Native Arteriovenous Fistula Creation in Patients With Continuous Flow Left Ventricular Assist Devices: A Case Report and a Narrative Review.

Worsening of kidney function after left ventricular assist device (LVAD) implantation is common, and many patients reaching end-stage kidney disease require long-term dialysis. Permanent vascular access in a patient with LVAD remains a clinical dilemma. There is a theoretical concern about the maturation of the arteriovenous fistula in a patient with LVAD due to the absence of a pulsatile flow in these patients. We described a case of successful creation of a left brachial-cephalic AVF in a patient with continuous flow LVAD (Abbott's HeartMate 3TM), which was used for dialysis without issue.

Absence of Zika virus among pregnant women in Vietnam in 2008.

BACKGROUND: Despite being first identified in 1947, Zika virus-related outbreaks were first described starting from 2007 culminating with the 2015 Latin American outbreak. Hypotheses indicate that the virus has been circulating in Asia for decades, but reports are scarce. METHODS: We performed serological analysis and screened placental samples isolated in 2008 for the presence of Zika virus from pregnant women in Ho Chi Minh City (Vietnam). RESULTS: None of the placental samples was positive for Zika virus. Four serum samples out of 176 (2.3%) specifically inhibited Zika virus, with variable degrees of cross-reactivity with other flaviviruses. While one of the four samples inhibited only Zika virus, cross-reactivity with other flaviviruses not included in the study could not be ruled out. CONCLUSION: Our results support the conclusion that the virus was not present among pregnant women in the Vietnamese largest city during the initial phases of the epidemic wave.

Chronic total occlusion percutaneous coronary intervention (CTO PCI) in an intractable heart failure patient: Is there any benefit?

One of the most difficult procedures in interventional cardiology is the percutaneous coronary intervention (PCI) on a chronic total occlusion (CTO) lesion case. To rate the difficulty of guidewire crossing, several angiographic scoring methods have been developed such as the Japan CTO (J-CTO) score. Here we demonstrate the advantages of revascularization using PCI procedure in a CTO case with intractable heart failure. A 53-year-old man presented to the emergency room of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia with acute decompensated heart failure. The patient had a history of past PCI with two patent drug eluting stents (DES): one in the left main (LM)-left anterior descending (LAD) artery and one in the distal left circumflex (LCX) artery. The patient had three times rehospitalizations in the last three months. According to single-photon emission computed tomography (SPECT) imaging, the right coronary artery was remained functional; however, the lesion was categorized into very difficult level (J-CTO >3). The PCI was carried out on the right coronary artery and the blood vessel was successfully revascularized after applying multiple techniques. Following the procedure, the heart failure was treated and the 6-minute walking test (6MWT) that performed 12 days after the PCI increased from 220 to 260 meters. The success of this case depended on a comprehensive history taking, adequate imaging methods, and the selection of the proper tools and PCI strategy. In conclusion, despite the challenges, PCI is still an option for patients with persistent complete occlusion. The PCI requires comprehensive preparation and the use of angiographic scoring systems, such as the J-CTO score, to determine the approach and the likelihood of success.

COMPLICATIONS OF NEPHROTIC SYNDROME IN CHILDREN.

OBJECTIVE: The aim: Study was conducted to determine NS-related complications and drug-related complications. PATIENTS AND METHODS: Materials and methods: A descriptive analytics cross section (case series study) was carried out in 109 children with NS diagnosed and followed up in the nephrology con¬sultation clinic at Child Welfare Teaching Hospital in Baghdad Medical City. RESULTS: Results: Most children have primary NS 88% and 12% Secondary NS. Nephrotic syndrome related complication: higher rate of infections and hypertension complications 76% and 48.6% respectively recorded in children with NS. 60.3% of infections in children with Frequent relapses and 25% in SSNS with statistically significant (p value0.018). Children with NS; have higher rate of UTI and Pneumonia.64% of Hypertension recorded in children with frequent relapses while 13.2% identified in children with secondary NS, with statistically non-significant (p value 0.063) 24% and 9% of patients have AKI &CKD respectively. Drug related complication: Children used steroid; have 34.5% Cushing face,30%gastritis,6.5% cataract,19.7% obesity and22.4% short stature. Children used cyclosporine; have33% hirsutism,9.5% nephrotoxicity and4.7% gingival hyperplasia, 27% vomiting, 22% alopecia and 11%Bone marrow suppression side effect with Cyclophosphamide. Patient used mycophenolate drugs, have 15.5% GIT problem and 7.7% BM suppression. CONCLUSION: Conclusions: NS is a chronic disease with a lot of complications like infections, AKI &CKD and hypertension complications. UTI and pneumonia are most common infection encountered in our patients. Many of the complications of children with NS can be attributed to immunosuppressant therapy.

