Value of Oxygenation Index in Selecting Neonates for Thoracoscopic Repair of Congenital Diaphragmatic Hernia

Introduction: The major obstacles for routine application of thoracoscopic repair for congenital diaphragmatic hernia (CHH) in neonates include intraoperative hypercarbia, acidosis and conversion to open surgery. Therefore, strict preoperative selection criteria should be followed for successful primary thoracoscopic repair of the diaphragm and achievement of minimal conversion rate. Materials and Methods: A prospective study was conducted from April 2016 to March 2018, where all neonates confirmed to have CDH were assessed by a specialized anaesthesia team for the possibility of undergoing thoracoscopic repair. In order to assess the severity of persistent pulmonary hypertension (PPH), oxygenation index (OI) was used and babies who had OI <5 were considered to have mild pulmonary hypertension; and consequently underwent thoracoscopic repair. Results: Twenty nine CDH cases met the selection criteria; hence, they underwent thoracoscopic repair. Primary diaphragmatic repair was successfully performed thoracoscopically in all neonates without perioperative complication. Conversion to open repair occurred in 3 cases, with causes related to surgical factors. Recurrence was discovered in 1 case only. Conclusion: While choosing candidates for thoracoscopic CDH repair in neonates, OI is a reliable indicator as it clarifies neonates who have good preoperative pulmonary functio

Current Review of Medical Research in Developing Countries: A Case Study from Egypt

It is amazing to see how medical science has progressed. Medical research is now cross-national and cross-cultural, the relentless progress of globalization poses complex ethical questions for those wishing to do medical research in developing countries. In developing countries, poverty, endemic diseases, and a low level of investment in health care systems influence both the ease of performing and the selection of trials that can benefit the people of the countries. In this chapter, we present an overview of medical research situation in developing countries with critique of different clinical trials that was conducted in Egypt after review. Egypt has 41 universities and 94 health related medical schools. There are 24 faculties of medicine with up to 34 departments in each. Clinical research is an essential mandate for getting Master, Doctorate Degrees, and for promotion of faculty members. In Egypt, the Profession Ethics Regulations issued by the Ministry of Health (MOH) No. 238/2003 was endorsed and maintained in Law 71/2009. Beside these regulations, more than 56 Institutional Review Board (IRB) have been registered. The Egyptian Network of Research Ethics Committees (ENREC) was created in 2008. Yet, in the absence of robust legislative constraints, there is no clear way to avoid violations. Our experience in Tanta Faculty of Medicine is also highlighted in this chapter

FPGA Implementation of a Reconfigurable Viterbi Decoder for WiMAX Receiver

Field Programmable Gate Array technology (FPGA) is a highly configurable option for implementing many sophisticated signal processing tasks in Software Defined Radios (SDRs). Those types of radios are realized using highly configurable hardware platforms. Convolutional codes are used in every robust digital communication system and Viterbi algorithm is employed in wireless communications to decode the convolutional codes. Such decoders are complex and dissipate large amount of power. In this paper, a low power-reconfigurable Viterbi decoder for WiMAX receiver is described using a VHDL code for FPGA implementation. The proposed design is implemented on Xilinx Virtex-II Pro, XC2vpx30 FPGA using the FPGA Advantage Pro package provided by Mentor Graphics and ISE 10.1 by Xilinx

Prediction of Length of Postoperative Ventilation in CDH Survivors; Preoperative and Operative Variables

Background/Purpose: The period taken for complete weaning from ventilation in cases of repaired congenital diaphragmatic hernia (CDH) varies greatly. We tried to relate the endo-tracheal tube removal time (ETTRT) in these cases with the different variables; both preoperative and operative. Materials & Methods: This is a retrospective study of cases of CDH survivors managed by the authors over the period from January 2003 till February 2010. The preoperative variables included gestational age, gender, birth weight, Apgar score, the time of intubation, the ventilation strategy, the presence of a significant PDA in the ECHO study and the time-lapse till surgery. The operative variables (all by laparotomy approach) included the side of the hernia, the herniated contents, the presence of a sac, the insertion of a chest tube and the degree of abdominal wall stretch required. The successful weaning from ventilation and ETTRT were classified into two groups; ≤7 days and > 7 days postoperatively. Results: During the study period, 26 cases were included (21 Males and 5 females). The ETTRT ranged from 2 to 23 days (mean=7.7 ±7.15). Among the variables studied; the statistically significant ones (P value < 0.05) were Apgar score at 1 minute (preoperatively) and the need for "vigorous" abdominal wall stretch (operatively). Conclusion: Apgar score of less than 8 at 1 minute; preoperatively, and the need for "vigorous" abdominal wall stretch; operatively, were associated with delayed weaning from ventilation in CDH survivors. This could have a predictive value in the management of these cases.Index Word: Congenital diaphragmatic hernia, Mechanical ventilation weaning, Endo-tracheal tube removal

Structural and dynamic determinants for highly selective RET kinase inhibition reveal cryptic druggability.

