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Marine sponges represent a valuable source of cyclodepsipeptides with anti-cancer potential.

BACKGROUND: Pneumonia is a prevailing and severe infectious disease that can lead to increased fatality. AIM: We conducted this study to assess the role of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP) in comparison to CXR and CT Chest. METHODS: An observational study on 120 patients with suspected CAP was done in the ICU of the Critical care department at Cairo University Hospital. Clinical and laboratory data were recorded on admission including different scoring systems (SOFA, APACHE II, confusion, uremia, respiratory rate and blood pressure 65, and pulmonary severity index). All patients, within 6 h of admission, were investigated by a LUS, CXR, and CT Chest. All imaging techniques were repeated after 48 h if the initial CT chest was negative. RESULTS: The study population had a mean age of 70.6 ± 6.9-years-old, most of them were male (75.8%). Using CT chest as a reference imaging tool to confirm the diagnosis of pneumonia, LUS showed 94.1% sensitivity, 97.1% specificity, positive predictive value (PPV) 98.8%, negative predictive value (NPV) 87.2%, accuracy 95.0%, and area under a curve (AUC) 0.92. LUS was found to be a highly significant imaging tool in predicting diagnosis of pneumonia (p < 0.001). Chest X-ray had 69.4% sensitivity, 94.3% specificity, PPV 96.7%, NPV 55.9%, 76.6% accuracy, and AUC 0.6 in the detection of pneumonia. CXR was found to be an insignificant Imaging tool in predicting diagnosis of pneumonia (P = 0.19). CONCLUSION: LUS is a very promising, sensitive, and feasible imaging tool in the diagnosis of CAP in comparison with CT chest.

Due to the risk of intracranial aneurysm (IA) recurrence and the potential requirement for re-treatment following endovascular treatment (EVT), radiological follow-up of these aneurysms is necessary. There is little evidence to guide the duration and frequency of this follow-up. The aim of this study was to establish the current practice in neurosurgical units in the UK and Ireland.A survey was designed with input from interventional neuroradiologists and neurosurgeons. Neurovascular consultants in each of the 30 neurosurgical units providing a neurovascular service in the UK and Ireland were contacted and asked to respond to questions regarding the follow-up practice for IA treated with EVT in their department.Responses were obtained from 28/30 (94%) of departments. There was evidence of wide variations in the duration and frequency of follow-up, with a minimum follow-up duration for ruptured IA that varied from 18 months in 5/28 (18%) units to 5 years in 11/28 (39%) of units. Young patient age, previous subarachnoid haemorrhage and incomplete IA occlusion were cited as factors that would prompt more intensive surveillance, although larger and broad-necked IA were not followed-up more closely in the majority of departments.There is a wide variation in the radiological follow-up of IA treated with EVT in the UK and Ireland. Further standardisation of this aspect of patient care is likely to be beneficial, but further evidence on the behaviour of IA following EVT is required in order to inform this process.

Background: MS is one of the most prevalent valve abnormalities in people with chronic rheumatic heart disease (RHD). The effect of Inoue and multi-track successful percutaneous balloon mitral valvuloplasty (PBMV) on the twist and untwist mechanisms of the left ventricle was evaluated using non-invasive two-dimensional speckle tracking imaging (STI). Methods: This study was conducted on patients with mitral stenosis of rheumatic origin fulfilling the criteria for PBMV. Cases were categorized into two equal groups; group 1: 30 Patients underwent PBMV using Inoue technique and group 2: 30 Patients underwent PBMV using multi-track technique. All patients were subjected to full history and clinical examination, twelve leads surface electrocardiogram (ECG) before and after the procedure, two-dimensional and Doppler echocardiography, LV twist and untwist measured by the 2D the two-dimensional speckle tracking imaging (STI) before and after the procedure and PBMV. Results: In both techniques; the mitral valve area (MVA) was highly significantly increased after balloon mitral valvuloplasty (BMV), while mean pressure gradient (MPG) and the estimated systolic pulmonary artery pressure (PAP) were highly significantly decreased. The apical rotation, basal rotation, twist and untwist were highly significantly decreased after the procedure in each technique.

