Pseudophakic reverse pupillary block after implantation of a single-piece foldable intraocular lens in the capsular bag: Case report and literature review.

Reverse pupillary block with intraocular pressure (IOP) elevation after cataract surgery with in-the-bag implantation of intraocular lens (IOL) is considered a very rare complication. We report the case of a 47-year-old female patient with bilateral high axial myopia and posterior staphyloma presented with left acute loss of vision and eye pain, headache, and vomiting 2 weeks after uneventful presenile cataract surgery with single-piece IOL implantation in the capsular bag 1 month and 2 weeks in the right and left eyes, respectively. Gonioscopy showed extremely wide angle in all quadrants compared to the other eye with Spaeth classification of E 60c + 2 (14). Ultrasound biomicroscopy of the left eye showed epithelial corneal edema, 4.56 mm-deep anterior chamber, abnormal iris configuration with posterior concavity, and angle opening ranging between 60° and 74°, with unremarkable posterior chamber IOL and ciliary body. We managed the patient with topical antiglaucoma medications and laser peripheral iridotomy. IOP returned to normal levels. The patient was followed for 12 consecutive months. Elevated IOP from the reverse pupillary block is a rare postoperative complication of cataract surgery. It was initially described in association with the ciliary sulcus implanted IOL. Elevated IOP from the reverse pupillary block was then reported associated with scleral sutured IOLs and Yamane technique, and most recently with in-the-bag implanted 3-piece-IOL. Herein, we report the first case of pseudophakic reverse pupillary block in association with in-the-bag implanted single-piece foldable acrylic IOL.

How Safe and Technical Is Modified Dunn Osteotomy in the Management of Patients with SCFE: A Clinical Trial with Short-Term Follow-Up.

Objective: Over the last decade, modified Dunn osteotomy has been widely used in the management of slipped capital femoral epiphysis (SCFE) with varying degrees of complications. Different conclusions have been adopted. Our study represented our experience in using such a technique in stable and unstable SCFE and tried to determine its safety and applicability for routine practice. Methods: Our study adopted an interventional prospective design performed on 24 hips divided evenly between both sexes with a mean age of 13.25. On the Southwick classification, the cases were distributed between moderate and severe, which constituted 41.7% and 58.33%, respectively. Three quarters of the study subjects were stable according to the Loder classification. Each underwent modified Dunn osteotomy after a safe surgical hip dislocation. Results: Over the period of about 1-year follow-up, clinical evaluation was performed by examining the surgical site and assessing the legs' length, range of hip movement, Harris hip score, and iHOT-12 score. Radiological assessment was performed by calculation of slip angle from the frog lateral view, assessment of union, and occurrence of any complications. The study showed that there was significant improvement in patients in terms of radiological and clinical outcomes, with the occurrence of AVN in 16.7% of cases (4 out of 24). All cases of AVN occurred in unstable hips. Conclusion: Despite the complication of AVN, we believe the results of this study add to the current literature which suggests that modified Dunn osteotomy is an effective and safe technique for the management of moderate and severe SCFE. This trial is registered with PACTR202312819351504.

The Diagnostic Utility of Natural Killer Cell Subsets in Deep Vein Thrombosis.

Background: Natural killer (NK) cells are important components of adaptive and innate immune responses. NK cell subsets have different functions and may play a role in vascular disorders. This study aimed to evaluate the proportions of NK cells and their subsets to determine whether they can be used as markers of venous thrombosis and to identify whether there was a link between NK cell proportion and citrullinated histone (H3) levels. Patients and Methods: This study included 100 participants divided into Group I (n=50, patients with deep venous thrombosis (DVT)) and Group II (n=50, age- and sex-matched healthy controls). Group I was further categorized into Group Ia (n=25, patients with acute DVT) and Group Ib (n=25, patients with chronic DVT). The proportions of NK cells and their subsets were evaluated by flow cytometry using CD3/CD16/CD56. The levels of citrullinated histones (H3) were estimated using enzyme-linked immunosorbent assay (ELISA). Results: Compared to the control group, DVT patients had a significantly lower proportion of (CD56 dim/CD16+) NK cells, a significantly higher proportion of (CD56-/CD16+) NK cells and a high level of citrullinated histone (H3). Conclusion: NK cell subsets and citrullinated histone (H3) could be used as markers for DVT and as targets for therapeutic drugs to inhibit the formation or progression of thrombosis.