The structural and dynamic determinants for highly selective RET kinase inhibition are poorly understood. Here we demonstrate by applying an integrated structural, computational and biochemical approach that the druggability landscape of the RET active site is determined by the conformational setting of the ATP-binding (P-) loop and its coordination with the αC helix. Open and intermediate P-loop structures display additional druggable vulnerabilities within the active site that were not exploited by first generation RET inhibitors. We identify a cryptic pocket adjacent to the catalytic lysine formed by K758, L760, E768 and L772, that we name the post-lysine pocket, with higher druggability potential than the adenine-binding site and with important implications in the regulation of phospho-tyrosine kinase activity. Crystal structure and simulation data show that the binding mode of highly-selective RET kinase inhibitors LOXO-292 and BLU-667 is controlled by a synchronous open P-loop and αC-in configuration that allows accessibility to the post-lysine pocket. Molecular dynamics simulation show that these inhibitors efficiently occupy the post-lysine pocket with high stability through the simulation time-scale (300 ns), with both inhibitors forming hydrophobic contacts in the pocket further stabilized by pi-cation interactions with the catalytic K758. Engineered mutants targeting the post-lysine pocket impact on inhibitor binding and sensitivity, as well as RET tyrosine kinase activity. The identification of the post-lysine pocket as a cryptic druggable vulnerability in the RET kinase and its exploitation by second generation RET inhibitors has important implications for future drug design and the development of personalized therapies for patients with RET-driven cancers.We thank the Centro Nacional de Investigaciones Oncológicas (CNIO), which is supported by the Instituto de Salud Carlos III and recognized as a “Severo Ochoa” Centre of Excellence (ref. CEX2019-000891-S, awarded by MCIN/AEI/ 10.13039/501100011033) for core funding and supporting this study. This work was further supported by projects: BFU2017-86710-R funded by MCIN/ AEI /10.13039/501100011033 and ERDF “A way of making Europe”, PID2020-117580RB-I00 funded by MCIN/ AEI /10.13039/501100011033, RYC-2016-1938 funded by MCIN/AEI /10.13039/501100011033 and ESF “Investing in your future”, and a Marie Curie WHRI-ACADEMY International grant (number 608765) to IP-M and a CNIO-Friends predoctoral Carmen Gloria Bonnet Fellowship to MAS.N

Thermodynamic Investigation and Mixed Ligand Complex Formation of 1,4-Bis-(3-aminopropyl)-piperazine and Biorelevant Ligands

Thermodynamic parameters for protonation of 1,4-bis(3-aminopropyl)-piperazine (BAPP) and its metal complexation with some divalent metal ions were determined in aqueous solution at constant ionic strength (0.1 M NaNO3) using a potentiometric technique. The order of –ΔG0 and –ΔH0 was found to obey , in accordance with the Irving-Williams order. The formation equilibria of zinc (II) complexes and the ternary complexes Zn(BAPP)L, where L = amino acid, amides, or DNA constituents), have been investigated. Ternary complexes are formed by a simultaneous mechanism. The concentration distribution of the complexes in solution was evaluated as a function of pH. Stoichiometry and stability constants for the complexes formed are reported and discussed. The stability of ternary complexes was quantitatively compared with their corresponding binary complexes in terms of the parameter Δlog K

Heavy Metals Can either Aid or Oppose the Protective Function of the Placental Barrier

BACKGROUND: In developing countries, toxic heavy metals are a threatening catastrophe to human health, particularly in the vulnerable group of pregnant mothers and their fetuses. Fortunately, the placenta can be a protective barrier to the fetuses. AIM: To explore the relationship between serum lead, cadmium and arsenic levels in pregnant mothers and their newborns, to address the placental barrier in this situation. METHODS: A cross-sectional study was conducted on 100 pregnant mothers at the time of labour and their newborns. Serum cadmium, lead, and arsenic levels were measured using the Inductively Coupled Plasma Mass Spectrometry. RESULTS: All the studied heavy metals concentrations showed a significant elevation in the maternal blood relative to the cord blood. There was a significant association between the maternal lead and both fetal lead and arsenic. Meanwhile, a negative but insignificant correlation was recorded between the maternal cadmium and each of the fetal cadmium, lead, and arsenic. CONCLUSION: The study findings indicated a weak relation between maternal and fetal blood heavy metals, except for the influence of maternal lead, so it can be assumed that the placental barriers are partially protective against those toxic pollutants, putting into consideration the influence of their different natures

Role of Imaging and AI in the Evaluation of COVID-19 Infection: A Comprehensive Survey

Coronavirus disease 2019 (COVID-19) is a respiratory illness that started and rapidly became the pandemic of the century, as the number of people infected with it globally exceeded 253.4 million. Since the beginning of the pandemic of COVID-19, over two years have passed. During this hard period, several defies have been coped by the scientific society to know this novel disease, evaluate it, and treat affected patients. All these efforts are done to push back the spread of the virus. This article provides a comprehensive review to learn about the COVID-19 virus and its entry mechanism, its main repercussions on many organs and tissues of the body, identify its symptoms in the short and long terms, in addition to recognize the role of diagnosis imaging in COVID-19. Principally, the quick evolution of active vaccines act an exceptional accomplishment where leaded to decrease rate of death worldwide. However, some hurdels still have to be overcome. Many proof referrers that infection with CoV-19 causes neurological dis function in a substantial ratio of influenced patients, where these symptoms appear severely during the infection and still less is known about the potential long term consequences for the brain, where Loss of smell is a neurological sign and rudimentary symptom of COVID-19. Hence, we review the causes of olfactory bulb dysfunction and Anosmia associated with COVID-19, the latest appropriate therapeutic strategies for the COVID-19 treatment (e.g., the ACE2 strategy and the Ang II receptor), and the tests through the follow-up phases. Additionally, we discuss the long-term complications of the virus and thus the possibility of improving therapeutic strategies. Moreover, the main steps of artificial intelligence that have been used to foretell and early diagnose COVID-19 are presented, where Artificial intelligence, especially machine learning is emerging as an effective approach for diagnostic image analysis with performance in the discriminate diagnosis of injuries of COVID-19 on multiple organs, comparable to that of human practitioners. The followed methodology to prepare the current survey is to search the related work concerning the mentioned topic from different journals, such as Springer, Wiley, and Elsevier. Additionally, different studies have been compared, the results are collected and then reported as shown. The articles are selected based on the year (i.e., the last three years). Also, different keywords were checked (e.g., COVID-19, COVID-19 Treatment, COVID-19 Symptoms, and COVID-19 and Anosmia)