A deep learning framework for automated classification of histopathological kidney whole-slide images.

Background: Renal cell carcinoma is the most common type of malignant kidney tumor and is responsible for 14,830 deaths per year in the United States. Among the four most common subtypes of renal cell carcinoma, clear cell renal cell carcinoma has the worst prognosis and clear cell papillary renal cell carcinoma appears to have no malignant potential. Distinction between these two subtypes can be difficult due to morphologic overlap on examination of histopathological preparation stained with hematoxylin and eosin. Ancillary techniques, such as immunohistochemistry, can be helpful, but they are not universally available. We propose and evaluate a new deep learning framework for tumor classification tasks to distinguish clear cell renal cell carcinoma from papillary renal cell carcinoma. Methods: Our deep learning framework is composed of three convolutional neural networks. We divided whole-slide kidney images into patches with three different sizes where each network processes a specific patch size. Our framework provides patchwise and pixelwise classification. The histopathological kidney data is composed of 64 image slides that belong to 4 categories: fat, parenchyma, clear cell renal cell carcinoma, and clear cell papillary renal cell carcinoma. The final output of our framework is an image map where each pixel is classified into one class. To maintain consistency, we processed the map with Gauss-Markov random field smoothing. Results: Our framework succeeded in classifying the four classes and showed superior performance compared to well-established state-of-the-art methods (pixel accuracy: 0.89 ResNet18, 0.92 proposed). Conclusions: Deep learning techniques have a significant potential for cancer diagnosis.

Cardiac Tamponade, Sever Hypothyroidism and Acute Respiratory Distress Syndrome (ARDS) with COVID-19 Infection.

A 21-years-old with Down syndrome presented with respiratory distress. Initial investigations revealed a cardiac tamponade. On further evaluation, he had positive coronavirus disease-2019 (COVID-19), severe chest infection and severe hypothyroidism. He responded well to urgent pericardiocentesis, levothyroxine, hydrocortisone and tocilizumab.

Non-sterile corn steep liquor a novel, cost effective and powerful culture media for Sporosarcina pasteurii cultivation for sand improvement.

AIMS: Microbial induced calcium carbonate precipitation (MICP) is one of the bio-cementation methods for improving granular soils. This study evaluate the feasibility of obtaining a bacterial solution with high optical density and urease activity by an inexpensive corn steep liquor (CSL) medium in non-sterile conditions in order to achieve sand improvement. METHODS AND RESULTS: Corn steep liquor media with different concentrations (different dilution rates) were prepared and, without any autoclaving (non-sterile conditions), different percentage of the inoculum solutions were added to them and incubated. Effect of inoculum solution percentage and CSL dilution rates on specifications of bacterial solution was evaluated. Urease activity and scanning electron microscope (SEM) and X-Ray Diffraction (XRD) were used to efficiency of CLS media in sand improvement. The considerable urease activity was measured as 5·7 mS cm-1  min-1 using nonsterile CLS. By using CYNU (CSL-Yeast extract-NH4Cl-Urea) bacterial solution, the urease activity of 5·5 mS cm-1  min-1 for the OD600 (optical density at 600 nm) of 1·88 and, consequently, specific urease activity of 2·93 mS cm-1  min-1  OD600 -1 was obtained. The highest unconfined compressive strength (811 kPa) was obtained for the CYNU. XRD revealed new calcite peaks next to the quartz peaks. CONCLUSIONS: Production of inexpensive bacterial solution using diluted CSL as the inexpensive, effective and powerful culture media for Sporosarcina pasteurii cultivation in nonsterile conditions, allows geotechnical and biotechnological engineers to use MICP technology more widely in land improvement and field-scale bio-cementation and bioremediation projects. SIGNIFICANCE AND IMPACT OF THE STUDY: Obtaining high urease activity of inexpensive microbial solution using diluted CSL as the culture medium in nonsterile conditions, as the unique results of this study, can be significant in the field of bioremediation studies using MICP.

Nonbacterial thrombotic endocarditis as an initial presentation of advanced cholangiocarcinoma in a young patient: A case report.

Nonbacterial thrombotic endocarditis, a form of noninfectious thrombotic endocarditis, is mainly characterized by deposition of sterile platelet thrombi on heart valves. Usually, it is observed in advanced malignancy. Herein, we report a case of a previously healthy male with recent unprovoked deep vein thrombosis presented with acute ischemic stroke. The echocardiogram revealed aortic and mitral valve masses. Eventually, he was discovered to have advanced cholangiocarcinoma. The present case, apart from being the youngest reported case, is among the few reported cases which manifest the association between cholangiocarcinoma and nonbacterial thrombotic endocarditis.

