Changes in the Etiologies of Liver Cancer in Upper Egypt over a Decade from 2010 to 2020: A Single Tertiary Care Center Study.

Yasser Fouad The profile of liver diseases in Egypt is changing dramatically and viral hepatitis is declining, while the fatty liver disease is increasing dramatically. However, the impact of these changes on the profile of hepatocellular carcinoma (HCC) remains uncertain. Therefore, we determined the temporal trends in the etiologies of HCC in Egypt over a decade. We retrospectively analyzed data from consecutive patients who were diagnosed with HCC over 10 years (2010-2020) in a large center in Upper Egypt. Standard tests were utilized to diagnose hepatitis C virus (HCV) and hepatitis B virus. In the absence of other liver disorders, the presence of obesity, or diabetes in the absence of other risk factors, metabolic dysfunction-associated fatty liver disease (MAFLD) was diagnosed. A total of 1,368 HCC patients were included, in which 985 (72%) had HCV, 58 (4%) had hepatitis B virus, and 143 (10.5%) had MAFLD, 1 patient had hemochromatosis, 1 had autoimmune liver disease, and 180 (13%) patients were with unknown cause. The annual proportions of MAFLD-related HCC were increased significantly between 8.3% in 2010 and 20.6% in 2020 ( p = 0.001), while HCV-related HCC declined from 84.8 to 66.7% ( p = 0.001). Throughout the study period, there were significant increases in the age at diagnosis of HCC, the proportion of female patients, obesity, diabetes, and less severe liver dysfunction at diagnosis ( p < 0.05 for all). With the decline of HCV, MAFLD is becoming a major cause of HCC in Egypt, which has increased substantially over the past 10 years. This study urges the creation of comprehensive action strategies to address this growing burden.

Endoscopic-Assisted Cochlear Implantation in Far Advanced Otosclerosis.

OBJECTIVES: To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to facilitate the identification of the round window membrane and the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy. STUDY DESIGN: Retrospective case-series study. SETTING: Tertiary academic CI center. PATIENTS AND METHODS: This study was conducted on patients with far advanced otosclerosis who underwent endoscopic-assisted CI between January 2010 and June 2020 at the same CI center. The minimum follow-up period was 2 years after surgery. RESULTS: Fourteen patients were included in the study. Ten patients had undergone a previous stapedotomy. Electrode insertion in the scala tympani was successfully accomplished in all cases included in the study. There was a statistically significant improvement in pure-tone average and speech discrimination scores in all cases of the study group (p < 0.0001). There were no statistically significant differences in postoperative pure-tone average or speech discrimination scores between cases with and without cochlear ossification or between cases with and without a previous stapedotomy (p > 0.05). CONCLUSION: Endoscopic-assisted CI is an effective option for hearing restoration in patients with far advanced otosclerosis. Otoendoscopy can facilitate visualization and access to the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.

MAFLD identifies patients with significant hepatic fibrosis better than MASLD.

BACKGROUND AND AIMS: Diagnostic criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) have been proposed but not yet validated. This study aimed to compare the diagnostic accuracy of the MASLD definition with the existing criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) in identifying patients with significant fibrosis. METHODS: The analysis included a total of 8317 individuals who had complete biochemical and liver ultrasonography data from the National Health and Nutrition Examination Survey (2017-2020). In this study, significant fibrosis (≥ F2) was determined by a median liver stiffness of ≥ 8.0 kPa. To identify independent factors associated with significant fibrosis, multivariable logistic regression analyses were applied. RESULTS: MAFLD (OR 3.44; 95% CI 2.88-4.12; P < 0.0001) has a trend for stronger and independent association with significant fibrosis compared to MASLD (OR 2.63; 95% CI 2.22-3.11; P < 0.0001). Non-MASLD MAFLD is independently associated with a 14.28-fold higher odds of significant fibrosis compared to non-MAFLD MASLD. The sensitivity for detecting significant fibrosis for MAFLD and MASLD was 76.23% vs 69.94%, respectively. The performance of MAFLD remains consistent in a sub-analysis of patients with no or mild alcohol intake. CONCLUSIONS: The definition of MAFLD provides a more precise identification of individuals who have both fatty liver and significant fibrosis, assessed by non-invasive tests.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

External Auditory Canal: Computed Tomography Analysis and Classification.

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