Computer-Aided Diagnosis System for Blood Diseases Using EfficientNet-B3 Based on a Dynamic Learning Algorithm.

The immune system's overproduction of white blood cells (WBCs) results in the most common blood cancer, leukemia. It accounts for about 25% of childhood cancers and is one of the primary causes of death worldwide. The most well-known type of leukemia found in the human bone marrow is acute lymphoblastic leukemia (ALL). It is a disease that affects the bone marrow and kills white blood cells. Better treatment and a higher likelihood of survival can be helped by early and precise cancer detection. As a result, doctors can use computer-aided diagnostic (CAD) models to detect early leukemia effectively. In this research, we proposed a classification model based on the EfficientNet-B3 convolutional neural network (CNN) model to distinguish ALL as an automated model that automatically changes the learning rate (LR). We set up a custom LR that compared the loss value and training accuracy at the beginning of each epoch. We evaluated the proposed model on the C-NMC_Leukemia dataset. The dataset was pre-processed with normalization and balancing. The proposed model was evaluated and compared with recent classifiers. The proposed model's average precision, recall, specificity, accuracy, and Disc similarity coefficient (DSC) were 98.29%, 97.83%, 97.82%, 98.31%, and 98.05%, respectively. Moreover, the proposed model was used to examine microscopic images of the blood to identify the malaria parasite. Our proposed model's average precision, recall, specificity, accuracy, and DSC were 97.69%, 97.68%, 97.67%, 97.68%, and 97.68%, respectively. Therefore, the evaluation of the proposed model showed that it is an unrivaled perceptive outcome with tuning as opposed to other ongoing existing models.

Zinc-α2-Glycoprotein (ZAG): A New Deficiency in Vitiligo Patients.

Zinc-α2-glycoprotein (ZAG), a recently identified adipokine, is a multidisciplinary protein, which is secreted in various body fluids. The ZAG plays roles in lipolysis, regulation of metabolism, cell proliferation and differentiation, regulation of melanin synthesis, cell adhesion, and immunoregulation. The aim of this study is to estimate serum and tissue levels of ZAG in patients with vitiligo. The study included 30 vitiligo patients and 30 healthy controls. Lesional skin biopsy was performed, and blood sample was retrieved to determine the level of ZAG in blood using ELISA kit. In this study, the mean level of ZAG was found to be significantly lower in the vitiligo patients' tissue in comparison with the healthy control subjects' tissue ( p=0.001); the level of ZAG was also lower in vitiligo patients' serum in comparison with the healthy control subjects' serum ( p=0.001). A highly significant correlation was observed between the duration of the disease and the level of ZAG in the tissue of patients (r =0.9; p=0.001). Also a highly significant positive correlation was observed between the age of patients and the level of ZAG in the tissue (r =0.5; p=0.006). Diminishing of ZAG in serum and tissue of vitiligo patients is another important player sharing in the complex pathogenesis of vitiligo.

Nebivolol enhances the effect of alendronate against methylprednisolone-induced osteoporosis in rats.

This study aimed to assess the possible modulatory effect of nebivolol against methylprednisolone-induced osteoporosis in rats. Weekly administration of methylprednisolone (7 mg/kg), for six consecutive weeks caused significant increases in serum calcium, bone malondialdehyde, and hydroxyproline as well as serum alkaline phosphatase, but it significantly decreased serum phosphorous and osteocalcin, bone reduced glutathione, and nitric oxide (NO) as well as bone antioxidant enzymes activities compared with the control group. The results were confirmed by histopathological findings of femur bone. On the other hand, administration of alendronate (1 mg/kg) with nebivolol (1.5 mg/kg) orally and daily for seven consecutive days after methylprednisolone treatment caused marked mitigation in the above-mentioned parameters compared with methylprednisolone group. In conclusion, nebivolol proved to enhance the effect of alendronate in modulating methylprednisolone osteoporotic effect, which might be attributed to its release of NO together with its profound reducing capability in the oxidative cascade of bone tissue.

Effects of transcutaneous electrical stimulation of lower limb muscles on experimental fatty liver.

