Efficacy of platelet-rich fibrin and tacrolimus on facial nerve regeneration: an animal study.

This study was performed to investigate the effect of platelet-rich fibrin membrane (PRFM), alone and with topical tacrolimus application, on regeneration of the crushed facial nerve (FN). Thirty healthy 7-week-old albino rats were used. The left FN was damaged by crushing in all rats. Three random groups of rats were formed: group 1, untreated; group 2, treated with PRFM; group 3, treated with PRFM plus topical tacrolimus. Functional recovery and histological and immunohistochemical evaluations were performed 4 and 8 weeks later. Anti-S100 was used to detect myelin sheath. At 4 weeks, blinking reflex recovery was more rapid in group 3 than in groups 2 and 1 (4.30 ± 0.48, 3.40 ± 0.52, and 2.20 ± 0.42, respectively); the difference was statistically significant (P = 0.001). Histologically, group 3 showed more apparent normal FN structures than the other groups. Immunohistochemical caspase-3 evaluation of the axon area revealed a significant difference between group 2 (PRFM alone; 8.67 ± 0.029) and group 3 (PRFM plus topical tacrolimus; 4.42 ± 0.028) (P = 0.001). Group 3 showed the greatest positive staining in the myelin sheath. Based on the results of this animal study, clinical studies should be performed to determine whether the combination of PRF and tacrolimus also improves the outcome of nerve regeneration in humans.

Realization of fractional-order capacitor based on passive symmetric network.

In this paper, a new realization of the fractional capacitor (FC) using passive symmetric networks is proposed. A general analysis of the symmetric network that is independent of the internal impedance composition is introduced. Three different internal impedances are utilized in the network to realize the required response of the FC. These three cases are based on either a series RC circuit, integer Cole-impedance circuit, or both. The network size and the values of the passive elements are optimized using the minimax and least m th optimization techniques. The proposed realizations are compared with well-known realizations achieving a reasonable performance with a phase error of approximately 2 o . Since the target of this emulator circuit is the use of off-the-shelf components, Monte Carlo simulations with 5 % tolerance in the utilized elements are presented. In addition, experimental measurements of the proposed capacitors are preformed, therein showing comparable results with the simulations. The proposed realizations can be used to emulate the FC for experimental verifications of new fractional-order circuits and systems. The functionality of the proposed realizations is verified using two oscillator examples: a fractional-order Wien oscillator and a relaxation oscillator.

Influence of Age and Tooth Loss on Masticatory Muscles Characteristics: A Population Based MR Imaging Study.

BACKGROUND: Aging is associated with a decline in masticatory muscles mass and performance. The present study aims to examine the differences in the cross-sectional areas of the masseter, medial and lateral pterygoid muscles in relation to age and the present dental status in a population-based magnetic resonance imaging study. METHODS: This cross sectional study involved 747 subjects aged between 30-89 years (344 male, 403 female) who underwent both a whole body MRI and a full oral examination. The cross-sectional areas of the masseter, medial and lateral pterygoid muscles were measured from MRI images using the software Osirix. Dental and prosthetic status data from the oral examination were classified according to Eichner index. The method of generalized least squares, also called growth curve model, was used to examine the associations between the cross-sectional areas, age and tooth status. RESULTS: The cross-sectional area of the lateral pterygoid muscle decreased substantially with age in women but did not depend on age in men. The medial pterygoid muscle depended on age but an effect modification by gender was uncertain. Masseter muscle was weakly associated with age but strongly associated with the number of teeth in both genders. CONCLUSIONS: Our findings suggest that age has a heterogeneous effect on masticatory muscles. This indicates that age related changes to the masticatory muscles are muscle specific and are not consistent between the different muscles.

[A pregnant patient with spontaneous haemothorax: hereditary haemorrhagic telangiectasia in pregnancy]. / Een zwangere met een spontane hematothorax.

