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Anorectal manometry is a valuable tool for objective assessment of motility motor and sensory function of the anorectum. The aim of this study was to investigate role of water-perfused (WP) three dimensional high-resolution anorectal manometry (3D-HRARM) compared to WP conventional manometry (CM) in the management of chronic idiopathic constipation (CIC) and faecal incontinence (FI) in children.This was a retrospective review of 122 consecutive children, who had WP 8-channel CM or 24 channel 3D-HRARM and endosonography under ketamine anaesthesia from September 2012 to February 2019. All patients had a validated symptom severity score questionnaire ranging from 0 (best) to 65 (worst). Mann-Whitney-U test and Spearman rank test were used and p0.05 was considered significant.Subjects were divided according to investigation: CM group (n = 75) and 3D-HRAM (n = 47), who were otherwise comparable. Median anal resting pressure was 50 mmHg and rectoanal inhibitory reflex (RAIR) threshold volume was 10mls across the entire cohort. There were no significant differences in resting pressure or RAIR threshold when using conventional or 3D-HRARM. Rectal capacity was significantly higher in the CM group (p = 0.002). Rectal capacity and internal anal sphincter (IAS) thickness positively correlated with symptom severity, duration and patient age. 3D-HRARM provided a more detailed depiction of the anorectal pressure profile. Botulinum toxin was injected into the external anal sphincter (EAS) muscle (n = 75, 61%) and an anterograde colonic enema (ACE) stoma was needed subsequently in 19 (16%) to treat recurrent constipation and soiling symptoms. Rectal biopsy was done in 43(35%) patients, if RAIR was absent or inconclusive.CM and 3D-HRARM are comparable in terms of resting pressure and RAIR threshold. 3D-HRAM is safe and provides detailed functional morphology of anal sphincters and it is useful to understand underlying pathophysiology of constipation and faecal incontinence in children and plan further treatment.Level I.

Airlines need to expand their flight networks with developing new routes and introducing more flights to increase their market share. In this work, we propose a two-stage stochastic mixed integer nonlinear program (MINLP), which expands an existing flight schedule by operating new flights either with existing fleet resources or a leased aircraft while considering the impact of departure time decisions on the probability distribution of random demand. Moreover, our study helps an airline to link a strategic decision of leasing an aircraft to the tactical aircraft assignment decisions by considering fuel efficiency and seat capacity of the aircraft alternatives in response to new passenger demand. However, the large number of scenarios, nonlinear fuel burn function and nonlinearities due to the decision dependent probabilities become main challenges of solving the problem. In order to deal with the computational requirements of a two-stage stochastic MINLP with decision dependent probabilities, we propose strong conic quadratic and McCormick inequalities, and an exact scenario group wise decomposition algorithm along with a new bounding method. In our computational results, we clearly demonstrate the effectiveness of proposed decomposition algorithm and the strength of the reformulations.

Background Inappropriate and excessive activation of type I interferon (IFN) system is a key feature of systemic lupus erythematosus (SLE), and its targeting has led to important achievements in the development of novel drugs for SLE. Aim of the work To evaluate the serum levels of interferon lambda IFNλ3 (IL28B) in Egyptian patients with SLE and investigate its potential relation with different clinical and laboratory parameters. Patients and methods The study included 40 SLE patients and 40 controls. The SLE disease activity index (SLEDAI) was assessed. The measurement of serum levels of IFNλ3 was performed in all participants using enzyme linked immunosorbent assay (ELISA). Results The mean age of the patients was 26.8 ± 7.8 years with disease duration 5.1 ± 4.5 years and they were 35 females and 5 males. The serum levels of IFNλ3 were significantly higher in SLE patients (9.7 ± 12.47 pg/mL) compared to the control (5.13 ± 1.63 pg/mL)(p = 0.02). Significant correlations were observed between serum IFNλ3 and serositis (r = 0.35,p = 0.03), C3 consumption (r −0.33, p = 0.04) and SLEDAI (r 0.34, p = 0.03). On multivariate regression analysis, serositis and SLEDAI (but not C3) were significant independent predictors of IFNλ3 levels (β = 0.08, p = 0.037 and β = 0.06, p = 0.014 respectively). Conclusion The results support a possible role of IFNλ3/IL28B in the immunopathogenesis of SLE. The significant association of serum IFNλ3 with disease activity highlights the utility of IFNλ3 as a novel biomarker for monitoring disease activity and predicting severity in SLE. Further studies on IFNλ3 in SLE could be promising in the development of personalized therapy for lupus patients.

