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Full-term neonatal intussusception is rare. Cecal duplication as a lead point for intussusception is very rare. We report a case of full-term neonate with ileo-cecal intussusception due to cecal duplication. Although cecal duplication represents rarely a surgical emergency, intussusception always needs immediate attention. The awareness of this entity is essential for diagnosis and management.

The aim of the article is to present the findings of the empirical research on the feeling of the value of one’s own life (VOL) in students. Experiencing the feeling of VOL is understood to be the intended activity of an individual through which they reinforce (strengthen) their psychological and personal being. A presumption about the important role of a cognitive factor in experiencing the feeling of VOL in students was tested. In the manifestation of VOL, the role of such a cognitive factor as basic beliefs was investigated. Methods. Basic beliefs were diagnosed using the modified questionnaire by R. Janoff-Bulman. To diagnose the parameters of the feeling of VOL, the author’s questionnaire was used. 286 students took part in the testing. The correlations between the scores of two questionnaires were calculated. Logistic regression was used. The results of the research. Parameters of the feeling of VOL such as «Optimism», «Health», «Self-control, Information, Self-development», «Power, Status, Wealth» and «Close relationships, Family, Relevance» turned out to be closely related to measures of basic beliefs. This is especially true of beliefs about justice, a positive self-image, control, goodwill. Age-related differences in the structure of correlations between the measures were revealed. For senior students, experiencing the feeling of VOL as possessing power, status and wealth is more closely linked to a basic belief about justice than for junior students. Concerning health, they often note the importance of control. When assessing the role of the family and close relationships senior students rely less on good luck than junior students. Two modes of experiencing the feeling of VOL were singled out, the «Building rapport with people» mode and the «Distancing from people» mode. Using the logistic regression, the probability was calculated with which the students’ tendency to build rapport with people would prevail over the students’ tendency to distance from people. As predictors, the regression equation included the measures of the basic belief questionnaire. Conclusions. It is proved that the predominance of the tendency of building rapport over the tendency of distancing when experiencing the feeling of VOL in students is determined by three cognitive predictors. These are beliefs about justice, about the control of the action and about a positive self-image. Beliefs about the goodwill of the surrounding community and about good luck were not included in the list of influential cognitive predictors for the feeling of VOL.

Introduction A review of the English literature indicates the faint superiority of laparoscopic (LA) over open appendectomy (OA) in the pediatric population; however, a developing-country’s experience in the field is not available yet. This study presents our experience in LA versus OA over the last 7 years in one university hospital in Lebanon and compares our results to the international ones. Method A single center retrospective study was done including all patients aged less than 15 years who underwent appendectomy. A description of each operative technique is presented. Patients’ characteristics, intraoperative finding, operative timing (OT), length of stay (LOS) and short term postoperative complications including surgical site infection (SSI) rate, intra-abdominal abscess formation (IAA) rate and reoperation rate were all studied. Statistical analysis was done using Chi-square or Fisher’s exact test, as for continuous, Student’s t test was used or one-way ANOVA in case of more than 2 categories. Result Appendectomy was performed in 84 patients. 52 patients underwent OA through a Rocky Davis incision, and 32 patients underwent a LA. We found an advantage of LA over OA in reducing SSI, otherwise both approaches were similar. Conclusion In accordance with international results, in our experience, LA is superior to OA only with regards to SSI.

Flower Pollination Algorithm (FPA) is a nature inspired algorithm based on pollination process of plants. Recently, FPA has become a popular algorithm in the evolutionary computation field due to its superiority to many other algorithms. As a consequence, in this paper, FPA, its improvements, its hybridization and applications in many fields, such as operations research, engineering and computer science, are discussed and analyzed. Based on its applications in the field of optimization it was seemed that this algorithm has a better convergence speed compared to other algorithms. The survey investigates the difference between FPA versions as well as its applications. To add to this, several future improvements are suggested.

