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Studies have shown that COVID-19 patients experience high levels of anxiety, depression, and stress during the pandemic. Patients adopt different coping strategies to reduce their psychological distress.To compare the immediate and long-term psychological impact of COVID-19 disease on patients with and without chronic medical illnesses (CMI) and identify coping styles of both groups during the peak of COVID-19 disease in Egypt.This is a cohort follow-up study, that included an online survey consisting of General Health Questionnaire-12, Taylor Manifest Anxiety Scale, Beck Depression Inventory and Brief-COPE scale. The Post-Traumatic Stress Disorder (PTSD) Checklist was completed after 6 months. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt.There was no significant difference between the two groups regarding anxiety and depression during the acute infection. Patients without CMI relied significantly on the use of informational support to cope with COVID-19 disease. Patients with CMI continued to show significant depressive symptoms after 6 months without significant PTSD symptoms.COVID-19 has similar immediate psychological impact on patients with and without CMI. However, patients with CMI continue to show depression on long-term follow-up.

This study was designed to investigate the influence of naturally protected eucalyptus oil supplementation in a form of leaves (EUL) or mature seed capsules (EUS) compared to crude eucalyptus oil (EUO). The control group (G1) received a diet containing concentrate feed mixture, fresh berseem, rice straw, and corn silage. Whereas the G2, G3, and G4 animals have a diet supplemented with 200 g/head/day of EUL or EUS or 4 mL/head/day EUO, respectively. Supplementation of EUL or EUS increased NH3-N, SCFA’s, and concentrations of acetic acid in-vitro. Bacterial total count, protozoa, and cellulolytic bacteria increased (P ) with EUL and EUS supplementation. Methane production dropped (P ) with EUS, EUL, and EUO supplementation. Milk fat decreased (P ) with EUO supplementation, while an adverse trend was shown for lactose. No differences in feed conversion were found among EUS, EUL, and EUO. Blood total protein, albumin, and urea increased (P P ) AST, ALT, glucose, and creatinine. Supplementation with EUL, EUS, or EUO decreased (P ) DM, OM, and CP digestibility. While digestibility of EE with supplementation by EUL, EUS, or EUO was higher (P ). The digestion coefficient of NDF and ADF decreased (P

Summary Introduction and objectives Ureteral prestenting before retrograde intrarenal surgery (RIRS) causes passive dilatation of the ureter, improves stone-free rate and is associated with shorter operative time. However, the presence of a ureteric stent may increase the risk for septic complications, which accelerates with increased dwelling time duration. The aim of the present study is to explore the impact of ureteral prestenting timing in a group of children undergoing retrograde intrarenal surgery (RIRS) on perioperative outcomes and complication rates and to define the optimum duration of prestenting dwelling time. Patients and methods A retrospective study on 60 children aged less than 14 years, presented with upper tract urinary stones, who were subdivided into two groups: Group 1 and 2, each included 30 children who had undergone RIRS after ureteric stenting for two weeks and four weeks respectively. Success of ureteroscope introduction, operative time, stone free rate (SFR), intraoperative and postoperative complications and number of retreatment procedures after definitive RIRS were recorded and compared between the two treatment groups. Results Ureteric access was successfully obtained in all children in both groups. Patients in group 1 and 2 had a SFR of 86.6% and 90%, respectively (p = 0.199). The mean operative time of group 1 and 2 were 56.5 and 52.9 min (p = 0.612). Postoperative UTI rates increased with prolonged dwelling time from 6.7% in group 1 to 30% in group 2. No patient in both groups developed high grade complications. Conclusions Increasing prestenting dwelling time from two to four weeks had no statistically significant effect on the successful ureteroscopic access nor the stone free rate in children undergoing RIRS. Reducing the ureteric stent dwelling time minimizes the rate of postoperative UTI without compromising the success of operative outcomes. Download : Download high-res image (136KB) Download : Download full-size image Summary Figure . Flow charts of children enrolled in the study.

