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This work encompasses the study of certain weak maps termed as weak right η-centralizers defined on [Formula: see text] a noncommutative prime ring to [Formula: see text]. The first section provides an overview of the motivation behind our work. In the second section, our main focus is to establish the characterization of weak right η-centralizers while addressing the theory of functional identities, particularly in the challenging case of low dimensions. Furthermore, in the third section, we derive the characterization of weak Jordan σ-derivations based on the aforementioned characterization.

Introduction: Among viruses, Epstein Barr Virus is an important cause of acute cervical lymphadenitis. The clinical features of acute Epstein-Barr virus infection overlap those of a variety of other infectious and non-infectious diseases so reliable laboratory tests are important to not only confirm but aid in the differential diagnosis. The aim of the present study was to investigate and compare the diagnostic utility of EBV DNA detection as an adjunct to serological diagnosis of primary EBV infection. Materials & Methods: In this hospital based cross sectional study 30 patients below 18 years of age with acute cervical lymphadenitis were included. Comparison between ELISA and PCR for Detection of Epstein - Barr virus in children with acute cervical lymphadenitis was done. EBV IgM and IgG-ELISA was done for the qualitative determination of IgM and IgG class antibodies against Epstein-Barr virus viral capsid antigen (VCA) in serum samples and Real-time PCR (by using RTP Pathogen Kit) was done for qualitative determination of EBV DNA. Results: EBV RT-PCR was negative in serum samples of all 30 patients. EB virus could not be detected by RT-PCR in all seropositive cases. There was no significant difference found between genders in the results of EB Virus serology, and that of EBV RT PCR (p value was >.05). Conclusion: The use of RT- PCR for EBV DNA detection resulted in an increase in reliability of diagnosis of primary EBV infection, enhancing overall diagnostic efficacy. Our study proves that serological antibody could be positive for EBV in many patients either because of cross reactivity with other viruses or past infection with EBV.

In this paper, we discuss technologies and approaches based on Knowledge Graphs (KGs) that enable the management of inline human interventions in AI-assisted manufacturing processes in Industry 5.0 under potentially changing conditions in order to maintain or improve the overall system performance. Whereas KG-based systems are commonly based on a static view with their structure fixed at design time, we argue that the dynamic challenge of inline Human-AI (H-AI) collaboration in industrial settings calls for a late shaping design principle. In contrast to early shaping, which determines the system's behavior at design time in a fine granular manner, late shaping is a coarse-to-fine approach that leaves more space for fine-tuning, adaptation and integration of human intelligence at runtime. In this context we discuss approaches and lessons learned from the European manufacturing project Teaming.AI, https://www.teamingai-project.eu/, addressing general challenges like the modeling of domain expertise with particular focus on vertical knowledge integration, as well as challenges linked to an industrial KG of choice, such as its dynamic population and the late shaping of KG embeddings as the foundation of relational machine learning models which have emerged as an effective tool for exploiting graph-structured data to infer new insights.

Abstract Background During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV. Methods All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent. Results Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p

Background: The prognostic value of the neutrophil–lymphocyte ratio (NLR) in ischemic stroke remains debated due to cohort variability and treatment heterogeneity across studies. This study evaluates the relationship between admission NLR, stroke severity and 90-day outcomes in patients with anterior circulation large vessel occlusion (LVO) undergoing early, successful revascularization. Methods: A retrospective multicenter study was conducted with 1082 patients treated with mechanical thrombectomy for acute ischemic stroke. The relationship between admission NLR, baseline National Institutes of Health Stroke Scale (NIHSS), 24 h NIHSS and 90-day modified Rankin Scale (mRS) outcomes was analyzed using logistic regression. Results: Admission NLR correlated weakly but significantly with both baseline (p = 0.018) and 24 h (p = 0.005) NIHSS scores, reflecting stroke severity. However, multivariate analysis showed that higher 24 h NIHSS scores (OR 0.831, p = 0.000) and prolonged puncture-to-recanalization times (OR 0.981, p = 0.000) were independent predictors of poor 90-day outcomes, whereas NLR was not (p = 0.557). Conclusions: Admission NLR is associated with stroke severity but does not independently predict clinical outcomes at 90 days in patients achieving early and successful revascularization. These findings underscore the critical role of inflammation in the acute phase of stroke but suggest that its prognostic value for long-term outcomes is limited in this context.