Clues and traces of the universe's origin and its developmental process are deeply buried in galaxy shapes and formations. Automated galaxies classification from their images is complicated due to the faintness of the galaxy images, conflicting bright background stars, and image noise. For this purpose, the current work proposes a novel logically structured modular algorithm that analyses galaxy morphological raw brightness data to automatically detect galaxy visual center, region, and classification. First, a novel selective brightness threshold is employed to eliminate the effect of bright background stars on detecting galaxy visual centers. Second, a galaxy region detection technique is developed. Finally, a novel technique based on galaxy brightness variation patterns is employed for galaxies classification. The current work has been tested with a run on a collection of 1000 galaxies from the EFIGI catalog. Results demonstrated a success rate of 97.2% in galaxies classification with an average processing time of 0.37 s per galaxy. The high success rates and the low processing time proved the efficiency of the proposed work.

Creation of the femoral tunnel for single-bundle anterior cruciate ligament (ACL) reconstruction has a high rate of nonanatomic placement with the transtibial (TT) technique but yields better restoration with the anteromedial portal technique and close restoration of the anatomic femoral footprint with the outside-in technique. Modifications of the traditional (TT) technique have been described to restore the native femoral ACL footprint and to simulate double-bundle reconstruction. Modified TT techniques try to capture the anatomic femoral footprint through an anatomic tibial tunnel. In the technique described in this article, the anatomic femoral footprint is drilled first by the use of a 2.5-mm Kirschner wire through the parapatellar anteromedial portal, making an angle 30° to the sagittal plane and 20° to the horizontal plane. The wire is drilled while the knee is hyperflexed and then withdrawn from outside until its distal end reaches the intercondylar notch. The wire is then advanced in an antegrade manner while the knee is flexed 90° until it reaches the center of the marked tibial footprint. The angle of knee flexion may be slightly increased or decreased around 90° with or without slight internal rotation to capture the anatomic tibial footprint. The procedure is completed as a TT single-bundle ACL reconstruction.

Behcet’s disease is an autoimmune type of vasculitis presenting by attacks of oral, skin and genital ulcers, as well as ophthalmic disorders that cause blindness in 25% of affected patients. Circul...

The present paper treats the lateral torsional buckling (LTB) of castellated rectangular hollow section (CRHS) beams. For the purpose, an analytical model was proposed to provide critical buckling loads in (LTB) resistance. In the present model two types of web openings are considered, referring to rectangular and hexagonal shape perforating. The sectional geometrical properties attributed to each type of opening are controlled by selecting the appropriate value of the reduction parameter. Ritz method is applied in order to found the governing equilibrium equations, following the critical buckling loads are determined from the eigenvalue problem imposed to the tangential stiffness matrix. The validity of the elastic lateral buckling resistances evaluated by the proposed method is checked with the finite element simulation using ABAQUS software. The numerical results for cantilevers and simply supported CRHS beams, with hexagonal and rectangular web openings, are presented for both short and long-span beams.

The large-scale integration of 1D hierarchical anode/cathode electrodes has huge application prospects in lithium ion battery (LIB) engineering. 1D geometric topology shapes have been adapted in coin-type half-/full-scale and pouch-type cell LIBs, which demonstrate electron stream movements and Li+ ion diffusions in 1D-hierarchical anode/cathode electrode materials. Controlling the geometrical and morphological configurations of 1D-hierarchical anode/cathode electrodes shows great potential in designing the charge/discharge capacity of LIBs with long-term stable cycles, rapid electron and Li+ ion diffusion kinetics, and maximum rate capacity and capacity storage. Coin-type full-cell LIBs show a distinct reversibility and rate capability performance and a superb Coulombic efficiency of ~99.7% after going through lithiation/delithiation (discharge/charge) cycling processes. LIB pouch-type cell assemblies are fabricated by densely packing 1D hierarchical anode/cathode electrode geometrics in collar-stacked layers. A pouch-type cell battery has a full recovery rate capability to withstand formidable long-term cycles (>>2000 cycles), a substantial areal discharge capacity (≈2.85 mAh/cm2), and remarkable gravimetric and volumetric cell energy densities of ≈187.39 Wh/kg and 243.37 Wh/L, respectively. We expect that the tradeoff requirements and demands in electric vehicles can be improved by these variable LIB designs based on 1D electrode patterns.