BACKGROUND AND AIMS: Although the beneficial effects of exercise on fatty liver have been described, a previous study conducted at our department showed that transcutaneous electrical muscle stimulation (TEMS) of lower abdominal muscles aggravated fatty liver. The present study aims to evaluate the ability of TEMS of the lower limb muscles to improve fatty liver infiltration. MATERIAL AND METHODS: Thirty male Wistar rats were randomly allocated into three groups: control; fructose-fed (F), fed fructose-enriched diet for 6weeks; and fructose-fed with transcutaneous electrical muscle stimulation (F+TEMS), fed fructose-enriched diet for 6weeks and lower limb muscles subjected to TEMS during the last 3weeks of feeding, five sessions/week. Body weight, length, body mass index (BMI), and abdominal and lower limb circumferences were all recorded. Fasting blood glucose, serum insulin, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, serum albumin, high density lipoprotein cholesterol (HDL-C), triglyceride (TG), and total cholesterol (TC) levels were measured. LDL cholesterol (LDL-C) and the atherogenic index (AI) were calculated. Absolute and relative hepatic weights as well as histological examination of the liver were assessed. RESULTS: Final body weight, abdominal and lower limb circumferences, absolute liver weight, homoeostasis model assessment (HOMA) score, and TG, LDL-C, AI, serum ALT, and AST levels were all significantly reduced in the (F+TEMS) group compared to the (F) group. There was a significant increase in GPx and HDL-C levels, HDL/LDL ratio, and total protein and serum albumin content in (F+TEMS) rats compared to (F) rats. Histologically, hepatic tissue from (F+TEMS) rats had minimal steatotic changes that were restricted to zone 1 and less marked inflammatory cell infiltration compared to (F) rats. CONCLUSION: TEMS was able to reverse steatosis, hyperglycaemia, insulin resistance, dyslipidaemia, and fatty liver caused by fructose feeding. The study confirmed that the variation in the anatomical site of skeletal muscle contraction affects fatty liver in different ways.

Effects of intrapartum epidural analgesia at high altitudes: maternal, fetal, and neonatal outcomes. A randomized controlled trial of two formulations of analgesics.

OBJECTIVES: To investigate whether intrapartum epidural analgesics (bupivacaine or ropivacaine) have an influence (safety and efficacy) on mothers, fetuses, or newborns at high altitudes (2,200 m above the sea level). DESIGN: Prospective randomized trial. SETTING: A tertiary referral hospital in Aseer region, Saudi Arabia. POPULATION: Eighty parturient women with normal full term pregnancy (37-40 weeks) were randomly allocated to a group receiving epidural bupivacaine 0.125% and the other receiving ropivacaine 0.2%, with fentanyl 100 microg given to both groups. METHODS: Intra- and postpartum clinical management of the pregnant women and newborns and fetal Doppler assessments were performed. MAIN OUTCOME MEASURES: Severity of pain, onset and duration of analgesia, and occurrence of motor blockade were primary outcomes. Progress of labor, need for oxytocin augmentation, mode of delivery, and neonatal condition were secondary outcomes. RESULTS: Demographic, labor characteristics, and neonatal outcomes of the two groups were comparable. The onset of analgesia was relatively more rapid for ropivacaine group (p = 0.067). Duration of analgesia after the first bolus dose was longer and the need for supplemental epidural analgesic doses was lesser in the bupivacaine group (p = 0.041 and 0.045, respectively). In both groups, the fetal umbilical and middle cerebral artery pulsatility indices showed significant change when compared to the baseline of the same group. CONCLUSION: At high altitudes, no major advantage was found for epidural ropivacaine over bupivacaine in addition to fentanyl for labor analgesia and no harmful effects of the medications were found on mothers, fetuses, or newborns.

Obstructed versus dilated nonobstructed kidneys in children with congenital ureteropelvic junction narrowing: role of urinary tubular enzymes.

