Search results for: left ventricular function

Authors: Abraham J. Rizkalla, Tristan D. Yan

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Atrial myxoma is the most common primary cardiac tumor, and can result in cardiac failure secondary to obstruction, or systemic embolism due to fragmentation. Traditionally, excision of atrial an myxoma has been performed through median sternotomy, however the robotic approach offers several advantages including less pain, improved cosmesis, and faster recovery. Here, we highlight the less well recognized advantages and technical aspects to robotic myxoma resection. This video-presentation demonstrates the resection of a papillary subtype left atrial myxoma using the DaVinci© Xi surgical robot. The 10x magnification and 3D vision allows for the interface between the tumor and the interatrial septum to be accurately dissected, without the need to patch the interatrial septum. Several techniques to avoid tumor fragmentation and embolization are demonstrated throughout the procedure. The tumor was completely excised with clear margins. There was no atrial septal defect or mitral valve injury on post operative transesophageal echocardiography. The patient was discharged home on the fourth post-operative day. This video-presentation highlights the advantages of the robotic approach in atrial myxoma resection compared with sternotomy, as well as emphasizing several technical considerations to avoid potential complications.

Keywords: cardiac surgery, left atrial myxoma, cardiac tumour, robotic resection

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Authors: Tarek Duzan, Walid Eddib

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The marine shallow carbonate reservoir (G- Eocene) is one of the biggest mature water drive reservoir of Waha Oil Company. The cumulative oil produced up to date is about to eighty percent of the booked original oil in place at ninety five percent of Water cut. However, the company believes that there is a good amount of remaining oil left need to be recovered. Many laboratory studies have been conducted to see the possibility drain the commercial oil left behind using two types of gases, namely, carbone dioxide and enriched hydrocarbon gas injection. The conclusions of those cases were inconclusive Technically and Economically. Therefore, the company has decided to verify another Tertiary Recovery (EOR) technique that may be applied to the interested reservoir. A global screening criteria and quick Laboratory chemical tests have been conducted by using many types of chemical injection into real rock samples. The outcomes were unique economically and provide a significant increase in the commercial oil left. Finally, the company has started conducting a sector pilot plan before proceeding with a full plan. There are many wellbores available to use in a potential field Enhanced Oil Recovery.

Keywords: chemical lab. test, ASP, rock types, oil samples, and global screening criteria

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Authors: Jihad H. Asad

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An expression for the Green’s function (GF) of anisotropic face cantered cubic (IFCC) lattice is evaluated analytically and numerically for a single impurity problem. The density of states (DOS), phase shift and scattering cross section are expressed in terms of complete elliptic integrals of the first kind.

Keywords: lattice Green's function, elliptic integral, physics, cubic lattice

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Authors: A. Lubis, R. Widayanti, Z. Hikmah, A. Endaryanto, A. Harsono, A. Harianto, R. Etika, D. K. Handayani, M. Sampurna

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Neonatal lupus erythematous (NLE) is a rare disease marked by clinical characteristic and specific maternal autoantibody. Many cutaneous, cardiac, liver, and hematological manifestations could happen with affect of one organ or multiple. In this case, both babies were premature, low birth weight (LBW), small for gestational age (SGA) and born through caesarean section from a systemic lupus erythematous (SLE) mother. In the first case, we found a baby girl with dyspnea and grunting. Chest X ray showed respiratory distress syndrome (RDS) great I and echocardiography showed small atrial septal defect (ASD) and ventricular septal defect (VSD). She also developed anemia, thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, increasing coagulation factors, hyperbilirubinemia, and positive blood culture of Klebsiella pneumonia. Anti-Ro/SSA and Anti-nRNP/sm were positive. Intravenous fluid, antibiotic, transfusion of blood, thrombocyte concentrate, and fresh frozen plasma were given. The second baby, male presented with necrotic tissue on the left ear and skin rashes, erythematous macula, athropic scarring, hyperpigmentation on all of his body with various size and facial haemorrhage. He also suffered from thrombocytopenia, mild elevated transaminase enzyme, hyperbilirubinemia, anti-Ro/SSA was positive. Intravenous fluid, methyprednisolone, intravenous immunoglobulin (IVIG), blood, and thrombocyte concentrate transfution were given. Two cases of neonatal lupus erythematous had been presented. Diagnosis based on clinical presentation and maternal auto antibody on neonate. Organ involvement in NLE can occur as single or multiple manifestations.