The prognostic role of urea-to-creatinine ratio in patients with acute heart failure syndrome: a case-control study.

BACKGROUND: Recent research has shown that the blood urea/creatinine ratio (BUN/Cr) rather than BUN or Cr alone can predict the prognosis of individuals with acute heart failure (AHF). The objective of this study was to estimate the urea-to creatinine serum ratio (BUN/Cr) in patients with acute decompensated heart failure (ADHF) and correlate the results with patient outcome, length of hospitalization, and mortality. RESULTS: Sixty ADHF patients were included and categorized into four groups; Group I: non-AKI with low BUN/Cr (n = 25); Group II: non-AKI with high BUN/Cr (n = 5); Group III: AKI with low BUN/Cr (n = 14); Group IV: AKI with high BUN/Cr (n = 16). Regarding urea and BUN levels, the first reading showed a considerable rise in urea and BUN levels in groups III and IV compared to group 1 and in group IV compared to groups I and III. Similar results were recorded in the second and third readings. Regarding the BUN/Cr ratio, the three readings revealed a significant elevation in group IV compared to groups I and II and in group IV compared to group III. Mortality was significantly higher in group IV compared to group I. Additionally, MACE was significantly more frequent in group IV compared to groups I and III. Multivariable logistic regression analysis revealed that hypertension, creatinine, and BUN were independent predictors of AKI. CONCLUSIONS: BUN/Cr may predict prognosis in AHF patients since AHF with an elevated BUN/Cr is associated with a higher death rate.

Physicochemical investigation of mercury sorption on mesoporous thioacetamide/chitosan from wastewater.

Mercury is a toxic environmental element, so it was necessary to prepare a new, highly efficient, cheap sorbent to remove it. A mesoporous thioacetamide/chitosan (MTA/CS) was manufactured via a simplistic strategy; the chitin deacetylation to gain chitosan (CS) and the addition of thioacetamide. The as-prepared MTA/CS was characterized using X-ray diffraction, EDX, SEM, FTIR, and BET surface analysis. According to the findings, the MTA/CS was effectively synthesized. The removal behaviors of Hg2+ onto MTA/CS composite were inspected, which suggested that the MTA/CS composite exhibited great sorption properties for Hg2+ in liquid solutions. The maximal Hg2+ sorption capacity was 195 mg/g. The effects of temperature, Hg2+ concentration, contacting time, and MTA/CS concentration on sorption were analyzed. The 2nd-order model and Langmuir isotherm were suitable for the physicochemical adsorption processes. Thermodynamic analysis showed that the Hg2+ adsorption process onto the MTA/CS composite is exothermic and occurred spontaneously. The desorption condition of Hg2+ from its loaded MTA/CS was also gained. Likewise, the MTA/CS sorbent was undoubtedly regenerated by 0.8 M NaNO3 80 min contacting and 1:50 S:L ratio. The versatility and durability of MTA/CS sorbent were investigated via nine sorption-extraction cycles. The optimum parameters were applied to wastewater. Based on the result, the as-prepared MTA/CS might be a potential sorbent for removing Hg2+ from liquid solutions.

The Correlation Between C-Peptide and Severity of Peripheral Atherosclerosis in Type 2 Diabetes Mellitus.

Background: One of the major issues affecting global health is Diabetes mellitus (DM), not only in terms of the disease itself but also its complications. Macrovascular complications are both common and serious, affecting many patients. This study aimed to assess fasting C-peptide levels and correlate them with the severity of the peripheral arterial disease complicating type 2 DM (T2DM). Patients and Methods: This study included 200 participants who were categorized into two groups: Group I (n=100, patients with T2DM complicated by femoropopliteal arterial atherosclerosis) and Group II (n=100, healthy age- and sex-matched individuals serving as controls). Fasting C-peptide levels were estimated using an immunochemiluminometric assay. Results: Fasting C-peptide levels were significantly higher in Group I than in the control group. Fasting C-peptide levels were positively correlated with the severity of atherosclerosis. In addition, the receiver operating characteristic (ROC) curve analysis revealed that fasting C-peptide levels served as a specific and sensitive marker for detecting the severity of this disease. Conclusion: Fasting C-peptide levels can be used as a sensitive and specific indicator of the severity of femoropopliteal arteriosclerosis that complicates T2DM.

