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Background: The goal of this prospective cohort study was to study the different determinants impacting primary varicose vein recurrence rates and patterns after endo venous laser ablation (EVLA) for primary lower limb varicose veins.Patients and Methods: 127 symptomatic patients (127 limbs) with great saphenous vein reflux (>0.5 seconds), GSV diameter> 3mm and pre-operative incompetent perforators were followed up within two years for recurrence after EVLA.Outcomes: Recurrence was defined clinically by venous clinical severity score (VCSS) and CEAP classification and radiologically by patterns of reflux on duplex ultrasound examination. Assessment was done at 1, 6, 12 and 24 months after the procedure. Results: Two-year life table analysis showed varicose vein recurrence in 9 (7.1%) of limbs. Varicose vein recurrence was mostly seen owed to due to BMI more than 30.5 kg/m2 in 77.8 % (p

Continuous Intrathecal Drug Delivery through an implanted pump is a well-known therapeutic option for the management of chronic pain and severe disabling spasticity. To have a successful therapy, pump refills need to be performed at regular time intervals after implantation. In line with the increased applications of Hospital at Home, these refill procedures might be performed at the patient’s home. The aim of this pilot study is to evaluate the feasibility, safety, and effectiveness of intrathecal pump refill procedures at home. Twenty patients were included whereby pump refill procedures were conducted at the patient’s home. To enable contact with the hospital, a video connection was set-up. Tele-ultrasound was used as post-refill verification. All procedures were successfully performed with complete patient satisfaction. Ninety-five percent of the patients felt safe during the procedure, and 95% of the procedures felt safe according to the physician. All patients indicated that they preferred their next refill at home. The median time consumption for the physician/nurse at the patient’s home was 26 min and for the researcher at the hospital 15 min. In light of quality enhancement programs and personalized care, it is important to continue urgent pain management procedures in a safe way, even during a pandemic.

The increase of conventional energy has negative impact on the earth and the environment which also affects the next generation. Therefore, renewable energy sources are used as they are sustainable. Besides, renewable energy sources, energy efficiency aspect is used to insure lowest negative impact on the environment which is measured by the green pyramid rating system in Egypt. The purpose of this research is to discuss the applicability of having a zero-energy educational building in Egypt by installing a PV system and decreasing the demand using the energy efficiency criteria of the green pyramid rating system. The case study is the energy and environmental engineering building in the British university in Egypt. This can be achieved by installing a PV system and decreasing the demand using the energy efficiency criteria of the green pyramid rating system.

The Industrial sector is considered the base of the economy for many countries. In Egypt industry participate with 20% of the country's national income. 10th of Ramadan city is one of the oldest industrial cities built in Egypt. It is now considered the biggest industrial city in Egypt with more than 2000 factories, with total investment of EGP 84bn. On the other hand, these factories may have a bad impact on the environment because the electricity they consume is from non-renewable sources. Moreover, many of them produce CO2 gas emissions that have a bad impact on the environment. The aim of this report is to set up a solar farm that can cover the electricity needed for these factories to operate. By this action the CO2 emissions produced from power plants run by fossils fuels or natural gas will stop.

Africa is one of the most populated continents in the world. With the increase in population, there is an increase in energy demand. Solar energy technologies are considered viable options for increasing the countries’ electrification. This is because Africa has relatively high solar energy potential. There are some challenges that face the solar energy market that can slow down the implementation of projects. Moreover, the spreading of Covid-19 across the continent may pose additional challenges. In this paper, the solar energy potential in Africa is discussed before and after Covid-19. This will determine whether Covid-19 is a challenge or an opportunity for the solar energy market.

Organic based perovskite semiconductors provide a suitable material candidate to fabricate optoelectronic devices such as solar cells due to its low deposition cost and high efficiency. Thermal stresses are generated during processing and operating steps of the perovskite/silicon layer due to the thermal mismatch between both materials. Different interfaces give different results and different stress distribution, the effect will be investigated in this paper.

