Background and Objective: The outcome of locally advanced and metastatic urothelial carcinoma LA/mUC has improved over the past years with a plethora of new treatments and the approval of immune checkpoint inhibitors ...Background and Objective: The outcome of locally advanced and metastatic urothelial carcinoma LA/mUC has improved over the past years with a plethora of new treatments and the approval of immune checkpoint inhibitors (ICIs), antibody-drug conjugates, and targeted agents, to identify locally advanced metastatic urothelial carcinoma’s current management practices in Lebanon and the implication of the ongoing economic crisis on the medical practice. Methods: An online questionnaire was used to survey ten Lebanese oncologists from six different hospitals, between July 5 and July 11, 2022, requesting information pertaining to their current clinical practice in the pharmacological treatment of locally advanced metastatic urothelial carcinoma. Key Findings: Cisplatin-based chemotherapy was the most frequently reported initial treatment of locally advanced metastatic urothelial carcinoma. Participants reported using immune checkpoint inhibitors in platinum-ineligible patients and those with PDL1 positive tumors. Also, they would not consider the concomitant use of immunotherapy and chemotherapy in the first-line setting. Participants believed that avelumab maintenance is effective in the absence of progression after first-line platinum-based chemotherapy;they would consider initiating it 2 - 10 weeks after completion of chemotherapy. Conclusions and Clinical Implications: After comparing with current international guidelines, this study shows that Lebanese oncologists follow international guidelines and have deep knowledge of recent clinical trials for the management of locally advanced metastatic urothelial carcinoma, regardless of economic crisis challenges.展开更多
Traditional Enterprise Resource Planning (ERP) systems with relational databases take weeks to deliver predictable insights instantly. The most accurate information is provided to companies to make the best decisions ...Traditional Enterprise Resource Planning (ERP) systems with relational databases take weeks to deliver predictable insights instantly. The most accurate information is provided to companies to make the best decisions through advanced analytics that examine the past and the future and capture information about the present. Integrating machine learning (ML) into financial ERP systems offers several benefits, including increased accuracy, efficiency, and cost savings. Also, ERP systems are crucial in overseeing different aspects of Human Capital Management (HCM) in organizations. The performance of the staff draws the interest of the management. In particular, to guarantee that the proper employees are assigned to the convenient task at the suitable moment, train and qualify them, and build evaluation systems to follow up their performance and an attempt to maintain the potential talents of workers. Also, predicting employee salaries correctly is necessary for the efficient distribution of resources, retaining talent, and ensuring the success of the organization as a whole. Conventional ERP system salary forecasting methods typically use static reports that only show the system’s current state, without analyzing employee data or providing recommendations. We designed and enforced a prototype to define to apply ML algorithms on Oracle EBS data to enhance employee evaluation using real-time data directly from the ERP system. Based on measurements of accuracy, the Random Forest algorithm enhanced the performance of this system. This model offers an accuracy of 90% on the balanced dataset.展开更多
In this work, an extended Jacobian elliptic function expansion method is proposed for constructing the exact solutions of nonlinear evolution equations. The validity and reliability of the method are tested by its app...In this work, an extended Jacobian elliptic function expansion method is proposed for constructing the exact solutions of nonlinear evolution equations. The validity and reliability of the method are tested by its applications to the system of shallow water wave equations and modified Liouville equation which play an important role in mathematical physics.展开更多
Background:Both bone marrow mesenchymal stem cell(BM-MSC)and transforming growth factor-β1(TGF-β1)have a strong anti-inflammatory capacity in stroke.But their relationship has not been well addressed.In this study,w...Background:Both bone marrow mesenchymal stem cell(BM-MSC)and transforming growth factor-β1(TGF-β1)have a strong anti-inflammatory capacity in stroke.But their relationship has not been well addressed.In this study,we investigated how intravenous BM-MSC transplantation in rats effected the expression of TGF-β148 h post cerebral ischemia,and we analyzed the main cells that produce TGF-β1.Methods:We used a distal middle cerebral artery occlusion(dMCAO)model in twenty Sprague-Dawley(SD)rats.The rats were randomly divided into two groups:the ischemic control group and the postischemic BM-MSC transplantation group.One hour after the dMCAO model was established,the rats were injected in the tail vein with either 1 ml saline or 1×106 BM-MSCs suspended in 1 ml saline.ELISAs were used to detect TGF-β1 content in the brain infarct core area,striatum and the plasma at 48 h after cerebral infarction.Immunofluorescent staining of brain tissue sections for TGF-β1,Iba-1,CD68 and NeuN was performed to determine the number and the proportion of double stained cells and to detect possible TGF-β1 producing cells in the brain tissue.Results:Forty-eight hours after ischemia,the TGF-β1 content in the infarcted area of the BM-MSC transplantation group(23.94±4.48 pg/ml)was significantly lower than it was in the ischemic control group(34.18±4.32 pg/ml)(F=13.534,P=0.006).The TGF-β1 content in the rat plasma in the BM-MSC transplantation group(75.91±12.53 pg/ml)was significantly lower than it was in the ischemic control group(131.18±16.07 pg/ml)(F=36.779,P=0.0002),suggesting that after transplantation of BM-MSCs,TGF-β1 levels in the plasma decreased,but there was no significant change in the striatum area.Immunofluorescence staining showed that the total number of nucleated cells(1037.67±222.16 cells/mm2)in the infarcted area after transplantation was significantly higher than that in the ischemic control group(391.67±69.50 cells/mm2)(F=92.421,P<0.01);the number of TGF-β1+cells after transplantation(35.00±13.66 cells/mm2)展开更多
Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aestheti...Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm<sup>3</sup> ± 59.57) cm<sup>3</sup>, while the mean flap volume was (218.27 cm<sup>3</sup> ± 53.64 cm<sup>3</sup>). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.展开更多