Holmium laser versus cold knife visual internal urethrotomy for management of short segment urethral stricture: a prospective randomized clinical trial.

OBJECTIVES: To report the safety and efficacy of holmium laser and compare its results with cold knife visual internal urethrotomy (VIU) in the management of short segment urethral stricture. METHODS: This prospective randomized study included 66 male patients aged more than 18 years, with short segment bulbar urethral strictures < 2 cm from March 2020 to March 2022. The patients were randomized into two groups each containing 33 patients. In group A (Cold knife group), Sachse cold knife was used for stricture treatment. In group B (Holmium group), internal urethrotomy was done with Ho:YAG laser. Patients were evaluated before the operation and followed up after the operation at 1, 3, 6 and 12 months by physical examination, IPSS, PVR, Qmax and retrograde urethrography. RESULTS: There was significant improvement in the mean values of IPSS, PVR and Qmax in both groups. There was no significant difference between both groups in the mean values of IPSS, PVR and Qmax during follow-up visits. However, at the end of follow-up at one year there was statistically significant difference between both groups in the mean values of IPSS, PVR and Qmax due to higher recurrence rate in cold knife group than laser group. The overall complication rate is significantly lower in laser group (p = 0.014). CONCLUSION: Holmium laser VIU is an effective and safe treatment option for short segment urethral stricture with shorter operative time, less complication rate and less recurrence than cold knife VIU.

Recovery of W(VI) from Wolframite Ore Using New Synthetic Schiff Base Derivative.

A new synthetic material, namely, (3-(((4-((5-(((S)-hydroxyhydrophosphoryl)oxy)-2-nitrobenzylidene) amino) phenyl) imino) methyl)-4-nitrophenyl hydrogen (R)-phosphonate)), was subjected to a quaternary ammonium salt and named (HNAP/QA). Several characterizations, such as FTIR spectrometry, 1H-NMR analysis, 13C-NMR analysis, 31P-NMR Analysis, TGA analysis, and GC-MS analysis, were performed to ensure its felicitous preparation. HNAP/QA is capable of the selective adsorption of W(VI) ions from its solutions and from its rock leachate. The optimum factors controlling the adsorption of W(VI) ions on the new adsorbent were studied in detail. Furthermore, kinetics and thermodynamics were studied. The adsorption reaction fits the Langmuir model. The sorption process of the W(VI) ions is spontaneous due to the negative value of ∆G° calculated for all temperatures, while the positive value of ∆H° proves that the adsorption of the W(VI) ions adsorption on HNAP/QA is endothermic. The positive value of ∆S° suggests that the adsorption occurs randomly. Ultimately, the recovery of W(IV) from wolframite ore was conducted successfully.

Heavy metal contamination levels, source distribution, and risk assessment in fine sand of urban surface deposited sediments of Ekaterinburg, Russia.

Urban surface deposited sediments (USDS) are unique indicators of local pollution that pose a potential threat to the living environment and human health. Ekaterinburg is a highly populated metropolitan area in Russia with rapid urbanization and industrialization activities. In Ekaterinburg's residential areas, about 35, 12, and 16 samples are represented by green zones, roads, driveways, and sidewalks, respectively. The total concentrations of heavy metals was detected using a chemical analyzer inductively coupled plasma mass spectrometry (ICP-MS). Zn, Sn, Sb, and Pb have the highest concentrations in the green zone, while V, Fe, Co, and Cu represent the utmost values on roads. Moreover, Mn and Ni are the prevailing metals in the fine sand fraction of driveways along with sidewalks. Broadly, the high pollution in the studied zones is generated by anthropogenic activities and traffic emissions. The potential ecological risk (RI) was observed in high risk (IR > 600), even though the results of all heavy metals reveal no adverse health effects from the considered noncarcinogenic metal for adults and children by different exposure pathways except the children's exposure to Co in case of the dermal contact, where the HI values of Co for children in the studied zones are higher than the proposed level (> 1). In all urban zones, the total carcinogenic risk (TLCR) values are predicted as a high potential inhalation exposure.

Outcome of hyaluronic acid gel injection in glans penis for treatment of lifelong premature ejaculation: A pilot study.