Background Stress urinary incontinence (SUI) is a common disabling pelvic floor dysfunction, particularly among aging women. Magnetic resonance imaging (MRI) with dynamic sequences has been proven reliable for detecting pelvic floor weaknesses, especially with multiple compartments defects. Since surgical and non-surgical management options exist, detailed imaging analysis and comprehension of the various surgical and non-surgical interventions are crucial for surgical planning and postoperative evaluation. However, patients often present with recurrent or new symptoms after surgery, where MR imaging is necessary to detect complications in this setting. We aimed to analyze MR images pre- and postoperative/intervention using the defect-specific approach aiming at better understanding of the underlying complication and/or the cause of recurrence. Results Thirty female patients with SUI were included in the study; 20 underwent surgery, 6 were treated by physiotherapy only, while 3 patients underwent both surgery and physiotherapy and 1 patient was treated conservatively. According to their clinical symptoms, patients with successful surgical/physiotherapy outcome were 18 cases (60%), while unsuccessful group comprised of 12 cases (40%) is classified as follows: persistent complaints subgroup 7 patients (23.3%), de novo complaint subgroup 2 patients (6.7%), while the complicated subgroup is comprised of 2 patients (6.7%) and the persistent/de novo complaints subgroup of the unsuccessful group is composed of 1 case (3.3%). They all underwent MRI of the pelvic floor with a standardized technique, pre- and postoperative/physiotherapy. Changes in level III endopelvic fascia defects between the pre- and postoperative/physiotherapy studies were statistically significant (p = 0.045). Urinary bladder and uterine descent were also found statistically significant between the pre- and postoperative/physiotherapy studies (p = 0.001 and p = 0.029, respectively). Comparing successful and unsuccessful groups pre- and postoperative/therapy, levator plate angle (LPA) was found statistically significant as well (p = 0.039 preoperative and p = 0.001 postoperative). Conclusions Analysis of the pre- and postoperative static and dynamic MRI sequences along with proper understanding of the preformed intervention can pinpoint the underlying pathology leading to the recurrent or de novo symptom and/or complications. The defect-specific approach can help determine the underlying pelvic floor defect by altering the MRI techniques tailored for each patient according to their complaint.

Objective Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom. Methods A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods. Results Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it. Conclusions There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.

Heterogeneous cloud radio access network (H-CRAN) has been deemed as a promising architecture for the fifth generation wireless networks. In H-CRAN, small remote radio heads (SRRHs) are deployed underlaying the macro remote radio head (MRRH) to boost the spectral efficiency. H-CRANs with dense RRHs suffer from severe inter-cell interference due to the random deployment of dense SRRHs, which limits its performance. In this paper, we propose an Edge-Aware RRH-Cooperation (EARC) scheme to mitigate the impact of both the cross-tier and co-tier interference. We partition the users into two groups, Cell Edge Device (CED) and Non-cell Edge Device (NED). These two groups, CED and NED, are mapped into two association modes, dual-association and single-association mode, respectively. In single-association mode, the NED associates with the RRH that provides the maximum received signal. On the other hand, in the dual-association mode, the CED associates with the two strongest RRHs where the two RRHs may belong to the same or different tier(s). Using tools from stochastic geometry, we quantify the performance gains of the proposed EARC scheme in terms of outage probability and ergodic rate. To further show the efficacy of the proposed scheme, we compare it to four schemes developed in the literature.