<strong>Introduction:</strong> Owing to the advanced development of MRI science, it causes obvious great changes of many diseases that affect the female genital system and affect their fertility. Hemorrhag...<strong>Introduction:</strong> Owing to the advanced development of MRI science, it causes obvious great changes of many diseases that affect the female genital system and affect their fertility. Hemorrhagic gynecological diseases especially endometriosis affect young females and cause cyclic pain, in addition to infertility. So early detection is essential for proper treatment. Susceptibility-weighted (SWI) as one of the most recent newly created MRI sequences is highly sensitive to detect products of hemorrhage within different gynecologic disorders with 94.7% sensitivity being more meticulous than conventional MRI sequences as T1 and T2. <strong>Aim of the Work:</strong> A comparison between T1 and T2 as conventional MRI sequences with susceptibility-weighted images (SWI) in many gynecologic disorders by the detection of the presence of internal products of hemorrhage at any stage. <strong>Subjects and Methods:</strong> 48 consecutive patients from Benha University clinics (age range, 17 - 60 years;mean age, 35.67 years). The patients included in the study were presenting with pelvic pain, irregular menses, Dyspareunia, and swelling. All with suspicious diagnosis of ovarian and extra-ovarian lesions. 38 patients out of the 48 patients were known to contain hemorrhagic disorder;all the patients underwent MRI routine pelvis protocol adding SWI sequence. <strong>Results:</strong> There was a greatly significant difference between SWI and conventional MRI sequences T1and T2 with sensitivity 94.7%, 57.9% and 33.3% respectively. <strong>Conclusion:</strong> SWI is a promising tool in the evaluation of hemorrhagic foci within different gynecological disorders. The great ability of detecting hemosiderin foci increases the value of SWI over conventional MRI or US.展开更多
In silico methods for linking genomic space to chemical space have played a crucial role in genomics driven discovery of new natural products as well as biosynthesis of altered natural products by engineering of biosy...In silico methods for linking genomic space to chemical space have played a crucial role in genomics driven discovery of new natural products as well as biosynthesis of altered natural products by engineering of biosynthetic pathways.Here we give an overview of available computational tools and then briefly describe a novel computational framework,namely retro-biosynthetic enumeration of biosynthetic reactions,which can add to the repertoire of computational tools available for connecting natural products to their biosynthetic gene clusters.Most of the currently available bioinformatics tools for analysis of secondary metabolite biosynthetic gene clusters utilize the“Genes to Metabolites”approach.In contrast to the“Genes to Metabolites”approach,the“Metabolites to Genes”or retro-biosynthetic approach would involve enumerating the various biochemical transformations or enzymatic reactions which would generate the given chemical moiety starting from a set of precursor molecules and identifying enzymatic domains which can potentially catalyze the enumerated biochemical transformations.In this article,we first give a brief overview of the presently available in silico tools and approaches for analysis of secondary metabolite biosynthetic pathways.We also discuss our preliminary work on development of algorithms for retro-biosynthetic enumeration of biochemical transformations to formulate a novel computational method for identifying genes associated with biosynthesis of a given polyketide or nonribosomal peptide.展开更多
AIM： To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS： Two groups each of them included 20 c...AIM： To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS： Two groups each of them included 20 cases of resistant mycotic corneal ulcers. Both groups treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity results. In one group argon laser photocoagulation was used as an adjunctive therapy to the specific antifungal drugs and in the other group, intrastromal injection of voriconazole was done besides the specific antifungal drugs. The 40 cases included in the study were proven according to culture and sensitivity to be 28 cases with pure fungal results and 12 cases with mixed （fungal and bacterial）. In argon laser group, argon laser irradiation of the corneal ulcer was performed using argon laser 532 nm wavelength （Carl Zeiss LSL 532s AG; Meditec, Inc.） after fluorescein staining. In the other group, voriconazole solution （500 pg/mL） was prepared and injected in the corneal stroma. All cases were followed up for 3mo after healing was achieved. RESULTS： Complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects were achieved in argon laser group in duration ranged from 2-4wk in 90% of cases. In voriconazole group 4 cases needed amniotic membrane graft due to thinning and 16 cases healed in duration ranged from 2- 6wk （80% of cases）. CONCLUSION： Argon superior to intrastromal treatment of resistant fungal laser photocoagulation is voriconazole injection in corneal ulcers.展开更多
This article studies the performance of analytical, semi-analytical and numerical scheme on the complex nonlinear Schr¨odinger(NLS) equation. The generalized auxiliary equation method is surveyed to get the expli...This article studies the performance of analytical, semi-analytical and numerical scheme on the complex nonlinear Schr¨odinger(NLS) equation. The generalized auxiliary equation method is surveyed to get the explicit wave solutions that are used to examine the semi-analytical and numerical solutions that are obtained by the Adomian decomposition method, and B-spline schemes(cubic, quantic, and septic). The complex NLS equation relates to many physical phenomena in different branches of science like a quantum state, fiber optics, and water waves. It describes the evolution of slowly varying packets of quasi-monochromatic waves, wave propagation, and the envelope of modulated wave groups, respectively. Moreover, it relates to Bose-Einstein condensates which is a state of matter of a dilute gas of bosons cooled to temperatures very close to absolute zero. Some of the obtained solutions are studied under specific conditions on the parameters to constitute and study the dynamical behavior of this model in two and three-dimensional.展开更多