Objective: To assess safety and efficacy of hyaluronic acid (HA) gel injection in glans penis for treatment of premature ejaculation (PE) using our new five puncture technique. Patients and methods: This is a prospective, non-randomized clinical trial on HA gel injection in glans penis for all patients with lifelong PE; all patients were circumcised having heterosexual normal marital life and sexually active. Patients with history of ejaculatory medication use within the previous 3 months, psychiatric disorders, erectile dysfunction, lower urinary tract symptoms (LUTS) due to prostatitis and acquired PE were excluded from the study. A local anesthetic was applied to the skin of glans penis for 30 minutes before the injection of 2 ml HA in glans penis via 30-gauge needle using our new Five-puncture technique. Intra-vaginal ejaculatory latency time (IELT) was measured at 1, 3, 6 and 12 months after injection. Results: Thirty patients completed our study follow up schedule. Mean age of the patients was 41.72 ± 8.50, while mean age of female partner was 37.23 ± 8.54 years. IELT was highly significantly increased (P-value < 0.001) after HA gel injection from baseline, which was in maximum 37.83 ± 11.01 sec at baseline to 323.03 ± 42.06, 281.07 ± 41.05, 241.03 ± 43.09 and 235.6 ± 41.87 sec after 1, 3, 6 and 12 months, respectively, after injection. Three patients complained from discomfort at the site of injection, two from bullae formation at the site of injection and one from ecchymosis, and all resolved spontaneously after 1 week to 10 days after injection. Conclusion: HA gel injection in glans penis using our new five-puncture technique is a safe and effective method that ensures a modest long-term significant increase in IELT and improves ejaculatory control.

ECG-COVID: An end-to-end deep model based on electrocardiogram for COVID-19 detection.

The early and accurate detection of COVID-19 is vital nowadays to avoid the vast and rapid spread of this virus and ease lockdown restrictions. As a result, researchers developed methods to diagnose COVID-19. However, these methods have several limitations. Therefore, presenting new methods is essential to improve the diagnosis of COVID-19. Recently, investigation of the electrocardiogram (ECG) signals becoming an easy way to detect COVID-19 since the ECG process is non-invasive and easy to use. Therefore, we proposed in this paper a novel end-to-end deep learning model (ECG-COVID) based on ECG for COVID-19 detection. We employed several deep Convolutional Neural Networks (CNNs) on a dataset of 1109 ECG images, which is built for screening the perception of COVID-19 and cardiac patients. After that, we selected the most efficient model as our model for evaluation. The proposed model is end-to-end where the input ECG images are fed directly to the model for the final decision without using any additional stages. The proposed method achieved an average accuracy of 98.81%, Precision of 98.8%, Sensitivity of 98.8% and, F1-score of 98.81% for COVID-19 detection. As cases of corona continue to rise and hospitalizations continue again, hospitals may find our study helpful when dealing with these patients who did not get significantly worse.

Characteristic Aspects of Uranium(VI) Adsorption Utilizing Nano-Silica/Chitosan from Wastewater Solution.

A new nano-silica/chitosan (SiO2/CS) sorbent was created using a wet process to eliminate uranium(VI) from its solution. Measurements using BET, XRD, EDX, SEM, and FTIR were utilized to analyze the production of SiO2/CS. The adsorption progressions were carried out by pH, SiO2/CS dose, temperature, sorbing time, and U(VI) concentration measurements. The optimal condition for U(VI) sorption (165 mg/g) was found to be pH 3.5, 60 mg SiO2/CS, for 50 min of sorbing time, and 200 mg/L U(VI). Both the second-order sorption kinetics and Langmuir adsorption model were observed to be obeyed by the ability of SiO2/CS to eradicate U(VI). Thermodynamically, the sorption strategy was a spontaneous reaction and exothermic. According to the findings, SiO2/CS had the potential to serve as an effectual sorbent for U(VI) displacement.

Impact of intermittent fasting on laboratory, radiological, and anthropometric parameters in NAFLD patients.