Background The Sickle cell disease (SCD) is a hemoglobinopathy that is recessively inherited commonly among people of Equatorial African, Saudi Arabian, and Mediterranean ancestry. It is characterized by chronic hemolytic anemia and intermittent vaso-occlusive events. The stroke is a common complication of SCD, which occurs in approximately 7% of children with SCD. The Transcranial Doppler ultrasonography is the only noninvasive examination that provides a reliable evaluation of intracranial blood flow patterns in real time with no need for sedation of the patient. The TCD can identify children with the highest risk of the first-ever stroke and those in need of prophylactic blood transfusion, as the blood transfusion is not in the protocol of management of SCD till now but just after complication occurrence. So, it is important to know if the chronicity and the regularity of the transfusion are useful or not. Results Sixty-nine patients diagnosed with sickle cell disease, recruited from the pediatric hematology outpatient clinic, over a period of 7 months, with age 2–13 years, examined by transcranial Doppler ultrasound. 44.9% of them were on regular blood transfusion, 39.1% occasionally transfused and 15.9% never transfused. Transcranial Doppler parameters of the cerebral arteries, namely TAMAX, PSV, were correlated with the frequency of transfusion and with (STOP) classification of the stroke risk. The Doppler parameters were also correlated with the different clinical parameters. The right MCA PSV and left DICA PSV were significantly higher among patients who were never transfused before. The Right DICA TAMAX was significantly higher among patients on regular transfusion, and the left DICA TAmax was significantly higher among patients who were never transfused before. Patients with high risk of stroke were diagnosed at a significantly older age. Regarding the laboratory parameters, platelets were significantly lower and total and direct bilirubin was significantly higher among the high stroke risk patients. Conclusions The regularity of the blood transfusion is extremely important in the stroke prevention. The most important velocities that may act as indicators for the risk are TAMAX of both DICAs and PSV of RT MCA & LT DICA.

Background: Dyspepsia is a clinical syndrome including manifestations related to the upper gastrointestinal tract. Options for evaluating dyspeptic patients include therapeutic trials, testing for Helicobacter pylori, upper gastrointestinal (UGI) radiography, and endoscopy. Objective: To compare the endoscopic and histopathologic diagnosis of gastritis in patients presented with chronic gastric dyspepsia to evaluate the relative frequency and pattern of different types of gastritis in patients presented with chronic gastric dyspepsia. Patient and method: Prospective cross-sectional study on 120 patients with chronic dyspepsia more than 8 weeks. All patients underwent gastroscopy. The findings of gastric inspection were recorded for all patients. Biopsy specimens were taken. Two from the anterior and posterior antrum, two from the anterior and posterior body, and two from any additional area of abnormality. Diagnostic criteria were applied to histological features and each histopathological parameter (chronic inflammation, activity, atrophy, intestinal metaplasia and H. pylori density) were graded for assessment of their severity as 0= absent, 1= mild, 2=moderate or 3= severe in the corpus and antrum. Results: Endoscope revealed normal gastric mucosa in 33 patients (27.5%), gastritis in 64 patients (53.3%) and other lesions in 23 patients (19.2%). As regard gastritis, there was edema in 61 patients (95.3%), erythema in 45 patients (70.3%), atrophy in 10 patients (15.6%) and mucosal nodularity in 10 patients (15.6%). As regard location of gastritis, it was pan-gastritis in 44 patients (68.8%), Antrum predominant gastritis in 10 patients (15.6%) & corpus predominant gastritis in 10 patients (15.6%).As regard other lesions, there was Duodenal ulcer in 7 patients (30.4%), peptic ulcer in 3 patients (13%), esophagitis in 2 patients (8.7%), erosive gastritis in 4 patients (17.4%), upper GIT suspecting malignancy in 2 patients (8.7%) and hiatal hernia in 5 patients (21.7%). Histopathology results were Normal in 18 (18.6%), Chronic inflammation in 79 (81.4%), Neutrophilic infiltration in 60 (61.7%), Glandular atrophy in 10 (10.3%), Intestinal metaplasia in 3 (3.1%) and H. pylori density in 47 (48.5%). Gastritis was detected by Endoscopy in 64 (53.3%) and in 79 (81.4%) by histopathology. This difference was statistically significant (p-value: 0.014). Conclusion: The prevalence of gastritis among the dyspeptic patients is very high since we observed endoscopically gastritis in 64 patients (53.3%) and other lesions in 23 patients (19.2%). The concordance between endoscopic findings and histopathological diagnosis of gastritis was (81%). High prevalence of H.Pylori among the dyspeptic patients (48.5%). Gastritis was better detected by histopathology.