COVID-19 patients, especially those with chronic medical illnesses (CMI), may use different coping strategies, to reduce their psychological distress while facing the COVID-19 infection. The aim was to compare anxiety, depression and coping styles between patients infected with COVID-19 disease with and without CMI during the peak of COVID-19 disease in Egypt. This is a cross sectional study, that included an online survey consisting of Arabic versions of General Health Questionnaire-12, Taylor Manifest Anxiety Scale (TMAS), Beck Depression Inventory (BDI) and Brief-COPE scale. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt. One hundred ninety-nine patients responded to the survey, where 46.73% of them had CMI. Religion, emotional support, use of informational support and acceptance were the most used coping strategies by participants. Avoidant coping strategies were frequently used by divorced patients, home quarantined individuals, patients who developed COVID-19 related anxiety/depression and patients who didn’t receive hydroxyl-chloroquine. Approach strategies were frequently used by patients with mild COVID-19. Understanding the used coping strategies has implications for how individuals might be helped to manage their illness during the current presentation and intervene with development of serious long-term mental health conditions.

Objective To prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT). Materials and Methods Forty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO). Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage. Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up. Results Staged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery. At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048). Conclusions Both staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.

The interactions between the metal and the surroundings are responsible for electrochemical reactions that contribute to corrosion. To mitigate or deter corrosion of exposed metal in a corrosive environment, and corrosion agent must be applied to the metal surface to prevent further oxidation and therefore the presence of corrosion materials. One of the common techniques used by professionals associated in conservation-restoration to preserve metallic cultural heritage is the corrosion inhibitors. The second section of the thesis deals with the conservation and management by using an environmentally friendly corrosion agent of the corrosion of brass composite brass leather parts from the Bulaq Museum, Cairo, Egypt. Microscope Optical and scanning electron Analysis was performed to determine the microstructure of the alloy. Determining the alloy chemical composition of the identified objects using dispersive energy spectroscopy (EDS). Using X-ray diffraction (XRD), corrosion products were established. Finally, the effectiveness of composites between industrial corrosion inhibitors and surfactant materials was identified by the positive effects of (TTA + SLS) on handling. Before and after treatments the brass surfaces were described using SEM, EDS, XRD, FTIR, and XPS.

Objectives: To prepare rebamipide (REB) -loaded cubosomal nanoparticles to improve the oral bioavailability of the drug in human volunteers. Methodology: The poorly water soluble drug REB was incorporated into cubosomal nanoparticles by solvent dilution method. The prepared REB-loaded cubosomes were in vitro characterized for particle size, polydispersity index (PDI), zeta potential, drug crystallinity and in vitro drug release. In vivo absorption of REB-loaded cubosomes was compared with drug powder and commercially available tablets Mucosta® (Egypt Otsuka Pharmaceutical Company) in healthy human volunteers. Results: In vitro, REB-loaded cubosomes entrapped about 82.44 % drug and revealed nanometer-size ranged from 303.1 ± 4.9 to 444.9 ± 6 nm. In vitro REB release from cubosomes exhibited a phase of rapid and high release of the drug during the first hour followed by a slower and complete drug release over a period of 3 hrs. The results of bioavailability study in healthy human volunteers showed that cubosomes significantly improved the rate and extent of REB absorption. The mean relative bioavailability of the REB loaded cubosomes compared to the drug powder and commercially available tablets (Mucosta®) was 191.23 ± 1.24 % and 166.29 ± 1.14 % respectively. Conclusion: The prepared cubosomes significantly improved the In-vivo absorption of REB in comparison with drug powder and commercially available tablets (Mucosta®).

We compared outcomes of percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of children with renal calculi larger than 2 cm.A total of 38 patients younger than 16 years with renal calculi larger than 2 cm were randomized to undergo percutaneous nephrolithotomy or retrograde intrarenal surgery between May 2011 and February 2014. Demographic data, stone criteria, operative technique, radiation time, complications, blood transfusion, hemoglobin decrease, stone-free rate and length of hospital stay were compared between the groups. Stone-free status was documented if there were no residual stones after 1 month.The study included 43 renal units, of which 21 were subjected to retrograde intrarenal surgery and 22 to percutaneous nephrolithotomy. Operative time was comparable for both groups. Mean radiation time and hospital stay were longer after percutaneous nephrolithotomy (p0.001). Stone-free rate was significantly lower after retrograde intrarenal surgery monotherapy vs percutaneous nephrolithotomy monotherapy (71% vs 95.5%, p=0.046). Patients in the percutaneous nephrolithotomy group had significantly more complications compared to the retrograde intrarenal surgery group (p=0.018). Three patients in the percutaneous nephrolithotomy group received blood transfusions, compared to none in the retrograde intrarenal surgery group (p=0.015).For treatment of large or complex renal stones in pediatric patients percutaneous nephrolithotomy monotherapy has the advantage of better stone-free rates, while retrograde intrarenal surgery has the advantages of decreased radiation exposure, fewer complications and shorter hospital stay.

