BACKGROUND The anterior talofibular ligament(ATFL)is the most commonly injured ligament in ankle sprains.While most individuals recover with conservative management,some patients develop persistent pain and instabilit...BACKGROUND The anterior talofibular ligament(ATFL)is the most commonly injured ligament in ankle sprains.While most individuals recover with conservative management,some patients develop persistent pain and instability from chronic ATFL tears.Surgical repair is often required,and minimally invasive techniques are gaining popularity.AIM To evaluate the clinical outcomes of a novel,totally percutaneous(TP)modified Broström repair(MBR)for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.METHODS This retrospective study analyzed 20 patients(14 males,6 females;mean age,28.7 years)who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center.All patients had persistent pain and instability for at least 3 months despite conservative treatment.Diagnosis was confirmed by magnetic resonance imaging,arthroscopy,and stress testing.TP-MBR was performed using suture anchors and percutaneous ligament advancement.Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.RESULTS All procedures were completed successfully with no intraoperative complications.At a mean follow-up of 1.5 years,patients showed significant improvements in American Orthopaedic Foot and Ankle Society score(from 39.85 to 84.4;P<0.001)and Karlsson scores(from 43.8 to 87.4;P<0.001).All patients returned to pre-injury activity levels with resolution of instability.The technique resulted in minimal tissue trauma,reduced operative time,accelerated recovery,and excellent cosmetic outcomes.No recurrences or major complications occurred.CONCLUSION TP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears.It offers the benefits of a minimally invasive approach,including less trauma and faster rehabilitation,making it a valuable option for appropriately selected patients.展开更多
Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in ...Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.展开更多
Objective: The purpose of this work is to examine the usefulness of the topological approach for analysis of current density maps during ST-T interval in detection of coronary artery disease (CAD) in patients with pro...Objective: The purpose of this work is to examine the usefulness of the topological approach for analysis of current density maps during ST-T interval in detection of coronary artery disease (CAD) in patients with proved CAD but normal results of routine tests. Materials and Methods: The patient group included 123 patients. Coronary angiography was done due to chest pain. The control group consisted of 124 healthy volunteers. The MCG test was done by 4-channels MCG system installed at unshielded setting. An integral topological index Kideal, consisting of 4 parameters, has been counted. Results and Conclusions: It is shown that Kideal was higher in patient group compared to control one. Sensitivity was 87%, and specificity was 64%. The topological analysis of MCG current density maps is a valuable tool in noninvasive detection of CAD in difficult-to-diagnose patients with uninformative results of routine tests.展开更多
Global atmospheric and oceanic perturbations and local weather variability induced factors highly alter the rainfall pattern of a region. Such factors result in extreme events of devastating nature to mankind. Rainfal...Global atmospheric and oceanic perturbations and local weather variability induced factors highly alter the rainfall pattern of a region. Such factors result in extreme events of devastating nature to mankind. Rainfall Intensity Duration Frequency (IDF) is one of the most commonly used tools in water resources engineering particularly to identify design storm event of various magnitude, duration and return period simultaneously. In light of this, the present study is aimed at developing rainfall IDF relationship for entire Rwanda based on selected twenty six (26) rainfall gauging stations. The gauging stations have been selected based on reliable rainfall records representing the different geographical locations varying from 14 to 83 years of record length. Daily annual maximum rainfall data has been disaggregated into sub-daily values such as 0.5 hr, 1 hr, 3 hr, 6 hr and 12 hr and fitted to the probability distributions. Quantile estimation has been made for different return periods and best fit distribution is identified based on least square standard error of estimate. At-site and regional IDF parameters were computed and subsequent curves were established for different return period. The moment ratio diagram (MRD) and L-moment ratio diagram (LMRD) methods have been used to fit frequency distributions and identify homogeneous regions for observed 24-hr maximum annual rainfall. The rainfall stations have been divided into five homogeneous rainfall regions for all 26 stations. The results of present analysis can be used as useful information for future water resources development planning purposes.展开更多
Background:This study examines the relationship between coping strategies and symptoms of anxiety or depression among Dutch servicemembers deployed to Afghanistan.Methods:Coping strategies were assessed in 33 battlefi...Background:This study examines the relationship between coping strategies and symptoms of anxiety or depression among Dutch servicemembers deployed to Afghanistan.Methods:Coping strategies were assessed in 33 battlefield casualties(BCs)and the control group(CTRLs)of 33 uninjured servicemembers from the same combat units using the Cognitive Emotion Regulation Questionnaire.A factor analysis was performed,and two clusters of coping strategies were derived,namely,adaptive and maladaptive coping.Symptoms of anxiety and depression were evaluated using the depression and anxiety subscales of the Symptom Checklist-90-Revised.Correlations between coping and symptoms of anxiety and between coping and symptoms of depression were calculated,and a logistic regression was performed.Results:A moderate correlation was observed between maladaptive coping and symptoms of anxiety in the BC group(r=0.42)and among the CTRLs(r=0.56).A moderate correlation was observed between maladaptive coping and symptoms of depression in both groups(r=0.55).The statistical analysis for the total sample(BCs and CTRLs)demonstrated no association between coping and symptoms of anxiety or depression.Conclusions:A correlation but no association was observed between maladaptive coping and mental health disorders in deployed Dutch servicemembers.Further research should focus on constructing cluster profiles of coping strategies and associating them with mental health outcomes and reintegration into society.展开更多