Introduction Biochemical exploration of effusion fluids plays a crucial role in the diagnosis of underlying pathologies. This study aimed to evaluate the performance of biochemical ratios and the albumin gradients in the diagnostic process of ascitic fluids. Methods The study was prospective, involving 56 samples from ascitic patients. For each patient, five biochemical parameters (glucose, protein, albumin, LDH, and total amylase) were performed in ascites and plasma samples. The ascites/plasma protein, LDH ratios, and serum-ascites albumin gradients (SAAG), were calculated to evaluate their diagnostic relevance. Results Twenty-eight adult patients presenting ascites were included in this study,18 women (64.28%) and 10 men (35.71%) with an M/F sex ratio of 0.55. The most efficient parameters to distinguish the transudate/exudate concept were: Ascitic proteins (p =0.01), ascitic/plasma proteins (p =0.004), ascitic LDH (p =0.011), ascitic/plasma LDH ratio (p =0.013), ascitic albumin (p = 0.012), ascitic albumin/plasma ratio (p = 0.002) and ascitic glucose/plasma ratio (p = 0.02). A threshold of 14 g/L of Albumine had a better positive predictive value than a threshold set at 20 g/L (73 vs 46%). The sensitivity, specificity, diagnostic efficiency, and positive and negative predictive values for SAAG were 100%, 64%, 78%, 64%, and 100% respectively, and for the modified Light’s criteria 78%, 86%, 82%, 80%, and 82% which had better diagnostic efficiency and specificity than the classic Light’s criteria with the respective comparative value 82 vs 78% and 86 vs 57% but less sensitivity (78 vs 100%). The criteria H20-30, H25, and TAL had good diagnostic efficiency with 75%, 75%, and 78% respectively. Conclusion The integration of biochemical ratios and the albumin’s gradient significantly improves the differential diagnosis of ascites. It is essential to promote the use of these parameters in clinical practice to improve the treatment of patients with ascites

Background-The high mortality of cirrhosis is a global public health problem. For predicting the outcome of patients with cirrhosis, many prognostic models were proposed.The new Model for End-Stage Liver Disease including serum sodium (MELD-Na) has been proposed as an alternative to the original MELD, to increase the accuracy of the score in predicting short-term mortality. The purpose of this study was to assess the ability of MELD-Na scoring system to predict three-month mortality among cirrhotic patients, and comparing it to the MELD score. Methods-An observational study was carried out, at the Hepato-Gastro-Enterology De­partment of the University Hospital Center of Oran. A retrospective review of the medical records of all patients with cirrhosis, between 1st January 2019 and 31st December 2021, was performed. Among 103 patients, 47 were selected after excluding the patients who were lost to follow-up after three months or with missing data. The information collected included demographic data, clinical characteristics and laboratory values of: bilirubin, creatinine, international normalized ratio (INR) of prothrombin and sodium. The MELD-Na and MELD scores were calculated using online calculators, then the ability of the mo­dels to predict the risk of mortality at three months was assessed, using the area under the receiver operating characteristic curve (AUC). Results - : Eight (17%) patients died at three months. The MELD-Na and MELD both had significantly high area under the curve (AUC): MELD-Na: 0.952, 95% confidence interval [CI]: 0.885–1.00, MELD: 0.931, 95% confidence interval [CI]: 0.834–1.000. The MELD-Na score was slightly better than the MELD, with a sensitivity and a specificity of 87.5% and 87.2%, respectively, for a cut-off value = 21. Conclusion -The MELD-Na score seems to be a good predictor of mortality at three mon­ths among patients with cirrhosis..

