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BACKGROUND: The choice of transcatheter aortic valve replacement (TAVR) prosthesis is crucial in optimizing short- and long-term outcomes. The objective of this study was to conduct a meta-analysis comparing outcomes of third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV). METHODS: Electronic databases were searched from inception to June 2023 for studies comparing third-generation BEV vs SEV. Primary outcome was all-cause mortality. Secondary outcomes included clinical and hemodynamic end points. Random-effects models were used to calculate pooled odds ratios (ORs) or weighted mean differences (WMDs). RESULTS: The meta-analysis included 16 studies and 10,174 patients (BEV, 5753 and SEV, 4421). There were no significant differences in 1-year all-cause mortality (OR, 1.15; 95% CI, 0.89-1.48) between third-generation BEV vs SEV. TAVR with third generation BEV was associated with a significantly lower risk of TIA/stroke (OR, 0.62; 95% CI, 0.44-0.87), permanent pacemaker implantation (OR, 0.55; 95% CI, 0.44-0.70), and ≥moderate paravalvular leak (PVL, OR, 0.43; 95% CI, 0.25-0.75), and higher risk of ≥moderate patient-prosthesis mismatch (OR, 3.76; 95% CI, 2.33-6.05), higher mean gradient (WMD, 4.35; 95% CI, 3.63-5.08), and smaller effective orifice area (WMD, -0.30; 95% CI, -0.37 to -0.23), compared with SEV. CONCLUSION: In this meta-analysis, TAVR with third-generation BEV vs SEV was associated with similar all-cause mortality, lower risk of TIA/stroke, permanent pacemaker implantation, and ≥moderate PVL, but higher risk of ≥moderate patient-prosthesis mismatch, higher mean gradient, and smaller effective orifice area. Large, adequately powered randomized trials are needed to evaluate long-term outcomes of TAVR with latest generations of BEV vs SEV.

Background: Typing and grading of endometrial carcinomas (ECs) on small biopsy specimens is crucial to determine the need for full surgical staging. Histological subtype and grade are key factors available for risk stratification before surgery. However, this can be diagnostically challenging on small biopsy specimens, especially when morphologic features are subtle or overlapping. Aims: The aims of this audit were to assess concordance of endometrial carcinomas on biopsy specimens with hysterectomy specimens and to determine if the immunohistochemistry (IHC) panel being used in our practice was adequately subtyping ECs. Settings and Design: The audit was approved by the Clinical Effectiveness Team of the Royal College of Pathologists (UK) as meeting all the criteria and standards set out by the College. Materials and Methods: Biopsies from 67 cases of EC were compared for histological subtype and grade of endometrioid carcinoma with resection specimens. A re-audit was carried out on 59 cases after implementation of changes recommended by the initial audit. Results: Two of 35 (6%) tumours defined as G1 on biopsy were upgraded (to G2) on final pathology, as was one of 7 (14%) G2 tumours (to G3). One of these cases had solid areas just amounting to more than 6% on resection. In the second case, a comment was made that assessment had been difficult as the specimen was suboptimally fixed, but nuclei appeared atypical. Of seven G2 biopsies, one case was upgraded to grade 3 on final pathology based on proportion of solid areas. Our data show lower rates of discordance as compared to previous studies and on re-audit, the concordance between endometrioid and nonendometrioid serous carcinoma improved with the addition of immunohistochemistry (IHC) for Phosphatase and tensin homolog (PTEN) to biopsies. Conclusions: PTEN IHC can complement other stains and aid in the distinction of grade 3 endometrioid carcinoma from serous carcinoma on endometrial biopsies.

Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient- and process-specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area [Formula: see text]1.0 cm2. Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08-0.69]; P=0.01), greater comorbid conditions (OR, 0.88 per 1-point increase in Combined Comorbidity Index [95% CI, 0.79-0.97]; P=0.01), low-flow, low-gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06-0.21]), and low-gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08-0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38-4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9-130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low-gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.