The Mesoamerican Ministers of Health have set 2020 as the target for malaria elimination to be achieved in the region. Imported malaria cases are a potential threat to countries attempting elimination or working to pr...The Mesoamerican Ministers of Health have set 2020 as the target for malaria elimination to be achieved in the region. Imported malaria cases are a potential threat to countries attempting elimination or working to prevent resurgence. We report the first imported Plasmodium ovale infection with molecular confirmation in Central America, which occurred in a Guatemalan soldier that had been deployed in Africa. The obstacles for its diagnosis using the standard microscopy technique and the need to improve its detection are discussed.展开更多
Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investig...Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021.In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones,B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow(AS)and twinkle artifacts(TA)as possible signs of stone(s)in ureter.Results:While the sensitivity and specificity of AS and TA were higher than 90%in patients with stones greater than 5 mm;positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%.The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm.At the same time,the diagnostic values of TA and AS for middle ureter stones were very limited.The most prevalent clinico-radiological variants of ureteric colic were types I,III,and V being observed in 39%,28% and 21% cases,respectively.Conclusion:Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm.The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm.Therefore,clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.展开更多
Electrocardiogram(ECG)signal is a measure of the heart’s electrical activity.Recently,ECG detection and classification have benefited from the use of computer-aided systems by cardiologists.The goal of this paper is ...Electrocardiogram(ECG)signal is a measure of the heart’s electrical activity.Recently,ECG detection and classification have benefited from the use of computer-aided systems by cardiologists.The goal of this paper is to improve the accuracy of ECG classification by combining the Dipper Throated Optimization(DTO)and Differential Evolution Algorithm(DEA)into a unified algorithm to optimize the hyperparameters of neural network(NN)for boosting the ECG classification accuracy.In addition,we proposed a new feature selection method for selecting the significant feature that can improve the overall performance.To prove the superiority of the proposed approach,several experimentswere conducted to compare the results achieved by the proposed approach and other competing approaches.Moreover,statistical analysis is performed to study the significance and stability of the proposed approach using Wilcoxon and ANOVA tests.Experimental results confirmed the superiority and effectiveness of the proposed approach.The classification accuracy achieved by the proposed approach is(99.98%).展开更多
In this editorial,I comment on the article conducted by Yang and Woo.Mental health in older adults remains underserved and underexamined,with final decades shaped by cumulative life stressors,chronic conditions,and so...In this editorial,I comment on the article conducted by Yang and Woo.Mental health in older adults remains underserved and underexamined,with final decades shaped by cumulative life stressors,chronic conditions,and social determinants that disproportionately affect marginalized communities.In this study,I would like to synthesize current evidence on the prevalence,presentation,and trajectories of mental health concerns among older adults,highlighting common challenges such as late-life depression,anxiety,cognitive concerns,and underutilization of care.I am going to examine barriers to outreach and treatment,including stigma,cultural and linguistic mismatches,access limitations,and gaps in geriatric mental health services.The analysis in the paper identifies promising pathways to improve outcomes:Community-engaged interventions,culturally tailored care models,integration of mental health with primary and geriatric care,and policy reforms to expand coverage and reduce disparities.As a conclusion,with actionable recommendations for clinicians,researchers,policymakers,and community organizations to break the silence,enhance early detection,and foster resilient aging through equitable,person-centered approaches.展开更多
With the increasing demand for secure infrastructure such as hydrogen refueling stations,chemical plants,and energy storage systems,the need for protective structures capable of withstanding close-in detonations has b...With the increasing demand for secure infrastructure such as hydrogen refueling stations,chemical plants,and energy storage systems,the need for protective structures capable of withstanding close-in detonations has become more critical.Existing design guidelines for protective walls(e.g.,UFC 3-340-02)primarily address mid-and far-field explosions,providing limited insights into near-field effects.Considering the effect of slight slopes(<40°)on reducing maximum reflected overpressure is deemed negligible.This study investigated the effectiveness of a reinforced concrete(RC)modular protection system(MPS)incorpo rating a diagonally tapered wall in attenuating re flected overpressures from closein detonations.Full-scale field experiments using a 51.3 kg TNT charge,representing the explosion energy of a typical hydrogen vessel rupture,demonstrated that a wall with a 7°slope significantly outperformed a vertical wall of equivalent concrete volume in terms of blast resistance.Observed structural responses included cracking,horizontal shear failure,and overturning.Complementary simulations using a validated computational fluid dynamics(CFD)model showed that the tapered wall reduced peak overpressure by 30%-40%compared to an equivalent vertical wall.This result highlights the potential of minor geometric modifications to enhance blast resilience.The tapered design effectively redirects incident blast waves,reducing localized damage while also conserving material,thus preserving modular benefits such as ease of transport and reusability.These findings suggest that diagonally tapered RC-based MPSs can offer a practical and resilient solution for industrial and military applications subject to near-field or sequential blast threats.展开更多
Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination thera...Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previousstudy, early initiation of the combination therapy was associated with better outcomes. Therefore, weperformed a new analysis to assess the difference in hearing outcome between patients in whomcombination therapy was started within two days, versus after more than two days.Methods: A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relativehearing improvement between first and last audiograms were calculated for all affected frequencies(defined as loss of 20 dB on initial audiogram). We also determined the amount of patients whorecovered to the level of Dutch military requirement, and performed speech discrimination tests.Results: In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5years (IQR 23e29). The median time to initiation of therapy with corticosteroids and HBOT were one andtwo days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on allaffected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB(gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearingimprovement when HBOT was started in 2 days, compared to >2 days.Conclusion: Our analysis shows results in favor of early initiation ( 2 days) of the combination treatmentof HBOT and corticosteroids in patients with AAT.展开更多
This work has a two-fold purpose.On the one hand,the theoretical formulation of a three-dimensional(3D)acoustic propagation model for shallow waters with a constant sound speed is presented,based on the boundary eleme...This work has a two-fold purpose.On the one hand,the theoretical formulation of a three-dimensional(3D)acoustic propagation model for shallow waters with a constant sound speed is presented,based on the boundary element method(BEM),which uses a half-space Green function instead of the more conventional free-space Green function.On the other hand,a numerical implementation is illustrated to explore the formulation in simple idealized cases,controlled by a few parameters,which provides necessary tests for the accuracy and performance of the model.The half-space Green's function,which has been previously used in scattering and diffraction,adds terms to the usual expressions of the integral operators without altering their continuity properties.Verifications against the wavenumber integration solution of the Pekeris waveguide suggest that the model allows an adequate prediction for the acoustic field.Likewise,numerical experiments in relation to the necessary mesh size for the description of the water-marine sediment interface lead to the conclusion that a transmission loss prediction with acceptable accuracy can be obtained with the use of a limited mesh around the desired evaluation region.展开更多
Metamaterial Antennas are a type of antenna that uses metamaterial to enhance performance.The bandwidth restriction associated with small antennas can be solved using metamaterial antennas.Machine learning is gaining ...Metamaterial Antennas are a type of antenna that uses metamaterial to enhance performance.The bandwidth restriction associated with small antennas can be solved using metamaterial antennas.Machine learning is gaining popularity as a way to improve solutions in a range of fields.Machine learning approaches are currently a big part of current research,and they’re likely to be huge in the future.The model utilized determines the accuracy of the prediction in large part.The goal of this paper is to develop an optimized ensemble model for forecasting the metamaterial antenna’s bandwidth and gain.The basic models employed in the developed ensemble are Support Vector Regression(SVR),K-NearestRegression(KNR),Multi-Layer Perceptron(MLP),Decision Trees(DT),and Random Forest(RF).The percentages of contribution of these models in the ensemble model are weighted and optimized using the dipper throated optimization(DTO)algorithm.To choose the best features from the dataset,the binary(bDTO)algorithm is exploited.The proposed ensemble model is compared to the base models and results are recorded and analyzed statistically.In addition,two other ensembles are incorporated in the conducted experiments for comparison.These ensembles are average ensemble and K-nearest neighbors(KNN)-based ensemble.The comparison is performed in terms of eleven evaluation criteria.The evaluation results confirmed the superiority of the proposed model when compared with the basic models and the other ensemble models.展开更多
GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who h...GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized—as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month—despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia. Ensure that people with T2DM and ASCVD, HF, or CKD are treated appropriately with an SGLT-2i or GLP-1 RA. This approach should be initiated independent of background therapy, glycaemic control, or individualized treatment goals. Healthcare professionals should do their best to prevent clinical inertia in T2DM to help people with T2DM achieve better glycemic control and prevent or delay diabetes-related complications. The availability of oral forms of GLP-1RA medications could help combat this problem of clinical inertia to start GLP-1RA at the right time, as patients prefer oral to injectable forms. The availability of oral GLP-1RA can help in starting this class early and encourage healthcare professionals in prescribing it at the right time. Moreover, it can help those patients who fear of the injections. The panel recommends the oral GLP-1RA semaglutide to be used early and encourage healthcare professionals in prescribing it at the right time. The injectable form can be preserved for further intensification of therapy whenever needed as add-on therapy particulary for poly-medicated patients for better compliance at this stage. .展开更多