Summary Introduction and objectives Radiation protection management recommends radiation exposures that are as low as reasonably achievable (ALARA), while still maintaining image quality. The aim of the study is to compare radiation exposure during pediatric percutaneous nephrolithotomy (PCNL) before and after implementation of strategy for optimization of fluoroscopic imaging by measuring the Dose Area Product (DAP) and the Fluoroscopy time (FT) and study its effect on surgical outcomes. Patients & methods We prospectively observed 56 children (group 1) undergoing PCNL for kidney stones in whom a radiation dose reduction strategy was adopted. The strategy included several intraoperative measures, including: optimizing position by keeping the fluoroscopy table as far from the X-ray tube as possible and the image intensifier close to the patient, preventing use of fluoroscopy for positioning, use of pulsed mode with last image hold technique, beam collimation and use of a designated fluoroscopy technician. Outcomes were compared to those in 42 children (group 2) before implementing dose reduction strategy. Results DAP was decreased by 44% from 2.46 in group 2 to 1.38 mGy m2 in group 1 (p Conclusions Radiation exposure in children undergoing PCNL can be reduced significantly after optimization of fluoroscopy imaging. A reduced radiation protocol did not increase surgical complexity, operative time, or complication rates while reducing radiation exposure in a population vulnerable to its hazardous effects. Summary Table 1 . Pre-fluoroscopy checklist. Image intensifier close to the patient Fluoroscopy table as far from the X-ray tube as possible Exposure mode set to digital Fluoroscopy operated with anti-scatter grid Last Image hold technique Beam collimation restricted the X-ray beam to relevant anatomical area Designated fluoroscopy technician

Image transmission over Orthogonal Frequency-Division Multiplexing (OFDM) communication system is prone to distortion and noise due to the encountered High-Peak-to-Average-Power-Ratio (PAPR) generated from the OFDM block. This paper studies the utilization of Residue Number System (RNS) as a coding scheme for digital image transmission over Multiple-Input-Multiple-Output (MIMO) – OFDM transceiver communication system. The use of the independent parallel feature of RNS, as well as the reduced signal amplitude to convert the input signal to parallel smaller residue signals, enable to reduce the signal PAPR, decreasing the signal distortion and the Bit Error Rate (BER). Consequently, improving the received Signal-to-Noise Ratio (SNR) and enhancing the received image quality. The performance analyzed though BER, and PAPR. Moreover, image quality measurement is achieved through evaluating the Mean Squared Error (MSE), Peak Signal to Noise Ratio (PSNR), and the correlation values between the initial and retrieved images. Simulation results had shown the performance of transmission/reception model with and without RNS coding implementation.

Urothelial tumors in children are rare pathology. A 20-months-old male patient presented with upper ureteric papillary tumor in a setting of ureteroscopy after multiple procedures for cystine stones former. Biopsy revealed low-grade papillary carcinoma.

The objectives of the study were to investigate the genetic behavior of some biological and economical traits of 14 okra populations collected from Dakahlia Governorate, which underwent two cycles of inbreeding with selection. Selection of individual plants based on earliness, high number of pods, and minimum neck/pod ratio was carried out in all generations. The results showed that the means and ranges of all studied traits for all families became smaller in the S2 generation than those in the S0 generation. Highly significant variations were observed among populations for all the studied traits. The mean performance clearly indicated the agronomic superiority of some families over the others. Family 9 followed by family 12 showed the earliest flowering plants and the highest yield per plant. Phenotypic variances were higher than the corresponding genotypic variances indicating predominance of environmental effects on the expression of these characters. The magnitude of phenotypic and genotypic coefficients of variation varied from one trait to another. High broad-sense heritability coupled with high genetic advance as percent of mean were shown by the different traits, especially, plant height, number of branches per plant, number of pods per plant, pod length, neck/pod ratio and plant yield. This implicates that these traits were under the control of additive genetic effects, and could be effectively improved through selection. Plant yield had positive and highly significant correlation at genotypic and phenotypic level with number of pods per plant, plant height and neck/pod ratio.