Three alluvial soil samples with different textures were artificially polluted with chloride solutions of Cd, Pb, Co and chromate solution for Cr. The aqua-regia extracted concentration ranges in the artificially poll...Three alluvial soil samples with different textures were artificially polluted with chloride solutions of Cd, Pb, Co and chromate solution for Cr. The aqua-regia extracted concentration ranges in the artificially polluted soils were 1134 - 1489 mg·kg-1 for Pb, 854 - 938 mg·kg-1 for Cr, 166 - 346 mg·kg-1 for Co and 44 - 54 mg·kg-1 for Cd. The aqua-regia extracted metals were the highest in the spiked clay soil due to its high adsorption capacity. Rock phosphate (PR), lime-stone (LS) and Portland-cement (Cem) were mixed with the spiked soils at 1% and 2% rates (w/w) and incubated at 30 C for 2, 7, 14, 30, 60, 150 and 360 days. The extracted DTPA metals significantly decreased with different magnitudes with increasing the incubation period accompanied by increases in both pH and EC. The data showed that cement (Cem) treatment dropped the DTPA-Pb from @ 1000 to @ 400 mg·kg-1 in all the studied soils (60% decrease) in the first 2 months while it gradually decreased from 400 to 200 mg·kg-1 (20% decrease) in the next 10 months. Limestone (LS) and rock phosphate (PR) materials were relatively less effective in lowering DTPA-Pb after 12 months of incubation. The data showed also that cement (Cem) treatment was the most effective one in lowering DTPA-Cd by @ 60% as compared to the un-amended soils after 12 months of soil incubation. Extractable DTPA-Co and Cr showed consistent decreases with time down to nearly 50% of un-amended soils due to the effect of the added amendments after 12 months of incubation with superior reductions for the cement treatment in all the investigated soils. The statistical analysis confirmed that in all the studied metals and treatment, cement treatment (Cem) was significantly the most effective in lowering the DTPA extracted metals as indicated from LSD test. It was found that up to 73% and 57% of the applied Pb and Cd, respectively, were fixed by only 1% cement. However, the present study showed that from the practical and economic points of view, that 1% Cement was the best treatment to展开更多
Juniperus thurifera L.is an endemic Cupres saceae from the Aure`s Mountains of north eastern Algeria and endangered,in part,due to the scarcity of viable seeds It is threatened by other abiotic factors and the lack of...Juniperus thurifera L.is an endemic Cupres saceae from the Aure`s Mountains of north eastern Algeria and endangered,in part,due to the scarcity of viable seeds It is threatened by other abiotic factors and the lack of an effective management strategy will increase its risk o extinction.The dearth of information on its in vitro regeneration impedes its application in forest managemen programs.We therefore developed a micropropagation protocol using microcuttings with auxiliary buds.Cuttings were grown on different combinations of media supplemented with plant growth regulators at different concentrations.The highest number of shoots and branches regenerated from original shoots was obtained on Woody Plant Medium(WPM)supplemented with 6-benzylaminopurine(BAP)(0.5 mg L^(-1))and 2,4-dichlorophe noxyacetic acid(2,4-D)(0.25 mg L^(-1)).The best elongation of shoots was achieved with WPM supplemented with0.5 mg L^(-1)of BAP and 0.25 or 1 mg L^(-1) of 2,4-D.On the second subculture,shoots had a higher number of branches than those of the first.The highest rooting rate,38.8%,was obtained with shoots cultured in 1/2 Murashige and Skoog(MS)medium supplemented with 5.0 mg L^(-1)each of indol-3-butyric(IBA)and naphthalene acetic acid(NAA).Similarly,the highest root numbers and lengths were produced on 1/2 MS medium supplemented with IBA and NAA(5.0 mg L^(-1)each).During transfer to acclimatization,rates of plant losses of 50% occurred.The second part of the experiment showed that the best shoot callusing was on WPM supplemented with BAP and 2,4-D,with either the combination 0.5+0.25 or 0.25+0.25 mg L^(-1).The results of this research provide a starting point for further studies on in vitro regeneration of J.thurifera for the sustainable management of its unique ecosystem in the Mediterranean basin.展开更多
Background: The treatment of breast cancer in large breast patients represents a great challenge to both surgical oncologist and radiation oncologist. The aim of this study is to evaluate the outcome of inferior pedic...Background: The treatment of breast cancer in large breast patients represents a great challenge to both surgical oncologist and radiation oncologist. The aim of this study is to evaluate the outcome of inferior pedicle therapeutic mammoplasty in large-breasted patients with upper quadrants early breast cancer. Methods: Thirty five large-breasted patients with early breast cancer were included in this study. Simultaneous bilateral inferior pedicle therapeutic mammoplasty was performed. Results: The age of the patients is ranged from 36 to 61 (median 46) years and tumour size is ranged from one to three and half cm. The weight of tissue removed is ranged from 350 gm to 780 gm and the tumour safety margins are ranged from three to eight cm. Wound dehiscence was the commonest post operative complications and six patients were affected (17.6%). The cosmetic outcome was excellent in 22 patients (64.5%), nine patients (26.5%) showed good results, two patients (6%) were satisfactory and one patient (3%) showed poor result. The follow up period is ranged from 6 to 42 months with one case (3%) of systemic metastasis. Conclusion: Inferior pedicle therapeutic reduction mammoplasty for upper quadrants early breast cancer in large breasted women is a surgically and oncologically safe procedure, and it carries a satisfactory aesthetic outcome.展开更多
Objective: Nerve blockade is commonly used in oncosurgical procedures as an alternative to general anesthesia for older patients and those with significant medical problems. We report a single tertiary oncology center...Objective: Nerve blockade is commonly used in oncosurgical procedures as an alternative to general anesthesia for older patients and those with significant medical problems. We report a single tertiary oncology center experience in performing various lip resections and reconstructive techniques using this technique. Patients and methods: sixty patients with lower lip tumors were enrolled into this study with exclusion of refusing, non-compliant and critically ill patients. A solution of 4 ml 2% Lidocaine and epinephrine was put in a 5 ml syringe. Half the solution (2 ml) was injected into each side with a 23 gauge needle and after 5 minutes the surgical resection was carried out after testing for anesthesia. Results: The mean age was 68 ± 6.2 years. The mean ASA score was 3 ± 0.75. There were 4 cases who expressed painful sensation and their operations were completed with fentanyl increments. Mean hospital stay was 1 ± 0.75 days. There were three cases of wound gaping who were treated with secondary closure in an outpatient basis. One patient expressed postoperative acute ischemic heart pain that was managed with anti-ischemic measurements. Conclusion: Bilateral mental nerve block is a safe and effective alternative to general anesthesia in lower lip tumors’ resection especially in older patients and those with poor tolerance for general anesthesia provided that there is no need for cervical nodal dissection.展开更多