Background Non-adherence is an important aspect of transplantation that affect outcomes. This study aims to investigate the impact of non-adherence to laboratory and clinic appointments on medication non-adherence and outcomes in kidney transplant (KT) recipients. Methods We analyzed KT recipients between 2005-14 with a detailed review of the medical records for non-adherence to laboratory and clinic appointments, as well as medication regimens. Baseline characteristics and clinical outcomes were compared between adherent and non-adherent groups. Results A total of 1413 KT recipients were included: 754 who were adherent and 659 who were non-adherent. Non-adherent recipients tend to be younger, African American, and have private insurance. Adherent patients tend to have a history of DM, heart disease, and receive an ECD kidney. Non-adherence to appointments was a strong predictor of medication non-adherence (OR 3.1), acute rejection (OR 1.4), and subsequent rejection episodes (OR 3.3 and 8.1 respectively for ≥ 1 and ≥ 2 rejection episodes). Subset analysis of patients who had early non-adherence within 1-year post-transplant showed predominance of younger, African American patients. The same patients had higher prevalence of medication non-compliance, overall and ≥ 1-year post-transplant, and mean number of readmissions. Kaplan-Meier analysis showed a trend towards lower graft survival in this group. Conclusions Early non-adherence to laboratory and clinic appointments is a strong predictor of late medication non-adherence, acute rejection, and graft loss. Targeting patients that demonstrate early non-adherence to appointments with focused interventions may help improve kidney transplant outcomes in this high risk group.

Background Foot deformity is one of the most common congenital musculoskeletal anomalies in the pediatric age group. Accurate diagnosis can be sometimes impossible to be established clinically. In the assessment of foot abnormalities, radiology plays a crucial role. Lack of ossification of the tarsal bones renders plain radiographs of the foot as of little diagnostic value in this age group. MRI apart from its cost requires anesthesia and sedation. In contrast, ultrasonography allows for the imaging of cartilaginous structures. As a result, newborn foot abnormalities can be thoroughly assessed. The whole anatomy of the foot is evaluated using several scanning views. Additional planes may be needed to show the pathologic features of a specific deformity. The purpose of this study was to demonstrate the additive value of ultrasound to plain radiographs in the assessment of foot deformities in the pediatric age group. Results This case–control study was performed on sixty children, 30 of which were patients admitted from the pediatric orthopedic clinic, presenting with foot deformity, after being examined clinically. Antero-posterior and lateral radiographs of foot, tibiocalcaneal, antero-posterior talocalcaneal, and lateral talocalcaneal angles were measured. Sonographic examination was done in different projections of both feet, while the patient is lying supine with dynamic sonography. The sonographic parameters measured were as follows: medial malleolar–navicular distance and medial soft tissue thickness on medial projection, calcaneocuboid distance on lateral projection, talonavicular relation on dorsal projection, and tibiocalcaneal distance on posterior projection. There was a statistically significant difference between patients and controls in the medial malleolar–navicular distance and medial soft tissue thickness measured on the medial view, the calcaneocuboid distance recorded on the lateral view, and the tibiocalcaneal distance measured on the posterior view. Conclusions Ultrasonography has a growing and useful role as a complementary imaging modality in the evaluation and follow-up of pediatric patients with foot deformity.