Photoelectric measurements are used to obtain additional information on the transportation mechanism of Schottky barrier structures. The main purpose of the study is to investigate the photoelectric properties of Shot...Photoelectric measurements are used to obtain additional information on the transportation mechanism of Schottky barrier structures. The main purpose of the study is to investigate the photoelectric properties of Shottky diodes based on PtSi - n - Si and PtSi - p - Si contacts.展开更多
Mediterranean spotted fever(MSF)has been diagnosed clinically in the Crimean Peninsula since the 1930s.We describe the recent illness of an elderly patient from Crimea who had developed a classic triad of MSF symptoms...Mediterranean spotted fever(MSF)has been diagnosed clinically in the Crimean Peninsula since the 1930s.We describe the recent illness of an elderly patient from Crimea who had developed a classic triad of MSF symptoms consisting of fever,maculopapular rash,and eschar.Clinical diagnosis of rickettsiosis was confirmed using real-time PCR and sequencing of 4 Rickettsia protein genes.The strain causing clinical illness was characterized as Rickettsia conorii subspecies conorii Malish 7.This report corroborates the utility of eschar swab material as a source of DNA for PCR-based diagnostics that enables timely patient treatment and management.展开更多
Background:Fingerprints are unique,persistent,and left on every object touched by bare hands.It can be used as a rapid and inexpensive method for identification.This study focuses on fingerprint white line counts(FWLC...Background:Fingerprints are unique,persistent,and left on every object touched by bare hands.It can be used as a rapid and inexpensive method for identification.This study focuses on fingerprint white line counts(FWLCs)and its importance in sex estimation.Aim and Objectives:This study aimed to clarify the potential ofFWLC in sex estimation among Egyptian and Malaysian ethnic groups.Materials and Methods:The study was conducted on two hundred adult participants,one hundred Egyptians and one hundred Malaysians(50 females and 50 males).Inked fingerprints of ten fingers were obtained from each participant then FWLC was extracted manually for each fingerprint.Results:The mean of females FWLC was significantly higher than males in all fingers in both populations.FWLC of the left index was the most significant predictor of sex in Egyptians,with an accuracy of 82%for males and 78%for females.FWLC more than seven in this digit was an absolute indication of being a female.The most significant predictors of sex in the Malaysian population were the left index and right ring with an accuracy of 80%for males and 71.4%for females and FWLC above six and seven in these fingers,respectively,was an absolute indication of being a female.The absence ofFWLC was more common in males than females in all digits.Conclusions:FWLC is a reliable predictor of sex among adult Egyptian and Malaysian ethnic groups,and females tend to have more FWLC.展开更多
Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use ...Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their preservation.The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves.Methods:Twenty three patients with various skull base tumors(chordomas,neuromas,pituitary adenomas,meningiomas,cholesteatomas)underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian Federation from 2013 to 2018.During the surgical interventions,mapping and identification of the cranial nerves were carried out using electromyography in triggered mode.The effectiveness of the method was evaluated based on a comparison with a control group(41 patients).Results:In the main group of patients,44 nerves were examined during surgery using triggered electromyography.During the study,the III,V,VI,VII,and XII cranial nerves were identified intraoperatively.Postoperative cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control group.The average length of hospitalization was 9 days.Conclusion:We did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits(p=0.56),but the odds ratio(0.6)suggests a less frequent occurrence of complications in the study group.Based on our experience,the trigger electromyography methodology appears quite promising and requires further research.展开更多
Objectives:The aim of this study was to evaluate the effects of the combination of bacteriophage therapy with antibiotics and bacteriophage treatment alone on relieving clinical symptoms of chronic recurrent cystitis ...Objectives:The aim of this study was to evaluate the effects of the combination of bacteriophage therapy with antibiotics and bacteriophage treatment alone on relieving clinical symptoms of chronic recurrent cystitis caused by multidrug-resistant bacteria.Materials and methods:This clinical trial compared the treatment methods of 217 female patients with chronic recurrent cystitiscaused by multidrug-resistant bacteria,who were investigated from June 2020 to May 2023.Patients were allocated into 4 groups:group I:received bacteriophage(Sextaphage)therapy alone;groupⅡ:received a combination of bacteriophages(Sextaphage)andfurazidin;groupⅢ:received a combination of bacteriophage(Sextaphage)and furazidin with cefixime;and group Ⅳ:received furazidinand cefixime(without bacteriophage).The primary outcome included changes in the acute cystitis symptom scale and the pain visualanalog scale,which were completed on days 7 and 14 following treatment.Secondary outcome measures included bladder diary records of urinary symptoms,median voided volumes,level of bacteriuria,and degree of leukocyturia.Results:Initially,217 female patients were presented during baseline visits.Those who did not meet the criteria inclusions were excluded,and 178 female patients were included in the final analysis.Statistically significant improvements from