BackgroundHypoplastic left heart syndrome (HLHS) accounts for 2.6% of congenital heart disease and is an invariably fatal cardiac anomaly if left untreated. Approximately 33,750 babies are born annually with HLHS in developing countries. Unfortunately, the majority will not survive due to the scarcity of resources and the limited availability of surgical management.AimTo describe and analyze our experience with the hybrid approach in the management of HLHS in a developing country.MethodsWe performed a retrospective single-center study involving all neonates born with HLHS over five years at the Children's Heart Center at the American University of Beirut. The medical records of patients who underwent the hybrid stage 1 palliation were reviewed, and data related to baseline characteristics, procedure details and outcomes were collected to describe the experience at a tertiary care center in a developing country.ResultsA total of 18 patients were diagnosed with HLHS over a five-year period at our institution, with male to female ratio of 1:1. Of those, eight patients underwent the hybrid stage I procedure. The mean weight at the time of the procedure was 3.3 ± 0.3 kg with an average age of 6.4 ± 4 days. The mean hospital length of stay was 27.25 days, with an interquartile range of 33 days. The cohort's follow-up duration averaged 5.9 ± 3.5 years. The surgical mortality was zero. Only one mortality was recorded during the interstage period between stage I and II and was attributed to sepsis. Notably, all surviving patients maintained preserved and satisfactory cardiac function with good clinical status.ConclusionOur limited experience underscores the potential of developing countries with proper foundations to adopt the hybrid procedure for HLHS, yielding outcomes on par with those observed in developed countries. This demonstrates the viability of establishing a more balanced global landscape for children with congenital heart disease.

BackgroundWhile research on congenital heart disease has been extensively conducted worldwide, comprehensive studies from developing countries and the Arab world remain scarce.AimThis study aims to perform a bibliometric review of research on congenital heart disease in the Arab world from 1997 to 2022.MethodsWe analyzed data from the Web of Science, encompassing various aspects such as topics, countries, research output, citations, authors, collaborations, and affiliations. This comprehensive science mapping analysis was done using the R statistical software's Bibliometrix Package.ResultsThe research output from Arab countries over the 25 years showed an average annual growth rate of 11.5%. However, Arab countries exhibited lower research productivity than the United States and Europe, with a 24-fold difference. There was substantial variation in research output among 22 Arab countries, with five countries contributing to 78% of the total publications. Most of the published research was clinical, with limited innovative contributions and a preference for regional journals. High-income Arab countries displayed higher research productivity and citation rates than their low-income developing counterparts. Despite being categorized as upper-middle-income, post-conflict countries exhibited low research productivity. About one-quarter of the published articles (26%) resulted from collaborative efforts among multiple countries, with the United States being the most frequent collaborator. Enhanced research productivity and impact output were strongly associated with increased international cooperation.ConclusionResearch productivity in the Arab region closely correlates with a country's GDP. Success hinges on governmental support, funding, international collaboration, and a clear research vision. These findings offer valuable insights for policymakers, educational institutions, and governments to strengthen research programs and nurture a research culture.

Abstract Choosing the proper engine that fits the desired application is a crucial design factor in robotics. Accordingly, this paper compares different types of engines for other Industrial robots (IR) and proposes to put practical criteria based on the mechanical design and its application. It starts from describing the IR choice to explaining the synchronous motor with permanent magnets as a base of the motor choice. Particular attention is paid to the consideration of components and their purpose supported by the creation of the subsequent drawings. SolidWorks system was implemented to obtain expressive and high-quality graphics and three dimensions design. Moreover, the entire Electrical Magnetic Force (EMF) was simulated using the method of variational parameterization. Accordingly, a developed synchronous motor with a built-in permanent magnet is proposed, which is supported by 3D design graphics to evaluate the deformation and margin of the housing and motor shaft safety.The obtained results provide a valuable study for the robotic engines' characteristics, such as the engine's strength, torque, power, and speed. An example of the comparison results is testing the synchronous motor, which confirms that the permanent magnets built-on synchronous motor is most recommended for the lightweight robots designed to work under average load weight. More results were performed to compare the proposed design with the robotics world's leading companies, showing that the developed proposed design has significant characteristics that outperform traditional motors.

ABSTRACT Autophagy plays an important role against pathogen infection in many organisms; however, little has been done with regard to vector-borne plant and animal pathogens, that sometimes replicate and cause deleterious effects in their vectors. Candidatus Liberibacter solanacearum (CLso) is a fastidious gram-negative phloem-restricted plant pathogen and vectored by the carrot psyllid, Bactericera trigonica. The plant disease caused by this bacterium is called carrot yellows and has recently gained much importance due to worldwide excessive economical losses. Here, we demonstrate that calcium ATPase, cytosolic calcium, and most importantly Beclin-1 have a role in regulating autophagy and its association with Liberibacter inside the psyllid. The presence of CLso generates reactive oxygen species and induces the expression of detoxification enzymes in the psyllid midguts, a main site for bacteria transmission. CLso also induces the expression of both sarco/endoplasmic reticulum Ca2+pump (SERCA) and 1,4,5-trisphosphate receptors (ITPR) in midguts, resulting in high levels of calcium in the cellular cytosol. Silencing these genes individually disrupted the calcium levels in the cytosol and resulted in direct effects on autophagy and subsequently on Liberibacter persistence and transmission. Inhibiting Beclin1-phosphorylation through different calcium-induced kinases altered the expression of autophagy and CLso titers and persistence. Based on our results obtained from the midgut, we suggest the existence of a direct correlation between cytosolic calcium levels, autophagy, and CLso persistence and transmission by the carrot psyllid. IMPORTANCE Plant diseases caused by vector-borne Liberibacter species are responsible for the most important economic losses in many agricultural sectors. Preventing these diseases relies mostly on chemical sprays against the insect vectors. Knowledge-based interference with the bacteria-vector interaction remains a promising approach as a sustainable solution. For unravelling how Liberibacter exploits molecular pathways in its insect vector for transmission, here, we show that the bacterium manipulates calcium levels on both sides of the endoplasmic reticulum membrane, resulting in manipulating autophagy. Silencing genes associated with these pathways disrupted the calcium levels in the cytosol and resulted in direct effects on autophagy and Liberibacter transmission. These results demonstrate major pathways that could be exploited for manipulating and controlling the disease transmission.