Background Autoimmune thyroiditis (AIT) is the most common thyroid pathology in pediatric patients among which Hashimoto’s thyroiditis has the highest prevalence. Along with size, measuring mechano-acoustic tissue elasticity is evolving as an important parameter in the evaluation of diffuse thyroid pathology. This study aims to investigate the role of shear wave elastography (SWE) in the diagnosis of autoimmune thyroid disease (AITD) in the pediatric population and also compare the elasticity between them and healthy individuals. Results This case–control analytical study was carried out on 64 pediatric subjects ranging in age from 7 to 17 years. All the cases were diagnosed as AIT by anti-thyroid antibodies, and their thyroid function was evaluated by thyroid hormones. We performed thyroid Ultrasonography and Shear wave elastography. Patients with AIT had significantly higher elasticity values (35.6 kPa, IQR 8.43–103.7 kPa) than the control group (9.35 kPa, IQR 5.73–13.21 kPa). There was no correlation of elasticity values of thyroid gland in patients with AIT with autoantibodies and thyroid function test, respectively. The cutoff value for elasticity was 12.317 kPa with sensitivity and specificity of 96.9% and 100%, respectively. Conclusions SWE is a highly sensitive imaging method integrating routine ultrasonography in the diagnosis of AITD which estimates the extent of fibrosis in numerical value.

Purpose To evaluate the difference in cerebral blood flow in neonates with and without extreme unconjugated hyperbilirubinemia. Methods Transcranial Doppler parameters of 26 full term newborns with extreme unconjugated hyperbilirubinemia (UCH) were compared to 13 postnatal age and sex matched normal healthy neonates serving as controls. Resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV) were measured in the middle cerebral, internal carotid and posterior cerebral arteries on both sides by transcranial color Doppler ultrasound. Results An increase in cerebral blood flow (decreased RI, PI and increased PSV) was observed in the extreme unconjugated hyperbilirubinemia (UCH) group. There was positive correlation between total serum bilirubin level and peak systolic velocity and vice versa with resistivity and pulsatility indices. Eight neonates developed clinical features of acute bilirubin encephalopathy and showed significantly increased peak systolic velocity in the right middle cerebral artery compared to those with normal outcome. Resistivity index and pulsatility index were lower in patients managed by exchange transfusion compared to those managed with phototherapy. Conclusion An increase in cerebral blood flow was observed in neonates with UCH compared to those without hyperbilirubinemia. By assessing the cerebral blood flow velocity, resistivity index (RI), and pulsatility index (PI) of particular intracranial arteries, the transcranial Doppler can identify the at-risk neonates, for development of neurological affliction in extreme unconjugated hyperbilirubinemia.

Background: Pituitary hyperplasia is an infrequent cause of visual disturbance and few such cases have been reported in the literature. Case Description: We describe the case of a 16-year-old female who presented with a short history of progressive headache and visual blurring. Examination revealed markedly constricted visual fields. Imaging revealed an enlarged pituitary gland. Hormonal panel was normal. Following endoscopic endonasal transsphenoidal biopsy and decompression of the optic apparatus, an immediate improvement in vision was noted. Final histopathological examination revealed pituitary hyperplasia. Conclusion: In patients with pituitary hyperplasia, visual deficit, and no identifiable reversible causes, surgical decompression can be considered to preserve vision.

Purpose Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. Methods Forty-five patients [females/males, 27/18; age, 30–59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. Results After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p p p p p Conclusion Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. Level of evidence Level I prospective randomised control clinical trial.