Aim of the study: Despite the ample flow of non-alcoholic fatty liver disease (NAFLD) drugs in the pipeline, lifestyle modifications are still the optimal solution of NAFLD. The aim of the study was to assess short term effects of Ramadan fasting (RF) as a sort of intermittent fasting (IF) on biochemical, radiological, and anthropometric parameters of NAFLD patients. Material and methods: Ninety-eight NAFLD patients were recruited and voluntarily subjected to 16 hours daily fasting for an average of 22-29 days, without special dietary recommendations. Anthropometric, laboratory and radiological parameters were measured before, at 30 days, and one month after fasting (fasting and non-fasting phases). Results: Patients were mostly rural (76%), hypertensive (34.7%), diabetic (43.9%), and female (76.8%), with overt criteria of metabolic syndrome (67.3%). Liver transaminases (ALT and AST) were ameliorated significantly after fasting (p ≤ 0.01), which continued in the following month (p ≤ 0.01) especially in those with elevated ALT before fasting (46%). Eleven patients (24.4%) experienced ALT normalization after one month of fasting, which was further increased to 15 (33.3%) one month later. Lipid profiles (cholesterol, triglycerides, HDL, LDL, cholesterol/HDL risk ratio) were significantly corrected following IF (p ≤ 0.01) and continuing in the next phase (p ≤ 0.010). Body mass index (BMI) lessened following the fasting (p ≤ 0.01), while no remarkable changes were noted regarding waist, hip, and triceps skin fold thickness (p ≤ 0.01). Glycemic indices (HbA1c, postprandial, HOMA-IR) and fibrosis markers (FIB-4 and APRI) were significantly ameliorated (p ≤ 0.01), while reduction in inflammatory markers was not long lasting (p ≤ 0.01). Conclusions: Intermittent fasting led to momentous improvements in ultrasonographic, biochemical, and anthropometric parameters of NAFLD especially in early phases and prediabetics.

Potentially harmful elements in urban surface deposited sediment of Ekaterinburg, Russia: Occurrence, source appointment and risk assessment.

In this study, the human health risks of potentially harmful elements (PHEs) in urban surface deposited sediments (USDS) were examined by collecting urban dust samples, measuring their PHE concentrations, and using index evaluation. About 35, 12 and 16 samples are represented a green zones, roads, driveways and sidewalks in residential areas of Ekaterinburg, respectively. The dust fraction (0.002-0.1 mm) was obtained by sieving, filtration, and decantation process. Total concentrations of 10 PHEs were measured using inductively coupled plasma mass spectrometry. The highest concentrations of Pb were found in USDS from green zones, while Fe, V, Mn, Co, Ni, Sn, and Sb on roads, Cu and Zn on driveways and sidewalks. The contamination levels in the investigated land-use areas were studied, where the highest contamination was contributed from Sb in the driveways and sidewalk. Moreover, the pollution in the studied zones was a high load, contributing to anthropogenic activities and traffic emissions. No non-cancerogenic risk was attributed from the PHEs based on the results of health indices (HI < 1) for both adult and children, except Co and Ni which has HI > 1 for children. The total carcinogenic risk (TLCR) in all urban landscape areas is defined as a high potential inhalation exposure and a low potential ingestion and dermal exposure.

Selective Recovery of Cadmium, Cobalt, and Nickel from Spent Ni-Cd Batteries Using Adogen® 464 and Mesoporous Silica Derivatives.

Spent Ni-Cd batteries are now considered an important source for many valuable metals. The recovery of cadmium, cobalt, and nickel from spent Ni-Cd Batteries has been performed in this study. The optimum leaching process was achieved using 20% H2SO4, solid/liquid (S/L) 1/5 at 80 °C for 6 h. The leaching efficiency of Fe, Cd, and Co was nearly 100%, whereas the leaching efficiency of Ni was 95%. The recovery of the concerned elements was attained using successive different separation techniques. Cd(II) ions were extracted by a solvent, namely, Adogen® 464, and precipitated as CdS with 0.5% Na2S solution at pH of 1.25 and room temperature. The extraction process corresponded to pseudo-2nd-order. The prepared PTU-MS silica was applied for adsorption of Co(II) ions from aqueous solution, while the desorption process was performed using 0.3 M H2SO4. Cobalt was precipitated at pH 9.0 as Co(OH)2 using NH4OH. The kinetic and thermodynamic parameters were also investigated. Nickel was directly precipitated at pH 8.25 using a 10% NaOH solution at ambient temperature. FTIR, SEM, and EDX confirm the structure of the products.

Efficient Recovery of Rare Earth Elements and Zinc from Spent Ni-Metal Hydride Batteries: Statistical Studies.