BACKGROUND: The incidence of hereditary haemorrhagic telangiectasia (HHT - Osler-Weber-Rendu disease) in the Netherlands is 1:5000 but approximately 1:1300 in people from the Antilles. The disease is characterised by the development of telangiectasia and arteriovenous malformations (AVMs) that may result in serious morbidity and mortality. CASE DESCRIPTION: A 31-year-old primigravid patient consulted her general practitioner at 31 1/7 weeks gestational age with dyspnoea. She was referred for further diagnostics because of suspected pulmonary embolism. A CT scan showed haemothorax and a bleeding arteriovenous malformation (AVM) in the left lung. Family history suggested the possibility of HHT. After multidisciplinary consideration, a primary caesarean section was performed, followed by embolisation of the AVM during the same surgical session. The patient had a gene mutation consistent with HHT type 2. CONCLUSION: Pregnant patients with HHT are at risk of serious morbidity, especially if they are not screened for AVMs. A multidisciplinary approach for such patients, with consideration of various scenarios, is highly recommended.

Prediction and optimization of the laccase-mediated synthesis of the antimicrobial compound iodine (I2).

An artificial neural network (ANN) and genetic algorithm (GA) were applied to improve the laccase-mediated oxidation of iodide (I(-)) to elemental iodine (I2). Biosynthesis of iodine (I2) was studied with a 5-level-4-factor central composite design (CCD). The generated ANN network was mathematically evaluated by several statistical indices and revealed better results than a classical quadratic response surface (RS) model. Determination of the relative significance of model input parameters, ranking the process parameters in order of importance (pH>laccase>mediator>iodide), was performed by sensitivity analysis. ANN-GA methodology was used to optimize the input space of the neural network model to find optimal settings for the laccase-mediated synthesis of iodine. ANN-GA optimized parameters resulted in a 9.9% increase in the conversion rate.

Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating.

BACKGROUND: Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool. AIM: To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist. METHODS: Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT. RESULTS: Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P < 0.0001). According to PA, 89% of patients with a C-ACT > 21 were controlled and 85% of patients with a C-ACT < 17 not controlled. CONCLUSION: We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period.

The use of a radial basis neural network and genetic algorithm for improving the efficiency of laccase-mediated dye decolourization.

A radial basis function neural network (RBF) and genetic algorithm (GA) were applied to improve the efficiency of the oxidative decolourization of the recalcitrant dye Reactive Black 5 (RB 5) by a technical laccase (Trametes spp.) and the natural mediator acetosyringone (ACS). The decolourization of RB 5 in aqueous solution was studied with a 3(4) factorial design including different levels of laccase (2, 100, 200 U L(-1)), acetosyringone (5, 50, 100 µM), pH value (3, 4.5, 6) and incubation time (10, 20, 30 min). The generated RBF network was mathematically evaluated by several statistical indices and revealed better results than a classical quadratic response surface (RS) model. The experimental data showed that within 10 min of incubation time a complete decolourization (>90%) was achieved by using the highest amount of laccase (200 U L(-1)) and acetosyringone (100 µM) at pH 6. By applying the RBF-GA methodology, the efficiency of the laccase-mediated decolourization was improved by minimising the required amount of laccase and acetosyringone by 25% and 21.7% respectively. Complete decolourization (>90%) was obtained within 10 min at the GA-optimised process conditions of laccase (150 U L(-1)) and acetosyringone (78.3 µM) at pH 5.67. These results illustrate that the RBF-GA methodology could be a powerful technique during scale-up studies.

Statistical approach to determine the effect of combined environmental parameters on conidial development of Trichoderma atroviride (T-15603.1).

Trichoderma atroviride (T-15603.1) is a promising fungal agent for biological control of wood decay fungi in urban tree wounds. The aim of this work was to determine the combined effects of water activity (a(w), 0.998-0.892), temperature (10-30 °C) and pH (3-7) on the development of conidia on low-nutrient agar (LNA). Lag phase prior to germination (h), germination rates (µ(m)) and germ-tube elongation were obtained at each set of conditions. The experimental data were used to fit a response surface model for predicting the germination rates of T-15603.1 and to analyze the effect of the abiotic parameters tested. The polynomial response surface model was mathematically evaluated using graphical plots and several statistical indices (RMSE, %SEP, A(f), B(f), pRE). Data analyses showed a highly significant effect on conidial development of a(w) and temperature (P < 0.001), whereas no significant effect of pH (P ≥ 0.05) was observed. The germination rate dropped and the lag prior to germination increased as the temperature and a(w) decreased, but T-15603.1 appeared to be more sensitive to a(w) reduction than to temperature. The minimum a(w) level for germination was 0.910 at 15-25 °C, and maximum germination rates were obtained at a(w) = 0.998, 25-30 °C and pH 5. The response surface model was useful and widely accurate (R² = 0.983) for predicting the germination rate of T-15603.1 and complemented the experimental results. These findings contribute to better understanding how combined environmental factors affect the environmental parameter tolerance levels of T-15603.1 and to the development of an adequate delivery system for optimized application of T-15603.