Laterally grown GaN-on-Si substrate is promising for solid state lighting, high power density devices, and wireless communication applications among others. Despite their superior optical and electrical properties, they suffer from high dislocation-densities due to high lattice and thermal expansion coefficients mismatch between both crystalline materials. Different approaches have been suggested to reduce defects in GaN-on-Si technology. One of these approaches is Embedded Void Approach (EVA), which has been employed to control defects mobility in GaN thin-film on Si substrate by inserting micro-voids near the interface. In the current study, a three-dimensional multiple-slip crystal plasticity model and specialized finite-element formulations were used to address GaN growth on Si substrate. Furthermore, EVA has been studied to understand the effectiveness of the experimentally developed approach in reducing defects mobility. Additionally, a parametric study has been conducted to examine the effect of voids size and aspect ratio on the intrinsic stresses. It was found that EVA results in considerable reduction in the stresses in the mid surface of the structure near the voids and consequently the dislocation density at the top surface, enhancing the performance of the proposed system.

Africa is currently welcoming and attracting new investments in energy with new regulations and programs focusing on renewable energy. However, the continent is still suffering the symptoms of the energy crises that are harming the economy and risking lives. Africa has a massive un-tackled potential of renewable energy. This study asses the obstacles facing the PV market in Africa and the outcomes assert that solar PV systems show a technical and economic feasible solution for the energy problem in Africa.

As there is a global move towards alternative energy sources, the Middle East and North Africa region has been one of the main targets for photovoltaic installations and analysis. Hence, many studies have been conducted on several photovoltaic techniques in different locations under different climatic conditions. Egypt plans to have Solar Energy form 22% of the total energy sources by 2035. This paper presents experimental results of poly-crystalline, mono-crystalline and thin-film modules in three grid-connected system over the duration of 12 months in Cairo. Also, a mathematical model for poly-crystalline system is presented and compared to the experimental results.

Concentrated Photovoltaic (CPV) systems offer several advantages such as their superior efficiency compared to conventional PV systems, moreover, producing CPV systems can reduce the cost because they use a very small area of costly PV material and replace it by a large area of inexpensive optical materials. This allows the use of high-efficiency solar cells that would have been prohibitively expensive in the case of a large area of traditional PV system. This paper focuses on determining the required tracking accuracy for a CPV system using a point-focus Fresnel lens and a CIMJ multi-junction solar cell with an aperture area of 98.9 square millimeters. The purposes of this paper is to simulate the power losses with respect to tracking errors, outlining the maximum allowed tolerance as well as the effect of temperature on the output power from the solar cell, and to design an inexpensive dual-axis solar tracker that is made of off the shelf commercial components that satisfies the required degree of accuracy with an efficient control algorithm that allows the system to rotate in Azimuth and Zenith axes.

The encryption efficiency of the Rivest-Shamir-Adleman cryptosystem is based on decreasing the number of multiplications in the modular exponentiation (ME) operation. An addition chain (AC) is one of the strategies used to reduce the time consumed by ME through generating a shortest/short chain. Due to the non-polynomial time required for generating a shortest AC, several algorithms have been proposed to find a short AC in a faster time. In this paper, we use the evolutionary algorithm (EA) to find a short AC for a natural number. We discuss and present the role of every component of the EA, including the population, mutation operator, and survivor selection. Then we study, practically, the effectiveness of the proposed method in terms of the length of chain it generates by comparing it with three kinds of algorithms: (1) exact, (2) non-exact deterministic, and (3) non-exact non-deterministic. The experiment is conducted on all natural numbers that have 10, 11, 12, 13, and 14 bits. The results demonstrate that the proposed algorithm has good performance compared to the other three types of algorithms.

