor of subpopulations in WWTPs. IMPORTANCE This study provides an innovative and applicable method for regulating subpopulations (activated sludge and acidogenic consortia), which contributes to the precise control of the metabolic division of labor in biological wastewater treatment processes.

Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country.

BACKGROUND: Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). METHODS: A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. RESULTS: Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43-30.39), 14.1 (5.67-35.10), 14.57 (5.83-33.78), and 4.57 (1.83-14.88), respectively]. CONCLUSION: Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates.

Computed tomography and magnetic resonance imaging of congenital thoracic systemic venous anomalies.

We present the imaging findings of thoracic systemic venous anomalies diagnosed by computed tomography and magnetic resonance imaging. Persistent left superior vena cava is the commonest anomaly of the thoracic systemic veins encountered either incidentally as an isolated finding or associated with congenital heart disease. Inferior vena cava (IVC) interruption with azygos continuation is the second most common anomaly, which may also be isolated or be associated with left isomerism syndrome. The article will also discuss other rarer systemic venous anomalies including retroaortic brachiocephalic vein and IVC drainage into the left atrium. Finally, the impact of pre-procedure reporting of thoracic systemic venous anomalies on the choice of intervention and patient outcome will be addressed.

Synergistic effects of paper mill sludge and sulfonated graphene catalyst for maximizing bio-hydrogen harvesting from sugarcane bagasse de-polymerization.

In this study, hydrogen harvesting from fermentation of sugarcane bagasse (SCB) was promoted by maintaining synergism between sulfonated graphene (SGR) catalyst and paper mill sludge (PMS). The sulfonic acid (-SO3H) groups in the catalyst played a major role in destructing the ß-1,4 glycosidic bonds of sugarcane bagasse, releasing readily biodegradable sugars into the fermentation medium. The cellulose, hemicellulose, and lignin conversion efficiency were improved by 127.5%, 495.0%, and 109.2%, respectively with 20 mgSGR/gVS catalyst addition, compared with the control samples. These values were also higher than those obtained by non-sulfonated graphene catalyst. The hydrogenation of sugarcane bagasse was maximized at a sulfonated graphene catalyst dosage of 60 mgSGR/gVS, providing the highest hydrogen harvesting of 4104 ± 321 mL. This was associated with an increase of the Proteobacteria phyla up to 52.0%, Firmicutes phyla to 13.9%, and Acinetobacter sp. to 39.8% compared with only 37.0%, 11.3% and 11.1% in the control assay respectively. Moreover, sulfonated graphene catalyst supplementation promoted the acetate fermentation reaction pathway by increasing the acetate/butyrate ratio up to 4.1. Nevertheless, elevating the catalyst dosage up to 120 mgSGR/gVS reduced the hydrogen harvesting (1190 ± 92 mL) due to the release of furfural (1.76 ± 0.02 g/L) in the fermentation cultures, deteriorating the microbes' internal composition and metabolism bioactivities. Finally maximizing the hydrogen productivity from sugarcane bagasse is feasible by incorporation of paper mill sludge and sulfonated graphene catalyst at dosage not exceeding 60 mgSGR/gVS. However, investigating the recyclability and disposal of digestate containing sulfonated graphene catalyst and the associated economic feasibility needs more attention in the future.

Treatment of hazardous landfill leachate containing 1,4 dioxane by biochar-based photocatalysts in a solar photo-oxidation reactor.

This study investigates a combined photocatalytic and adsorption system to maximize the removal of 1,4 dioxane from hazardous landfill leachate (HLL). The production of transformation products was also investigated to obtain a comprehensive evaluation of the treatment system. Copper/iron doped zinc oxide (Cu-Fe-ZnO) was introduced to biochar to form a hybrid materials and used to treat HLL contaminated with 1,4 dioxane of 355.0 ± 11.7 mg/L. The Cu-Fe-ZnO/biochar removed 93.1 ± 8.7% of 1,4 dioxane at a dose of 0.6 g/L within 90 min, as compared with only 42.7 ± 3.3% by 1.2 g/L of bare biochar within 210 min. The Cu-Fe-ZnO/biochar degraded 1,4 dioxane into ethylene glycol, glycolic acid, and formic acid. The 1,4 dioxane removal mechanisms were investigated using the density functional theory, demonstrating that doping of ZnO with metal atoms (Cu-Fe) narrowed the bandgap from 3.307 eV to 2.736 eV. The enhanced photocatalytic activity of ZnO was also supported by the role of biochar in increasing the reactive species and adsorbing the pollutant molecules. The high degradation efficiency of 1,4 dioxane using small catalyst doses with short reaction times would reduce the treatment cost and improve the system's applicability for treating HLL and industrial effluents.