Ultimate Eradication of the Ciprofloxacin Antibiotic from the Ecosystem by Nanohybrid GO/O-CNTs.

Eradication of pharmaceutical drugs from the global ecosystem has received remarkable attention due to the extensive horrible consequences on the human immunological system and the high rate of human deaths. The urgent need for drug eradication became the dominant priority for many research institutions worldwide due to the sharp increase of antimicrobial resistance (AMR) in the human body, which inhibits drug effectiveness and leads ultimately to death. Nanohybrid GO/O-CNTs was fabricated from graphene oxide (GO) cross-linked via calcium ions (Ca2+) with oxidized carbon nanotubes (O-CNTs) to eradicate the well-known ciprofloxacin antibiotic drug from aqueous solutions. The ciprofloxacin drug is medically prescribed in millions of medical prescriptions every year and typically exists in domestic and wastewaters. Characterization of the nanohybrid GO/O-CNTs was carried out through spectroscopic (Fourier Transform Infrared (FTIR) and X-ray diffraction (XRD)), thermal (Thermogravimetric analysis (TGA) and derivative thermogravimetry (DTG)), and microscopic (scanning electron microscopy (SEM)) techniques. Optimum parameters for the drug eradication process from aqueous solutions were verified and selected as follows: contact time = 4 h, pH = 6.0, temperature = 290 K, %CaCl2 = 0.5%, GO/O-CNT ratio = 4:1, and adsorbent mass = 1.0 mg. The equilibrium data were fitted to different adsorption isotherms, and the Langmuir isotherm provided the best fit to our data. Dynamic studies demonstrated a pseudo-second-order removal process for the ciprofloxacin drug, and thermodynamic parameters confirmed exothermic drug adsorption (-27.07 kJ/mol) as well as a physisorption process. For the sake of fighting against the generated AMR, our working strategy demonstrated a removal efficiency of 99.2% of the ciprofloxacin drug and drug uptake as high as 512 mg/g.

Use of nanohybrid nanomaterials in water treatment: highly efficient removal of ranitidine.

Entire elimination of pharmaceutical drugs from waste- and domestic-waters has attracted great attention due to their potent adverse effects on human health, particularly the human immune system. Many risks have been related to the presence of different types of drugs at different concentrations in wastewater. These risks include antimicrobial resistance (AMR), endocrine action, hormonal activation of cancers, and photodegradation of drugs. In this study, new nanohybrid materials consisting of graphene oxide (GO) and oxidized carbon nanotubes (OCNTs) were developed to remove a well-known drug, namely, ranitidine that treats stomach ulcers and gastrointestinal (GI) reflux disease from aqueous solutions. The characterization of synthesized nanohybrid GO-OCNTs was performed using spectroscopic (FTIR, and XRD), thermogravimetric (TGA) and microscopic (SEM) techniques. Batch adsorption experiments were used to investigate the technical feasibility of using synthesized GO-OCNTs for the removal of ranitidine from aqueous solutions. The effects of different operating conditions such as contact time, nanohybrid mass, solution temperature, solution pH, % crosslinking agent, and GO-to-OCNT ratio on the entire elimination of ranitidine were investigated. The experimental results indicated that the removal of ranitidine was very efficient, where 98.3% removal of the drug from aqueous solutions was achieved with a drug uptake of 97.8 mg g-1. Moreover, the results indicated the optimum conditions for the removal of ranitidine, which are as follows: contact time = 140 minutes, nanohybrid GO-OCNT mass = 10 mg, solution temperature = 290 K, solution pH = 6.4, % crosslinking agent = 0.5%, and GO to O-CNT ratio = 1 : 4. The equilibrium data were fitted to different adsorption isotherms and Langmuir was found to best describe our data. Dynamic studies demonstrated that ranitidine adsorption followed pseudo-second order, and the thermodynamic parameters confirmed exothermic drug adsorption as well as the physisorption process.

Variation in Lipid Components from 15 Species of Tropical and Temperate Seaweeds.