Vehicular Ad-hoc Network (VANET) is still a recent topology in wireless networks. It is not far different from Mobile Ad-hoc Network (MANET) except VANET is making the benefits of vehicles instead of mobiles. However; the high speed of the vehicles, the rapidly change of VANET topology, and the city environment characteristics, has become today’s issues in terms of wireless communication using vehicles. Thus this type communication has become very famous as a field for researchers. There are two main types of VANET communications as categorized by many researchers, which are vehicle to vehicle (V2V) and vehicle to Infrastructure (V2I). In terms of routing protocols, there are so many protocols that could be used by VANET. However; these protocols are not capable enough to achieve the communication. There are two main types of routing protocols in VANET: VANET routing topology-based and routing position-based. In this current paper we will make an overview about both of them. However; our main focus is to make comparison of geographical-based routing protocols. For example, qualitative comparison of protocols that are used for packages’ carrying and forwarding such as some Delay Tolerant Network (DTN) and non-Delay Tolerant Network Non-DTN geographic routing protocols. Finally, each protocol has its own advantages and disadvantages. So it is important to have an idea about them because at least they will be as a guide lines for the readers to determine their own researches. Depends on this comparison it is observed that hybrid DTN and non-DTN will perform better since it will take the advantages of all DTN and non-DTN.

The detection of the target depends on the accuracy of the classification of the radar return signals. This classification accuracy is based on the features which extracted from that signal. This paper presents an optimal algorithm for select optimal features. Three cases were studied of the situation of targets in receiving signal; single, multi-, and close multi-targets. The types and number of features represent the base of the algorithm, while the processing time and the classification rate represent the criteria for features selection. Hybrid methods, which combine the optimum characteristics of wrappers and filter methods are used for making the compromise between the number of features and best candidate subset. Multilayer perceptron back propagation neural network has been used as a classifier, while the classification is 98% for single target with two third processing time of multi-targets for the same classification rate, and nearly half processing time for the close-multi target.

Speech separation is attracting widespread interest due to the sound mixing in real environments in and out door applications. Although the researchers have used many algorithms, the separation rate in the real environment is still poor. This paper presents speech separation using a modified Deep learning neural (DLN) algorithm. Interestingly, the modification has reduced the complexity of the original DLN algorithm, while, high value of separation rate has been gained caused by using Hamming instead of Hanning windows against the other algorithms. The separation rate reaches 98.6%, while, the advancement over the nearest algorithm is 2.8%.

There is a major shift toward integrating renewable energy (RE) within the urban context to create zero energy buildings, passive buildings and smart cities. Landscape approximately occupies 65% of the urban area, which nominates landscape to play a major role in generating energy from renewable sources (e.g. solar, wind, etc). In order to achieve this objective, “Energy-scape” elements have been introduced to generate clean and efficient energy by integrating renewable energy (RE) devices with landscape elements. Previous research presented Energy-scape database to help landscape and urban designers to replace landscape with Energy-scape elements and to focus on integrating renewable energy (RE) within the urban environment. Several architects and landscape designers still lack the basic knowledge of RE, never to mention, the complexity of Energy-scape database that is continuously updated. Furthermore, the lack of computer-aided engineering (CAE) tools that can help architects, designers and decision-makers to swiftly integrate RE devices with the urban environment is another barrier to spread the implementation of similar projects. This research attempts to overcome this challenge by introducing a new web-based application to design landscape while integrating Energy-scape elements in urban environment. The algorithm of this web-based application analyzes existing landscape based on existing resources to select suitable Energy-scape elements, required area, and the best suitable locations of these elements within a specific project. The proposed algorithm enables the users to modify suggested locations and area of the Energy-scape elements to meet the project’s needs in term of the available budget, area or the required energy production. Further, the new algorithm calculates the impact of integrating Energy-scape elements within the project in term of cost (e.g. capital and running costs), lifetime, and total energy saving. Moreover, the current paper introduces a simplified user-friendly web-based tool of the proposed new algorithm that will help architects and landscape designers to use Energy-scape elements efficiently within their projects. The efficiency of the presented web-based application will be tested in a case study of Al-Azhar Park in Cairo, Egypt to validate the software capabilities in a real-case scenario. The research concludes that the proposed software application is an effective tool for landscape designers to use Energy-scape elements through identifying the optimum type and location of them within landscape design projects and calculating the impact of using them in terms of energy-savings and carbon emission (CO2) reduction.