Prognostication of AML patients depends on association of genetic and epigenetic abnormalities. We aimed to evaluate the frequency and prognostic significance of Additional Sex comb's Like1 (ASXL1), Isocitrate Dehydrogenase (IDH) and Casitas B- lineage Lymphoma (CBL) mutations in AML assessing their association with different cytogenetic risk category.We used High Resolution Melting (HRM) technology that detects small differences in PCR amplified sequences by direct melting using EvaGreen saturating dye to analyze epigenetic mutations in 70 denovo AML patients.Median age of AML patients was 39.5 years (18-75). ASXL1, IDH and CBL mutations were detected in 14 (20%), 10 (14%) and 5 (7%) patients, respectively. Mean age of ASXL1 and IDH mutants vs. wild type was 35.9±14.6 years and 42.9±14.4 years (p=0.114) and 46.7±15.2 years vs. 40.6±14.5 years (p=0.290), respectively. AML cytogenetic risk groups included low (25/70, 36%), intermediate (33/70, 47%) and high-risk (12/70, 17%). Nine/14 (64%) ASXL1 and 8/10 (80%) IDH mutants were classified as intermediate risk and 9 ASXL1 positive (64%) were adolescent and young adults (AYA). Overall survival (OS) of mutant ASXL1 vs. wild type was 1.1 years (95% CI 0.83-1.4) vs. 1.9 years (95% CI 0.71-7.51), respectively (p=0.056). OS of mutant IDH vs. wild type was 1.25 years (95% CI 0.85-1.6) vs. 1.8 years (95% CI 1.2-6.7), respectively (p=0.020). In intermediate risk cytogenetic group, ASXL1 and IDH mutants had shorter OS than wild type; 1.1 years (95% CI 0.97-1.2) vs. 2.1 years (95% CI 0.14-10.8) (p=0.002) and 1.8 years (95% CI 0.69-3.15) vs. 2.3 years (95% CI 1.1-5.5) (p=0.05), respectively.ASXL1 and IDH mutations occur at a high incidence among young Egyptian AML patients with intermediate risk cytogenetics and confer a poorer outcome. Integration of mutations into risk profiling may predict outcome and impact therapeutic approach of young AML patient with uncertain prognosis.

Background Breast cancer is considered the most common type of cancer and the second leading cause of cancer-related death among women. The prognostic factors including histological type, tumor nuclear grade, tumor size, and preoperative tumor-nodes-metastasis (TNM), hormone receptor and immunohistochemical molecular markers in the specimens, define the prognosis and survival rate. Early diagnosis and accurate follow-up of these patients affect the management. 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) has proved to be an effective and accurate imaging technique for a variety of diagnostic oncology tasks in breast cancer, lymph node staging, staging and restaging of recurrent and metastatic disease, and treatment follow up. Sufficient knowledge of the initial characteristics of breast tumors that may affect 18F-FDG uptake is essential for optimal use and interpretation of 18FFDG PET/CT imaging. Several pioneering studies have investigated the correlation between the affinity to 18F-FDG uptake and some of the histological and biological characteristics such as tumor type, grade, hormonal receptor status and HER2 status. Objective To correlate the relation of 18F-fluoro-2-deoxy-D-gIucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) uptake in breast cancer to histopathological and biological characteristics. Methods A prospective descriptive study over the course of 6 months from August 2019 till February 2020. It included twenty five patients with pathologically proven breast carcinoma referred to the Radiology department, Ain Shams University Hospitals/ Private centers for a preoperative 18FDG PET/CT scan. Results For the tumors in 25 women, the mean SUVmax was 4.75±2.55. Primary tumor 18FFDG uptake ratio was correlated with patients' age (P = 0.032), tumor size (P = 0.034), histological grade (P=O.OI 8), estrogen and progesterone negativity (P = 0.012), Her2/neu positivity (P = 0.012), high Ki-67 level (>10%) (P = 0.024), axillary lymph node involvement (P = 0.038) and distant metastasis (P = 0.039). High Ki-67 level (Pearson Correlation Coefficient= 0.457; 95% confidence interval; P = 0.037) and tumor size (Pearson Correlation Coefficient =0.458; 95% confidence interval, P = 0.021) were determining factors for high 18F-FDG uptake values. The histological type (P = 0.525) was not significantly correlated with 18F-FDG uptake. Conclusion FDG PET imaging was used to estimate tumor biologic behavior of breast cancer such as histopathologic grading, immunohistochemistry, axillary lymph node status and distant metastasis. SUVmax correlated with several of pathological prognostic factors may have potential for predicting the prognosis of breast cancer. 18F-FDG PET/CT could be a useful tool to pretherapeutically predict biological characteristics and baseline risk of breast cancer Increased 18FFDG uptake on PET/CT was correlated with a high Ki-67 proliferation index and larger tumor size. These results suggest a potential role of 18F-FDG PET/CT in identifying tumor aggressiveness.