Background: Pistacia vera L. (green pistachio) has been shown to increase antioxidant capacity and protect against cardiovascular diseases and cancer. This study investigated the protective effect of the Pistacia vera L. hull in rats with experimental cardiac damage induced by doxorubicin. Methods: Sixty adult Wistar albino rats were randomly divided into 5 groups (n = 12). Sham, doxorubicin, doxorubicin + Pistacia vera L. extract 50 mg/kg, doxorubicin + Pistacia vera L. extract 100 mg/kg, and Pistacia vera L. extract 100 mg/kg. Biochemistry parameters, total antioxidant status, total oxidant status, oxidative stress index, 8-hydroxydeoxy guanosine, and caspase 3/7 values were measured in serum samples. Excised heart tissues were examined histopathologically. Results: The groups were statistically significantly different in 8hydroxydeoxy guanosine, caspase 3/7, total antioxidant status, total oxidant status, oxidative stress index, and basal biochemical parameter values (P

Abstract Objectives Our aim in the study was evaluating sacroiliac morphology in patients with DDH and its possible effect on appropriate iliosacral screw fixation. Design Retrospective cohort study. Setting Level of evidence 3. Patients/participants We evaluated the anteroposterior pelvis X-ray and pelvic CT scans of patients. We mainly divided the patients into two groups: DDH group (n:105) and control group (n:105). Intervention The presence of the five qualitative characteristics of sacral dysplasia evaluated according to Route in both groups. The DDH group was divided into four subgroups according to the degree of hip dysplasia. Main outcome measurement The cross-sectional area, length of the osseous corridor, coronal and vertical angulation evaluated in both groups. Results The DDH group also exhibited a significantly higher S1 coronal and axial angulation, lower S1 cross-sectional area and S1 iliosacral screw length than the control group (p:0.033, p:0,002, p:0.006, p:0,019, respectively). According to the Rout classification, 9% were normal, 31% transient, 58% dysplastic in the DDH group. 45.7% were normal, 38% transient, 17% dysplastic in the control groups. These differences between the groups were statistically significant (p

In this paper, we present an advanced adaptive cruise control (ACC) concept powered by Deep Reinforcement Learning (DRL) that generates safe, human-like, and comfortable car-following policies. Unlike the current trend in developing DRL-based ACC systems, we propose defining the action space of the DRL agent with discrete actions rather than continuous ones, since human drivers never set the throttle/brake pedal level to be actuated, but rather the required change of the current pedal levels. Through this human-like throttle-brake manipulation representation, we also define explicit actions for holding (keeping the last action) and coasting (no action), which are usually omitted as actions in ACC systems. Moreover, based on the investigation of a real-world driving dataset, we cast a novel reward function that is easy to interpret and personalized. The proposed reward enforces the agent to learn stable and safe actions, while also encouraging the holding and coasting actions, just like a human driver would. The proposed discrete action DRL agent is trained with action masking, and the reward terms are completely derived from the real-world dataset collected from a human driver. We present exhaustive comparative results to show the advantages of the proposed DRL approach in both simulation and scenarios extracted from real-world driving. We clearly show that the proposed policy imitates human driving significantly better and handles complex driving situations, such as cut-ins and cut-outs, implicitly, in comparison with a DRL agent trained with a widely-used reward function proposed for ACC, a model predictive control structure, and traditional car-following approaches.

This study reports on the physicochemical and sensory attributes, total phenolic content, and antioxidant activity of 36 honey samples produced by two different stingless bee species (Tetragonula carbonaria and Tetragonula hockingsi) from Australia. The findings reveal moisture content across all samples ranges from 24.9% to 30.8% (w/w), electrical conductivity from 1.02 to 2.15 mS/cm, pH levels between 3.57 and 6.54, soluble solids from 69.2 to 75.1 °Brix, trehalulose concentrations from 6.20 to 38.2 g/100 g, fructose levels from 7.79 to 33.4 g/100 g, and glucose content from 3.36 to 26.8 g/100 g. Sucrose was undetectable in all investigated samples. In a sensory analysis involving 30 participants, Australian stingless bee honey was perceived as having a more pronounced sourness compared with New Zealand Manuka honey. The study reveals considerable variability in the composition of Australian stingless bee honey, influenced by factors such as floral availability, geographical origin, and time of harvest. It also demonstrates the presence of phenolic compounds and antioxidant activity in stingless bee honey, underlining their potential as a natural source of antioxidants. All investigated samples contain trehalulose, which supports the findings of other recent studies that propose this unusual disaccharide as a marker compound of stingless bee honey.