This paper presents a robust clutter classifier based on the neural network to assist the radar receiver by choosing optimal constant false alarm rate where this classifier has been trained for 16 classes, four radar return distribution with different situations. The return radar signal distributions are Rayleigh, Weibull, lognormal and K-distribution, while the situations are, signal, multi-target, closed multi-target, and clutter edge. Multilayer perceptron with back-propagation as a neural network with seven features, mean, variance, mode, kurtosis, skewness, median, and entropy, have been used to classify the return signal. A least mean square error is used to evaluate the classifier performance. The simulation is evaluated for the signal to clutter ration from +35 dB to −35 dB, with 5-20 neurons of the hidden layer, and 60-360 samples. By performing, the optimisation has been gained by using 240 samples and 20 neurons then lead to 98.1% return signal classification.

Gastrointestinal stromal tumors (GISTs) are rare, but remain the most common GI mesenchymal neoplasms. In the present study, six cases of GIST are reported, and one of these cases, a patient with esophageal GIST, is reported in-depth. Certain recent developments in the clinical therapy of GISTs are also discussed. The records of all surgically-resected GI stromal tumors treated at the Al-Hada Military Hospital between January 2007 and December 2012 were reviewed. There were six cases of surgically resected GISTs during this time period, three males and three females, with a mean age of 69.3±16.4 years. The stomach was involved in 66.7% of cases, the small intestine in 16.7% and the esophagus, which is an extremely rare site, in 16.7% of cases. The most common symptom at presentation was abdominal pain, followed by GI bleeding. The mean tumor size was 8.7±6.3 cm. Surgery was indicated by the presence of the aforementioned symptoms or a tumor size >5 cm. All tumors were completely resected with histologically negative margins. The diagnoses were established by immunohistochemistry. Four patients were classified as possessing a high-grade variant, and were administered with tyrosine kinase inhibitors (TKIs). Following a mean follow up of 31 months, no recurrence or mortality was detected. Complete surgical resection with tumor-free margins is the standard treatment for GISTs, and TKIs should be used as adjuvant therapy if the risk of progressive disease is high.

Radar is a promising device for detection and recognition of invisible moving objects, Where, the micro-Doppler frequency shift caused by moving the object's parts have been represented as an attractive feature in the recognition process. In spite of that, no thorough analysis of human movement by bicycle and no discriminate from the running one through the wall in the literature. This paper presents a mathematical model of bicycle movement, then, the recognition of moving objects through the wall. Where three human movements; walking, running and on a bicycle have been recognized through two types of wall wood and cork. The theoretical analysis and measured was given a recognition 98.7% for human walking on his feet, 99% of the passenger on a bicycle, and 98% of the person running have been achieved without walls. While, a 95.4%, 96.2%, and 95% recognition have been gained from walking, moving by bicycle and running with wooden wall and 94%, 94.8%, and 93.3% respectively with cork wall. 2.4 GHz as a detector and SVM as classifier are used.

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation., SCOPUS: ar.j, info:eu-repo/semantics/published

Using technology to reduce defects at heterogeneous interfaces of thin-films is at a high-priority for modern semiconductors. The current work utilizes a three-dimensional multiple-slip crystal-plasticity model and specialized finite-element formulations to study the impact of the embedded void approach (EVA) to reduce defects in thin-films deposited on a substrate with a highly mismatched thermal expansion coefficient, in particular, the growth of an InGaN thin-film on a Si substrate, where EVA has shown a remarkable reduction in stresses on the side of the embedded voids.