baseline in acute cystitissymptom scale scores for differential,typical symptoms,and quality of life domains were observed after 14 days of treatment in groupsⅡ,Ⅲ,and Ⅳ.The pain level measured on the 14th day with the visual analog scale significantly decreased in groupsⅡ,Ⅲ,and Ⅳ comparedwith group Ⅰ.The patients of group Ⅰ had a reduction of mean level bacteriuria of Escherichia coli from 106 to 102 CFU/mL at 14 days oftherapy.Significant improvement of voided volume from baseline was observed in groupsⅡ,Ⅲ,and Ⅳ.Episodes of urinary frequency,both daytime and night-time,reduced significantly from baseline in all 4 groups only at 14 days of treatment.Conclusions:Bacteriophage cocktail alone or with antibiotics may improve clinical symptoms in women with chronic recurrent cystitiscaused by multidrug-resistant bacterial pathogens.In addition to improving clinical symptoms,the therapy with a phage cocktail mayrestore antibiotic sensitivity and increase the efficacy of antimicrobial agents.展开更多
INTRODUCTION Respiratory syncytial virus(RSV)is the leading cause of severe acute lower respiratory tract infection(LRTI)in infants and young children,resulting in an estimated 33 million infections annually,>3 mil...INTRODUCTION Respiratory syncytial virus(RSV)is the leading cause of severe acute lower respiratory tract infection(LRTI)in infants and young children,resulting in an estimated 33 million infections annually,>3 million hospitalizations,and>100000 deaths in children under 5 years globally,with a mortality rate of up to 9%in low-resource countries,which have 99%of the global RSV mortality.1 RSV infection is associated with an increased risk of respiratory failure,admission to the ICU,mechanical ventilation,use of oxygen therapy,and death.2,3 Severe RSV-LRTI in early childhood increases the risk of long-term respiratory disorders such as repeated wheezing or asthma.展开更多
文摘BACKGROUND The anterior talofibular ligament(ATFL)is the most commonly injured ligament in ankle sprains.While most individuals recover with conservative management,some patients develop persistent pain and instability from chronic ATFL tears.Surgical repair is often required,and minimally invasive techniques are gaining popularity.AIM To evaluate the clinical outcomes of a novel,totally percutaneous(TP)modified Broström repair(MBR)for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.METHODS This retrospective study analyzed 20 patients(14 males,6 females;mean age,28.7 years)who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center.All patients had persistent pain and instability for at least 3 months despite conservative treatment.Diagnosis was confirmed by magnetic resonance imaging,arthroscopy,and stress testing.TP-MBR was performed using suture anchors and percutaneous ligament advancement.Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.RESULTS All procedures were completed successfully with no intraoperative complications.At a mean follow-up of 1.5 years,patients showed significant improvements in American Orthopaedic Foot and Ankle Society score(from 39.85 to 84.4;P<0.001)and Karlsson scores(from 43.8 to 87.4;P<0.001).All patients returned to pre-injury activity levels with resolution of instability.The technique resulted in minimal tissue trauma,reduced operative time,accelerated recovery,and excellent cosmetic outcomes.No recurrences or major complications occurred.CONCLUSION TP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears.It offers the benefits of a minimally invasive approach,including less trauma and faster rehabilitation,making it a valuable option for appropriately selected patients.
文摘Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.
文摘Objective: The purpose of this work is to examine the usefulness of the topological approach for analysis of current density maps during ST-T interval in detection of coronary artery disease (CAD) in patients with proved CAD but normal results of routine tests. Materials and Methods: The patient group included 123 patients. Coronary angiography was done due to chest pain. The control group consisted of 124 healthy volunteers. The MCG test was done by 4-channels MCG system installed at unshielded setting. An integral topological index Kideal, consisting of 4 parameters, has been counted. Results and Conclusions: It is shown that Kideal was higher in patient group compared to control one. Sensitivity was 87%, and specificity was 64%. The topological analysis of MCG current density maps is a valuable tool in noninvasive detection of CAD in difficult-to-diagnose patients with uninformative results of routine tests.
文摘Global atmospheric and oceanic perturbations and local weather variability induced factors highly alter the rainfall pattern of a region. Such factors result in extreme events of devastating nature to mankind. Rainfall Intensity Duration Frequency (IDF) is one of the most commonly used tools in water resources engineering particularly to identify design storm event of various magnitude, duration and return period simultaneously. In light of this, the present study is aimed at developing rainfall IDF relationship for entire Rwanda based on selected twenty six (26) rainfall gauging stations. The gauging stations have been selected based on reliable rainfall records representing the different geographical locations varying from 14 to 83 years of record length. Daily annual maximum rainfall data has been disaggregated into sub-daily values such as 0.5 hr, 1 hr, 3 hr, 6 hr and 12 hr and fitted to the probability distributions. Quantile estimation has been made for different return periods and best fit distribution is identified based on least square standard error of estimate. At-site and regional IDF parameters were computed and subsequent curves were established for different return period. The moment ratio diagram (MRD) and L-moment ratio diagram (LMRD) methods have been used to fit frequency distributions and identify homogeneous regions for observed 24-hr maximum annual rainfall. The rainfall stations have been divided into five homogeneous rainfall regions for all 26 stations. The results of present analysis can be used as useful information for future water resources development planning purposes.