INTRODUCTION: Malreduction of the syndesmosis is associated with a poor prognosis; recent studies have focused on identifying intraoperative radiological parameters to prevent this phenomenon. Our study aimed to determine easily applicable and reproducible radiological parameters from magnetic resonance image (MRI)-based cross-sectional image analysis in determining the ideal trans-syndesmotic angle (TSA) and syndesmotic fixation axis (SFA). METHODS: A total of 120 ankle MRI scans without osseous/ligamentous injury were performed blindly by an orthopedist and a radiologist. Talar anterior tangent and talar axis line (TAL) were determined by cross-sectional measurements. The bisector of the anterior and posterior tangents of the syndesmotic joint was determined by the SFA, and the TSA was determined by the intersection of SFA and TAL. RESULTS: The average TSA was 16–17°. The SFA was between 28%+-6.6% and 30%+-5.7% anterior to the anteroposterior distance of the tibia laterally and the fibular apex medially. The intraclass correlation coefficient (ICC) range for measurements obtained by observer 1 was 0.600–0.882, while that for those obtained by observer 2 was 0.565-0.904. Interobserver agreement was between 0.589 and 0.901; reliability was acceptable for this new set of measurements. DISCUSSION AND CONCLUSION: Our measurements showed that the ideal TSA was between 16° and 17°, and SFA was located between the fibular apex laterally and the anterior third of the tibia medially. All parameters to be applied should be evaluated on a true lateral radiograph of the ankle because rotation will affect the TSA and the appearance of the SFA in a two-dimensional image.

INTRODUCTION: We evaluated the functional results of open and mini open surgical approaches in carpal tunnel syndrome patients. METHODS: Group 1 was undergone open surgery while Group 2 patients were operated by mini open technique. Clinical results were evaluated with patient satisfaction questionnaire, daily activities and grip strength. RESULTS: Twenty-eight patients were male and 63 were female. There were 13 male and 29 female with a total of 42 patients in Group 1, whereas 15 male and 34 female with a total of 49 patients were present in Group 2. Daily activity score was 13.86+-1.00 for open group and 13.61+-0.98 for Group 2. Grip strength was 0.27+-0.07 bar in Group 1 and 0.31+-0.09 bar in Group 2. There was no significant difference between two groups regarding to age, sex, operation site, daily activity scores, and grip strength. Surgical time was 18.05+-1.78 minutes in Group 1 and 13.18+-1.52 min in Group 2. Return to daily activity was 16.17+-2.07 day in Group 1 and 12.53+-1.80 day in Group 2. Surgery time and time to activity return is statistically significantly higher in open surgery group compared to mini-open group. Patient satisfaction score was 87.60+-2.63 in Group 1 and 87.60+-2.63 in Group 2. Patient satisfaction questionnaire result was statistically higher for mini-open group compared to Group 1. DISCUSSION AND CONCLUSION: In tandem with similar functional results, mini-open surgery can be preferred in callous hand, while open surgery is more suitable to patients with serious thenar atrophy along with suspicion of median nerve compression.

ABSTRACT Introduction: Fuziline is one of the many antioxidants currently being tested to treat cardiac damage. In our study, histopathological and biochemical effects of fuziline were investigated in mice with dobutamine-induced heart damage in vitro. Methods: Thirty-two adult male BALB/c mice, average weight of 18-20 g, were randomly divided into four groups - Group 1 (sham, n=8), Group 2 (control, dobutamine, n=8), Group 3 (treatment 1, dobutamine + fuziline, n=8), and Group 4 (treatment 2, fuziline, n=8). Biochemical parameters and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were measured. Interleukin 1 beta (IL-1β), NLR family, pyrin domain containing protein 3 (NLRP3), 8-hydroxy-deoxyguanosine (8-OHDG), gasdermin D (GSDMD), and galectin 3 (GAL-3) levels were analyzed by enzyme-linked immunosorbent assay method, and histopathological examination of heart tissues was performed. Results: When dobutamine + fuziline and fuziline groups were compared, troponin-I (P