This chapter tracks the story of Egypt’s modern entrepreneurs during 60 years of military rule (1950–2010). While the period covered is the same in chapters 3 and 4, the two chapters differ in perspectives. Whereas chapter 3 examines state policies toward economic issues in general and the business community in particular, this chapter looks at the response of entrepreneurship to those policies. The two perspectives thus complement one another; they are essentially two sides of the same coin. While numerous issues appear in both chapters there is no analytical repetition. The perspective analysis of the same events is vastly different in each.

In chapter 1, we examined the relationship between state and entrepreneurs in theory and practice. We learned of the success of the state in improving national economic performance through public-private collaboration. From the experience of other countries, we understand that more and more entrepreneurs recognize the value of that collaboration to implement a win-win strategy and expand their own businesses. The specific nature of the role of state as applied to Egypt is the subject matter of this chapter. With the benefit of documented observations we find seven different formulas used by the state in managing the economy. Each has produced results some of which could be measured and assessed while some could not be measured but could still be assessed. Each has its own strengths and weaknesses. The question is: So what? The idea is to use the review as a guide for the future role of the state in Egypt. By implication, the usefulness of this approach could go beyond Egypt to benefit other countries. That the state plays a role in a country’s development is no longer the issue. Rather, it is what specific role or combination of roles does it play.

Vehicular Ad-hoc Network (VANET) is still a recent topology in wireless networks. It is not far different from Mobile Ad-hoc Network (MANET) except VANET is making the benefits of vehicles instead of mobiles. However; the high speed of the vehicles, the rapidly change of VANET topology, and the city environment characteristics, has become today’s issues in terms of wireless communication using vehicles. Thus this type communication has become very famous as a field for researchers. There are two main types of VANET communications as categorized by many researchers, which are vehicle to vehicle (V2V) and vehicle to Infrastructure (V2I). In terms of routing protocols, there are so many protocols that could be used by VANET. However; these protocols are not capable enough to achieve the communication. There are two main types of routing protocols in VANET: VANET routing topology-based and routing position-based. In this current paper we will make an overview about both of them. However; our main focus is to make comparison of geographical-based routing protocols. For example, qualitative comparison of protocols that are used for packages’ carrying and forwarding such as some Delay Tolerant Network (DTN) and non-Delay Tolerant Network Non-DTN geographic routing protocols. Finally, each protocol has its own advantages and disadvantages. So it is important to have an idea about them because at least they will be as a guide lines for the readers to determine their own researches. Depends on this comparison it is observed that hybrid DTN and non-DTN will perform better since it will take the advantages of all DTN and non-DTN.

Egypt is currently experiencing the symptoms of an energy crisis, such as electricity outage and high deficit, due to increasing rates of fossil fuels consumption. Conversely, Egypt has a high solar availability of more than 18.5 MJ daily. Additionally, Egypt has large uninhabited deserts on both sides of the Nile valley and Sinai Peninsula, which both represent more than 96.5 % of the nation’s total land area. Therefore, solar energy is one of the promising solutions for the energy shortage in Egypt. Furthermore, these vast lands are advantageous for commissioning large-scaled solar power projects, not only in terms of space availability, but also of availability of high quality silicon (sand) required for manufacturing silicon wafers used in photovoltaic (PV) modules. Also, rural Egypt is considered market a gap for investors, due to low local competition, and numerous remote areas that are not connected to the national electricity grid. Nevertheless, there are some obstacles that hinder the progress of solar energy in Egypt; for instance, the lack of local manufacturing capabilities, security, and turbulent market in addition to other challenges. This paper exhibits an experience of the authors designing and installing decentralized PV solar systems, with a total rated power of about 11 kW, installed at two rural villages in at the suburbs of Fayoum city, in addition to a conceptual design of a utility scale, 2 MW, PV power plant to be installed in Kuraymat. The outcomes of this experience asserted that solar PV systems can be a more technically and economically feasible solution for the energy problem in rural villages.