文摘Background:This study examines the relationship between coping strategies and symptoms of anxiety or depression among Dutch servicemembers deployed to Afghanistan.Methods:Coping strategies were assessed in 33 battlefield casualties(BCs)and the control group(CTRLs)of 33 uninjured servicemembers from the same combat units using the Cognitive Emotion Regulation Questionnaire.A factor analysis was performed,and two clusters of coping strategies were derived,namely,adaptive and maladaptive coping.Symptoms of anxiety and depression were evaluated using the depression and anxiety subscales of the Symptom Checklist-90-Revised.Correlations between coping and symptoms of anxiety and between coping and symptoms of depression were calculated,and a logistic regression was performed.Results:A moderate correlation was observed between maladaptive coping and symptoms of anxiety in the BC group(r=0.42)and among the CTRLs(r=0.56).A moderate correlation was observed between maladaptive coping and symptoms of depression in both groups(r=0.55).The statistical analysis for the total sample(BCs and CTRLs)demonstrated no association between coping and symptoms of anxiety or depression.Conclusions:A correlation but no association was observed between maladaptive coping and mental health disorders in deployed Dutch servicemembers.Further research should focus on constructing cluster profiles of coping strategies and associating them with mental health outcomes and reintegration into society.
文摘The Mesoamerican Ministers of Health have set 2020 as the target for malaria elimination to be achieved in the region. Imported malaria cases are a potential threat to countries attempting elimination or working to prevent resurgence. We report the first imported Plasmodium ovale infection with molecular confirmation in Central America, which occurred in a Guatemalan soldier that had been deployed in Africa. The obstacles for its diagnosis using the standard microscopy technique and the need to improve its detection are discussed.
文摘Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021.In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones,B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow(AS)and twinkle artifacts(TA)as possible signs of stone(s)in ureter.Results:While the sensitivity and specificity of AS and TA were higher than 90%in patients with stones greater than 5 mm;positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%.The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm.At the same time,the diagnostic values of TA and AS for middle ureter stones were very limited.The most prevalent clinico-radiological variants of ureteric colic were types I,III,and V being observed in 39%,28% and 21% cases,respectively.Conclusion:Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm.The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm.Therefore,clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.
文摘Electrocardiogram(ECG)signal is a measure of the heart’s electrical activity.Recently,ECG detection and classification have benefited from the use of computer-aided systems by cardiologists.The goal of this paper is to improve the accuracy of ECG classification by combining the Dipper Throated Optimization(DTO)and Differential Evolution Algorithm(DEA)into a unified algorithm to optimize the hyperparameters of neural network(NN)for boosting the ECG classification accuracy.In addition,we proposed a new feature selection method for selecting the significant feature that can improve the overall performance.To prove the superiority of the proposed approach,several experimentswere conducted to compare the results achieved by the proposed approach and other competing approaches.Moreover,statistical analysis is performed to study the significance and stability of the proposed approach using Wilcoxon and ANOVA tests.Experimental results confirmed the superiority and effectiveness of the proposed approach.The classification accuracy achieved by the proposed approach is(99.98%).
文摘In this editorial,I comment on the article conducted by Yang and Woo.Mental health in older adults remains underserved and underexamined,with final decades shaped by cumulative life stressors,chronic conditions,and social determinants that disproportionately affect marginalized communities.In this study,I would like to synthesize current evidence on the prevalence,presentation,and trajectories of mental health concerns among older adults,highlighting common challenges such as late-life depression,anxiety,cognitive concerns,and underutilization of care.I am going to examine barriers to outreach and treatment,including stigma,cultural and linguistic mismatches,access limitations,and gaps in geriatric mental health services.The analysis in the paper identifies promising pathways to improve outcomes:Community-engaged interventions,culturally tailored care models,integration of mental health with primary and geriatric care,and policy reforms to expand coverage and reduce disparities.As a conclusion,with actionable recommendations for clinicians,researchers,policymakers,and community organizations to break the silence,enhance early detection,and foster resilient aging through equitable,person-centered approaches.
基金supported by the Dong-A University of the Republic of Korea research fund。
文摘With the increasing demand for secure infrastructure such as hydrogen refueling stations,chemical plants,and energy storage systems,the need for protective structures capable of withstanding close-in detonations has become more critical.Existing design guidelines for protective walls(e.g.,UFC 3-340-02)primarily address mid-and far-field explosions,providing limited insights into near-field effects.Considering the effect of slight slopes(<40°)on reducing maximum reflected overpressure is deemed negligible.This study investigated the effectiveness of a reinforced concrete(RC)modular protection system(MPS)incorpo rating a diagonally tapered wall in attenuating re flected overpressures from closein detonations.Full-scale field experiments using a 51.3 kg TNT charge,representing the explosion energy of a typical hydrogen vessel rupture,demonstrated that a wall with a 7°slope significantly outperformed a vertical wall of equivalent concrete volume in terms of blast resistance.Observed structural responses included cracking,horizontal shear failure,and overturning.Complementary simulations using a validated computational fluid dynamics(CFD)model showed that the tapered wall reduced peak overpressure by 30%-40%compared to an equivalent vertical wall.This result highlights the potential of minor geometric modifications to enhance blast resilience.The tapered design effectively redirects incident blast waves,reducing localized damage while also conserving material,thus preserving modular benefits such as ease of transport and reusability.These findings suggest that diagonally tapered RC-based MPSs can offer a practical and resilient solution for industrial and military applications subject to near-field or sequential blast threats.