PURPOSE: We evaluated the role of voided urine lysosomal enzyme N-acetyl-beta-D-glucosaminidase and brush border enzymes alkaline phosphatase and gamma-glutamyl transferase in differentiating between children with ureteropelvic junction obstruction in need of pyeloplasty and those with dilated nonobstructed kidneys suitable for conservative treatment. MATERIALS AND METHODS: The study included 35 children with unilateral ureteropelvic junction obstruction treated with pyeloplasty (study group) and 15 children with dilated nonobstructed kidneys who were treated conservatively and followed for 15 months (control group). Voided urine samples were obtained before treatment from both groups, and from the study group at 1, 2, 3, 6, 9 and 12 months postoperatively and the control group at 3, 9 and 15 months of followup. N-acetyl-beta-D-glucosaminidase, alkaline phosphatase and gamma-glutamyl transferase were measured in urine samples collected from both groups. RESULTS: In the study group the activities of preoperative urinary N-acetyl-beta-D-glucosaminidase, alkaline phosphatase and gamma-glutamyl transferase were significantly higher than in the control group. A cutoff value of 7.8 mU/mg creatinine N-acetyl-beta-D-glucosaminidase yielded a sensitivity of 97.1%, a specificity of 80% and an overall accuracy of 92%. A cutoff value of 34.5 IU/gm creatinine alkaline phosphatase resulted in a sensitivity of 91.4%, a specificity of 100% and an overall accuracy of 94%. A cutoff value of 54 IU/gm creatinine gamma-glutamyl transferase yielded a sensitivity of 62.9%, a specificity of 100% and an overall accuracy of 74%. The combination of urinary N-acetyl-beta-D-glucosaminidase and alkaline phosphatase resulted in a sensitivity of 100%, a specificity of 80% and an overall accuracy of 94%. Compared to preoperative activities, N-acetyl-beta-D-glucosaminidase, alkaline phosphatase and gamma-glutamyl transferase decreased significantly at 12 months after pyeloplasty in the study group. CONCLUSIONS: Voided urinary N-acetyl-beta-D-glucosaminidase, alkaline phosphatase and gamma-glutamyl transferase are accurate markers for differentiating between children with ureteropelvic junction obstruction requiring pyeloplasty and those with dilated nonobstructed kidneys suitable for conservative treatment. Measurement of these enzymes in voided urine could be used as a noninvasive tool for long-term followup of children with ureteropelvic junction obstruction after pyeloplasty and those receiving conservative treatment.

Diagnosis of ureteropelvic junction obstruction in children: role of endothelin-1 in voided urine.

OBJECTIVES: To examine the role of voided urine endothelin-1 (ET-1) in the diagnosis and follow-up of children with ureteropelvic junction obstruction. METHODS: The study included 35 children with unilateral ureteropelvic junction obstruction who underwent pyeloplasty and 30 control children, including 10 healthy children, 10 with vesicoureteral reflux, and 10 with renal stones. Voided urine samples were obtained from the children in the study group before surgery and from the renal pelvis by needle aspiration during pyeloplasty. Bladder urine samples were also collected from the study group 1, 2, 3, 6, 9, and 12 months postoperatively. Bladder urine samples were also collected from all 30 control children. ET-1 was measured in the urine samples collected from the study and control groups. RESULTS: The preoperative ET-1 level in the voided urine of the study group was significantly greater than its level in each of the three control groups. For the whole study group, a cutoff value of 3 fmol/mg creatinine gave a sensitivity of 74.3%, a specificity of 90%, and an overall accuracy of 81.5%. In 8 children (1 year old or younger), a cutoff value of 4 fmol/mg creatinine gave a sensitivity and specificity of 100%. Compared with the preoperative value, ET-1 had decreased significantly at 12 months after pyeloplasty. CONCLUSIONS: The ET-1 level in voided urine is a useful marker that could be used as a noninvasive tool for the diagnosis and long-term follow-up of children with ureteropelvic junction obstruction.

Pelvi-ureteric junction obstruction in children: the role of urinary transforming growth factor-beta and epidermal growth factor.

OBJECTIVES: To investigate the role of transforming growth factor beta(1) (TGF-beta(1)) and epidermal growth factor (EGF) in voided urine for the diagnosis and follow-up of children with pelvi-ureteric junction obstruction (PUJO). PATIENTS, SUBJECTS AND METHODS: The study included 35 children with unilateral PUJO who had a pyeloplasty, and 30 healthy control children. Urine samples were obtained from the bladders of patients before surgery, and as voided samples at 1, 2, 3, 6, 9 and 12 months after surgery. Bladder urine samples were also collected from all 30 children in the control group. TGF-beta(1) and EGF were then measured in all the urine samples. RESULTS: The level of bladder TGF-beta(1) before surgery in the patients was significantly higher than that in the healthy control group. A threshold of 190 pg/mg creatinine gave a sensitivity of 100%, a specificity of 80%, a positive predictive value of 85.4%, negative predictive value of 100% and an overall accuracy of 90.8%. Compared with the value before surgery, urinary TGF-beta(1) was significantly lower at 1 year after pyeloplasty. There was no significant difference between the level of EGF before surgery in the patients and that in the control group, and no significant difference in the level of EGF before and after surgery over the follow-up. CONCLUSION: We do not recommend using EGF levels in voided urine in the routine diagnosis of children with hydronephrosis. The urinary level of TGF-beta(1) is a useful noninvasive tool for the long-term follow-up of children with PUJO treated by pyeloplasty. Further studies with various controls are required to confirm the diagnostic accuracy of TGF-beta(1) in children with PUJO.