The management literature reports on numerous studies examining relationships among the variables of job satisfaction and organizational commitment, and more recently organizational character, organizational citizenship behavior, and propensity for participative decision making. The present study empirically examines relationships among these constructs among Egyptian managers. Although general support was demonstrated for the previously validated scales, the evidence suggests that these constructs are culturally specific and must be redefined, especially in emerging countries. Further, findings support some, but not all of the conclusions typically reached in existing studies of Western managers.

This research reports the results of a single case study that covers a successful project of IT implementation in International Commercial Bank (ICB) from the Egyptian banking industry. The case highlights leadership actions, as well as other related factors regarding effectiveness of IT implementation that are linked to strategic competitiveness and value creation. Multiple sources of data were used. Primary sources include in-depth interviews in semi-structured format with industry authorities, IT and retail banking managers, and the bank’s executives in general; whereas, secondary sources of data include annual reports, website information, and financial statements. Findings show that successful implementation was influenced by the interplay of several management practices, which eventually, had an impact on strategic competitiveness through their impact on some in-house attributes; notably, a dominating constructive cultural pattern leading to higher levels of organizational commitment, and the bank’s value chain.

An approach based on auscultatory percussion, a technique used by some orthopedists both for bone fracture detection and bone fracture healing assessment, is described. Low-frequency, low-intensity mechanical power, very much like the finger tap of orthopedists, is used to evaluate the vibrational response of the bone. The novel element is the data processing, which incorporates specialized preprocessing and a neural network for estimating fractured bone strength. In addition, a new mathematical model for the vibrational response of a fractured limb, which provides data to design and test the neural network processing scheme, is presented. An experimental procedure is described for acquiring real data from animal and human fractures in a form necessary for neural network input. >

We present a patient who developed Guillain-Barre syndrome (GBS) after a Cyclospora-induced diarrheal illness. We raise the possibility that Cyclospora is an infectious trigger for GBS in this patient. An active search for this agent in patients with GBS preceded by diarrheal illness is recommended.

In this paper we present a method for assessing the architecture of vertebral trabecular bone. This methods employs a specialized image segmentation algorithm to provide a binary image of the trabecular portion of a computer tomographic image of a vertebral body. Once segmented, an estimate of the structural anisotropy is obtained using the mean intercept length as a function of angle. The relationship between mass, architecture, and ultimate compressive strength is discussed and data is presented for seven vertebral specimens.

Complications of orthopedic and spine operations can be life threatening. Proper patient selection, careful planning of patient care, and prophylactic measures are important determinants of a successful outcome. After elective orthopedic surgery such as total joint replacement, the intensivist should be aware of potential systemic complications common to any major surgical intervention (pneumonia, pulmonary embolism, sepsis, myocardial infarction) and also of procedure-specific problems (cement-related cardiac events, fat embolism) and local complications (neurovascular injuries). Patients undergoing spine procedures should have close neurologic monitoring for immediate and delayed deficits.

To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.All patients with symptomatic gallstones were included in the study. Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography. Patients with normal ultrasound were referred to magnetic resonance cholangiopancreatography. All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function.This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.