The present study describes the variation in lipid components from 15 species of seaweeds belonging to the Chlorophyta, Ochrophyta, and Rhodophyta phyla collected in tropical (Indonesia) and temperate (Japan) areas. Analyses were performed of multiple components, including chlorophylls, carotenoids, n-3 and n-6 polyunsaturated fatty acids (PUFAs), and alpha tocopherol (α-Toc). Chlorophyll (Chl) and carotenoid contents varied among phyla, but not with the sampling location. Chl a and b were the major chlorophylls in Chlorophyta. Chl a and Chl c were the main chlorophylls in Ochrophyta, while Chl a was the dominant chlorophylls in Rhodophyta. ß-Carotene and fucoxanthin were detected as major seaweed carotenoids. The former was present in all species in a variety of ranges, while the latter was mainly found in Ochrophyta and in small quantities in Rhodophyta, but not in Chlorophyta. The total lipids (TL) content and fatty acids composition were strongly affected by sampling location. The TL and n-3 PUFAs levels tended to be higher in temperate seaweeds compared with those in tropical seaweeds. The major n-3 PUFAs in different phyla, namely, eicosapentaenoic acid (EPA) and stearidonic acid (SDA) in Ochrophyta, α-linolenic acid (ALA) and SDA in Chlorophyta, and EPA in Rhodophyta, accumulated in temperate seaweeds. Chlorophylls, their derivatives, and carotenoids are known to have health benefits, such as antioxidant activities, while n-3 PUFAs are known to be essential nutrients that positively influence human nutrition and health. Therefore, seaweed lipids could be used as a source of ingredients with health benefits for functional foods and nutraceuticals.

Seismic imaging and petrology explain highly explosive eruptions of Merapi Volcano, Indonesia.

Our seismic tomographic images characterize, for the first time, spatial and volumetric details of the subvertical magma plumbing system of Merapi Volcano. We present P- and S-wave arrival time data, which were collected in a dense seismic network, known as DOMERAPI, installed around the volcano for 18 months. The P- and S-wave arrival time data with similar path coverage reveal a high Vp/Vs structure extending from a depth of ≥20 km below mean sea level (MSL) up to the summit of the volcano. Combined with results of petrological studies, our seismic tomography data allow us to propose: (1) the existence of a shallow zone of intense fluid percolation, directly below the summit of the volcano; (2) a main, pre-eruptive magma reservoir at ≥ 10 to 20 km below MSL that is orders of magnitude larger than erupted magma volumes; (3) a deep magma reservoir at MOHO depth which supplies the main reservoir; and (4) an extensive, subvertical fluid-magma-transfer zone from the mantle to the surface. Such high-resolution spatial constraints on the volcano plumbing system as shown are an important advance in our ability to forecast and to mitigate the hazard potential of Merapi's future eruptions.

Induced interval-valued Pythagorean trapezoidal fuzzy aggregation operators based on Einstein operations and their application in group decision making.

The aim of this paper is to investigate the information aggregation methods under induced interval-valued Pythagorean trapezoidal fuzzy environment. Some Einstein operational laws on Pythagorean trapezoidal fuzzy numbers are defined based on Einstein sum and Einstein product. In this paper, we introduce the idea of induced interval-valued Pythagorean trapezoidal fuzzy Einstein ordered weighted geometric (I-IVPTFEOWG) operator and induced interval-valued Pythagorean trapezoidal fuzzy Einstein hybrid geometric (I-IVPTFEHG) operator. We discuss some basic properties of the proposed operator, including idempotency, commutativity and monotonicity. We construct an algorithm for multiple attribute group decision making problem, and apply the proposed aggregation operator to deal with multiple attribute group decision making. Finally we construct a numerical example for multiple attribute group decision making and compare the result with existing methods.

Effect of γ radiation processing on fungal growth and quality characteristcs of millet grains.

The aim of this study was to evaluate the effect of gamma radiation processing of millet grains on fungal incidence, germination, free fatty acids content, protein solubility, digestible protein, and antinutritional factors (tannin and phytic acid). The grains were exposed to gamma radiation at doses 0.25, 0.5, 0.75, 1.0, and 2.0 kGy. Obtained results revealed that radiation of millet grains at a dose level higher than 0.5 kGy caused significant (P < 0.05) reduction on the percentage of fungal incidence and the free fatty acid of the seeds, while, no significant change in the germination capacity was observed of the grains after radiation. Additionally, the radiation process caused significant (P < 0.05) reduction on both tannins and phytic acid content and gradual increment on in vitro protein digestibility of the grains. On the other hand, the treatments significantly (P < 0.05) increased the protein solubility of the grains. Obtained results indicate that gamma irradiation might improve the quality characteristics of millet grains, and can be used as a postharvest method for disinfestations and decontamination of millet grains.

Removal of 4-Chlorophenol from Contaminated Water Using Activated Carbon from Dried Date Pits: Equilibrium, Kinetics, and Thermodynamics Analyses.