Aim:Tendon transfers and autografts can be used in the reconstruction of chronic peroneal tendon tears. This cadaveric study aimed to evaluate the use of autograft hamstring tendons to reconstruct peroneal tendons in terms of diameter suitability.Materials and Methods:In this study, 13 hamstring tendons (gracilis, semitendinosus) without macroscopic injury and degeneration from the lower extremity of 13 fresh frozen cadavers were harvested and measured by standard methods. Then, peroneal tendons (peroneus longus, peroneus brevis) of the same cadavers were harvested and measured by standard methods. Tendon diameters were measured from the middle region of the tendon using a digital micro-caliper. After the measurements were completed, the thickness of the hamstring tendons and both peroneal tendons were statistically evaluated.Results:The mean age of the cadavers included in the study was 74.07±12.25 (minimum: 51, maximum: 94) years, and the mean body mass index was calculated as 25.38±6.07. There was no statistically significant difference by gender in the evaluated tendon diameters (p>0.05 for each). A positive correlation was found between hamstring tendons (gracilis and semitendinosus) and peroneus longus and brevis tendons in terms of size (p

The popularity of commercial unmanned aerial vehicles has drawn great attention from the e-commerce industry due to their suitability for last-mile delivery. However, the organization of multiple aerial vehicles efficiently for delivery within limitations and uncertainties is still a problem. The main challenge of planning is scalability, since the planning space grows exponentially to the number of agents, and it is not efficient to let human-level supervisors structure the problem for large-scale settings. Algorithms based on Deep Q-Networks had unprecedented success in solving decision-making problems. Extension of these algorithms to multi-agent problems is limited due to scalability issues. This work proposes an approach that improves the performance of Deep Q-Networks on multi-agent delivery by drone problems by utilizing state decompositions for lowering the problem complexity, Curriculum Learning for handling the exploration complexity, and Genetic Algorithms for searching efficient packet-drone matching across the combinatorial solution space. The performance of the proposed method is shown in a multi-agent delivery by drone problem that has 10 agents and ≈1077 state–action pairs. Comparative simulation results are provided to demonstrate the merit of the proposed method. The proposed Genetic-Algorithm-aided multi-agent DRL outperformed the rest in terms of scalability and convergent behavior.

Abstract Background The objective of this study was to assess the impact of consultant presence, volume of patients seen and weekend opening on the health and cost-related outcomes associated with different Early Pregnancy Assessment Unit (EPAU) configurations. Methods This was an observational study with a prospective cohort design. Six thousand six hundred six pregnant women (16 years of age and over) attending EPAUs because of suspected early pregnancy complications were recruited from 44 EPAUs across the UK. The main outcome measures were quality of life, costs, and anxiety. Results Costs, quality of life and anxiety scores were similar across configurations with little evidence to suggest an impact of consultant presence, weekend opening or volume of patients seen. Mean overall costs varied from £92 (95% CI £85 - £98) for a diagnosis of normally developing pregnancy to £1793 (95% CI £1346 - £2240) for a molar pregnancy. EQ-5D-5L score increased from 0.85 (95% CI 0.84–0.86) at baseline to 0.91 (95% CI 0.90–0.92) at 4 weeks for the 573 women who completed questionnaires at both time points, largely due to improvements in the pain/discomfort and anxiety/depression dimensions. 78% of women reported a decrease in their anxiety score immediately following their EPAU appointment. Conclusions EPAU configuration, as specified in this study, had limited impact on any of the outcomes examined. However, it is clear that care provided in the EPAU has a positive overall effect on women’s health and emotional wellbeing, with significant improvements in EQ-5D and anxiety shown following an EPAU visit.

Bariatric surgery is used as a treatment for morbid obesity and often results in rapid weight loss. This procedure has been associated with postoperative nutritional deficiencies. Neurological complications due to nutritional deficiencies include Wernicke encephalopathy, a disorder that affects the central and peripheral nervous system due to thiamine (vitamin B1) deficiency. Wernicke encephalopathy can lead to irreversible consequences if not treated early. Here, we present a case of a 40-year-old woman that developed Wernicke encephalopathy 2 months after gastric bypass surgery, with additional findings of flat affect and concurrent polyradiculopathy. Her diagnosis was delayed due to unique symptoms and an initial workup with negative imaging findings, making the identification of this disorder more complex.