Micro-CT analysis of marginal and internal fit of milled and pressed polyetheretherketone single crowns.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) has been increasingly used as a framework material in prosthetic dentistry. However, data on the marginal and internal fit of PEEK restorations fabricated by using either the computer-aided design and computer-aided manufacturing (CAD-CAM) or heat-pressing technique are sparse. PURPOSE: The aim of this in vitro study was to assess the marginal and internal fit of milled and pressed PEEK single crowns by using microcomputed tomography (µCT). MATERIAL AND METHODS: A custom-made, single stainless-steel die was designed to replicate a maxillary first premolar prepared for a ceramic crown. PEEK copings (N=30) were fabricated and allocated to 3 groups (n=10) according to the fabrication technique: milled from a prefabricated PEEK blank, heat pressed from PEEK pellets, and heat pressed from PEEK granules. All copings were veneered with a composite resin material. The marginal fit was recorded at 4 predetermined points and the internal fit at 8 predetermined points on each crown by using µCT. Two-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and simple main effect tests were used for statistical analysis of the data (α=.05). RESULTS: Concerning marginal fit, the milled crowns demonstrated the best marginal fit overall (44 ±3 µm), followed by those pressed from pellets (92 ±3 µm), and finally by those pressed from granules (137 ±7 µm) (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the marginal fit was not statistically significant (P=.142). The milled crowns demonstrated the lowest mean gap values overall, followed by those pressed from pellets and those pressed from granules (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the internal fit was statistically significant (P<.001). Except for the distal occlusal gap and mesial occlusal gap, all tested groups showed a statistically significant difference (P<.001). In addition, statistically significant differences were observed among all measurement points in different fabrication techniques (P<.001). CONCLUSIONS: The marginal and internal fit of milled PEEK crowns was significantly better than pressed crowns. However, both CAD-CAM and heat-pressing techniques produced PEEK crowns with a clinically acceptable marginal and internal fit. The mean marginal gap of the PEEK crowns pressed from granules was above the range of clinically acceptable value.

Effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia fixed partial dentures: An in vitro study.

STATEMENT OF PROBLEM: Strength-gradient zirconia combining 3 zirconia formulations with different flexural strengths has been reported to have outstanding mechanical properties. However, data concerning the effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia fixed partial dentures (FPDs) are sparse. PURPOSE: The purpose of this in vitro study was to test the effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia FPDs. MATERIAL AND METHODS: Two custom-made stainless-steel master dies were designed to replicate a mandibular right second premolar and second molar prepared to receive a 3-unit monolithic zirconia FPD. Thirty monolithic zirconia FPDs were milled from gradient zirconia blanks and allocated to 3 groups (n=10) according to the sintering protocols: high-speed sintering, speed sintering, and conventional sintering. The FPDs were cemented onto the corresponding dies with traditional glass ionomer cement. All FPDs were cyclic loaded (600 000 cycles/49 N/1.7 Hz) in a mastication simulator. Fracture load measurements for each FPD were determined by using a universal testing machine. Scanning electron microscopy (SEM) at ×80 magnification was used to examine a fractured FPD from each group. A representative specimen from each group was examined with SEM at ×30 000 magnification to determine the grain size. One-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and Pearson correlation tests were used for statistical analysis of the data (α=.05). RESULTS: The high-speed sintered FPDs recorded the highest statistically significant fracture load mean ±standard deviation value (2526 ±300 N), followed by the speed sintered FPDs (2136 ±127 N), while the lowest statistically significant fracture load mean value was recorded with the conventionally sintered FPDs (1361 ±181 N) (P<.001). In addition, the mean ±standard deviation grain size values were 488 ±272 nm for the high-speed sintered specimen, 578 ±409 nm for the speed sintered specimen, and 832 ±551 nm for the conventionally sintered specimen (P<.001). A significant negative correlation was found between fracture strength and grain size among the 3 groups. CONCLUSIONS: The fracture strength of 3-unit monolithic gradient zirconia FPDs sintered by using a high-speed protocol was significantly higher than that of speed and conventionally sintered FPDs (P<.001). The high-speed sintering protocol reduced the mean grain size of gradient zirconia FPDs compared with that of both speed and conventional sintering protocols.