Background: Laparoscopic cholecystectomy (LC) is the standard of care for symptomatic cholelithiasis, but is associated with a higher incidence of bile duct injuries than the open approach. We evaluated a multidisciplinary approach for managing these injuries after LC. Materials and Methods: From April 2006 to August 2011, all patients who developed bile duct injury after LC and were treated by the hepatobiliary team of Al-Hada Armed Forces Hospital, Taif, Saudi Arabia were included in our study. If an injury was suspected intraoperatively, intraoperative cholangiography was performed; thereafter, if the injury was confirmed, immediate laparotomy and primary repair or hepaticojejunostomy (H-J) involving lowering of the hilar plate were performed. Injuries occurring postoperatively were treated by endoscopic cholangiopancreatography (ERCP) to diagnose the type of Strasberg injury. Strasberg type A injuries were managed endoscopically, and more advanced cases underwent open surgery. Results: Of 30 females and 18 males (mean age, 45 years; range, 18-90 years), 6 cases of bile duct injuries were discovered intraoperatively. Of these, two were classified as type C and underwent primary repair with internal stenting. The other four were classified as type E and were treated by Roux-en-Y H-J reconstruction. Forty-two cases of bile duct injuries presented postoperatively, including 18 Strasberg type A and 24 Strasberg type E injuries. Type A injuries were treated with ERCP and stenting, and six with endoscopic removal of a retained stone. Of the 28 patients who underwent H-J, 20 underwent the technique involving lowering of the hilar plate. Of these, three subsequently developed anastomotic strictures and were treated with percutaneous transhepatic balloon dilatation. There were no mortalities. The mean follow-up was for 36 months. Conclusion: Early referral to a specialized surgeon and a multidisciplinary approach help manage bile duct injury after LC in all patients with an acceptable low stricture rate.

To plan and design dairy housing, several calculations should be made; this requires time and efforts, with the possibility of making mistakes. The objectives of this paper are to develop a tool to assist the designers in planning and designing dairy housing in arid and semi-arid zones, to save time and efforts, and to provide a new design model. Two mathematical models were developed to plan and design corral systems and the required concrete constructions. Subsequently, an electronic spark map (decision tree) was developed for each mathematical model, and then the mathematical models were integrated into the electronic spark maps. Afterwards, C# (C Sharp) programming language was used to develop the software by integrating the electronic spark maps, and making the user interface. The developed software is able to plan and design the housing system (corrals system), specify corrals and house dimensions, and compute the required amounts of construction materials (iron rods, cement, sand, and gravels) to build the required concrete base. Furthermore, it calculates the capital investment and the fixed, variable, and total costs of the construction. Data of 6 dairy farms were used to validate the model, and to evaluate the software. The differences between actual and calculated values were determined, and the standard deviations were calculated. The coefficients of variation (COVs) range between 3% and 7%.

Myocardial performance is diminished in persistent SVT and will lead to hydrops fetalis (HDF). This study sought to determine which methods of fetal echocardiography are best for evaluating treatment and outcome in these fetuses. Methods: Ten infants with HDF due to SVT were included in this study. No fetus has structural heart disease. Serial cardiovascular function was estimated from CC/TC ratio, left ventricular shortening fraction, tricuspid E and A velocities and E/A ratio, mitral E, A velocities and E/A ratio and Doppler flow patterns in the free loop of the umbilical cord, MCA, ductus arteriosus and ductus venosus (DV) as well as maximal velocities and time velocity integrals into the ascending aorta and main pulmonary artery. The Tei index was calculated as the sum of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) divided by the ejection time using the ‘‘clicks’’ method. These parameters were compared to age matched normal fetuses from our data base. Changes in the gross measurements of third space effusions were considered demonstrable of improvement of fetal cardiovascular status. Results: The most sensitive indicator of change in fetal function was the Tei index followed by CC/TC ratio. Tei index is the first cardiovascular parameter which gets normalised in these fetuses responding to the treatment. There was no significant change over time with E/A ratios, LV shortening fraction or peripheral arterial Doppler values. DV A wave reversal normalized with cessation of SVT with normal PI values. DV size went from greater than the 95% to normal with cessation of SVT. Conclusions: The Tei index easily performed from 14 weeks through term. It is a useful and likely the most sensitive method of evaluating global myocardial performance in followup of fetuses with HDF especially due to SVT.