Nowadays kaolin raw material is usually used to produce nano-kaolin for geopolymer enhancement by using firing method.In the present study,kaolin used was taken from the Naqus Formation(Cambro-Ordovician age),west of ...Nowadays kaolin raw material is usually used to produce nano-kaolin for geopolymer enhancement by using firing method.In the present study,kaolin used was taken from the Naqus Formation(Cambro-Ordovician age),west of Gabal El Gunna,Sinai,Egypt.Nano-kaolin material is an ultrafine material and was prepared from the taken kaolin by the firing process at 800 for 2℃h with a heating rate of 5/min.Six mixes were prepared and their laboratory specimens were made℃and cured up to 90 days.Water cooled slag was used as starting material,and sodium hydroxide and sodium silicate were used in the study as activators for the used kaolin.The formed geopolymer mixes with different ratios(1%,1.5%,3%,5%,and 7%)of nano-kaolin as a partial replacement for the raw kaolin were investigated.Gelenium Ace super plasticizer was added in the ratio of 4%from the dry weight to ensure good dispersing of the used nano clay.Results showed that increasing the percentage of nano-kaolin up to 3%results in an enhancement in the mechanical properties as compared with the control mix up to 90 days of curing,while higher ratios are not preferable where they lead to agglomeration of the added nano materials and matrix dilution.展开更多
This paper presents a comprehensive overview study of the DDPMSG （direct driven permanent magnet synchronous generator） for wind energy generation system. Wind turbine controls are provided. The PMSG （permanent mag...This paper presents a comprehensive overview study of the DDPMSG （direct driven permanent magnet synchronous generator） for wind energy generation system. Wind turbine controls are provided. The PMSG （permanent magnet synchronous generator） is introduced as construction and model. Configurations of different power converters are presented for use with DDPMSG in wind systems at variable speed operation and maximum power capture. Control techniques for the system are discussed for both machine-side and grid-side in details. Grid integration is provided with focus on how to insure power quality of the system and the performance at disturbances.展开更多
This paper presents a sliding mode observer for sensorless operation of SRM （switched reluctance motor） drive. Design of such an observer depends mainly on the nonlinear model of SRM. In this technique, neither extr...This paper presents a sliding mode observer for sensorless operation of SRM （switched reluctance motor） drive. Design of such an observer depends mainly on the nonlinear model of SRM. In this technique, neither extra hardware nor huge memory space are not required but it only requires active phase measurements. Furthermore, PI （proportional integral） and adaptive FLPI （fuzzy logic PI） controllers are suggested to operate individually along with the SMO （sliding mode observer） to cover a full speed range of sensorless controller. Both controller schemes operate in PWM （pulse width modulation） control mode. The proposed observer is implemented and tested using a digital signal processor. All results obtained with both simulation and experimental investigations corroborate the superior performance of the adaptive fuzzy logic controller （FLPI） when compared with those of PI controller.展开更多
In 1965, the first forest map of Lebanon was produced. It is the oldest spatial distribution representation of junipers. Landcover maps of 2002 and 2010 are the most detailed spatial distribution that spatially shows ...In 1965, the first forest map of Lebanon was produced. It is the oldest spatial distribution representation of junipers. Landcover maps of 2002 and 2010 are the most detailed spatial distribution that spatially shows forests. Juniper forests are found in Lebanon as mainly as clear to low density coverage. High-density juniper forests are rarely found and only on Mount-Lebanon. Juniper forests are also mixed with oaks on the Eastern flank of Mount-Lebanon. Mapping juniper forests have demonstrated high degree of complexity, especially because of their low density and being mixed. The spatial representation of juniper forests was compared between the 1965 forest map and the landcover maps of 2002 and 2010. GIS environment was used to extract juniper forests from all maps. The degree of matching between juniper forests was investigated regarding the total area and spatial overlapping. Juniper forests were examined to their spatial locations, comparing the three maps. Spatial changes and anthropogenic effect were obtained, using Google Earth facilities. Google earth had satellite images acquired since 2014. Landcover maps of 2002 and 2010 have spatially matched forest map of 1965 by about 90% and 50% respectively. Spatial coverage of juniper forests were about 12,000, 26,000 and 28,000 ha on the 1965 forest map, landcover maps of 2003 and 2010 respectively. Anti-Lebanon juniper forests were not well represented on both landcover maps. Anthropogenic activities were mainly agriculture that affected juniper forests. Cultivations have replaced about 2% of the spatial coverage of 1965 Juniper forests. Quarries and urban existed inside juniper forests but in very limited areas. Juniper forests delineation did not completely match neither between the available maps, nor to the ground. Some juniper forests were not spatially represented on all maps or existing maps represented only portion of juniper forests. Juniper forest mapping requires more consideration and field investigation. High spatial resolution satellite images 展开更多
Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second s...Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second surgical operation, so many breast surgeons have started to depend on intraoperative frozen sections to ensure free safety margins. Aim of work: To assess our policy that we prefer to depend on intraoperative frozen section analysis to get free safety margin in breast conserving surgery from the 1st surgery, and its oncologic outcome. Patients and Methods: This is a retrospective study conducted in Oncology Center—Mansoura University (OCMU), where the data of 219 patients with breast cancer, who were managed by breast conserving surgery with intraoperative frozen section analysis of the safety margins, was analyzed. Results: The intraoperative frozen section analysis of safety margin was negative from the start in 183 (83.6%) patients, while it was positive in 36 patients (16.4%). Intraoperative decision of margin re-excision was applied for 29 patients (13.2%) in order to reach negative margin, modified radical mastectomy was offered for 4 patients (1.8%), while nipple sparing mastectomy with immediate breast reconstruction using latissimus dorsi flap was offered for 3 patients (1.4%). The postoperative paraffin results were typical with intraoperative frozen section analysis results in 216 patients (98.6%) and different results were obtained in only 3 patients (1.4%) who were managed by modified radical mastectomy in a second operation. Only 4 patients had local recurrence (1.8%) during the period of follow-up duration which was ranged from 1 to 86 months with mean ± SD (22.3 ± 14.1). Conclusion: The intraoperative frozen section analysis of safety margins in breast conserving surgery has very high-rate typical results with the paraffin section analysis and it is very helpful in decreasing the rate of second surgical operation in cases of infiltrated margins. It should be used routinely in all c展开更多