Keywords: neonatus lupus erythematous, maternal autoantibody, clinical characteristic, multiple organ manifestation

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Authors: Rachelle Angeli Maranon

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This research explored the relationships of a child’s family condition, sex and subjective well-being (SWB) to gain some understanding of the experiences of both transnational and non-transnational families. A descriptive-correlational design was used to study the variables. Participants included 52 male and female children from Iloilo and Kabankalan cities, representing the family conditions in this study. Data were gathered using a semi-structured interview guide. Responses were analyzed using Mann-Whitney U Test. The results showed that the SWB of non-transnational children was significantly higher compared to their transnational counterparts (U = 134, p = .00). Also, analysis between females and males indicated a significant difference only on some aspects (U = 318, p = .71). Some recommendations were suggested to better understand the plight of the left-behind children.

Keywords: left-behind children, mothers, subjective well-being, transnational families

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Authors: Benseghir Omar, Bahmed Mohamed

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In this work, we presented a numerical study of the phenomenon of heat transfer through the laminar, incompressible and steady mixed convection in a closed square cavity with the left vertical wall of the cavity is subjected to a warm temperature, while the right wall is considered to be cold. The horizontal walls are assumed adiabatic. The governing equations were discretized by finite volume method on a staggered mesh and the SIMPLER algorithm was used for the treatment of velocity-pressure coupling. The numerical simulations were performed for a wide range of Reynolds numbers 1, 10, 100, and 1000 numbers are equal to 0.01,0.1 Richardson, 0.5,1 and 10.The analysis of the results shows a flow bicellular (two cells), one is created by the speed of the fan placed in the inner cavity, one on the left is due to the difference between the temperatures right wall and the left wall. Knowledge of the intensity of each of these cells allowed us to get an original result. And the values obtained from each of Nuselt convection which allow to know the rate of heat transfer in the cavity.Finally we find that there is a significant influence on the position of the fan on the heat transfer (Nusselt evolution) for values of Reynolds studied and for low values of Richardson handed this influence is negligible for high values of the latter.

Keywords: thermal transfer, mixed convection, square cavity, finite volume method

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Authors: Kamyar Moradi

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Background: There is mixed evidence regarding the association between recreational cannabinoid use and memory performance. One of the major reasons for the present controversy is different cannabinoid use-related covariates that influence the cognitive status of an individual. Adjustment of these confounding variables provides accurate insight into the real effects of cannabinoid use on memory status. In this study, we sought to investigate the association between recent recreational cannabinoid use and memory performance while correcting the model for other possible covariates such as demographic characteristics and duration, and amount of cannabinoid use. Methods: Cannabinoid users were assigned to two groups based on the results of THC urine drug screen test (THC+ group: n = 110, THC- group: n = 410). THC urine drug screen test has a high sensitivity and specificity in detecting cannabinoid use in the last 3-4 weeks. The memory domain of NIH Toolbox battery and brain MRI volumetric measures were compared between the groups while adjusting for confounding variables. Results: After Benjamini-Hochberg p-value correction, the performance in all of the measured memory outcomes, including vocabulary comprehension, episodic memory, executive function/cognitive flexibility, processing speed, reading skill, working memory, and fluid cognition, were significantly weaker in THC+ group (p values less than 0.05). Also, volume of gray matter, left supramarginal, right precuneus, right inferior/middle temporal, right hippocampus, left entorhinal, and right pars orbitalis regions were significantly smaller in THC+ group. Conclusions: this study provides evidence regarding the acute effect of recreational cannabis use on memory performance. Further studies are warranted to confirm the results.