الأهداف: هدفت هذه الدراسة إلى معرفة مستويات اليقظة العقلية بين الأفراد، والمهارات الاجتماعية لدى الطلبة، وتقصي العلاقة بينهما. كما هدفت أيضا إلى معرفة المقدرة التنبؤية لليقظة العقلية بين الأفراد بالمهارات الاجتماعية. المنهجية: اعتمدت الدراسة على المنهج الوصفي الارتباطي، وتكونت عينة الدراسة من (600) طالب وطالبة (212 ذكوراً و 388 إناثاً) من طلبة جامعة اليرموك المسجلين في الفصل الدراسي الثاني للعام الجامعي (2020-2021)، جرى اختيارهم بالطريقة المتيسرة. لتحقيق أهداف الدراسة جرى استخدام مقياس اليقظة العقلية بين الأفراد المعد من قبل براتشر وزملائه (Pratscher, et al., 2019)، ومقياس المهارات الاجتماعية الذي أُعدَّ لغايات هذه الدراسة. النتائج: أظهرت نتائج الدراسة أنَّ مستوى اليقظة العقلية بين الأفراد ومستوى المهارات الاجتماعية جاءا بمستوى متوسط وبمتوسطين حسابيين مقدارهما (3.519) و(3.495) على التوالي، ووجود علاقة ارتباطية دالة احصائياً بينهما (r= 0.601). كما أظهرت النتائج أيضاً أن مربع معامل الانحدار الخطي البسيط قد بلغ (0.360)، أي أنه يمكن تفسير ما يقارب من (36%) من التباين في متغير المهارات الاجتماعية بمعرفة مستوى اليقظة العقلية بين الأفراد. وأخيراً أظهرت نتائج تحليل الانحدار الخطي المتعدد أنَّ الأبعاد الأربعة لليقظة العقلية قد ساهمت في تفسير ما نسبته (37%) من التباين الحاصل في المهارات الاجتماعية. الخلاصة: بناء على النتائج أعلاه يوصى بإجراء دراسات بموضوع اليقظة العقلية بين الأفراد على مراحل عمرية مختلفة.

Robotic systems play an important role in the development and modernization processes of production, facilitation of labor, and human life. The robotic manipulators are outstanding among such systems. Such robots can be used for various spheres of their application. In this case, there is the manipulator’s effective control problem in the working area, of which there may be various obstacles. Therefore, a procedure is required to find the optimal path for moving the robotic arm. To develop such a procedure, the literature was reviewed, and the structural diagram of the control system of such a robot and its components was summarized. It proposed a mathematical formalization of the search for the optimal path to move the robot arm, an algorithm based on a modified method of navigation graphs, to realize the more natural movement of the robot arm. Experimental studies were conducted with different numbers of objects on the path of robot arm movement, which were combined into groups. The temporal results of this process are presented in a diagram.

This paper presents the global analysis of two extended decreases in the galactic cosmic-ray intensity observed by worldwide networks of ground-based detectors in 2012. This analysis is capable of separately deriving the cosmic-ray density (or omnidirectional intensity) and anisotropy, each as a function of time and rigidity. A simple diffusion model along the spiral field line between Earth and a cosmic-ray barrier indicates the long duration of these events, resulting from about 190° eastern extent of a barrier such as an interplanetary shock followed by the sheath region and/or the corotating interaction region (CIR). It is suggested that the coronal mass ejection merging with and compressing the preexisting CIR at its flank can produce such an extended barrier. The derived rigidity spectra of the density and anisotropy both vary in time during each event period. In particular we find that the temporal feature of the “phantom Forbush decrease (FD)” reported in an analyzed period is dependent on rigidity, and looks quite different at different rigidities. From these rigidity spectra of the density and anisotropy, we derive the rigidity spectrum of the average parallel mean free path of pitch angle scattering along the spiral field line and infer the power spectrum of the magnetic fluctuation and its temporal variation. The possible physical cause of the strong rigidity dependence of the phantom FD is also discussed. These results demonstrate the high-energy cosmic rays observed at Earth responding to remote space weather.