Added value of 3D THRIVE (T1-weighted high-resolution isotropic volume examination) MRI pulse sequence in the detection of bony erosions of sacroiliac joints in patients of spondyloarthritis.

Purpose: Early depiction of bony erosions in sacroiliac (SI) joints increases the diagnostic accuracy of spondyloarthritis. The new 3D magnetic resonance imaging (MRI) sequence THRIVE (T1-weighted high-resolution isotropic volume examination) can depict cartilage erosions in sacroiliac joints. The aim of the study was to compare the diagnostic capacity of the new MRI sequence 3D THRIVE (T1-weighted high-resolution isotropic volume examination) with the routinely used T1 TSE pulse sequence in the depiction of structural erosions in sacroiliac joints by using MRI sequence zero echo time (zero ET) as a reference standard. Material and methods: Seventy five adult patients were included in this study. They underwent MRI sacroiliac joints examination using routine T1 TSE and STIR pulse sequences with the addition of the new 3D THRIVE and zero echo time (zero ET) sequences. Images of T1 TSE, 3D THRIVE, and zero ET sequences were evaluated by 2 radiolo-gists separately for the detection of sacroiliac joints erosions, then a comparison between T1 TSE and 3D THRIVE sequences was done using a CT-like image MRI sequence zero ET as a reference standard. Sensitivity, specificity, and accuracy for each sequence were calculated by the 2 readers. Results: Sensitivity, specificity, and accuracy of 3D THRIVE were higher than those of T1 TSE for reader 1 (sensitivity: 94.5% vs. 86.2%; specificity: 93.4% vs. 85.1%; and accuracy 95.2% vs. 88.5%) and for reader 2 (sensitivity: 93.3% vs. 79.9%; specificity: 94.7% vs. 86.2%; and accuracy 95.8% vs. 82.1%). Conclusions: Using CT-like image MRI sequence zero ET as the reference standard, 3D THRIVE pulse sequencing of the sacroiliac joints has much better diagnostic value in the depiction of bony erosions in patients suspected having spondyloarthritis as compared to the routinely used T1 TSE sequence.

Whole-body diffusion-weighted imaging with background body signal suppression and quantitative apparent diffusion coefficient in the detection, staging, and grading of non-Hodgkin lymphoma.

Purpose: Assess reproducibility of detection, staging, and grading of non-Hodgkin lymphoma (NHL) using whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS). Material and methods: Thirty NHL patients underwent WB-DWIBS, divided into 2 groups according to staging and grading. Image analysis and apparent diffusion coefficient (ADC) measurement of the largest lymph node in each group were performed by 2 observers. Inter-observer agreement was performed. Results: Overall inter-observer agreement for detection of NHL was excellent (k = 0.843; 92.05%) with excellent inter-observer agreement of nodal disease (cervical, thoracic and abdominal) (k = 0.783, 0.769, and 0.856; 96.67%, 90.0%, and 93.3% respectively), extra-nodal disease (k = 1; 100%), and splenic involvement (k = 0.67; 83.3%). The overall inter-observer agreement of DWIBS in staging of NHL was excellent (k = 0.90; 94.9%) with excellent inter-observer agreement for stage I (k = 0.93; 96.4%), stage II (k = 0.90; 94.8%), stage III (k = 0.89; 94.6%), and stage IV (k = 0.88; 94.0%). There was significant difference between ADC in stage I, II (0.77 ± 0.13, 0.85 ± 0.09 × 10-3 mm2/s), and stage III, IV (0.63 ± 0.08, 0.64 ± 0.11 × 10-3 mm2/s, p < 0.002, < 0.001). Interclass correlation showed almost perfect agreement for ADC measurement in staging and grading groups (r = 0.96 and r = 0.85, respectively, p < 0.001). There was significant difference between ADC in aggressive lymphoma (0.65 ± 0.1, 0.67 ± 0.13 × 10-3 mm2/s) and indolent lymphoma (0.76 ± 0.14, 0.84 ± 0.09 × 10-3 mm2/s, p < 0.028, < 0.001). Conclusion: DWIBS is reproducible for detection and staging of nodal and extra-nodal involvement in patients with NHL. ADC can quantitatively participate in the staging and grading of NHL.