Keywords: brain MRI, cannabis, memory, recreational use, THC urine test

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Authors: X. Wang, T. J. Craft, H. Iacovides

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When handling the near-wall regions of turbulent flows, it is necessary to account for the viscous effects which are important over the thin near-wall layers. Low-Reynolds- number turbulence models do this by including explicit viscous and also damping terms which become active in the near-wall regions, and using very fine near-wall grids to properly resolve the steep gradients present. In order to overcome the cost associated with the low-Re turbulence models, a more advanced wall function approach has been implemented within OpenFoam and tested together with a standard log-law based wall function in the prediction of flows which involve 2-D shock wave/turbulent boundary layer interactions (SWTBLIs). On the whole, from the calculation of the impinging shock interaction, the three turbulence modelling strategies, the Lauder-Sharma k-ε model with Yap correction (LS), the high-Re k-ε model with standard wall function (SWF) and analytical wall function (AWF), display good predictions of wall-pressure. However, the SWF approach tends to underestimate the tendency of the flow to separate as a result of the SWTBLI. The analytical wall function, on the other hand, is able to reproduce the shock-induced flow separation and returns predictions similar to those of the low-Re model, using a much coarser mesh.

Keywords: SWTBLIs, skin-friction, turbulence modeling, wall function

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Authors: Amil Suleimanov, Aigul Saduakassova, Denis Vinnikov

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Objective: To assess functional visceral fat (VAT) activity evaluated by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) as a predictor of metastases in colorectal cancer (CRC). Materials and methods: We assessed 60 patients with histologically confirmed CRC who underwent 18F-FDG PET/CT after a surgical treatment and courses of chemotherapy. Age, histology, stage, and tumor grade were recorded. Functional VAT activity was measured by maximum standardized uptake value (SUVmax) using ¹⁸F-FDG PET/CT and tested as a predictor of later metastases in eight abdominal locations (RE – Epigastric Region, RLH – Left Hypochondriac Region, RRL – Right Lumbar Region, RU – Umbilical Region, RLL – Left Lumbar Region, RRI – Right Inguinal Region, RP – Hypogastric (Pubic) Region, RLI – Left Inguinal Region) and pelvic cavity (P) in the adjusted regression models. We also report the best areas under the curve (AUC) for SUVmax with the corresponding sensitivity (Se) and specificity (Sp). Results: In both adjusted for age regression models and ROC analysis, 18F-FDG accumulation in RLH (cutoff SUVmax 0.74; Se 75%; Sp 61%; AUC 0.668; p = 0.049), RU (cutoff SUVmax 0.78; Se 69%; Sp 61%; AUC 0.679; p = 0.035), RRL (cutoff SUVmax 1.05; Se 69%; Sp 77%; AUC 0.682; p = 0.032) and RRI (cutoff SUVmax 0.85; Se 63%; Sp 61%; AUC 0.672; p = 0.043) could predict later metastases in CRC patients, as opposed to age, sex, primary tumor location, tumor grade and histology. Conclusions: VAT SUVmax is significantly associated with later metastases in CRC patients and can be used as their predictor.

Keywords: ¹⁸F-FDG, PET/CT, colorectal cancer, predictive value

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Authors: Maria Luisa Barcena De Arellano, Sofya Pozdniakova, Pavelas Karkacas, Anja Kuhl, Istvan Baczko, Yury Ladilov, Vera Regitz-Zagrosek