In the field of eclipsing binary stars, the relative coordinate positions of each star with respect to the other stars in the system are adapted. Therefore the orbital parameters of the system will be adapted by the criterion of dynamical and physical (photometric) properties. Orbital elements have been determined for binaries from a combination of velocities in the literature. The formulas that are obtained for computing the orbital elements are determined from the directions of the bases of space data. So the present work is a new presented method for the determination of optimal orbital elements of binary stars based on flower pollination algorithm. The proposed algorithm seek to solve the problem of detecting global minimisers as a function instead of problem of finding periodic orbits, to get a best fit of Keplerian and phase curves. The experimental results implemented on star η Bootis of MK type G0 IV. Demonstrate that the flower pollination algorithm (FPA) reaches good results compared to the results of the standard particle swarm optimisation and other optimisation algorithms.

Primary sternal osteomyelitis is a rare disease in children caused mainly by Staphylococcus aureus. We describe 2 cases resulting from Streptococcus pneumonia and Candida albicans. On the basis of these cases and other documented case reports, we discuss the pathogens, clinical course, and pathophysiology and suggest a management protocol based on early debridement to initiate appropriate antibiotic therapy and shorten hospitalization.

Summary: Transporter-associated with antigen processing (TAP1 and TAP2) gene products are involved in the transport/processing of self-peptides from cytosol into endoplasmic reticulum (ER). In ER, these peptides associate with human leucocyte antigen (HLA)-class I molecules for further presentation at cell surface. Deficient processing and/or presentation could lead to altered self-tolerance resulting in autoimmunity. We studied TAP1 and TAP2 genes and genotypes frequencies in 49 controls and in 101 patients with primary IgA nephritis (IgAN). the patients were divided into two groups: 45 patients with end-stage renal failure (ESRF) and 56 patients with normal kidney function (NKF). DNA was extracted from peripheral blood and amplified by double amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) using appropriate primers for the two point-mutations on TAP1 genes and for the three point-mutations on TAP2 genes, which are the basis of TAP polymorphism. We have found a weak association between TAP2-p379-VAL/ILE genotype and total-IgAN (24%vs 12% in controls; P= 0.05). However, the analysis of a subgroup of IgAN patients bearing HLA-B35 antigen, a former poor prognosis marker, disclosed an association between the TAP2-1993Ntd-Guanine variant (coding for TAP2-p665-ALA): 31% in B35-ESRF-IgAN subgroup vs 6% in controls (P=0.04) and 13% in B35-NKF-IgAN (P=NS). the complexity of immunogenetic studies in IgAN is further increased by the existence of two opposite pathological subgroups: normal glomerular basement membrane (GBM) thickness vs thin-GBM. There was a complex relation in IgAN between this TAP2 variant and the following parameters: ESRF, HLA-B35, and normal-GBM. Further investigations are therefore needed.

To evaluate the effect of bone grafting in corticotomy-facilitated orthodontics in adults, using a further modified conventional corticotomy technique.Twenty adult orthodontic patients with moderate crowding of the lower anterior teeth were equally divided into two groups and treated with either a modified corticotomy-faciIitated orthodontic tooth movement alone (Group I) or modified corticotomy-facilitated orthodontic tooth movement combined with bone grafting (Group II). Total treatment time was calculated in weeks from the time of activation of the orthodontic appliance immediately following the corticotomy procedure to the time of debracketing. Clinical periodontal parameters and standardized periapical radiographs were recorded at baseline, post-orthodontic treatment (debracketing time) and six months post-operatively. The primary radiographic variables were root length and bone density.Treatment duration for patients in both groups ranged from 14-20 weeks. There was no statistically significant difference between the two groups in clinical parameters at each time interval. The net percentage of change that occurred to bone density from baseline to six months post-orthodontic treatment was statistically significantly different between the two groups. Group I demonstrated a net decrease in bone density of -17.59%, while Group II demonstrated a net increase in bone density of 25.85%. Group I demonstrated an average net decrease in root length of -0.056 mm +/- 0.025, while Group II demonstrated an average net decrease in root length of -0.050 mm +/- 0.026, which was not statistically significantly different.The results of the current study suggest that corticotomy-facilitated orthodontic tooth movement significantly reduces the total time of treatment. In addition, the incidence of apical root resorption and periodontal problems associated with orthodontic tooth movement were reduced. The incorporation of bone graft material significantly increased the alveolar bone density in adult patients.