Five different activated carbons (ACs) have been prepared from dried date pits using air and phosphoric acid as activating agents. The used phosphoric acid:date pit ratio dictated the characteristics of the prepared ACs; the equivalent BET-nitrogen surface area varied from 794 m²/g for a ratio of 5:1, to 1707 m²/g for a ratio of 2:1, whereas the micropore volume changed in value from 0.24 cm³/g for the 5:1 ratio to 0.59 cm³/g for the 2:1 ratio. The prepared ACs were tested to remove 4-chlorophenol (4-CP) from aqueous solutions by means of batch adsorption process. The prepared 2:1 AC exhibited the highest uptake with a maximum of 525 mg/g. Equilibrium pH studies showed that 4-CP removal was pH dependent; the maximum uptake occurred at an equilibrium pH value of 5.5. Dynamic studies showed that 4-CP uptake on 2:1 AC is rapid, with 80% of the maximum uptake achieved during the first 40 min. Both surface adsorption and intraparticle diffusion were identified to be effective adsorption mechanisms. Kinetic studies indicated a pseudo second-order reaction. Results of equilibrium adsorption experiments showed that the adsorption of the 4-CP on 2:1 AC is best described by the Langmuir model. The thermodynamics parameters of the adsorption (ΔG°, ΔH°, and ΔS°) were determined by studying the adsorption equilibrium at different temperatures. The values of these parameters indicated the spontaneous and endothermic nature of the adsorption phenomenon of 4-CP on the prepared ACs.

Induction, purification and molecular characterization of sulfhydryl oxidase from an Egyptian isolates of Aspergillus niger.

The conditions for the sulfhydryl oxidase (SOX) production and activity from an Egyptian isolate of Aspergillus niger were optimized. Purification and determination of the kinetic properties (K(m) and V(max)) of the purified enzyme have been done. The possibility for the SOX induction using L-Cys (as a natural substrate) was studied to determine whether SOX could be produced as an inducible enzyme in addition to being a constitutive one (i.e. whether induction leads to increase SOX production and activity or not). The optimum temperature and pH for its activity were found to be 60 degrees C and 5.5, respectively. The activity of the induced intracellular SOX, was measured according to Ellman's method using the standard GSH oxidation where it reached 94% while that of non-induced one reached only 27.6%. This wide difference in activity between the induced and non-induced SOX indicates the successful L-Cys-induction of the SOX production (i.e. SOX from A. niger AUMC 4947 is an inducible enzyme). Molecular characterization of the pure SOX revealed that it is constituted of two 50-55 KDa subunits. K(m) and V(max) were found to be 6.0 mM and 100 microM/min/mg respectively.

Effects of salt stress on some nitrogen fixation parameters in faba bean.

The adverse effects of sea water salinity on number of nodules, nitrogen content, nitroginase activity, Chlorophyll a and b content, proline accumulation and protein pattern of faba bean plants (Vicia faba commercial cultivar Nubaria 1) were investigated. Faba bean plants were irrigated with sea water at 20, 25, 30, 40 and 50% concentrations and inoculated with rhizobial isolate ARC307 or with gamma rays treated isolates namely; ARC1, ARC2, ARC3, ARC4, ARC5, ARC6 and ARC7. Nodules number, nitrogen content, nitroginase activity and chlorophyll a and b content parameters were decreased by increasing sea water salinity with all used isolates, while proline accumulation parameter increased. At the same time, ARC2 isolate showed the highest values for these parameters above all isolates including the parental isolate ARC307 at all studied concentrations except for proline accumulation parameter, it was the least. Therefore, ARC2 considered as a promising isolate for salt tolerance. Salinity enhanced the occurrence of particular novel proteins in faba bean plants infected with ARC2 isolate.

Laser versus dissection technique of tonsillectomy.

Tonsillectomy is the single most common operation performed in Ear Nose and Throat Department. Various methods of tonsillectomy have been practiced over the century aimed at reducing or eliminating intraoperative and postoperative morbidity. Due to various blood supplies received, intraoperative bleeding is the most difficult problem and securing it is time-consuming. The time taken to control the bleeding would invariably determine the length of operation. Common postoperative complications are bleeding and pain. This study evaluated the operative time, intraoperative blood loss, postoperative pain and other postoperative complications of tonsillectomy performed by laser as compared to conventional dissection technique. This is a prospective randomized study whereby sixty patients were divided into two groups of equal number. In one group, the tonsillectomy performed by laser and in the other group the tonsillectomy performed by conventional dissection technique. Operative time and amount of blood loss is significantly reduced in the laser group. Total postoperative pain and post operative complications were not significantly different between the two groups. Tonsillectomy by using laser have shown less intraoperative bleeding and shortened the operative time. In the hospital where laser machine and expertise are available, it is justifiable to use this technique as effective method of performing tonsillectomy.