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Introduction: Aging is associated with deterioration of the physiological function, leading to systemic inflammation and mitochondrial dysfunction that promote the development of cardiovascular diseases. Sex differences in aging-related cardiovascular diseases have been postulated. However, their precise mechanisms remain unclear. In the current study, we aimed to investigate the sex difference in the age-related alteration in Sirt1-AMPK signaling and its relation to the mitochondrial biogenesis and inflammation. Methods: Male and female human non-disease lateral left ventricular wall tissue (young (17–40 years; n= 7 male and 7 female) and old (50–68 years; n= 9 male and 8 female)) were used. qRT-PCR, western blot and immunohistochemistry assays were performed for expression analyses of Sirt1, AMPK, pAMPK, ac-Ku70, TFAM, PGC-1α, Sirt3, SOD2 and catalase. CD68 was used as a marker for macrophages and the ratio of IL-12:IL10 (pro-inflammatory phenotype (high IL-12/low IL-10) and anti-inflammatory phenotype (low IL-12/high IL-10) was used to examine the inflammatory stage in the heart. Results: Sirt1 expression was significantly higher in young females compared to young males, whereas in aged hearts Sirt1 expression was significantly downregulated in females, but not in males. In line with the Sirt1 downregulation in aged females, acetylation of nuclear Ku70, a direct target of Sirt1, in aged female hearts was significantly elevated. The activity of AMPK was significantly decreased in aged individuals, however no sex differences in the AMPK expression or activity were found in young or old individuals. The expression of mitochondrial proteins TOM40, SOD2 and Sirt3 was significantly higher in young females compared to young males, while in aged female hearts SOD2 and TOM40 were downregulated. In addition, the expression of catalase, a key cytosolic and mitochondrial anti-oxidative enzyme was significantly higher in young females and this female sex benefit was lost in aged hearts. In addition, the number of cardiac macrophages was significantly increased in old female, but not in male hearts. Consistently, the pro-inflammatory shift in old females was further confirmed by differences in the IL12/IL10 ratio in young female cardiac tissue in a favour of the anti-inflammatory mediator IL-10 (ratio 1:4) compared to young males (ratio 1:1). The anti-inflammatory environment in the heart was lost in aged females (ratio 1:1). Conclusion: Aging leads to the significant downregulation of Sirt1 expression and elevated acetylation of Ku70 in female, but not in male hearts. Furthermore, a beneficial upregulation of mitochondrial and anti-oxidative proteins in young females is lost with aging. Moreover, the malfunctions in the expression of Sirt1 and mitochondrial proteins in aged female hearts is accompanied by a significant pro-inflammatory shift. The study provides a molecular basis for the increased incidence of cardiovascular diseases in old women.

Keywords: inflammation, mitochondrial dysfunction, aging, Sirt1-AMPK axis

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Authors: Adrienne Kline, Jaydip Desai

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Electroencephalogram (EEG) is a noninvasive technique that registers signals originating from the firing of neurons in the brain. The Emotiv EEG Neuroheadset is a consumer product comprised of 14 EEG channels and was used to record the reactions of the neurons within the brain to two forms of stimuli in 10 participants. These stimuli consisted of auditory and visual formats that provided directions of ‘right’ or ‘left.’ Participants were instructed to raise their right or left arm in accordance with the instruction given. A scenario in OpenViBE was generated to both stimulate the participants while recording their data. In OpenViBE, the Graz Motor BCI Stimulator algorithm was configured to govern the duration and number of visual stimuli. Utilizing EEGLAB under the cross platform MATLAB®, the electrodes most stimulated during the study were defined. Data outputs from EEGLAB were analyzed using IBM SPSS Statistics® Version 20. This aided in determining the electrodes to use in the development of a brain-machine interface (BMI) using real-time EEG signals from the Emotiv EEG Neuroheadset. Signal processing and feature extraction were accomplished via the Simulink® signal processing toolbox. An Arduino™ Duemilanove microcontroller was used to link the Emotiv EEG Neuroheadset and the right and left Mecha TE™ Hands.

Keywords: brain-machine interface, EEGLAB, emotiv EEG neuroheadset, OpenViBE, simulink

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Authors: Talal Asif, Maya Kosinska, Lucas Georger, Krish Sardesai, Muhammad Shah Miran

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This article presents a case review and literature review focused on the challenges of managing subaortic membranes (SAM) in young adult patients with mild aortic regurgitation (AR) or aortic stenosis (AS). The study aims to discuss the diagnosis of SAM, imaging studies used for assessment, management strategies in young patients, the risk of valvular damage, and the controversy surrounding prophylactic resection in mild AR. The management of SAM in adults poses challenges due to limited treatment options and potential complications, necessitating further investigation into the progression of AS and AR in asymptomatic SAM patients. The case presentation describes a 40-year-old male with muscular dystrophy who presented with symptoms and was diagnosed with SAM. Various imaging techniques, including CT chest, transthoracic echocardiogram (TTE), and transesophageal echocardiogram (TEE), were used to confirm the presence and severity of SAM. Based on the patient's clinical profile and the absence of surgical indications, medical therapy was initiated, and regular outpatient follow-up was recommended to monitor disease progression. The discussion highlights the challenges in diagnosing SAM, the importance of imaging studies, and the potential complications associated with SAM in young patients. The article also explores the management options for SAM, emphasizing surgical resection as the definitive treatment while acknowledging the limited success rates of alternative approaches. Close monitoring and prompt intervention for complications are crucial in the management of SAM. The concluding statement emphasizes the need for further research to explore alternative treatments for SAM in young patients.