文摘Background and Objective: The outcome of locally advanced and metastatic urothelial carcinoma LA/mUC has improved over the past years with a plethora of new treatments and the approval of immune checkpoint inhibitors (ICIs), antibody-drug conjugates, and targeted agents, to identify locally advanced metastatic urothelial carcinoma’s current management practices in Lebanon and the implication of the ongoing economic crisis on the medical practice. Methods: An online questionnaire was used to survey ten Lebanese oncologists from six different hospitals, between July 5 and July 11, 2022, requesting information pertaining to their current clinical practice in the pharmacological treatment of locally advanced metastatic urothelial carcinoma. Key Findings: Cisplatin-based chemotherapy was the most frequently reported initial treatment of locally advanced metastatic urothelial carcinoma. Participants reported using immune checkpoint inhibitors in platinum-ineligible patients and those with PDL1 positive tumors. Also, they would not consider the concomitant use of immunotherapy and chemotherapy in the first-line setting. Participants believed that avelumab maintenance is effective in the absence of progression after first-line platinum-based chemotherapy;they would consider initiating it 2 - 10 weeks after completion of chemotherapy. Conclusions and Clinical Implications: After comparing with current international guidelines, this study shows that Lebanese oncologists follow international guidelines and have deep knowledge of recent clinical trials for the management of locally advanced metastatic urothelial carcinoma, regardless of economic crisis challenges.
文摘Traditional Enterprise Resource Planning (ERP) systems with relational databases take weeks to deliver predictable insights instantly. The most accurate information is provided to companies to make the best decisions through advanced analytics that examine the past and the future and capture information about the present. Integrating machine learning (ML) into financial ERP systems offers several benefits, including increased accuracy, efficiency, and cost savings. Also, ERP systems are crucial in overseeing different aspects of Human Capital Management (HCM) in organizations. The performance of the staff draws the interest of the management. In particular, to guarantee that the proper employees are assigned to the convenient task at the suitable moment, train and qualify them, and build evaluation systems to follow up their performance and an attempt to maintain the potential talents of workers. Also, predicting employee salaries correctly is necessary for the efficient distribution of resources, retaining talent, and ensuring the success of the organization as a whole. Conventional ERP system salary forecasting methods typically use static reports that only show the system’s current state, without analyzing employee data or providing recommendations. We designed and enforced a prototype to define to apply ML algorithms on Oracle EBS data to enhance employee evaluation using real-time data directly from the ERP system. Based on measurements of accuracy, the Random Forest algorithm enhanced the performance of this system. This model offers an accuracy of 90% on the balanced dataset.
文摘In this work, an extended Jacobian elliptic function expansion method is proposed for constructing the exact solutions of nonlinear evolution equations. The validity and reliability of the method are tested by its applications to the system of shallow water wave equations and modified Liouville equation which play an important role in mathematical physics.
基金This work was supported by grants from the National Natural Science Foundation of China(No.81371377)Beijing Municipal Science and Technology Commission(No.Z111107067311033)+2 种基金Beijing Natural Science Foundation(No.7172055)Jiangsu Provincial Department of Human Resources and Social Security"Six Talents Summit"High-level Talents Funding Project(No.2016-WSN-274)2017 Jiangsu Province Phase 5"333 Project"Research Project(No.BRA2017168)。
文摘Background:Both bone marrow mesenchymal stem cell(BM-MSC)and transforming growth factor-β1(TGF-β1)have a strong anti-inflammatory capacity in stroke.But their relationship has not been well addressed.In this study,we investigated how intravenous BM-MSC transplantation in rats effected the expression of TGF-β148 h post cerebral ischemia,and we analyzed the main cells that produce TGF-β1.Methods:We used a distal middle cerebral artery occlusion(dMCAO)model in twenty Sprague-Dawley(SD)rats.The rats were randomly divided into two groups:the ischemic control group and the postischemic BM-MSC transplantation group.One hour after the dMCAO model was established,the rats were injected in the tail vein with either 1 ml saline or 1×106 BM-MSCs suspended in 1 ml saline.ELISAs were used to detect TGF-β1 content in the brain infarct core area,striatum and the plasma at 48 h after cerebral infarction.Immunofluorescent staining of brain tissue sections for TGF-β1,Iba-1,CD68 and NeuN was performed to determine the number and the proportion of double stained cells and to detect possible TGF-β1 producing cells in the brain tissue.Results:Forty-eight hours after ischemia,the TGF-β1 content in the infarcted area of the BM-MSC transplantation group(23.94±4.48 pg/ml)was significantly lower than it was in the ischemic control group(34.18±4.32 pg/ml)(F=13.534,P=0.006).The TGF-β1 content in the rat plasma in the BM-MSC transplantation group(75.91±12.53 pg/ml)was significantly lower than it was in the ischemic control group(131.18±16.07 pg/ml)(F=36.779,P=0.0002),suggesting that after transplantation of BM-MSCs,TGF-β1 levels in the plasma decreased,but there was no significant change in the striatum area.Immunofluorescence staining showed that the total number of nucleated cells(1037.67±222.16 cells/mm2)in the infarcted area after transplantation was significantly higher than that in the ischemic control group(391.67±69.50 cells/mm2)(F=92.421,P<0.01);the number of TGF-β1+cells after transplantation(35.00±13.66 cells/mm2)
文摘Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation;wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer;30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm<sup>3</sup> ± 59.57) cm<sup>3</sup>, while the mean flap volume was (218.27 cm<sup>3</sup> ± 53.64 cm<sup>3</sup>). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.