National Survey of Prevalence of Mental Disorders in Egypt: preliminary survey.

This study is an initial step for the National Survey of Prevalence of Mental Disorders in Egypt. We conducted a door-to-door household survey of 14,640 adults aged 18-64 years in 5 regions in Egypt. Mental disorders were diagnosed using the MINI-Plus diagnostic interview. Overall prevalence was estimated at 16.93% of the studied adult population. The main problems were mood disorders, 6.43%, anxiety disorders, 4.75%, and multiple disorders, 4.72%. Mental disorders were associated with sociodemographic factors (e.g. being female, being unemployed, being divorced) and physical illness (e.g. heart disease, kidney disease, hypertension).

Information provision in fertility care: a call for improvement.

BACKGROUND: Adequate information provision is a crucial dimension of high-quality fertility care. Clinical practice guidelines containing consensus-based recommendations may standardize practice between settings. This study was designed for three purposes: (i) to assess actual adherence to recommendations on information provision, (ii) to measure patient satisfaction with current practice and (iii) to analyse how variation in adherence relates to the characteristics of patients and clinics. METHODS: All recommendations concerning patient information were extracted from 10 national fertility guidelines and edited into a patient questionnaire. Additional questions concerning patient satisfaction and potential determinants of information provision at patient level were included. A total of 2698 couples from 16 clinics were invited to participate. A professional's questionnaire was sent to all gynaecologists to gather potential determinants at clinic level. Multilevel regression analysis was performed to identify the determinants of information provision. RESULTS: A total of 1499 couples (56%) participated. The percentage of couples who reported to have received complete information varied between recommendations from 10 to 96% (mean 57%). Overall, 94% of couples were satisfied with fertility services. The use of checklists for information provision, the presence of obstetrics/gynaecology residents and specialized nursing personnel, and higher patient anxiety scores were significantly associated (P < 0.05) with higher levels of information received. CONCLUSIONS: Despite the possibility of recall bias in questionnaire studies and observed high patient satisfaction with fertility services, we conclude that information provision for infertile couples is currently poor and in need of improvement. This could easily be procured by, for example, the use of information checklists.

Determination of optimal growth parameters for the bioincising fungus Physisporinus vitreus by means of response surface methodology.

AIM: To evaluate the influence of water activity (a(w)), temperature and pH on the radial growth and lag phase of Physisporinus vitreus (E-642), a basidiomycete was used in the biotechnological process of bioincising. METHODS AND RESULTS: Radial growth was monitored for 20 days on malt extract agar medium. Five levels of a(w) (0.998, 0.982, 0.955, 0.928, 0.892) were combined with three incubation temperatures (10, 15, 20 degrees C) and three pH values (4, 5, 6). Data analyses showed a highly significant effect of a(w) and temperature (P < 0.0001) and a significant effect of pH (P < 0.05). The radial growth rate and lag phase of P. vitreus were very sensitive to a(w) reduction. Although P. vitreus was able to grow at all the selected temperatures and pH values, the lag phase increased with decreasing a(w) and growth became inhibited at a(w) = 0.955. Optimal conditions for growth of P. vitreus were a(w) = 0.998, 20 degrees C and pH 5. The response surface model provided reliable estimates of these growth parameters and confirmed a greater dependence on a(w) than on temperature or pH under in vitro conditions. CONCLUSIONS: Low levels of a(w) can prevent growth of P. vitreus, so wood moisture content should be adjusted accordingly. SIGNIFICANCE AND IMPACT OF THE STUDY: Implementation of these results should contribute towards the optimization and efficiency of bioincising.