Objective To study the natural history of stone passage in children with ureterolithiasis and to define factors predictive of spontaneous passage. Patients and methods In all, 72 children with ureteric stones were evaluated; patients with ureteric calculi of >10 mm were excluded, as were those with absolute indications for surgical stone removal. Stone size, location, side, presence of hydronephrosis, perinephric stranding and degree of the tissue-rim sign were estimated by unenhanced helical computed tomography (UHCT). All patients were sent home with no administration of an α-blocker. The stone status was evaluated by a plain abdominal film or CT at ≈6 weeks after the initial diagnostic evaluation. The time from the initial complaint to the passage of the stone was recorded for each patient. Results In all, 54 (75%) children with ureteric stones of ⩽6 mm eventually passed their stones spontaneously. However, stones of

Summary Introduction and aims Behavioral therapy and bowel management are the initial and mainstay treatments for overactive bladder (OAB). Antimuscarinic agents are initiated if these measures fail or symptoms are severe. This study reported the results of treatment with a high dosage of a single drug in children with refractory detrusor overactivity (DO). After the children maintained their previous antimuscarinic medication, a second antimuscarinic drug (trospium chloride) was added as a combination therapy. Materials and method Seventy-two children with DO were enrolled in this prospective study (Figure). They had persistent urgency and urgency urinary incontinence (UUI), even with behavioral bowel therapy, and used an optimized dosage of oxybutynine. All patients demonstrated DO at urodynamic study and started on oxybutynin and trospium chloride at the lowest weight-adjusted dose (10–20 mg/day for trospium chloride). A bladder diary was recorded for 3 days, and urodynamic studies were repeated at 3 and 6 months. Results Sixteen children (22.2%) became dry. Thirty-three children (45.8%) attained a significant decrease in incontinence from an average of 5 to 1.3 episodes per day. A statistically significant increase of mean cystometeric bladder capacity (P = 0.006) was also observed at the 6-month follow-up. The overall success rate was 68%, since 23 children (32%) discontinued combined treatment due to persistent symptoms and/or intolerable side effects. A total of 41 children (57%) reported no side effects, 25 (34.7%) reported mild side effects, six (8.3%) reported moderate side effects, and two withdrew from the study due to their side effects. Download : Download high-res image (282KB) Download : Download full-size image Figure . Flow chart showing clinical response to combined low-dose antimuscarinic treatment. Conclusions The addition of low-dose trospium chloride to oxybutynine seemed to be an effective and safe treatment approach for children with DO who were refractory to high-dosage monotherapy. Different combinations with different antimuscarinics drugs could be evaluated in the future.

Based on efficacy demonstrated in the adult population, tamsulosin was evaluated with regard to facilitating ureteral stone expulsion in children presenting with distal ureteric calculi.A prospective randomized controlled study involving 61 children with distal ureteric calculi12 mm was performed. The children were randomly divided into two groups. Group I (study group, n = 33) received tamsulosin and standard analgesia, and Group II (placebo group, n = 28) received standard analgesia and placebo. Patients were offered a closely monitored trial for spontaneous stone passage in the 4-week period prior to definitive therapy. The stone expulsion rate, number and duration of pain episodes, need for analgesia and possible side effects of medications were observed.All patients completed the study and none were excluded due to side effects. No significant differences were found between the groups for age, gender and stone size. Mean patient age was 8.1 ± 6.8 years. There were 25 females and 36 males. The stone-free rate was 87.8% in Group I (29/33), compared with 64.2% (18/28) in Group II. A mean stone expulsion time of 8.2 and 14.5 days was recorded for Group I and II respectively, and this difference was statistically significant (P0.001).Medical expulsion therapy for lower ureteric stones is a successful procedure in children. Tamsulosin demonstrated no clinically significant adverse effect, while proving to be a safe and effective treatment option.

Toxoplasmosis is a zoonotic disease that commonly infects goat in Egypt. For its diagnosis, sera form 48 pregnant does were tested for Toxoplasma gondii antibodies through indirect haemagglutination test (IHAT) and modified agglutination test (MAT). Samples were collected between the periods extended from November 2006 to March 2007. The seropositive rate of pregnant does (Meet Kenana, Kalubyia Governorate, Egypt) was 35.42% (17/48). After using MAT test against T. gondii- IgM, 11 sera (22.9%) were found positive. The older animals were more frequently infected (50%) than the younger goats (26.3%). Higher prevalence in aged does was confirmed by MAT. Total T.gondii antibodies and IgM were gradually increased with the development of pregnancy. Two months post treatment with sulfademidine 33.3 %, for 5 successive days at a dose of 200 mg/kg, resulted in not only reduction of T.gondii total antibodies and IgM in all treated does, but re-modulation of T.gondii antibody titres moderately toward the mild titres, and prevention of congenital infection and abortion as well. Whereas IgM was not recorded in treated does, it was detected in the untreated ones. No abortion was recorded in all treated does, but an untreated doe delivered two dead fetuses. The delivered kids belonged to treated does were seropositive for T. gondii antibodies by using IHAT, yet they were seronegative for T.gondii– IgM by using MAT. In contrast, kids belonged to untreated does were seropositive by using both IHAT and MAT. Adequate management might be useful and essential to control toxoplasmosis in the goat herds of Kalubyia Governorate.