Hajj, the Muslim pilgrimage, is a large mass gathering event that involves performing rituals at several sites on specific days and times in a fixed order, thereby requiring transport of pilgrims between sites. For the past two decades, Hajj transport has relied on conventional and shuttle buses, train services, and pilgrims walking along pedestrian routes that link these sites. To ensure smooth and efficient transport during Hajj, specific groups of pilgrims are allocated with the cooperation of Hajj authorities to specific time windows, modes, and routes. However, the large number of pilgrims, delays and changes in bus schedules/timetables, and occasional lack of coordination between transport modes have often caused congestion or delays in pilgrim transfer between sites, with a cascading effect on transport management. This study focuses on modelling and simulating the transport of pilgrims between the sites using a discrete event simulation tool called “ExtendSim”. Three transport modules were validated, and different scenarios were developed. These scenarios consider changes in the percentages of pilgrims allocated to each transport mode and the scheduling of various modes. The results can aid authorities to make informed decisions regarding transport strategies for managing the transport infrastructure and fleets. The proposed solutions could be implemented with judicious allocation of resources, through pre-event planning and real-time monitoring during the event.

Abstract Patients with complex Stanford type B aortic dissection are very difficult to treat. Many methods have been proposed so far in the treatment of these patients, and the emergence of hybrid techniques has made the treatment easier. In this article, we shared the extra-anatomical bypass (aorto-celiac-mesenteric bypass) + thoracic endovascular aortic repair + cholecystectomy operation technique applied to a patient with complex type B aortic dissection.

Purpose: We aimed to investigate the role of mean Hounsfield Unit(HU) values measured on enhanced or unenhanced Computed Tomography(CT) images for the differentiation of benign and malignant kidney lesions. Materials and Methods: In this retrospective study, CT images, demographic features, and histopathological results of the patients with renal lesions were reviewed from the hospital database. The pathological results were classified as benign and malignant. Mean attenuation values of the lesions were measured as HU on enhanced or un-enhanced CT images. The mean HU values of benign and malignant lesions were compared by using the student’s t-test. Results: The mean HU value of lesions who have enhanced CT scan with malignant histopathological results (17 males, 11 females) was 83,7±39,4, with benign histopathological results (5 males, 4 females) was 81,0±52,9. There was no statistically significant difference between malignant and benign lesions regarding the HU values on enhanced (70. Second delay) CT images (p:0.8704). The mean HU value of lesions which has unenhanced CT scan with malignant histopathological results (12 males, 9 females) was 29,3±8,1 with benign histopathological results (1 male, 4 females) was 9.4±42,0. The mean HU value of malignant lesions was higher than those of benign lesions on unenhanced images, and this difference was statistically significant (p:0,0426). Conclusion: The mean HU values of kidney masses on unenhanced CT images were found to be useful for the differentiation of benign and malignant lesions but values on enhanced (70 second delay) images in our study did not achieve such discrimination.

ABSTRACT Introduction: Medical improvements are needed to prevent ischemia-reperfusion injury in thoracoabdominal aortic surgery. The aim of this study was to determine the antioxidant effects of thymoquinone, silymarin, and curcumin against ischemia-reperfusion injury associated with abdominal aorta. Methods: Twenty-five Wistar albino rats were included in the study. Sham, control, and treatment (thymoquinone, silymarin, and curcumin) groups were set in equal numbers. Ischemia-reperfusion was applied by clamping (120 minutes) and de-clamping (60 minutes) the infrarenal aorta of all groups, except the sham group. Before reperfusion, thymoquinone, silymarin, and curcumin were given intraperitoneally to the treatment groups. After reperfusion, blood samples were taken from the right ventricle. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in serum samples and histopathological examination was performed on the gastrocnemius muscle. Results: There was a significant difference in TOS and OSI values between the control and sham groups. Both values were found higher in the control group than in the sham group (P