Monitoring DNA–nucleobases and their oxidized forms in living cells is regarded as a biomarker for DNA damage. Adenine (Ad) electrochemical sensor was designed based on phosphorus-doped carbon spherical eye-like structure (P-CES). Spherical electrochemical sensors oriented with abundant multiple directional gates, such as micro-, meso-pores, and open cave-like eyes may lead to design a potential sensor with fast response, low surface charge resistance, high electron diffusion, and functionalized binding active centers to accommodate Ad molecules. The P-CES hierarchically ordered sphere electrode features dense and reactive exposure sites for a variety of additional interactions and flexible mobility surfaces during the detection of Ad. The key role of the circular shape with a rugged surface, multi-hole construction, and open grooves creates an active catalyst of strong binding to the target molecules and facilitate the molecular diffusion inner/outer the electrode surface. Moreover, the doping of P atoms to the hierarchical carbon chain leads to the distortion of sp2-graphitic construction, increases the number of plane edge defects, and induces the functionalization of the abundant active sites. Thus, P-CES provides active transducing element for detection of Ad in its resources (oxidative DNA in living cells) with high sensitivity, good selectivity, excellent stability, and facile reproducibility. The fabricated P-CES shows an ultrasensitive Ad sensor with a limit of detection as low as 0.002 μmolL−1, with a wide linear range of 0.01–0.8 μmolL−1. The Ad liberated from the oxidative-DNA in living cells can be detected with high affinity and sensitivity. The Ad sensor assay can be employed for investigation of DNA damage and deliver information for diagnosis of diseases caused by cell mutation and immune system deficiency.

Sensory protocols for evaluation of DNA distortion due to exposure to various harmful chemicals and environments in living cells are needed for research and clinical investigations. Here, a design of non-metal sensory (NMS) electrode was built by using boron-doped carbon spherules for detection of DNA nucleobases, namely, guanine (Gu), adenine (Ad), and thymine (Th) in living cells. The key-electrode based nanoscale NMS structures lead to voids with a facile diffusion, and strong binding events of the DNA nucleobases. Furthermore, the NMS geometric structures would significantly create electrode surfaces with numerous centrally active sites, curvature topographies, and anisotropic spherules. The NMS shows potential as sensitive protocol for DNA-nucleobases in living cells exposed to oxidative stresses. In one-step signaling assay, NMS shows high signaling transduction of Gu-, Ad-, and Th-DNA nucleobases targets with ultra-sensitive and low detection limits of 3.0, 0.36, and 0.34 nM, respectively, and a wide linear range of up to 1 μM. The NMS design and protocol show evidence of the role of surface construction features and B-atoms incorporated into the graphitic carbon network for creating abundant active sites with facile electron diffusion and heavily target loads along with within-/out-plane circular spheres. Indeed NMS, with spherule-rich interstitial surfaces can be used for sensitive and selective evaluation of damaged-DNA to various dysfunctional metabolism in the human body.

Background: MicroRNAs (miRs) are noncoding gene regulators that may have a role as diagnostic or prognostic biomarkers in systemic lupus erythematosus (SLE) and its complications. SLE is an autoimmune disease that may be associated with secondary antiphospholipid syndrome (APS). Aim of the work: To evaluate the plasma levels of both miR-146a and miR-126 as well as serum alpha interferon (α IFN) in Egyptian SLE patients with and without secondary APS and to investigate their potential role in disease pathogenesis and their utility as biomarkers for APS. Patients and methods: 88 SLE patients including 30 cases with secondary APS and 40 matched healthy individuals were enrolled in this study. SLE disease activity index (SLEDAI) was assessed. The plasma levels of miR-146a and miR-126 were determined by Realtime polymerase chain reaction (PCR) in all participants. Results: The mean age of the patients was 31.3 ± 9.6 years with disease duration 1–17 years. Plasma miR-146a was significantly lower and miR-126 significantly higher in SLE compared to controls. MiR126 was also higher in secondary APS patients compared to patients without. Serum IFN-α ws significantly higher in patients (71.2 ± 19.7 pg/ml) compared to control (43.2 ± 9.7 pg/ml) (p

In this study, nitrogen (N) and boron (B) heteroatom doped graphene aerogel support materials have been employed for the dispersion of platinum (Pt) nanoparticles to improve their electrocatalytic activities for formic acid and methanol oxidation. Pt nanoparticles dispersed on the heteroatom doped graphene aerogel (GA) support materials by a microwave heating method. The as-prepared catalysts were characterized by a variety of means such as SEM, EDS, ICP-MS, TEM, XRD, BET and XPS. The electrocatalytic activities, stability and impedance of the synthesized catalysts were investigated for formic acid and methanol oxidation using electrochemical measurements. The 3D graphene aerogels have higher capacitive currents than the Vulcan XC-72 in the double layer region. The results of electrochemical chronoamperometry tests reveal that Pt/BGA shows the best stability for methanol oxidation and also exhibited superior electrocatalytic activity towards the oxidation of methanol in cyclic voltammetry. In addition to, heteroatom doped GA supported catalysts higher activity compared to the Vulcan XC-72 supported catalyst for formic acid oxidation.