Valve bladder syndrome represents the worst end of the posterior urethral valve spectrum. Recent data suggest that early valve ablation can provide the chance for the bladder to heal and improve dynamics. We tested the hypothesis that early valve ablation can decrease the incidence of bladder dysfunction in these boys.A total of 16 full-term males with prenatally diagnosed hydronephrosis and a full bladder proved postnatally to have posterior urethral valve were studied. Valve ablation was performed during the neonatal period (group 1). The records of 16 boys with posterior urethral valves who underwent valve ablation after age 1 year were obtained (group 2). Ultrasound was performed every month and urodynamics were performed every 6 months. At age 3 years voiding diary and toilet training results were obtained. The incidence of bladder dysfunction in the 2 groups was recorded according to clinical, ultrasound, voiding cystourethrogram and urodynamic parameters.Mean followup was 3 years. Post-void residual urine, measured as more than 30% of expected bladder capacity for age, improved in 14 patients (87.5%) in group 1 and in 10 (62.5%) in group 2. Excluding cases of vesicoureteral reflux-renal dysplasia syndrome, vesicoureteral reflux was present in 20 renal units initially in group 1 and showed resolution or improvement in 16. In group 2 vesicoureteral reflux was present in 26 units and improved in 14. At last followup mean cystometric bladder capacity, measured at 30 cc H(2)O, in group 1 was 145 +/- 22 ml which was comparable to age matched normal bladder capacity. In group 2 mean +/- SD cystometric bladder capacity was 130 +/- 30 ml, which was significantly lower than age matched normal bladder capacity. Hypocompliance and instability were significantly lower in group 1. Toilet training was easier and yielded better results for dryness in group 1. Overall bladder dysfunction was present in 2 boys (12.5%) in group 1 and in 8 (50%) in group 2.Neonatal valve ablation would protect the bladder and allow normal cycling, which helps in bladder healing. This underscores the importance of routine prenatal screening and early intervention at a specialized center.

Severe penile curvature correction by corporeal body grafting has been successfully performed using various grafts and biomaterials. We present our initial experience with buccal mucosa as a free corporeal graft to correct severe penile curvature as part of a multistage approach to posterior hypospadias repair.A total of 12 children with a mean age of 6.2 years (range 4 to 8) with posterior hypospadias and severe ventral chordee (greater than 45 degrees) necessitating ventral grafting underwent correction using buccal mucosa. Preoperative androgen supplement was given when penile and glanular size was significantly small for age. Buccal mucosa was harvested from the inner side of the cheek or the lower lip. The harvested graft was defatted, fashioned and fixed to the ventral corporeal defect. The pre-grafting penile angle, immediate post-grafting angle and penile angle at 6 months were assessed.All children had penoscrotal or perineal hypospadias, 4 had partial androgen insensitivity syndrome and 1 underwent multiple previous failed repairs. Androgen was given preoperatively in 3 children. After chordee release and urethral plate transection the penile angle was between 45 and 80 degrees. Mean graft length and width was 2.5 and 1.6 cm, respectively. All children had a straight penis at the end of the procedure and none required additive dorsal plication. At the last followup at 12 months all children had a straight penis except 2 with mild curvature (less than 10 degrees). No complications were noted with this technique.Preliminary results of the novel use of buccal mucosa as a corporeal graft for severe chordee appear satisfactory. Longer term followup is needed to further document these data.