文摘<strong>Introduction:</strong> Owing to the advanced development of MRI science, it causes obvious great changes of many diseases that affect the female genital system and affect their fertility. Hemorrhagic gynecological diseases especially endometriosis affect young females and cause cyclic pain, in addition to infertility. So early detection is essential for proper treatment. Susceptibility-weighted (SWI) as one of the most recent newly created MRI sequences is highly sensitive to detect products of hemorrhage within different gynecologic disorders with 94.7% sensitivity being more meticulous than conventional MRI sequences as T1 and T2. <strong>Aim of the Work:</strong> A comparison between T1 and T2 as conventional MRI sequences with susceptibility-weighted images (SWI) in many gynecologic disorders by the detection of the presence of internal products of hemorrhage at any stage. <strong>Subjects and Methods:</strong> 48 consecutive patients from Benha University clinics (age range, 17 - 60 years;mean age, 35.67 years). The patients included in the study were presenting with pelvic pain, irregular menses, Dyspareunia, and swelling. All with suspicious diagnosis of ovarian and extra-ovarian lesions. 38 patients out of the 48 patients were known to contain hemorrhagic disorder;all the patients underwent MRI routine pelvis protocol adding SWI sequence. <strong>Results:</strong> There was a greatly significant difference between SWI and conventional MRI sequences T1and T2 with sensitivity 94.7%, 57.9% and 33.3% respectively. <strong>Conclusion:</strong> SWI is a promising tool in the evaluation of hemorrhagic foci within different gynecological disorders. The great ability of detecting hemosiderin foci increases the value of SWI over conventional MRI or US.
基金grants to National Institute of Immunology,New Delhi from Department of Biotechnology(DBT),Government of India.DM also acknowledges financial support from DBT,India under BTIS project(BT/BI/03/009/2002)Bioinformatics R&D grant(BT/PR13526/BID/07/311/2010).
文摘In silico methods for linking genomic space to chemical space have played a crucial role in genomics driven discovery of new natural products as well as biosynthesis of altered natural products by engineering of biosynthetic pathways.Here we give an overview of available computational tools and then briefly describe a novel computational framework,namely retro-biosynthetic enumeration of biosynthetic reactions,which can add to the repertoire of computational tools available for connecting natural products to their biosynthetic gene clusters.Most of the currently available bioinformatics tools for analysis of secondary metabolite biosynthetic gene clusters utilize the“Genes to Metabolites”approach.In contrast to the“Genes to Metabolites”approach,the“Metabolites to Genes”or retro-biosynthetic approach would involve enumerating the various biochemical transformations or enzymatic reactions which would generate the given chemical moiety starting from a set of precursor molecules and identifying enzymatic domains which can potentially catalyze the enumerated biochemical transformations.In this article,we first give a brief overview of the presently available in silico tools and approaches for analysis of secondary metabolite biosynthetic pathways.We also discuss our preliminary work on development of algorithms for retro-biosynthetic enumeration of biochemical transformations to formulate a novel computational method for identifying genes associated with biosynthesis of a given polyketide or nonribosomal peptide.
文摘AIM： To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS： Two groups each of them included 20 cases of resistant mycotic corneal ulcers. Both groups treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity results. In one group argon laser photocoagulation was used as an adjunctive therapy to the specific antifungal drugs and in the other group, intrastromal injection of voriconazole was done besides the specific antifungal drugs. The 40 cases included in the study were proven according to culture and sensitivity to be 28 cases with pure fungal results and 12 cases with mixed （fungal and bacterial）. In argon laser group, argon laser irradiation of the corneal ulcer was performed using argon laser 532 nm wavelength （Carl Zeiss LSL 532s AG; Meditec, Inc.） after fluorescein staining. In the other group, voriconazole solution （500 pg/mL） was prepared and injected in the corneal stroma. All cases were followed up for 3mo after healing was achieved. RESULTS： Complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects were achieved in argon laser group in duration ranged from 2-4wk in 90% of cases. In voriconazole group 4 cases needed amniotic membrane graft due to thinning and 16 cases healed in duration ranged from 2- 6wk （80% of cases）. CONCLUSION： Argon superior to intrastromal treatment of resistant fungal laser photocoagulation is voriconazole injection in corneal ulcers.
文摘This article studies the performance of analytical, semi-analytical and numerical scheme on the complex nonlinear Schr¨odinger(NLS) equation. The generalized auxiliary equation method is surveyed to get the explicit wave solutions that are used to examine the semi-analytical and numerical solutions that are obtained by the Adomian decomposition method, and B-spline schemes(cubic, quantic, and septic). The complex NLS equation relates to many physical phenomena in different branches of science like a quantum state, fiber optics, and water waves. It describes the evolution of slowly varying packets of quasi-monochromatic waves, wave propagation, and the envelope of modulated wave groups, respectively. Moreover, it relates to Bose-Einstein condensates which is a state of matter of a dilute gas of bosons cooled to temperatures very close to absolute zero. Some of the obtained solutions are studied under specific conditions on the parameters to constitute and study the dynamical behavior of this model in two and three-dimensional.