Aim of work The aim of the study is to show the feasibility of diffusion weighted (DWI) MRI with calculation of the apparent diffusion coefficient in characterization of hepatic focal lesions as well as differentiating benign from malignant lesions in cirrhotic patients. Patients and Methods The study included 35 patients (25 males and 10 females) by cross sectional study and convenient sampling at the Demerdash hospital, inclusion criteria: patients diagnosed by hepatic focal lesions on top of post-viral induced cirrhosis, detected by ultrasound, triphasic CT or dynamic MRI imaging. All patients to be included in the study underwent characterization of hepatic focal lesions to differentiate benign from malignant lesions using a combination of characteristic imaging criteria, including contrast enhancement patterns on MRI. Sequences used were T2 weighted imaging, T2 Spectral Attenuated Inversion Recovery (SPAIR), and diffusion weighted imaging sequences with estimation of the ADC map and calculation of the ADC values. Results Our study was carried on a total of 35 patients including 25 males and 10 female patients having a mean age of 59 ± 10.2 years (58.1 ± 11 and 61.2 ± 8 years for the male and female patients respectively). DWI and ADC showed statistically significant difference among the benign and malignant focal lesions in terms of their diffusion restriction criteria ( P Summary and conclusion DWI MRI and the calculation of the ADC are great non invasive possible tools to detect and characterize hepatic focal lesions as well as to differentiate benign from malignant lesions in cirrhotic patients especially in patients with renal impairment and allergy to contrast media also to avoid unnecessary biopsies.

This paper investigates the duct’s noise distribution pattern due to the heating, ventilation, and air conditioning systems. This study is considering the longitudinal sound wave distribution that can permit a higher reduction of these heating, ventilation, and air conditioning systems duct noise. The proposed technique is depending on the lowest sound pressure level points in the duct or duct quiet zones. Moreover, each heating, ventilation, and air conditioning systems duct has several quiet zones, depending on the sound pressure level of the fan noise source and the duct length as well as the duct diameter. Furthermore, the noise standing wave has a wavelength (λ) which is the distance between two successive quiet zones. This work utilizes orthogonal acoustical noise with the standing wave via feed-forward control speakers. This system confirmed that the distance (λ) is linearly proportional to the duct source noise level. This system noise reduction enhancement has been fulfilled by installing further noise feed-forward control speakers at different duct quiet zones. The system simulation results were displaying satisfactory agreement with the field experimental results.

Nowadays, modern Big Stream Processing Solutions (e.g. Spark , Flink ) are working towards being the ultimate framework for streaming analytics. In order to achieve this goal, they started to offer extensions of SQL that incorporate stream-oriented primitives such as windowing and Complex Event Processing (CEP). The former enables stateful computation on infinite sequences of data items while the latter focuses on the detection of events pattern. In most of the cases, data items and events are considered instantaneous, i.e., they are single time points in a discrete temporal domain. Nevertheless, a point-based time semantics does not satisfy the requirements of a number of use-cases. For instance, it is not possible to detect the interval during which the temperature increases until the temperature begins to decrease, nor for all the relations this interval subsumes. To tackle this challenge, we present D2IA ; a set of novel abstract operators to define analytics on user-defined event intervals based on raw events and to efficiently reason about temporal relationships between intervals and/or point events. We realize the implementation of the concepts of D2IA on top of Flink , a distributed stream processing engine for big data.