Abstract Background Joubert syndrome (JS) is a rare autosomal recessive genetic heterogeneously inherited disorder characterized by neurological features that include hypotonia, ataxia, developmental delay, intellectual disability, abnormal eye movements, and neonatal breathing dysregulation. Case presentation The main purposes of the case report are to highlight the benefit of multidisciplinary rehabilitation team approach and describe the clinical features associated with Joubert syndrome. In this case report, we have discussed a 9-month-old girl who presented with developmental delay, impaired vision, and a history of recurrent respiratory infection with respiratory distress. On examination, she had facial dysmorphism, myopia, and hypotonia. Brain magnetic resonance imaging showed a thick, elongated, and abnormally oriented superior cerebellar peduncle showing molar tooth appearance with elongated bat-wing shaped 4th ventricle and hypoplasia of the vermis suggestive of JS. The patient has been treated at Garden Reach Institute for the Rehabilitation and Research (GRIRR), Kolkata, India, by a multidisciplinary team of physiotherapist, speech therapist, special educator, orthotist, medical officer, and social worker that shown excellent improvement in her condition, and she has achieved good sitting balance, able to sit without support, stand with wall support, and able to walk using bilateral AFO and reverse walker. Conclusion Knowledge of characteristic clinical and radiological findings in JS will help in early diagnosis and successful rehabilitation.

Abstract Introduction: Halting ventilation during cardiopulmonary bypass (CPB) is implemented to operate in a less bleeding setting. It sustains a better visualization of the operation area and helps to perform the operation much more comfortably. On the other hand, it may lead to a series of postoperative lung complications such as atelectasis and pleural effusion. In this study, we investigated the effects of low tidal volume ventilation on inflammatory cytokines during CPB. Methods: Twenty-eight patients undergoing cardiovascular surgery were included in the study. Operation standards and ventilation protocols were determined and patients were divided into two groups: patients ventilated with low tidal volume and non-ventilated patients. Plasma samples were taken from patients preoperatively, perioperatively from the coronary sinus and postoperatively after CPB. IL-6, IL-8, TNF-α and C5a levels in serum samples were studied with enzyme-linked immunosorbent assay (ELISA) kits. Results: C5a, IL-6, IL-8 and TNF-α were similar when compared to the low tidal volume ventilated and non-ventilated groups (P>0.05) Comparing the groups by variables, IL-6 levels were increased during CPB in both groups (P=0.021 and P=0.001), and IL-8 levels decreased in the ventilation group during CPB (P=0.018). Conclusion: Our findings suggest that low tidal volume ventilation may reduce the inflammatory response during CPB. Although the benefit of low tidal volume ventilation in CPB has been shown to decrease postoperative lung complications such as pleural effusion, atelectasis and pneumonia, we still lack more definitive and clear proofs of inflammatory cytokines encountered during CPB.

Abstract Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

In recent years, both the scientific community and the industry have focused on moving computational resources with remote data centres from the centralized cloud to decentralised computing, making them closer to the source or the so called “edge” of the network. This is due to the fact that the cloud system alone cannot sufficiently support the huge demands of future networks with the massive growth of new, time-critical applications such as self-driving vehicles, Augmented Reality/Virtual Reality techniques, advanced robotics and critical remote control of smart Internet-of-Things applications. While decentralised edge computing will form the backbone of future heterogeneous networks, it still remains at its infancy stage. Currently, there is no comprehensive platform. In this article, we propose a novel decentralised edge architecture, a solution called OMNIBUS, which enables a continuous distribution of computational capacity for end-devices in different localities by exploiting moving vehicles as storage and computation resources. Scalability and adaptability are the main features that differentiate the proposed solution from existing edge computing models. The proposed solution has the potential to scale infinitely, which will lead to a significant increase in network speed. The OMNIBUS solution rests on developing two predictive models: (i) to learn timing and direction of vehicular movements to ascertain computational capacity for a given locale, and (ii) to introduce a theoretical framework for sequential to parallel conversion in learning, optimisation and caching under contingent circumstances due to vehicles in motion.