Keywords: subaortic membrane, management, case report, literature review, aortic regurgitation, aortic stenosis, left ventricular outflow obstruction, guidelines, heart failure

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Authors: Mariia A. Parfenenko, Ilya S. Dantsev, Sergei V. Bochenkov, Natalia V. Vinogradova, Olga S. Groznova, Victoria Yu. Voinova

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Introduction: Autism is the most common neurodevelopmental disorder. Autism is characterized by difficulties in social interaction and adherence to stereotypic behavioral patterns and frequently co-occurs with epilepsy, intellectual disabilities, connective tissue disorders, and other conditions. CHD8 codes for chromodomain-helicase-DNA-binding protein 8 - a chromatin remodeler that regulates cellular proliferation and neurodevelopment in embryogenesis. CHD8 is one of the genes most frequently involved in autism. Patients and methods: 2 unrelated male patients, P3 and P12, aged 3 and 12 years old, underwent whole genome sequencing, which determined that they both had different likely pathogenic variants, both previously undescribed in literature. Sanger sequencing later determined that P12 inherited the variant from his affected mother. Results: P3 and P12 presented with autism, a developmental delay, ataxia, sleep disorders, overgrowth, and macrocephaly, as well as other clinical features typically present in patients with causative variants in CHD8. The mother of P12 also has autistic traits, as well as ataxia, hypotonia, sleep disorders, and other symptoms. However, P3 and P12 also have different cardiac abnormalities. P3 had signs of a repolarization disorder: a flattened T wave in the III and aVF derivations and a negative T wave in the V1-V2 derivations. He also had structural valve anomalies with associated regurgitation, local contractility impairment of the left ventricular, and diastolic dysfunction of the right ventricle. Meanwhile, P12 had Wolff-Parkinson-White syndrome and underwent radiofrequency ablation at the age of 2 years. At the time of observation, P12 had mild sinus arrhythmia and an incomplete right bundle branch block, as well as arterial hypertension. Discussion: Cardiac abnormalities were not previously reported in patients with causative variants in CHD8. The underlying mechanism for the formation of those abnormalities is currently unknown. However, the two hypotheses are either a disordered interaction with CHD7 – another chromodomain remodeler known to be directly involved in the cardiophenotype of CHARGE syndrome – a rare condition characterized by coloboma, heart defects and growth abnormalities, or the disrupted functioning of CHD8 as an A-Kinase Anchoring Protein, which are known to modulate cardiac function. Conclusion: We observed 2 unrelated autistic males with likely pathogenic variants in CHD8 that presented with typical symptoms of CHD8-related neurodevelopmental disorder, as well as cardiac abnormalities. Cardiac abnormalities have, until now, been considered uncharacteristic for patients with causative variants in CHD8. Further accumulation of data, including experimental evidence of the involvement of CHD8 in heart formation, will elucidate the mechanism underlying the cardiophenotype of those patients. Acknowledgements: Molecular genetic testing of the patients was made possible by the Charity Fund for medical and social genetic aid projects «Life Genome.»