The dust of cement furnace is the actual secondary result of cement industry. That, there’s more than three million tons annually aggregated in Egypt, as it representing great danger whether to man and the surrounded environment. This because such dust has harmful effect on environment and beings, especially the close areas from cement factories. That, using of any cement dust quantity considers good solution of environment pollution, which resulted from the recent industry, especially cement. In this research, it uses cement dust to glass mixtures with increased rates may reach 70% of glass composition mixture’s weight, where such rate doesn’t affect the chemical or physical properties of obtained glass, so it shall be suitable to be used in many applicable purpose in this industry.

Objectives To evaluate the effect of vascular endothelial growth factor (VEGF) on regeneration of the bladder acellular matrix graft (BAMG). Methods A total of 40 female rats were divided into two groups. In the experimental group (VEGF+), the BAMG was incubated in VEGF and VEGF was injected into the host bladder. In the control rats, sterile solution replaced VEGF. Urodynamic studies were performed at grafting and repeated at 2, 4, 8, and 12 weeks. The bladders were harvested for histologic examination. Immunostaining was used to monitor VEGF treatment by examining VEGF and VEGF-receptor 2 expression. Neovascularity, smooth muscle induction, and nerve regeneration were assessed immunohistochemically. Results Increased VEGF and VEGF-receptor 2 were present in the VEGF+ rats 2 weeks after grafting. The maximal intravesical pressure was significantly greater in the VEGF+ group at 2 weeks than in the controls, despite the same bladder capacity. At 4 weeks, a significant increase in bladder capacity and a decrease in the postvoid residual volume ratio were observed. After 8 weeks, no differences were noted in the urodynamic parameters between the two groups. Numerous alpha-actin-positive spindle cells were observed in the VEGF+ rats at 2 weeks, and the smooth muscle content was significantly greater at all points. Enhanced angiogenesis was noted at 2 and 4 weeks. Nerve fibers were observed at 4 weeks and nerve growth factor-positive cells were significantly greater at 2, 4, and 8 weeks in the VEGF+ rats. Conclusions Administration of VEGF had significant effects on the BAMG at early periods after grafting. Our results have shown that VEGF enhances BAMG regeneration in rats as assessed by functional restoration and histologic examination.

Introduction We present our experience with the use of semirigid ureteroscopy for the treatment of ureteric stones in children less than or equal to 6 years of age. Material and methods The records of 21 children (12 female, 9 male) with an average age of 4.7 years (range 8 months to 6 years) treated with semirigid ureteroscopy between June 2006 and July 2010 were reviewed. In 13 ureteral units 7Fr semirigid ureteroscopy was carried out in a retrograde manner to treat stone disease, while an adult ureteroscope (9.5 fr) was used in the remaining patients. Stones were located in the upper ureter in 2 cases, middle ureter in 2 cases, and lower ureter in 17 cases. Ureteral dilation was not required in all patients. Results Stone size varied from 4 to 13 mm (mean 6 mm). The management of stones in 18 (90.7%) children was straightforward and a single ureteroscopy was required to clear the ureters. In 2 (6.2%) children, repeat ureteroscopy was undertaken to render the ureters stone free, and in 1 child (3.1%) it was not possible to remove the stone. Stones were fragmented with pneumatic lithotripsy in 12 cases and stones were removed mechanically without fragmentation in the remaining 9 cases. Intraoperative complications occurred in 2 (9.3%) children and included extravasation (1 patient), which was managed with ureteral stenting and stone upward migration (1 patient). Early postoperative complications included pyelonephritis (1 patient). Mean follow-up was 6.4 (3-36) months. Incidence of stricture at the site of stone impaction was not detected in any patients. None of the patients managed without a post-operative stent required subsequent intervention. Conclusions In the hands of an experienced surgeon, ureteroscopy in young children can be a safe and efficient treatment for ureteral stones that can be performed without ureteral dilation. Routine ureteral stenting is not a requirement when the procedure is relatively atraumatic. Further studies and longer follow-up are necessary to determine the success of this technique.