Abstract Objective: To evaluate preoperative and postoperative body fluid distribution with a bioelectrical impedance analyzer in patients undergoing cardiopulmonary bypass. Methods: Fifteen adult patients undergoing cardiopulmonary bypass were included in this study. Total body fluid changes, basal metabolism rates, body fat masses, lean body masses, and total cell masses were recorded. The patients’ values were measured before anesthesia, after anesthesia, after sternotomy, at the 5th, 30th, and 60th minutes of cardiopulmonary bypass, and on the 1st, 3rd, and 5th postoperative days. All values were compared with preoperative values. Results: Total body fluid changed significantly after cardiopulmonary bypass (P0.05). Conclusion: Changes in body fluids during and after cardiopulmonary bypass are inevitable. The increase in total body weight shows that this fluid load shifts to the extracellular space during bypass and the fluid load in this area passes into the intravascular area in the early postoperative period. This may cause edema and dysfunction in the major organs. Therefore, the fluid balance should be adjusted very carefully, especially during the bypass phase and the early postoperative period.

Objective: To show the effects of corticosteroids on inflammatory reactions in the injured Achilles tendon in rats. Material and Method: Thirty-two adult Wistar Albino rats were used in the study. The rats were divided into 4 groups. In the first group (Intact Saline), saline solution was injected to the intact Achilles tendon. In the second group (Intact Corticosteroid), corticosteroid was injected to the intact tendon. In the third group (Injured Saline), saline solution was injected to the injured Achilles tendon. In the fourth group (Injured Corticosteroid), corticosteroid was injected to the injured tendon. All groups were sacrificed on day 30 and Achilles tendons were taken and prepared for histological and biomechanical evaluation. Results: According to the biomechanical test; mean load-to-failure of the Intact Saline group was significantly lower than the Intact Corticosteroid (p=0.016), Injured Saline (p=0.001) and Injured Corticosteroid) (p=0.012) groups. According to the histopathological evaluation, tenocyte mean of the Intact Saline group was statistically lower than the Injured Saline and Injured Corticosteroid groups. Tenocyte mean of the Intact Corticosteroid group was statistically significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Saline group was significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Corticosteroid group was significantly lower than the Injured Saline and Injured Corticosteroid groups. There was no statistically significant difference between the groups in terms of calcification. Conclusion: It has been found that there is biomechanical and histopathological significant benefit of intra-tendon corticosteroid administration in the experimentally generated Achilles tendon injury model.

INTRODUCTION[|]Aim is to investigate the morphology of the knee of the people living in our country and to evaluate the harmony of the knee arthroplasty with their prosthetics, which are widely used in our country.[¤]METHODS[|]In this study, 200 patients, who had a CT taken for the angio of the lower extremity for various reasons, were included. Among 200 patients, 104 (52%) of them were male and 96 (48%) of them were female. Five different parameters from the proximal tibia and distal femur were used as evaluation criteria. After the measurements, the appropriate denture size for each denture brand was determined and the appropriate denture size and patient measurements were statistically evaluated.[¤]RESULTS[|]The femoral measurements of the patients and the femoral components of the prosthetics of the companies included in this study were not statistically compatible (p>0.05). Similarly, the tibia measurements and tibial components of the prosthetics of the companies included were not statistically compatible (p>0.05).[¤]DISCUSSION AND CONCLUSION[|]As a result of the metric evaluations, it was observed that there was no harmony between the size of knee prosthetic brands and the anthropometric values of living people in our country.[¤]

Extracranial carotid artery aneurysms are extremely rare aneurysms. Treatment options are conventional open surgery, endovascular surgery, and conservative treatment. Surgical treatment of such aneurysms is challenging and it is important to determine the treatment strategies wisely. There is still no definite association for treatment modalities. In this case report, we present open surgical treatment of a 58-year-old female patient with internal carotid artery aneurysm. The patient was admitted to our clinic with spontaneous pulsatile mass in the right jugular region. Computed tomography angiography shown right internal carotid artery aneurysm. Aneurysm cranial distance was enough to perform end to end anastomosis. Aneurysm was excised by preserving cranial nerves. No complications developed during the postoperative period.

ObjectiveTo determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.DesignProspective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes".Setting44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.Participants6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.ExposuresPlanned and actual senior clinician presence, unit size, and weekend opening.Main outcome measuresUnplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.Results205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.ConclusionsInvolvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.