Acute colonic pseudo-obstruction rarely presents in children. Upon diagnosis, initiating conservative management and identification of an underlying etiology is mandatory. We describe the case of an 8-year-old girl who presented with signs of acute abdominal distention with no evident etiology. The diagnosis of celiac disease was suspected and confirmed by intestinal biopsy. Based on this case and other reported cases in the literature, we discuss this unusual mode of presentation of celiac disease, the underlying etiology and suggest management options to avoid unnecessary aggressive interventions.

QA / QC Program to improve Safety & Integrity of all Wells: The Equipment Integrity Assurance & Certification System is created with the target of Assuring Well Equipment Integrity before running in the well and therefore eliminating unforeseen equipment failures which extends the well life and improves well quality, performance and integrity. The equipment check list was initially developed to cover gas well equipment, however when it was proven successful and of added value on HSE & Operations the utilization was extended to equipment for all wells. The system is been created to assure Equipment Integrity and eliminate equipment failures during any stage of well drilling and construction till the succesfull completion run and handover integral well as intended. The system covers the preparation, inspection, and make up of equipment in town as follows: Dimensional checks (ID's, OD's, Drift). Visual/Calliper Thread Inspection. Make-ups of accessories to Casing and Pup Joints. Assemble Setting Tools to liner hangers and liner top packers and carry out all required tests. Provide supporting pressure test charts / certificates for the made-up and assembled components. Provide reference of all involved parties / personnel carried out and witnessed the activities. Issue the equipment to the rig with Check List (Certificate), briefing all the actions implemented in town. The Check List is signed by all participants & approved by Equipment & Service Team Leader (EQSTL) and Drilling Operations Team Leader (DROTL) as Single Point of Responsibility (SPA).

Smart Zeidan, Rezkalla Akkary, Ramy Ghabril, Nabil Diab and Pauline Abou-Jaoude Department of Pediatric Surgery and Urology, Saint George University Hospital, University of Balamand, Beirut, Lebanon; Department of Clinical Pediatrics and Nephrology, Saint George University Hospital, University of Balamand, Beirut, Lebanon and Department of Clinical Pediatrics and Nephrology, Medical University Center–Rizk Hospital, Beirut, Lebanon

Acute steroid-resistant rejection episodes in kidney allograft recipients require treatment with antilymphocyte antibodies. Monoclonal anti-CD3 and polyclonal antilymphocyte antibodies have been widely used but seldom compared. Recent data have suggested that these antibodies could be used at reduced doses without jeopardizing their efficacy. In this study, we randomized renal transplant recipients who encountered a first acute steroid-resistant rejection episode to low-dose ATG or low-dose OKT3 treatment. Sixty patients were enrolled in the study. They received prophylactic immunosuppression with cyclosporin, azathioprine, and prednisolone. Treatment of biopsy-proven rejection consisted of a 10-day course of either ATG (n = 31) or OKT3 (n = 29). The total ATG dose was 484 ± 110 mg, i. e., 0.75 mg/kg per day. The total OKT3 dose was 32 ± 4 mg, i. e., 0.05 mg/kg per day. We compared reversion of rejection, side effects, immunodepression, and graft function. Reversion of rejection was similar in the two groups, although we noted a trend in favor of ATG. Results were 3 % vs 10 % early graft failures, 13 % vs 23 % overall graft failures, 28 % vs 38 % 3-month actuarial incidence of rebound rejection, and 89 % vs 81 % 1-year graft survival rate in the ATG and OKT3 groups, respectively. Tolerance was worse in the OKT3 group due to the first-dose syndrome. Infections and cancers occurred with the same frequency. ATG resulted in a deeper and longer decrease in peripheral lymphocyte subsets. Graft function was similar in the two groups. We conclude that low-dose ATG and low-dose OKT3 are equally effective in reversing steroid-resistant acute rejection. Tolerance was better with ATG, which also gave a more potent and longlasting immunodepression. The use of reduced doses of ATG and OKT3 did not appear to lessen their efficacy.