Considering how important rare earth elements (REEs) are for many different industries, it is important to separate them from other elements. An extractant that binds to REEs inexpensively and selectively even in the presence of interfering ions can be used to develop a useful separation method. This work was designed to recover REEs from spent nickel-metal hydride batteries using ammonium sulfate. The chemical composition of the Ni-MH batteries was examined. The operating leaching conditions of REE extraction from black powder were experimentally optimized. The optimal conditions for the dissolution of approximately 99.98% of REEs and almost all zinc were attained through use of a 300 g/L (NH4)2SO4 concentration after 180 min of leaching time and a 1:3 solid/liquid phase ratio at 120 °C. The kinetic data fit the chemical control model. The separation of total REEs and zinc was conducted under traditional conditions to produce both metal values in marketable forms. The work then shifted to separate cerium as an individual REE through acid baking with HCl, thus leaving pure cerium behind.

Synthesis of a New Chelating Iminophosphorane Derivative (Phosphazene) for U(VI) Recovery.

A new synthetic chelating N-hydroxy-N-trioctyl iminophosphorane (HTIP) was prepared through the reaction of trioctylphosphine oxide (TOPO) with N-hydroxylamine hydrochloride in the presence of a Lewis acid (AlCl3). Specifications for the HTIP chelating ligand were successfully determined using many analytical techniques, 13C-NMR, 1H-NMR, FTIR, EDX, and GC-MS analyses, which assured a reasonable synthesis of the HTIP ligand. The ability of HTIP to retain U(VI) ions was investigated. The optimum experimental factors, pH value, experimental time, initial U(VI) ion concentration, HTIP dosage, ambient temperature, and eluents, were attained with solvent extraction techniques. The utmost retention capacity of HTIP/CHCl3 was 247.5 mg/g; it was achieved at pH = 3.0, 25 °C, with 30 min of shaking and 0.99 × 10-3 mol/L. From the stoichiometric calculations, approximately 1.5 hydrogen atoms are released during the extraction at pH 3.0, and 4.0 moles of HTIP ligand were responsible for chelation of one mole of uranyl ions. According to kinetic studies, the pseudo-first order model accurately predicted the kinetics of U(VI) extraction by HTIP ligand with a retention power of 245.47 mg/g. The thermodynamic parameters ΔS°, ΔH°, and ΔG° were also calculated; the extraction process was predicted as an exothermic, spontaneous, and advantageous extraction at low temperatures. As the temperature increased, the value of ∆G° increased. The elution of uranium ions from the loaded HTIP/CHCl3 was achieved using 2.0 mol of H2SO4 with a 99.0% efficiency rate. Finally, the extended variables were used to obtain a uranium concentrate (Na2U2O7, Y.C) with a uranium grade of 69.93% and purity of 93.24%.

Risk factors of penile resurfacing in re-operative hypospadias repair: A retrospective analytical study.

INTRODUCTION: In re-operative hypospadias repair, scarred urethral plate, and deficient unhealthy penile skin are usually problematic. Difficulties are not only in urethroplasty but also in penile skin coverage. Penile skin coverage after urethroplasty with good viable skin decreases the complication rate and increases the satisfaction with repair. Studies reporting variables that increase the risks of the need for penile resurfacing in re-operative hypospadias are lacking. OBJECTIVES: To determine the risk factors of the need for penile resurfacing techniques (PRSTs) in re-operative hypospadias. STUDY DESIGN: A retrospective analysis of the redo hypospadias cases operated in-between January 2010 and December 2020 was done. Surgical data of the previous repairs, the indications for intervention, and the penile shaft coverage techniques at the time of the last repair were collected and analyzed. Patients' records were reviewed and categorized into two main groups. Group one include patients with simple skin closure, and group two include patients in whom penile resurfacing was done. Univariate analysis and Stepwise logistic regression measured the risk factors of the need for penile resurfacing techniques. RESULTS: Out of 223 re-operative hypospadias, simple skin closure was done in 105 (group 1). Penile skin resurfacing (Byars flaps, Heineke-Mikulicz technique, and Z-Plasty) was in 55 (group 2a). In 63 patients (group 2b), scrotal flaps and skin grafts (split and full thickness) were the PRSTs. Patients ages, proximal hypospadias, number of prior surgery, one-stage repair, penile skin use in repair especially flap techniques, more than one complication in the same case, and unsatisfactory skin appearance increased the risk for PRSTs. Each previous repair increases the odds ratio of penile and non-penile resurfacing 1.9 and 3.2 folds respectively. One-stage repair increases odds of PRSTs 4 folds. DISCUSSION: We analyzed the risk factors of the need for penile resurfacing techniques in the re-operative hypospadias cases. Step-wise logistic regression showed that the number of previous repairs and one-stage repair are the independent risk factors of penile resurfacing. Also, it showed that the number of prior surgeries is the only independent risk factor for non-penile skin resurfacing. CONCLUSION: Number of previous repair is the independent risk factors of penile resurfacing and non-penile skin use in resurfacing. Previous repair in one-stage is an independent risk factor of the need for penile resurfacing.