A method is described for screening all pregnant women for abnormal glucose tolerance. It is based on determining random plasma glucose at 28-30 weeks gestation, having simply noted whether the woman had eaten within the preceding 2 h. If the random plasma glucose level was greater than or equal to 97.5th centile, a 75 g oral glucose tolerance test was performed. This method of screening is cheaper and slightly more efficient than screening based on conventional risk indications.

A method for assessing the strength of a healing fractured bone is described. A four-port electrical network model of the low frequency (SOHz-IkHr) transverse vibration response of a healing fractured bone is derived using Timoshenko beam theory. A backpropagation neural net with one hidden layer processes computer simulated bone fracture model data, and classifies it with respect to the fracture gap stiffness. relative to intact bone. The effect of changing the number of hidden units is also evaluated. In vivo vibration measurements from a patient with a fractured humerus

Background Pancreatic paragangliomas are rare tumors, with only 16 reported cases to date. One of these cases demonstrates metastasis to lymph node, while another case was functional, however, none of these cases showed malignant and large, pancreatic paraganglioma with marked invasion. Also another unique feature was the age of our patient compared to the average reported ages in published literature (42–85 years). Case presentation A 19-year-old woman presented with a one-year history of intermittent abdominal pain. Physical examination showed a palpable mass in the right upper abdomen, but initial laboratory results were within normal ranges; tumor markers (CEA, AFP, and CA19-9) were negative. An abdominal and pelvic computed tomography (CT) scan showed a well-defined retroperitoneal para-aortic mass. The CT scan revealed that the surrounding lymph nodes were not enlarged, but the liver showed evidence of parenchymal infiltration. Intraoperatively, a large, firm tumor originating from the head of pancreas was found pushing on the caudate hepatic lobe and the inferior vena cava (IVC). The tumor was resected through a pancreaticoduodenectomy, involving segment VI of the liver and a small segment of the IVC. The blood pressure spiked (>220 mm Hg) when the tumor was manipulated during the operation. The final pathology report showed a 9-cm tumor with lymphovascular invasions; immunohistochemistry was positive for synaptophysin and chromogranin. All resection margins were negative and 1/15 lymph nodes was positive for metastasis. Post-operative recovery was unremarkable. One month after discharge, the patient was re-admitted with abdominal pain and found to have an abdominal collection at the resection site, which was drained under CT guidance. She received a therapeutic dose of I131-metaiodobenzylguanidine (MIBG). Follow-ups showed the absence of recurrence, and she has remained disease free. Conclusion This patient was an extraordinary example of a rare tumor. Even more remarkable was that the tumor was malignant with lymph node invasion. To our knowledge, a case similar to that presented here has not been previously reported in the literature.

International audience; Background: Changes in body representations (body image and/or body schema) have been reported in several chronic musculoskeletal pain syndromes, but rarely in patients with neuropathic pain and never in patients with spinal cord injury (SCI)-related pain. Methods: We used implicit motor imagery (the laterality judgement task and visuospatial body perception tests) in 56 patients with thoracic SCI with (n = 32) or without (n = 24) pain below the level of the injury, and in a group of matched healthy controls (n = 37). We compared the participants' reaction time and the accuracy with which they identified the laterality of hands and feet presented in various orientations. Visuospatial body perception was assessed with a series of tests referred to as the 'horizontal subjective body midline', and the umbilicus-reaching task (URT), in which participants were asked to estimate the location of the umbilicus under different experimental conditions. Results: Both groups of patients had longer reaction times for the identification of laterality for the feet than for the hands, but with no difference in accuracy. This longer reaction time was not correlated with spinal lesion severity, but was directly related to both average pain intensity and specific neuropathic pain components. The URT was affected in both groups of patients, with no effect of pain intensity. By contrast, the horizontal subjective body midline task was unaffected. Conclusion: These results suggest an interplay between lower body scheme distortions and pain in patients with SCI. Significance: Spinal cord injury is associated with alterations of lower body scheme as assessed with the laterality judgement task, which are directly related to pain intensity in patients with below-level neuropathic pain.