A randomized controlled study of early versus standard cannulation of arteriovenous grafts in hemodialysis patients.

OBJECTIVE: Arteriovenous grafts (AVGs) are frequently needed in hemodialysis (HD) patients with unsuitable superficial veins. First cannulation of standard arteriovenous grafts (sAVGs) still require about 2 weeks after implantation. Early cannulation arteriovenous grafts (eAVGs) were suggested to overcome this shortcoming. The present randomized study proposed to compare the clinical outcomes of sAVGs and eAVGs in HD patients. METHODS: The present single-center randomized clinical study recruited 477 HD patients indicated for AVG creation. They included 236 in the sAVG group and 241 in the eAVG group. Eligible patients were simply randomized and allocated to the studied groups using 1:1 allocation ratio. Blinding was secured using the sealed envelope technique. Enrolled patients were followed up for 12 months. The primary outcome in the present study was primary, primary assisted, and secondary patency rates at 12 months. Other outcome parameters included time to first cannulation, graft complications, and mortality. RESULTS: Comparison between the studied groups regarding the primary outcomes revealed no statistically significant differences. Primary patency rate was 65.7% and 68.0% (P = .58) at 6 months and 53.8% and 56.4% (P = .57) at 12 months in the sAVG and eAVG groups, respectively. Primary assisted patency rate was 70.8% and 69.7% (P = .8) in patients with sAVG and eAVG, whereas the reported rates at 12 months were 59.3% and 61.0% (P = .71), respectively. Secondary patency rate was 78.4% and 73.9% (P = .25) at 6 months and 67.8% and 69.7% (P = .65) at 12 months in the sAVG and eAVG groups, respectively. As expected, patients in the eAVG group experienced significantly earlier cannulation when compared with patients in the sAVG group (median, 3.0 days; range, 1.0-9.0 days vs 19.0 days; range, 15.0-22.0 days; P < .001). CONCLUSIONS: Patients in the eAVG group have comparable outcomes to those in the sAVG group at 12 months with the added advantage of earlier time to first cannulation.

Tadalafil monotherapy in management of chronic prostatitis/chronic pelvic pain syndrome: a randomized double-blind placebo controlled clinical trial.

PURPOSE: In this placebo-controlled trial, we aimed to evaluate the clinical results of using PDE-5 inhibitor, tadalafil 5 mg OD, for management of CP/CPPS. PATIENTS AND METHODS: 140 patients ≤ 45 years old with moderate/severe CP/CPPS associated with ED (IIEF-5 < 22) were randomly divided and received either tadalafil 5 mg OD (tadalafil-group) or placebo (control-group) for 6 weeks. Post-treatment CPSI scores were compared to baseline and to placebo. Clinically significant responders (≥ 25% reduction from baseline score) were calculated. Tadalafil-induced changes in IIE-5 were evaluated in correlation to that of CPSI scores. RESULTS: By the 6th week, 59 and 56 patients were available in both groups respectively. Compared to baseline, tadalafil-group patients showed significant improvement in total, pain, urinary and Qol domains of CPSI (19.1 ± 5.26, 10.42 ± 3.55, 4.2 ± 1.72 and 4.47 ± 1.64 vs. 24.21 ± 5.05, 12.14 ± 3.57, 6.08 ± 1.53 and 6.22 ± 1.76), p < 0.5. When compared to placebo, all 6th week CPSI domains scores, except for pain, were significantly better in tadalafil-group (p < 0.05). Post-treatment pain score didn't significantly differ between both groups (10.42 ± 3.55, vs. 11.71 ± 3.9, p > 0.05). Clinically significant responders were 30 patients (50.8%) in tadalafil-group vs. 3 patients (5.4%) in control. Tadalafil-induced changes in IIEF-5 score had weak but significant correlation to Qol domain (r = - 0.28, p < 0.05). CONCLUSION: Tadalafil 5 mg OD can significantly improve all CPSI domains as compared to baseline. Post-treatment CPSI scores, except for pain, were better than placebo. About 50.8% of patients can develop ≥ 25% reduction in their total CPSI scores after treatment. Apart from Qol domain, these changes are not significantly correlated to tadalafil-induced IIEF-5 scores changes.