Objective After posterior urethral valve ablation, some boys are still have a hostile bladder. We conducted a prospective randomized study to determine if Botox injection at the bladder neck will help improve vesical dysfunction in this subgroup of boys or not. Patients and methods Twenty boys with history of posterior urethral valve ablation and severe bladder dysfunction with a mean age of 16 months were studied. Cases were further randomized into two groups. Group I (study group) had endoscopic injection of a single dose of 100 IU of Botox into the hypertrophied bladder neck at 3, 6, and 9 o’clock. Group II (control group) patients with the same parameters had urethroscopy to exclude residual valves. Both groups had the standard conservative treatment. Cases were followed after 6 months of initiating the management protocol. This includes laboratory studies (urine culture and sensitivity, blood urea nitrogen, serum creatinine), ultrasound of the urinary tract. Voiding cysto-urethrogram and urodynamic study (pressure flow study). Results There was no statistical difference in both groups regarding rate of urinary tract infection, improvement of hydronephrosis, resolution of vesico-ureteral reflux, creatinine level at the start or at the end of the study. Urodynamic parameters revealed an increase in cystometric capacity in both groups at the end of the study but without statistical difference. The mean voiding pressure reduced significantly in both groups but without statistical difference. Conclusions Temporarily abolishing the effect of bladder neck by Botox injection does not seem to improve the outcome of those boys who had a severe voiding dysfunction after valve ablation.

Objective To define the parameters that accompanied a successful extracorporeal shock wave lithotripsy (ESWL), namely the number of shock waves (SWs), expulsion time (ET), mean stone density (MSD), and the skin-to-stone distance (SSD). Methods A total of 368 patients diagnosed with renal calculi using noncontrast computerized tomography had their MSD, diameter, and SSD recorded. All patients were treated using a Siemens lithotripter. ESWL success meant a stone-free status or presence of residual fragments 934 HUs and SSD >99 mm. The required number of SWs and the expected ET can be anticipated.

Friction Stir Welding (FWS) is a relatively refreshing joining approach developed in the early nineties. Although originally intended for aluminum alloys, the research of FSW has now extended to a variety of materials including steels and polymers. The work presented here was to evaluate the effect of process parameters such as tool rotational speed and traverse speed on the tensile strength of friction stir welded Nylon 6. The results showed that a combination of high speed and low feed rate would result in the best ultimate tensile strength of the weldments. Optimized welding conditions of 1250 rpm rotational speed and 10 mm min-1 feed rate resulted in the highest UTS of the FSW joint which was equivalent to 48% that of the base material.

Summary Introduction and objectives Complete eradication of stone fragments is an important goal during stone management in children. The mode of fragmentation employed to clear stones during ureteroscopic laser lithotripsy raises concerns related to operative time, associated morbidity, costs, and especially potential endoscope damage. The purpose of this study was to evaluate the outcomes of fragmentation into extractable pieces and stone dusting during ureteroscopic laser lithotripsy in children. Material and methods One hundred children with ureteral stones undergoing ureteroscopic holmium laser lithotripsy were prospectively randomized into two groups: group I in which stones were fragmented to dust (n = 50), and group II in which lithotripsy resulted in extractable fragments (n = 50). Different Holmium laser settings were applied during ureteroscopic lithotripsy for each group: low power (500 mJ) and high frequency (12–15 Hz) for lithotripsy to dust. High power (1000–1500 mJ) and reduced frequency (8–10 Hz) for lithotripsy to extractable fragments. The fragmentation time, operating time, stone-free rate, and perioperative complications were compared ( Figure ). Results The mean age of the patients was 6.8 (1–12) years and 8.2 (1–15) years, in groups I and II respectively. The mean fragmentation time and operating time were statistically significantly lower in group II (p = 0.008 and 0.0069 respectively). Minor complications occurred in eight cases (5 in group I and 3 in group II) in the form of hematuria and urinary tract infection. No major complications were encountered in either groups. Conclusions Fragmenting stones into extractable pieces has a significantly shorter fragmentation time and operative time than stone dusting, with similar stone-free and complication rates. Ureteroscopic laser lithotripsy treatment resulting in extractable fragments seems to be an effective and time-saving procedure in children. Download : Download high-res image (137KB) Download : Download full-size image Figure . Study cases.

This paper considers field programmable gate array (FPGA) implementations for blind adaptive decision feedback equalizer (DFE) based on the IP core reported in [1]. The design can achieve channel equalization for 16-QAM and 64-QAM. Constant modulus algorithm (CMA) and multi-modulus algorithm (MMA) are considered for update the coefficients in the blind mode of operation which are followed by decision-directed (DD) mode. The system can work at a maximum clock frequency of 22 MHz. The design steps first consider fixed-point simulations using MATLAB fixed-point toolbox follows by FPGA implementations. The implementations are divided into complex weight update module, output computation module, error adjustment module, and decision device module. Finally, the DFE is implemented using Xilinx Virtex-II XC2VP100 FPGA.