文摘Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previousstudy, early initiation of the combination therapy was associated with better outcomes. Therefore, weperformed a new analysis to assess the difference in hearing outcome between patients in whomcombination therapy was started within two days, versus after more than two days.Methods: A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relativehearing improvement between first and last audiograms were calculated for all affected frequencies(defined as loss of 20 dB on initial audiogram). We also determined the amount of patients whorecovered to the level of Dutch military requirement, and performed speech discrimination tests.Results: In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5years (IQR 23e29). The median time to initiation of therapy with corticosteroids and HBOT were one andtwo days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on allaffected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB(gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearingimprovement when HBOT was started in 2 days, compared to >2 days.Conclusion: Our analysis shows results in favor of early initiation ( 2 days) of the combination treatmentof HBOT and corticosteroids in patients with AAT.
文摘This work has a two-fold purpose.On the one hand,the theoretical formulation of a three-dimensional(3D)acoustic propagation model for shallow waters with a constant sound speed is presented,based on the boundary element method(BEM),which uses a half-space Green function instead of the more conventional free-space Green function.On the other hand,a numerical implementation is illustrated to explore the formulation in simple idealized cases,controlled by a few parameters,which provides necessary tests for the accuracy and performance of the model.The half-space Green's function,which has been previously used in scattering and diffraction,adds terms to the usual expressions of the integral operators without altering their continuity properties.Verifications against the wavenumber integration solution of the Pekeris waveguide suggest that the model allows an adequate prediction for the acoustic field.Likewise,numerical experiments in relation to the necessary mesh size for the description of the water-marine sediment interface lead to the conclusion that a transmission loss prediction with acceptable accuracy can be obtained with the use of a limited mesh around the desired evaluation region.
文摘Metamaterial Antennas are a type of antenna that uses metamaterial to enhance performance.The bandwidth restriction associated with small antennas can be solved using metamaterial antennas.Machine learning is gaining popularity as a way to improve solutions in a range of fields.Machine learning approaches are currently a big part of current research,and they’re likely to be huge in the future.The model utilized determines the accuracy of the prediction in large part.The goal of this paper is to develop an optimized ensemble model for forecasting the metamaterial antenna’s bandwidth and gain.The basic models employed in the developed ensemble are Support Vector Regression(SVR),K-NearestRegression(KNR),Multi-Layer Perceptron(MLP),Decision Trees(DT),and Random Forest(RF).The percentages of contribution of these models in the ensemble model are weighted and optimized using the dipper throated optimization(DTO)algorithm.To choose the best features from the dataset,the binary(bDTO)algorithm is exploited.The proposed ensemble model is compared to the base models and results are recorded and analyzed statistically.In addition,two other ensembles are incorporated in the conducted experiments for comparison.These ensembles are average ensemble and K-nearest neighbors(KNN)-based ensemble.The comparison is performed in terms of eleven evaluation criteria.The evaluation results confirmed the superiority of the proposed model when compared with the basic models and the other ensemble models.
文摘GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized—as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month—despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia. Ensure that people with T2DM and ASCVD, HF, or CKD are treated appropriately with an SGLT-2i or GLP-1 RA. This approach should be initiated independent of background therapy, glycaemic control, or individualized treatment goals. Healthcare professionals should do their best to prevent clinical inertia in T2DM to help people with T2DM achieve better glycemic control and prevent or delay diabetes-related complications. The availability of oral forms of GLP-1RA medications could help combat this problem of clinical inertia to start GLP-1RA at the right time, as patients prefer oral to injectable forms. The availability of oral GLP-1RA can help in starting this class early and encourage healthcare professionals in prescribing it at the right time. Moreover, it can help those patients who fear of the injections. The panel recommends the oral GLP-1RA semaglutide to be used early and encourage healthcare professionals in prescribing it at the right time. The injectable form can be preserved for further intensification of therapy whenever needed as add-on therapy particulary for poly-medicated patients for better compliance at this stage. .
文摘Photoelectric measurements are used to obtain additional information on the transportation mechanism of Schottky barrier structures. The main purpose of the study is to investigate the photoelectric properties of Shottky diodes based on PtSi - n - Si and PtSi - p - Si contacts.
文摘Mediterranean spotted fever(MSF)has been diagnosed clinically in the Crimean Peninsula since the 1930s.We describe the recent illness of an elderly patient from Crimea who had developed a classic triad of MSF symptoms consisting of fever,maculopapular rash,and eschar.Clinical diagnosis of rickettsiosis was confirmed using real-time PCR and sequencing of 4 Rickettsia protein genes.The strain causing clinical illness was characterized as Rickettsia conorii subspecies conorii Malish 7.This report corroborates the utility of eschar swab material as a source of DNA for PCR-based diagnostics that enables timely patient treatment and management.