Introduction: Migraine is a common and debilitating pain disorder associated with dysfunction of the central nervous system. Advanced magnetic resonance imaging (MRI) studies have reported relevant pathophysiologic states in migraine. However, its molecular mechanistic processes are still poorly understood in vivo. This study examined migraine patients with a novel machine learning (ML) method based on their central μ-opioid and dopamine D2/D3 profiles, the most critical neurotransmitters in the brain for pain perception and its cognitive-motivational interface.Methods: We employed compressive Big Data Analytics (CBDA) to identify migraineurs and healthy controls (HC) in a large positron emission tomography (PET) dataset. 198 PET volumes were obtained from 38 migraineurs and 23 HC during rest and thermal pain challenge. 61 subjects were scanned with the selective μ-opioid receptor (μOR) radiotracer [11C]Carfentanil, and 22 with the selective dopamine D2/D3 receptor (DOR) radiotracer [11C]Raclopride. PET scans were recast into a 1D array of 510,340 voxels with spatial and intensity filtering of non-displaceable binding potential (BPND), representing the receptor availability level. We then performed data reduction and CBDA to power rank the predictive brain voxels.Results: CBDA classified migraineurs from HC with accuracy, sensitivity, and specificity above 90% for whole-brain and region-of-interest (ROI) analyses. The most predictive ROIs for μOR were the insula (anterior), thalamus (pulvinar, medial-dorsal, and ventral lateral/posterior nuclei), and the putamen. The latter, putamen (anterior), was also the most predictive for migraine regarding DOR D2/D3 BPND levels.Discussion: CBDA of endogenous μ-opioid and D2/D3 dopamine dysfunctions in the brain can accurately identify a migraine patient based on their receptor availability across key sensory, motor, and motivational processing regions. Our ML-based findings in the migraineur’s brain neurotransmission partly explain the severe impact of migraine suffering and associated neuropsychiatric comorbidities.

The National Aeronautics and Space Administration Soil Moisture Active Passive (SMAP) mission has been validating its soil moisture (SM) products since the start of data production on March 31, 2015. Prior to launch, the mission defined a set of criteria for core validation sites (CVS) that enable the testing of the key mission SM accuracy requirement (unbiased root-mean-square error 3/m3). The validation approach also includes other (“sparse network”) in situ SM measurements, satellite SM products, model-based SM products, and field experiments. Over the past six years, the SMAP SM products have been analyzed with respect to these reference data, and the analysis approaches themselves have been scrutinized in an effort to best understand the products’ performance. Validation of the most recent SMAP Level 2 and 3 SM retrieval products (R17000) shows that the L-band (1.4 GHz) radiometer-based SM record continues to meet mission requirements. The products are generally consistent with SM retrievals from the European Space Agency Soil Moisture Ocean Salinity mission, although there are differences in some regions. The high-resolution (3-km) SM retrieval product, generated by combining Copernicus Sentinel-1 data with SMAP observations, performs within expectations. Currently, however, there is limited availability of 3-km CVS data to support extensive validation at this spatial scale. The most recent (version 5) SMAP Level 4 SM data assimilation product providing surface and root-zone SM with complete spatio–temporal coverage at 9-km resolution also meets performance requirements. The SMAP SM validation program will continue throughout the mission life; future plans include expanding it to forested and high-latitude regions.

Complex fuzzy sets (CFSs) have recently emerged as a potent tool for expanding the scope of fuzzy sets to encompass wider ranges within the unit disk in the complex plane. This study explores complex fuzzy numbers and introduces their application for the first time in the literature to address a complex fuzzy partial differential equation that involves a complex fuzzy heat equation under Hukuhara differentiability. The researchers utilize an implicit finite difference scheme, namely the Crank–Nicolson method, to tackle complex fuzzy heat equations. The problem’s fuzziness arises from the coefficients in both amplitude and phase terms, as well as in the initial and boundary conditions, with the Convex normalized triangular fuzzy numbers extended to the unit disk in the complex plane. The researchers take advantage of the properties and benefits of CFS theory in the proposed numerical methods and subsequently provide a new proof of the stability under CFS theory. A numerical example is presented to demonstrate the proposed approach’s reliability and feasibility, with the results showing good agreement with the exact solution and relevant theoretical aspects.