Cetylpyridinium Bromide/Polyvinyl Chloride for Substantially Efficient Capture of Rare Earth Elements from Chloride Solution.

A new sorbent cetylpyridinium bromide/polyvinylchloride (CPB/PVC) was prepared and tested to extract rare earth elements (REEs) from their chloride solutions. It was identified by FTIR, TGA, SEM, EDX, and XRD. The impact of various factors such as pH, RE ion initial concentration, contacting time, and dose amount via sorption process was inspected. The optimum pH was 6.0, and the equilibrium contact time was reached at 60 min at 25 °C. The prepared adsorbent (CPB/PVC) uptake capacity was 182.6 mg/g. The adsorption of RE ions onto the CPB/PVC sorbent was found to fit the Langmuir isotherm as well as pseudo-second-order models well. In addition, the thermodynamic parameters of RE ion sorption were found to be exothermic and spontaneous. The desorption of RE ions from the loaded CPB/PVC sorbent was investigated. It was observed that the optimum desorption was achieved at 1.0 M HCl for 60 min contact time at ambient room temperature and a 1:60 solid: liquid phase ratio (S:L). As a result, the prepared CPB/PVC sorbent was recognized as a competitor sorbent for REEs.

Urethral complex thickness and thickness index are the independent risk factors for urethroplasty complications after tubularized incised plate hypospadias repair.

INTRODUCTION: In tubularized incised plate urethroplasty, the depth of the mid-line relaxing incision is the key factor for urethral plate tubularization without tension. The incision depths will be different from one case to the other even if they have been done by the same surgeon. This difference in depths resulted from the different thicknesses of the urethral plate and the underlying corpus spongiosum (urethral complex). OBJECTIVES: To evaluate the urethral complex thickness and thickness index as risk factors for the complications of TIPU in penile shaft hypospadias repair. STUDY DESIGN: All primary penile shaft (distal and mid-penile) hypospadias (with or without mild penile chordee) were operated with TIPU between March 2018 and February 2021. We measured the urethral complex thickness in the hypospadiac and proximal normal parts of urethra pre-operatively with superficial U/S probe. Intraoperative, we measured the urethral plate width before and after the midline relaxing incision, calculate the relative increase in urethral plate width (RIUPW). Stepwise logistic regression assessed the effect of different variables on the complication rate. These variables include; urethral plate width before and after incision, urethral complex thickness, thickness index, RIUPW, site of hypospadiac meatus and patients ages. RESULTS: 10 cases had 11 complications (12.7%). Fistulae were the commonest complication (8.9%). Complication rate has significant negative correlations with many variables on Univariate analysis. Stepwise logistic regression shows that urethral plate thickness and thickness index are the independent risk factors for complications after TIPU in penile shaft hypospadias. DISCUSSION: Urethral plate width was suggested to be a risk factor for TIPU complications. In our study, Univariate analysis shows that complications were more with plate width ˂8 mm but without significant difference (P = 0.487). Also it shows that post incision width and RIUPW have significant negative correlation with complications rate. Multivariate analysis showed that the urethral complex thickness and thickness index are the independent risk factors for complications after TIPU hypospadias repair (AUC 0.94 95% CI 0.894-0.972 P Ë‚ 0.001 and 0.965 95% CI 0.921-0.996, respectively). CONCLUSION: The thickness of the urethral plate and the underlying spongiosum is the determining factor for TIPU success. We can use it as an objective reproducible assessment tool for urethral plate quality and to predict TIPU complications.