A new cutting-edge review on the bioremediation of anaerobic digestate for environmental applications and cleaner bioenergy.

Circular agriculture and economy systems have recently emerged around the world. It is a long-term environmental strategy that promotes economic growth and food security while reducing negative environmental consequences. Anaerobic digestion (AD) process has a high contribution and effective biodegradation route for bio-wastes valorization and reducing greenhouse gases (GHGs) emissions. However, the remaining massive digestate by-product contains non-fermented organic fractions, macro and/or micro-nutrients, heavy metals, and metalloids. Direct application of digestate in agriculture negatively affected the properties of the soil due to the high load of nutrients as well as the residuals of GHGs are emitted to the environment. Recycling and valorizing of anaerobic digestate is the main challenge for the sustainable biogas industry and nutrients recovery. To date, there is no global standard process for the safe digestate handling. This review described the biochemical composition and separation processes of anaerobic digestate. Further, advanced physical, chemical, and biological remediation's of the diverse digestate are comprehensively discussed. Moreover, recycling technologies such as phyco-remediation, bio-floc, and entomoremediation were reviewed as promising solutions to enhance energy and nutrient recovery, making the AD technology more sustainable with additional profits. Finally, this review gives an in-depth discussion of current biorefinery technologies, key roles of process parameters, and identifies challenges of nutrient recovery from digestate and prospects for future studies at large scale.

Unraveling the metabolic shift in anaerobic digestion pathways associated with the alteration of onion skin waste concentration.

Onion skin waste (OSW) is common waste in developing countries, which can cause severe environmental pollution when not properly treated. Value-added products can be chemically extracted from OSW; however, that process is not economically feasible. Alternatively, dry anaerobic digestion (DAD) of OSW is a promising approach for both energy recovery and environment protection. The main hurdles during DAD of OSW can be the hydrolysis and acidification. In batch tests, sludge digestate (SD) rich with methanogens was co-digested with different fractions of OSW for enhancing hydrolysis and raising biogas productivity. The cumulative biogas production (CBP) was 36.6 ± 0.3 mL for sole DAD of SD (100% SD) and increased up to 281.9 ± 14.1 mL for (50% SD: 50% OSW) batch. Self-delignification of OSW took place by SD addition, where the lignin removal reached 75.3 ± 10.5% for (85% SD: 15% OSW) batch. Increasing the fraction of OSW (45% SD: 55% OSW) reduced the delignification by a value of 68.8%, where initial lignin concentration was 9.48 ± 1.6% in dry weight. Lignin breaking down resulted a high fraction of phenolic compounds (345.6 ± 58.8 mg gallic acid equivalent/g dry weight) in the fermentation medium, causing CBP drop (219.0 ± 28.5 mL). The presence of elements (K, Ca, Mg, Fe, Zn, Mn, S and P) in OSW improved the enzymatic activity, facilitated phenolic compounds degradation, shifted the metabolism towards acetate fermentation pathway, and raised biogas productivity. Acidogenesis was less affected by phenolic compounds than methanogenesis, causing higher H2 contents and lower CH4 contents, at batches with high share of OSW.

Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema.

BACKGROUND: The goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation. METHODS: Retrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 µm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months). RESULTS: After 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030). CONCLUSIONS: Combined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.