Background. Sensitized kidney allograft recipients require special management to improve their outcome. One strategy is heavy immunosuppression with antilymphocyte antibodies. Controversy continues about the actual advantage of induction protocols whilst infections and cancers are a constant risk. In addition, little is known about how to handle sensitized patients with low levels of sensitization. Methods. In this study, we randomized sensitized renal transplant recipients, who received prophylactic treatment with or without antithymocyte globulin (ATG), in addition to a standard triple regimen consisting of cyclosporin, steroids and azathioprine at ATG discontinuation. The induction treatment consisted of a low-dose ATG course over 10 days. Randomization was stratified on the maximum PRA, according to the five following classes: 5% < PRA ≤ 20%, 20% < PRA ≤ 40%, 40% < PRA ≤ 60%, 60% < PRA ≤ 80% and 80% < PRA < 100%. Results. Eighty nine patients were enrolled: 47 patients received ATG and 42 did not. ATG induction lowered the incidence of biopsy-proven acute rejection episodes from 64 to 38%, increased 1 year graft survival from 76 to 89% and was associated with a higher 1 year inulin clearance (37 ± 15 vs 49 ± 18 ml/min). ATG-associated side effects were restricted to leucopenia and thrombocytopenia, whereas bacterial and viral infections, gammopathies and cancers did not occur more frequently. ATG induction benefited all sensitized patients, and not only the hypersensitized patients. Conclusions. We conclude that ATG induction is beneficial for all sensitized patients, regardless of their level of sensitization, with regard to acute rejection episodes, graft survival and graft function. Low-dose ATG is sufficient and prevents additional complications.

The results in transplantation are widely analyzed with both patient (dead or alive) and graft (functioning or not) survivals at different follow-up times. However, further information is needed about the quality of graft function, if any.

Treatment of end stage renal failure (ESRF) is achieved either by chronic dialysis (haemodialysis or peritoneal dialysis) or by renal transplantation (RTx). The advantages of RTx over dialysis include lower mortality (annual death rate about 1% for transplanted patients, compared with 14% for dialysed patients in year 1995 for France) [1], better long-term rehabilitation of patients, regular improved graft survival (we can expect about 60% at 10 years under triple therapy) and lower cost (on a 10 year basis, the cost of transplantation is 5.5 times less than the cost of hospital dialysis). All these previous demonstrations were made with global data including 85–90% of first grafts.

It is now without doubt that organ transplant recipients are prone to develop malignancies. A major role seems to be played by oncogenic viruses in these cancers. Different clinical risk factors have been sought after, mainly the type and the amount of immunosuppression. Azathioprine has been suspected to have its own oncogenic effect. More recently, reports pointed out the excessive immunosuppression achieved with long lasting use of anti-CD3 monoclonal antibodies. The actual influence of the induction protocols is still controversial and we cannot identify the patients who are at risk to eventually develop a tumour.

In general nephrology, HCV infection has been associated with type I membranoproliferative glomerulonephritis (MPGN type I) associated with cryoglobulinaemia. In a cohort of 399 renal transplantation (RT) recipients, 117 of whom (29%) were HCV-positive, we selected all patients diagnosed as having membranous GN or type I MPGN by graft biopsy. The prevalence of MGN was 16/399 (4%) with three recurrences, and 13 de novo cases. Only 5/16 (31%) were HCV+, not different from the general RT population. Five patients had an outcome of graft failure after 43 months. Conversely, there were 15 cases of type I MPGN (two recurrences, 13 de novo) but with eight HCV+ recipients (53%, P = 0.02). Considering only the French patients, prevalence was 44% vs 12% in the French RT population (P = 0.006). Eight patients had graft rejection after 59 months (five HCV+). In this type I MPGN subgroup, there were two positive cryoglobulins, two rheumatoid factors and four hypocomplementaemias. In conclusion, there is a clear association between HCV infection and the occurrence of type I MPGN in the allograft in renal transplantation, with terminal renal failure as an outcome.