National survey of Prevalence of Mental Disorders in Egypt: preliminary survey

This study is an initial step for the National Survey of Prevalence of Mental Disorders in Egypt. We conducted a door-to-door household survey of 14 640 adults aged 18-64 years in 5 regions in Egypt. Mental disorders were diagnosed using the MINI-Plus diagnostic interview. Overall prevalence was estimated at 16.93% of the studied adult population. The main problems were mood disorders, 6.43%, anxiety disorders, 4.75%, and multiple disorders, 4.72%. Mental disorders were associated with sociodemographic factors [e.g. being female, being unemployed, being divorced] and physical illness [e.g. heart disease, kidney disease, hypertension]

Variation in subfertility care measured by guideline-based performance indicators.

BACKGROUND: About 30-40% of patients do not receive care based on available scientific evidence. For subfertility, this may imply unnecessary and expensive diagnostic tests and treatments. It is therefore important to identify gaps in performance by monitoring current subfertility care. A set of 39 guideline-based performance indicators was previously developed for this purpose. This study aimed to assess several quality criteria of the indicator-set and to use the set to assess current subfertility care. METHODS: A historic cohort study was performed in 16 Dutch subfertility clinics; 2698 couples were invited to participate. Indicator data were gathered by medical record extraction, and patient and professional questionnaires. Quality criteria for each indicator (measurability, reliability, applicability, improvement potential, discriminatory capacity, complexity and case-mix stability) were assessed. Current practice was measured as adherence to the separate indicators. RESULTS: One thousand four-hundred and ninety-nine (56%) couples participated. All indicators were measurable, but the results for the other quality criteria varied. In total, 14 of the 39 indicators scored <50% adherence. Variation in performance between the clinics was up to 100%. The highest median adherence (86%) is found within the guideline 'indications for IVF-treatment'. The lowest median adherence is found within the guideline 'initial assessment of fertility' (43%), followed closely by the guideline 'anovulation' (44%). CONCLUSIONS: This study shows the quality of the developed indicator-set for monitoring clinical subfertility care. A first assessment in the Netherlands reveals large variation between clinics and ample room for improvement of care.

Determination of paper filler Z-distribution by low-vacuum SEM and EDX.

Paper, mainly constituted of cellulose fibres, often contains mineral fillers. These fillers increase some of the properties of the paper (whiteness, printability, etc.) and are cheaper than the cellulose fibres. Nevertheless, the fillers reduce the mechanical properties of the sheet. Paper presents an anisotropy corresponding to three main directions. This anisotropy characterises the sheet mechanical properties, structure and filler distribution. Analyses of the cross section of the paper sheet with a low-vacuum scanning electron microscope with an energy dispersive spectrometer analysis module can show this distribution. The procedure developed consists in analysing discrete profiles to build the mean profile known as filler Z-distribution for each of the fillers. To develop this method, problems such as determination of the surface points, the number of points to analyse to define a cross section profile and the time required for the test, have been solved. Paper is sensitive to electron irradiation. In order to avoid deterioration of the material and to obtain satisfactory results, the time span for analyses is restricted to 40 s with a 12 kV electron beam accelerating voltage. Monte Carlo simulations are used to determine the diffusion cloud size and thus to determine the number of points that constitute a profile. The samples are gold sputtered and, with the aid of backscattered imaging, the coated surface allows determination of the sample surface points.

Guideline-based development of quality indicators for subfertility care.

BACKGROUND: Internationally, several organizations have developed clinical guidelines for subfertility care to supply patients with the best possible care. However, to improve the implementation of such guidelines, we first need to gain insight into the application of clinical guidelines in daily practice. Valid quality indicators are necessary to estimate actual guideline adherence. However, none of the existing subfertility guideline programmes is accompanied by a satisfactory set of quality indicators. In this study, we develop a set of valid guideline-based quality indicators for subfertility care. METHODS: A systematic RAND-modified Delphi method was used to develop a set of key recommendations based on 10 national Dutch subfertility guidelines, international literature and existing international indicators. Experts' opinions were used to appraise recommendations regarding specific criteria such as efficacy, level of health gain, applicability and potential for care improvement. RESULTS: A representative set of 39 key recommendations was selected from 303 initial recommendations. The recommendations covered two structural and 37 procedural aspects, the latter encompassing 'indications for treatment', 'diagnostic procedures', 'treatment procedures' and 'patient information'. CONCLUSIONS: This study describes the systematic, stepwise method used to develop 39 process and structure indicators that can be used to monitor subfertility care.

Monitoring reproductive health in Europe: what are the best indicators of reproductive health? A need for evidence-based quality indicators of reproductive health care.