Risk-averse mixed-integer multi-stage stochastic programming forms a class of extremely challenging problems since the problem size grows exponentially with the number of stages, the problem is non-convex due to integrality restrictions, and the objective function is nonlinear in general. We propose a scenario tree decomposition approach, namely group subproblem approach, to obtain bounds for such problems with an objective of dynamic mean conditional value-at-risk (mean-CVaR). Our approach does not require any special problem structure such as convexity and linearity, therefore it can be applied to a wide range of problems. We obtain lower bounds by using different convolution of mean-CVaR risk measures and different scenario partition strategies. The upper bounds are obtained through the use of optimal solutions of group subproblems. Using these lower and upper bounds, we propose a solution algorithm for risk-averse mixed-integer multi-stage stochastic problems with mean-CVaR risk measures. We test the performance of the proposed algorithm on a multi-stage stochastic lot sizing problem and compare different choices of lower bounds and partition strategies. Comparison of the proposed algorithm to a commercial solver revealed that, on the average, the proposed algorithm yields 1.13% stronger bounds. The commercial solver requires additional running time more than a factor of five, on the average, to reach the same optimality gap obtained by the proposed algorithm.

This paper adapts a multi-dimensional Random Variable Transformation technique to derive a comprehensive stochastic description of the Susceptible-Infected-Recovered epidemiological model. An approximate solution of a system of nonlinear differential equations, that characterizes this model, is deterministically obtained and, from this approximation, we derive the first probability density functions for the solution processes of susceptible, infected and recovered percentages. These probability density functions are used to find the approximate mean and variance functions, as well as the confidence intervals. Taking a general situation, the infection contact rate, the recovery rate and the initial conditions are taken to be random variables with arbitrary distributions. To test the validity of the theoretical findings associated to the proposed random epidemiological model, some numerical results are tabulated and graphically presented through an illustrative example.

A novel technique, named (KLE-RVT), is constructed to find a full probabilistic solution of a finite Milne problem of radiative transfer in spatially stochastic atmosphere. This technique is a combination between the random variable transformation (RVT) technique and the Karhunen–Loeve expansion (KLE) of the input stochastic process (the total cross section of the medium) to find the probability density function of the solution stochastic process. The RVT technique is applicable only if the probability density function of the input random variable (process) is known in a closed form. To overcome this obstacle, KLE is applied to represent the spatially continuous random cross section, defined only by its mean and covariance function, in terms of a finite number of uncorrelated random variables with known probability density functions. By this technique, the probability density function of the solution process is evaluated dealing with the input process itself instead the integral transformation of it. This solution is general and valid for any input second order stochastic process. Numerical results of our findings are presented to realize this work.

Cadmium and Ni chemical reactivities in soils are highly dependent on various soil properties. In this study, batch sorption-desorption experiments were carried out to quantify the potential of different soils to retain and release of Cd and Ni. Results revealed that several soil characteristics control Cd and Ni sorption-desorption where, the mutual effects of pH, CEC, soil carbon, clay, silt, and CaCO3 contents govern their behavior in soils. Sorption of Cd and Ni was found to be concentration dependent. The studied soils exhibited higher Ni sorption capacities than Cd (Ni-Smax > Cd-Smax). Statistical relationships between soil properties and Langmuir parameters were achieved by stepwise regression analysis. Simulations of Cd and Ni kinetic reactions were performed using a multireaction model (MRM). Cadmium and Ni exhibited sorption-desorption kinetics and hysteresis in the soils and were well simulated by MRM. The highest reversible reaction rate and low hysteresis for Cd and Ni were associated with the low soil sorption capacities. Whereas, a strong nonsingularity of sorption-desorption isotherms was observed for soils with high CaCO3 contents.