A variable step size technique is applied to joint Modified Constant Modulus Algorithm (MCMA) and Decision- Directed (DD) equalization algorithm to speed up convergence with respect to the original algorithm. The same technique is used with joint CMA and DD algorithm and exhibits improved performance.

Children with valve bladder syndrome represent the worst end of the posterior urethral valve spectrum. When conservative measures fail to control recurrent infections, prevent deterioration of the upper tract (in the form of increasing hydronephrosis and or worsening of kidney function) and improve incontinence, augmentation cystoplasty is considered. In most of these boys, renal insufficiency precludes the use of intestine for augmenting the bladder. Our aim was to evaluate the efficacy and safety of ureterocystoplasty in managing children with valve bladder syndrome.Eight boys (mean age 5 years) with valve bladder syndrome were included in this study. All boys had successful valve ablation at the time of presentation. When conservative treatment failed, ureterocystoplasty was scheduled. The entire ureter was folded and used in four boys after nephrectomy for a non-functioning kidney. The lower dilated ureter was used to augment the bladder, and transureteroureterostomy in two and re-implantation of the remaining ureter in two were performed. Radiological and urodynamic investigation was performed preoperatively and postoperatively at 3, 6 and 12 months. Improvement of hydroureteronephrosis was judged by ultrasound.Bladder capacity (as measured during cystometry at 30 cmH(2)O) and compliance were significantly improved in all children following the procedure (P0.001), and reached or exceeded the normal calculated capacity for age-matched boys. Hydroureteronephrosis improved in six boys (75%). The procedure avoids almost all the complications of enterocystoplasty. Clean intermittent self-catheterization was performed in all cases routinely after surgery, weaning off as judged by the voiding pattern of the child.Ureterocystoplasty is an ideal option for augmenting the hypocompliant bladder in boys with valve bladder syndrome. The entire ureter or the dilated lower part can be used. This is a solution for boys with impaired renal function when enterocystoplasty cannot be performed.

Objectives Isolated male epispadias defect is present in 10% of cases of epispadias-exstrophy complex. Surgical repair of epispadias malformation remains debatable as evident by the different techniques adopted. The current study presents our experience in partial penile disassembly for isolated epispadias repair. Methods Epispadias repair was performed on 11 male patients aged 4 to 13 years. Two were penopubic, 6 penile, and 3 glanular. All cases were fresh. Extensive disassembly of penile components was performed to the corporal attachments down to the horizontal branches of pubic bones. The corporal bodies were separated with the urethral plate left attached to 1 corpus to preserve its blood supply. Urethral plate was tubularized and then transported from dorsal to ventral position by using corporal rotation technique. Glanuloplasty was then performed. Patients were followed up for 6 to 12 months. Results The penis had a satisfactory cosmetic appearance with no significant dorsal chordee. Two cases were transformed to subcoronal hypospadias, as it was difficult to bring the urethral plate to the tip of the glans because of its shortening. One child had a minute penopubic fistula that was repaired at a later stage. Conclusion Partial penile disassembly technique restores the anatomic relationship of the penile components. Our repair of partial penile disassembly is a simple modification of the Mitchell technique for isolated epispadias repair.

Aim Evaluation of cosmetic and functional outcome of single-stage exstrophy–epispadias complex repair in older children and those with previously failed repair. Materials and methods This study comprised 15 children (12 boys and 3 girls) with classic bladder exstrophy and a mean age at repair of 8.6 months (range 2–24 months). Eight children had a previously failed repair. All children underwent complete primary repair using the single-stage Mitchell technique. Half of the boys had complete penile disassembly, while in the others a modified Cantwell–Ransley technique for epispadias repair was used. Anterior iliac osteotomy was performed and hip spica used for immobilization in all children. Results One child had urethral stricture treated by endoscopic visual urethrotomy. Three children had penopubic fistulae that closed spontaneously. No bladder dehiscence or prolapse was encountered. Vesicoureteral reflux was present in 20 renal units but ureteral reimplantation was not performed. Average bladder capacity after closure was 134 cm3 (range 110–160 cm3) with only two partially continent and six incontinent children. Mean follow-up period is 2 years (range 1–3 years). Conclusions Single-stage repair was performed in children with previously failed repair and those presenting at an older age with satisfactory results. Acceptable bladder and genital anatomy and function were achieved together with preservation of renal function. The impact of this technique on continence is not encouraging, but needs to be determined in a longer follow-up period.

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International audience

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