文摘Three alluvial soil samples with different textures were artificially polluted with chloride solutions of Cd, Pb, Co and chromate solution for Cr. The aqua-regia extracted concentration ranges in the artificially polluted soils were 1134 - 1489 mg·kg-1 for Pb, 854 - 938 mg·kg-1 for Cr, 166 - 346 mg·kg-1 for Co and 44 - 54 mg·kg-1 for Cd. The aqua-regia extracted metals were the highest in the spiked clay soil due to its high adsorption capacity. Rock phosphate (PR), lime-stone (LS) and Portland-cement (Cem) were mixed with the spiked soils at 1% and 2% rates (w/w) and incubated at 30 C for 2, 7, 14, 30, 60, 150 and 360 days. The extracted DTPA metals significantly decreased with different magnitudes with increasing the incubation period accompanied by increases in both pH and EC. The data showed that cement (Cem) treatment dropped the DTPA-Pb from @ 1000 to @ 400 mg·kg-1 in all the studied soils (60% decrease) in the first 2 months while it gradually decreased from 400 to 200 mg·kg-1 (20% decrease) in the next 10 months. Limestone (LS) and rock phosphate (PR) materials were relatively less effective in lowering DTPA-Pb after 12 months of incubation. The data showed also that cement (Cem) treatment was the most effective one in lowering DTPA-Cd by @ 60% as compared to the un-amended soils after 12 months of soil incubation. Extractable DTPA-Co and Cr showed consistent decreases with time down to nearly 50% of un-amended soils due to the effect of the added amendments after 12 months of incubation with superior reductions for the cement treatment in all the investigated soils. The statistical analysis confirmed that in all the studied metals and treatment, cement treatment (Cem) was significantly the most effective in lowering the DTPA extracted metals as indicated from LSD test. It was found that up to 73% and 57% of the applied Pb and Cd, respectively, were fixed by only 1% cement. However, the present study showed that from the practical and economic points of view, that 1% Cement was the best treatment to
基金funded by The General Directorate of Scientific Research and Technological Development of the Algerian Ministry of Higher Education and Scientific Research
文摘Juniperus thurifera L.is an endemic Cupres saceae from the Aure`s Mountains of north eastern Algeria and endangered,in part,due to the scarcity of viable seeds It is threatened by other abiotic factors and the lack of an effective management strategy will increase its risk o extinction.The dearth of information on its in vitro regeneration impedes its application in forest managemen programs.We therefore developed a micropropagation protocol using microcuttings with auxiliary buds.Cuttings were grown on different combinations of media supplemented with plant growth regulators at different concentrations.The highest number of shoots and branches regenerated from original shoots was obtained on Woody Plant Medium(WPM)supplemented with 6-benzylaminopurine(BAP)(0.5 mg L^(-1))and 2,4-dichlorophe noxyacetic acid(2,4-D)(0.25 mg L^(-1)).The best elongation of shoots was achieved with WPM supplemented with0.5 mg L^(-1)of BAP and 0.25 or 1 mg L^(-1) of 2,4-D.On the second subculture,shoots had a higher number of branches than those of the first.The highest rooting rate,38.8%,was obtained with shoots cultured in 1/2 Murashige and Skoog(MS)medium supplemented with 5.0 mg L^(-1)each of indol-3-butyric(IBA)and naphthalene acetic acid(NAA).Similarly,the highest root numbers and lengths were produced on 1/2 MS medium supplemented with IBA and NAA(5.0 mg L^(-1)each).During transfer to acclimatization,rates of plant losses of 50% occurred.The second part of the experiment showed that the best shoot callusing was on WPM supplemented with BAP and 2,4-D,with either the combination 0.5+0.25 or 0.25+0.25 mg L^(-1).The results of this research provide a starting point for further studies on in vitro regeneration of J.thurifera for the sustainable management of its unique ecosystem in the Mediterranean basin.
文摘Background: The treatment of breast cancer in large breast patients represents a great challenge to both surgical oncologist and radiation oncologist. The aim of this study is to evaluate the outcome of inferior pedicle therapeutic mammoplasty in large-breasted patients with upper quadrants early breast cancer. Methods: Thirty five large-breasted patients with early breast cancer were included in this study. Simultaneous bilateral inferior pedicle therapeutic mammoplasty was performed. Results: The age of the patients is ranged from 36 to 61 (median 46) years and tumour size is ranged from one to three and half cm. The weight of tissue removed is ranged from 350 gm to 780 gm and the tumour safety margins are ranged from three to eight cm. Wound dehiscence was the commonest post operative complications and six patients were affected (17.6%). The cosmetic outcome was excellent in 22 patients (64.5%), nine patients (26.5%) showed good results, two patients (6%) were satisfactory and one patient (3%) showed poor result. The follow up period is ranged from 6 to 42 months with one case (3%) of systemic metastasis. Conclusion: Inferior pedicle therapeutic reduction mammoplasty for upper quadrants early breast cancer in large breasted women is a surgically and oncologically safe procedure, and it carries a satisfactory aesthetic outcome.
文摘Objective: Nerve blockade is commonly used in oncosurgical procedures as an alternative to general anesthesia for older patients and those with significant medical problems. We report a single tertiary oncology center experience in performing various lip resections and reconstructive techniques using this technique. Patients and methods: sixty patients with lower lip tumors were enrolled into this study with exclusion of refusing, non-compliant and critically ill patients. A solution of 4 ml 2% Lidocaine and epinephrine was put in a 5 ml syringe. Half the solution (2 ml) was injected into each side with a 23 gauge needle and after 5 minutes the surgical resection was carried out after testing for anesthesia. Results: The mean age was 68 ± 6.2 years. The mean ASA score was 3 ± 0.75. There were 4 cases who expressed painful sensation and their operations were completed with fentanyl increments. Mean hospital stay was 1 ± 0.75 days. There were three cases of wound gaping who were treated with secondary closure in an outpatient basis. One patient expressed postoperative acute ischemic heart pain that was managed with anti-ischemic measurements. Conclusion: Bilateral mental nerve block is a safe and effective alternative to general anesthesia in lower lip tumors’ resection especially in older patients and those with poor tolerance for general anesthesia provided that there is no need for cervical nodal dissection.