To understand the mechanistic pathway of arsenic (As) enrichment and mobilization in groundwater (southeastern Bangladesh) and to evaluate the water quality as well as associated health risks, a suite of systematically collected groundwater samples (depth: 17-61 m) were analyzed. Arsenic concentrations (μg L

Follow up of neuronal disorders, such as Alzheimer’s and Parkinson’s diseases using simple, sensitive, and selective assays is urgently needed in clinical and research investigation. Here, we designed a sensitive and selective enzymeless electrochemical acetylcholine sensor that can be used in human fluid samples. The designed electrode consisted of a micro spherical construction of Cu-metal decorated by a thin layer of carbon (CuMS@C). A simple and one-pot synthesis approach was used for Cu-metal controller formation with a spherical like structures. The spherical like structure was formed with rough outer surface texture, circular build up, homogeneous formation, micrometric spheres size (0.5 −1 µm), and internal hollow structure. The formation of a thin layer of carbon materials on the surface of CuMS sustained the catalytic activity of Cu atoms and enriched negatively charge of the surface. CuMS@C acted as a highly active mediator surface that consisted of Cu metal as a highly active catalyst and carbons as protecting, charge transport, and attractive surface. Therefore, the CuMS@C surface morphology and composition played a key role in various aspects such as facilitated ACh diffusion/loading, increased the interface surface area, and enhanced the catalytic activity. The CuMS@C acted as an electroactive catalyst for ACh electrooxidation and current production, due to the losing of two electrons. The fabricated CuMS@C could be a highly sensitive and selective enzymeless sensor for detecting ACh with a detection limit of 0.1 µM and a wide linear range of 0.01 – 0.8 mM. The designed ACh sensor assay based on CuMS@C exhibited fast sensing property as well as sensitivity, selectivity, stability, and reusability for detecting ACh in human serum samples. This work presents the design of a highly active electrode surface for direct detection of ACh and further clinical investigation of ACh levels.

Portable sensors for detecting biomolecules have been widely applied in designing a new generation of clinical and biomedical devices. A portable sensor-based device was designed to integrate the interdigitated electrode array (IDA) decorated by dual phosphorus and nitrogen doped carbon urchin-like (P-, N-doped CU) structure. The morphological structure, surface nature of porosity and surface area, and electrochemical sensing property to signaling dopamine (DA) molecules of P-, N-doped CU were investigated under various annealing temperatures and activation. The P-, N-doped CU-800K showed the best active surface materials with urchin-like round shape morphology covered by nano-dendritic ends. The outer surface with a rough texture of connected nano-dendrites formed multiple grooves, U-undulates, and a high mass-to-volume ratio that facilitated molecular diffusion and increased the loading of DA molecules on the active electrode surface. The P-, N-doped graphitic carbon chain produced a functionalized surface with N and P groups creating several plane edge defects and enriching the surface by massive negative charges. These intrinsic features formed an active interfacial surface with fast electron diffusion, low surface charge resistance, high loading, and strong binding to DA molecules. The P-, N-doped CU-800K/IDA showed high sensitivity (4461.4 µA/µM×cm2), low detection limit of 0.1 nM, wide linear range of 0.01 – 0.5 µM, good selectivity, high stability, low cytotoxicity, and biocompatibility. Therefore, the designed portable sensor of P, N-doped CU-800K/IDA can be used for on-site detection of DA secreted from the human neuronal cell line model (SHSY-5Y) with a high sensitivity.

Numerical technique was employed to present the hybrid nano-powder behavior through a permeable enclosure with considering irreversibility. Various factors of MHD (magnetohydrodynamic) and permeability have been added in velocity equations and for applying the nanomaterial properties, correlations based of single phase technique were employed. CVFEM was incorporated to achieve the amounts of scalars. With measuring the velocity and temperature, terms of irreversibility have been calculated and reported in view of contours. Water has been mixed with hybrid nano-powders (Fe3O4+MWCNT). The buoyancy force helps the carrier fluid to move faster inside the container and if the zone has higher permeability, greater velocity of fluid can be obtained. But, magnetic field makes the speed of hybrid nano-powders to decrease. Increase of Da (Darcy number) and Ra (Rayleigh number) causes the temperature of sinusoidal surface to reduce about 25% and 57.1% while impose of greater Ha leads to decrease the cooling efficiency about 33.3%. Greater Da causes the eddy to become stronger about 75% while it decreases with augment of Ha about 50%. Sgen,th grows about 70.5% with rise of Ha (Hartmann number). Rising Ra and Da makes Nu (Nusselt number) to enhance about 207.98% and 21.09% while augmenting Ha leads to reduction of Nu about 23.87%. Be decreases with rising Da about 3.77% while it augments about 9.36% with imposing stronger Lorentz force.