文摘Background:Fingerprints are unique,persistent,and left on every object touched by bare hands.It can be used as a rapid and inexpensive method for identification.This study focuses on fingerprint white line counts(FWLCs)and its importance in sex estimation.Aim and Objectives:This study aimed to clarify the potential ofFWLC in sex estimation among Egyptian and Malaysian ethnic groups.Materials and Methods:The study was conducted on two hundred adult participants,one hundred Egyptians and one hundred Malaysians(50 females and 50 males).Inked fingerprints of ten fingers were obtained from each participant then FWLC was extracted manually for each fingerprint.Results:The mean of females FWLC was significantly higher than males in all fingers in both populations.FWLC of the left index was the most significant predictor of sex in Egyptians,with an accuracy of 82%for males and 78%for females.FWLC more than seven in this digit was an absolute indication of being a female.The most significant predictors of sex in the Malaysian population were the left index and right ring with an accuracy of 80%for males and 71.4%for females and FWLC above six and seven in these fingers,respectively,was an absolute indication of being a female.The absence ofFWLC was more common in males than females in all digits.Conclusions:FWLC is a reliable predictor of sex among adult Egyptian and Malaysian ethnic groups,and females tend to have more FWLC.
文摘Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their preservation.The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves.Methods:Twenty three patients with various skull base tumors(chordomas,neuromas,pituitary adenomas,meningiomas,cholesteatomas)underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian Federation from 2013 to 2018.During the surgical interventions,mapping and identification of the cranial nerves were carried out using electromyography in triggered mode.The effectiveness of the method was evaluated based on a comparison with a control group(41 patients).Results:In the main group of patients,44 nerves were examined during surgery using triggered electromyography.During the study,the III,V,VI,VII,and XII cranial nerves were identified intraoperatively.Postoperative cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control group.The average length of hospitalization was 9 days.Conclusion:We did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits(p=0.56),but the odds ratio(0.6)suggests a less frequent occurrence of complications in the study group.Based on our experience,the trigger electromyography methodology appears quite promising and requires further research.
文摘Objectives:The aim of this study was to evaluate the effects of the combination of bacteriophage therapy with antibiotics and bacteriophage treatment alone on relieving clinical symptoms of chronic recurrent cystitis caused by multidrug-resistant bacteria.Materials and methods:This clinical trial compared the treatment methods of 217 female patients with chronic recurrent cystitiscaused by multidrug-resistant bacteria,who were investigated from June 2020 to May 2023.Patients were allocated into 4 groups:group I:received bacteriophage(Sextaphage)therapy alone;groupⅡ:received a combination of bacteriophages(Sextaphage)andfurazidin;groupⅢ:received a combination of bacteriophage(Sextaphage)and furazidin with cefixime;and group Ⅳ:received furazidinand cefixime(without bacteriophage).The primary outcome included changes in the acute cystitis symptom scale and the pain visualanalog scale,which were completed on days 7 and 14 following treatment.Secondary outcome measures included bladder diary records of urinary symptoms,median voided volumes,level of bacteriuria,and degree of leukocyturia.Results:Initially,217 female patients were presented during baseline visits.Those who did not meet the criteria inclusions were excluded,and 178 female patients were included in the final analysis.Statistically significant improvements from baseline in acute cystitissymptom scale scores for differential,typical symptoms,and quality of life domains were observed after 14 days of treatment in groupsⅡ,Ⅲ,and Ⅳ.The pain level measured on the 14th day with the visual analog scale significantly decreased in groupsⅡ,Ⅲ,and Ⅳ comparedwith group Ⅰ.The patients of group Ⅰ had a reduction of mean level bacteriuria of Escherichia coli from 106 to 102 CFU/mL at 14 days oftherapy.Significant improvement of voided volume from baseline was observed in groupsⅡ,Ⅲ,and Ⅳ.Episodes of urinary frequency,both daytime and night-time,reduced significantly from baseline in all 4 groups only at 14 days of treatment.Conclusions:Bacteriophage cocktail alone or with antibiotics may improve clinical symptoms in women with chronic recurrent cystitiscaused by multidrug-resistant bacterial pathogens.In addition to improving clinical symptoms,the therapy with a phage cocktail mayrestore antibiotic sensitivity and increase the efficacy of antimicrobial agents.
文摘INTRODUCTION Respiratory syncytial virus(RSV)is the leading cause of severe acute lower respiratory tract infection(LRTI)in infants and young children,resulting in an estimated 33 million infections annually,>3 million hospitalizations,and>100000 deaths in children under 5 years globally,with a mortality rate of up to 9%in low-resource countries,which have 99%of the global RSV mortality.1 RSV infection is associated with an increased risk of respiratory failure,admission to the ICU,mechanical ventilation,use of oxygen therapy,and death.2,3 Severe RSV-LRTI in early childhood increases the risk of long-term respiratory disorders such as repeated wheezing or asthma.