文摘Nowadays kaolin raw material is usually used to produce nano-kaolin for geopolymer enhancement by using firing method.In the present study,kaolin used was taken from the Naqus Formation(Cambro-Ordovician age),west of Gabal El Gunna,Sinai,Egypt.Nano-kaolin material is an ultrafine material and was prepared from the taken kaolin by the firing process at 800 for 2℃h with a heating rate of 5/min.Six mixes were prepared and their laboratory specimens were made℃and cured up to 90 days.Water cooled slag was used as starting material,and sodium hydroxide and sodium silicate were used in the study as activators for the used kaolin.The formed geopolymer mixes with different ratios(1%,1.5%,3%,5%,and 7%)of nano-kaolin as a partial replacement for the raw kaolin were investigated.Gelenium Ace super plasticizer was added in the ratio of 4%from the dry weight to ensure good dispersing of the used nano clay.Results showed that increasing the percentage of nano-kaolin up to 3%results in an enhancement in the mechanical properties as compared with the control mix up to 90 days of curing,while higher ratios are not preferable where they lead to agglomeration of the added nano materials and matrix dilution.
文摘This paper presents a comprehensive overview study of the DDPMSG （direct driven permanent magnet synchronous generator） for wind energy generation system. Wind turbine controls are provided. The PMSG （permanent magnet synchronous generator） is introduced as construction and model. Configurations of different power converters are presented for use with DDPMSG in wind systems at variable speed operation and maximum power capture. Control techniques for the system are discussed for both machine-side and grid-side in details. Grid integration is provided with focus on how to insure power quality of the system and the performance at disturbances.
文摘This paper presents a sliding mode observer for sensorless operation of SRM （switched reluctance motor） drive. Design of such an observer depends mainly on the nonlinear model of SRM. In this technique, neither extra hardware nor huge memory space are not required but it only requires active phase measurements. Furthermore, PI （proportional integral） and adaptive FLPI （fuzzy logic PI） controllers are suggested to operate individually along with the SMO （sliding mode observer） to cover a full speed range of sensorless controller. Both controller schemes operate in PWM （pulse width modulation） control mode. The proposed observer is implemented and tested using a digital signal processor. All results obtained with both simulation and experimental investigations corroborate the superior performance of the adaptive fuzzy logic controller （FLPI） when compared with those of PI controller.
文摘In 1965, the first forest map of Lebanon was produced. It is the oldest spatial distribution representation of junipers. Landcover maps of 2002 and 2010 are the most detailed spatial distribution that spatially shows forests. Juniper forests are found in Lebanon as mainly as clear to low density coverage. High-density juniper forests are rarely found and only on Mount-Lebanon. Juniper forests are also mixed with oaks on the Eastern flank of Mount-Lebanon. Mapping juniper forests have demonstrated high degree of complexity, especially because of their low density and being mixed. The spatial representation of juniper forests was compared between the 1965 forest map and the landcover maps of 2002 and 2010. GIS environment was used to extract juniper forests from all maps. The degree of matching between juniper forests was investigated regarding the total area and spatial overlapping. Juniper forests were examined to their spatial locations, comparing the three maps. Spatial changes and anthropogenic effect were obtained, using Google Earth facilities. Google earth had satellite images acquired since 2014. Landcover maps of 2002 and 2010 have spatially matched forest map of 1965 by about 90% and 50% respectively. Spatial coverage of juniper forests were about 12,000, 26,000 and 28,000 ha on the 1965 forest map, landcover maps of 2003 and 2010 respectively. Anti-Lebanon juniper forests were not well represented on both landcover maps. Anthropogenic activities were mainly agriculture that affected juniper forests. Cultivations have replaced about 2% of the spatial coverage of 1965 Juniper forests. Quarries and urban existed inside juniper forests but in very limited areas. Juniper forests delineation did not completely match neither between the available maps, nor to the ground. Some juniper forests were not spatially represented on all maps or existing maps represented only portion of juniper forests. Juniper forest mapping requires more consideration and field investigation. High spatial resolution satellite images
文摘Introduction: Nowadays the more accepted surgical option for treating early breast cancer is breast conserving surgery. The main challenge in this type of surgery is to get free safety margins without need of second surgical operation, so many breast surgeons have started to depend on intraoperative frozen sections to ensure free safety margins. Aim of work: To assess our policy that we prefer to depend on intraoperative frozen section analysis to get free safety margin in breast conserving surgery from the 1st surgery, and its oncologic outcome. Patients and Methods: This is a retrospective study conducted in Oncology Center—Mansoura University (OCMU), where the data of 219 patients with breast cancer, who were managed by breast conserving surgery with intraoperative frozen section analysis of the safety margins, was analyzed. Results: The intraoperative frozen section analysis of safety margin was negative from the start in 183 (83.6%) patients, while it was positive in 36 patients (16.4%). Intraoperative decision of margin re-excision was applied for 29 patients (13.2%) in order to reach negative margin, modified radical mastectomy was offered for 4 patients (1.8%), while nipple sparing mastectomy with immediate breast reconstruction using latissimus dorsi flap was offered for 3 patients (1.4%). The postoperative paraffin results were typical with intraoperative frozen section analysis results in 216 patients (98.6%) and different results were obtained in only 3 patients (1.4%) who were managed by modified radical mastectomy in a second operation. Only 4 patients had local recurrence (1.8%) during the period of follow-up duration which was ranged from 1 to 86 months with mean ± SD (22.3 ± 14.1). Conclusion: The intraoperative frozen section analysis of safety margins in breast conserving surgery has very high-rate typical results with the paraffin section analysis and it is very helpful in decreasing the rate of second surgical operation in cases of infiltrated margins. It should be used routinely in all c