Monitoring reproductive health by the Reprostat indicators in Europe will facilitate the transparency of reproductive health as well as comparisons over time and between countries. However, for the monitoring and improvement of reproductive health care, we suggest the systematic development of evidence-based quality indicators, especially process and structure indicators.

Long-term efficacy of macroplastique injection for the treatment of urinary incontinence in males and females

Objective To evaluate the long-term efficacy of endoscopic injection of Macroplastique (Polydimethylsiloxane; PDMS) in male and female urinary incontinence (UI). Patients and Methods A total of 87 patients with different causes of urinary incontinence have been treated by endoscopic injection of PDMS at our department between 1997 and 2001. The group consisted of 39 male and 48 female patients with a mean age of 58 and 44 years; respectively. All patients underwent a sophisticated history taking including urodynamics and were instructed to complete a pre- and postoperative voiding diary. The results were evaluated by questionnaire at 1; 6; 12 and 24 months after injection. The outcome was classified as dry in all circumstances; improved or failed. Results At one month; 5 male (13) and 10 female (21) patients were dry; while 27 males and 29 females had improved and treatment had failed in 7 males (18) and 9 females (19). At the last follow-up (mean injections = 2.5); 12 males patients (31) and 27 female patients (56) were classified as dry; 18 males (46) and 14 females (29) were improved; while in 9 males (23) and 7 females (15) the procedure had failed. The overall success rate (dry and improved) was 77for the males and 85for the females. Conclusion The use of PDMS (Macroplastique) is a good and effective alternative for the treatment of intrinsic sphincter deficiency in male and female patients. The implants do not lose volume over time and have a good long-term effect

"Le traitement de la stenose uretrale d'origine tuberculeuse par sonde en ""double J""."

Objective: To precise the clinical features and evaluate the accuracy of treatment by JJ endo-prsthesis associated with antituberculous medications and more or less corticoid treatment. Patients and Methods: From January 1992 to December 2001; 12 patients presenting with ureteral strictures due to tuberculosis were treated by JJ catheter for a mean of 12 months in association with antituberculous medication for 8 months and corticoid treatment in 2 cases. The population included 6 males and 6 females aged 20 - 73 years (mean age: 40 years). Results: The most frequent clinical expressions were pain (66.66) and haematuria (41.6). The stricture was unilateral and unifocal in 4 casers; unilateral and bifocal in 3 cases; multifocal in 3 cases. The controlateral kidney was normal in 9 cases and mastic in 3 cases. The stricture was bilateral in 2 cases; located on the right ureter in 6 cases and on the left side in 4 cases. The outcome was favourable in 9 cases with complete disappearance of the stricture in 4 cases; a partial regression of the stricture and the pyelo-calyceal dilatation in 5 cases; while the condition of the remaining 3 cases deteriorated 6 months after removal of the JJ catheter leading to reconstructive surgery using a Boari flap (1 case); a psoas hitch (1 case) and uretero-pelvic junction plastic surgery (1 case). Conclusion: JJ endoprosthesis associated with antituberculous medication is proposed as an alternative treatment to classic surgery. A corticoid treatment used early can be helpful to reduce the stricture

One-stage anterior urethroplasty.

PURPOSE: A deficient urethral segment was replaced with penile skin during a 1-stage procedure in patients with a long, tight urethral stricture, multiple attempts at hypospadias repair or severe hypospadias and circumcision. MATERIALS AND METHODS: In 29 patients a pedicled circumferential strip of distal penile skin was used to construct a neourethral floor. The roof was formed by regeneration of the epithelium from the edges of the floor over Buck's fascia. In our series the urethra was reconstructed because of an anterior urethral stricture in 11 patients, multiple failed hypospadias repairs in 6 and severe hypospadias with circumcision in 12. RESULTS: A neourethra of sufficient caliber and length was constructed with minimal postoperative complications in all patients. There were 2 cases of urethrocutaneous fistula at the subcoronal region, 1 meatal stenosis, 1 persistent chordee and 1 small distal penile skin patch slough that required only prolonged dressings. Mean followup was 19 months. CONCLUSIONS: Our urethroplasty technique can be used to correct various types of anterior urethral stricture or hypospadias associated with insufficient penile or preputial skin.