Keywords: autism spectrum disorders, chromodomain-helicase-DNA-binding protein 8, neurodevelopmental disorder, cardio phenotype

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Authors: Mark Pizzato

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How do ideas, images, and emotions in stage-plays and videos affect us? Do they evoke a greater awareness (or cognitive reappraisal of emotions) through possible shifts between left-cortical, right-cortical, and subcortical networks? To address these questions, this presentation summarizes the research of various neuroscientists, especially Bernard Baars and others involved in Global Workspace Theory, Matthew Lieberman in social neuroscience, Iain McGilchrist on left and right cortical functions, and Jaak Panksepp on the subcortical circuits of primal emotions. Through such research, this presentation offers an ‘inner theatre’ model of the brain, regarding major hubs of neural networks and our animal ancestry. It also considers recent experiments, by Mario Beauregard, on the cognitive reappraisal of sad, erotic, and aversive film clips. Finally, it applies the inner-theatre model and related research to survey results of theatre students who read and then watched the ‘To be or not to be’ speech in 8 different video versions (from stage and screen productions) of William Shakespeare’s Hamlet. Findings show that students become aware of left-cortical, right-cortical, and subcortical brain functions—and shifts between them—through staging and movie-making choices in each of the different videos.

Keywords: cognitive reappraisal, Hamlet, neuroscience, Shakespeare, theatre

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Authors: Ajeevan Gautam, Gulam Anwer Khan, Pratibha Pokhrel

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Introduction: Dermatoglyphics is the science which deals with the study of dermal ridge configuration on the digits, palms and soles. It is grooved by ridges and forms variety of configurations. The aim of the study was to identify dermal ridge patterns on fingertip of hypertensive patients and in normal population and to compare patterns among them. Methods: The subjects of the study were 130 hypertensives and 130 non-hypertensives cases of Kathmandu Valley aged between 40 to 80 years. Case history was recorded after consent finger prints were taken. Different parameters as whorl, loop, arch and composite patterns were studied and analysed. Result: It revealed, increased whorl pattern in hypertensive. It showed 65.69% whorl, 29.23% loop and 5.07% arch patterns in right hand of hypertensive people. In control, it was found to be 34.46% whorl, 58.15% loop and 5.38% arch patterns respectively. Similarly in left hand 63.69% whorl, 32% loop and 4.30% arch in hypertensive group. In control group it was 60.15% as loop, 35.69% as whorl and 15% as arch. Discussion: Based on findings of the result, it was concluded that the whorl, loop and arch patterns observed as 65.69%, 29.23% and 5.07% respectively in hypertensive cases in right hand. Similarly in left hand, it was found to be 4.30% as arch, 32% as loop and 63.69% as whorl patterns, but in normotensive subjects these patterns were recorded as 36.43%, 58.15%, 5.38% in right hand and 35.69%, 60.15%, 4.15% in left hand as whorl, loop and arch respectively.

Keywords: arch, dermatoglyphics, hypertension, loop, whorl

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Authors: Takashi Mitsuishi, Koji Saigusa

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This paper presents circular polar coordinates transformation of periodic fuzzy membership function. The purpose is identification of domain of periodic membership functions in consequent part of IF-THEN rules. The proposed methods are applied to the simple color construct system.

Keywords: periodic membership function, polar coordinates transformation, defuzzification, circular coordinates

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Authors: A. F. Suleimanov, A. B. Saduakassova, V. S. Pokrovsky, D. V. Vinnikov

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Relevance: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, with relapse occurring in about 70% of advanced cases with poor prognoses. The aim of the study was to evaluate functional visceral fat activity (VAT) evaluated by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) as a predictor of metastases in epithelial ovarian cancer (EOC). Materials and methods: We assessed 53 patients with histologically confirmed EOC who underwent ¹⁸F-FDG PET/CT after a surgical treatment and courses of chemotherapy. Age, histology, stage, and tumor grade were recorded. Functional VAT activity was measured by maximum standardized uptake value (SUVₘₐₓ) using ¹⁸F-FDG PET/CT and tested as a predictor of later metastases in eight abdominal locations (RE – Epigastric Region, RLH – Left Hypochondriac Region, RRL – Right Lumbar Region, RU – Umbilical Region, RLL – Left Lumbar Region, RRI – Right Inguinal Region, RP – Hypogastric (Pubic) Region, RLI – Left Inguinal Region) and pelvic cavity (P) in the adjusted regression models. We also identified the best areas under the curve (AUC) for SUVₘₐₓ with the corresponding sensitivity (Se) and specificity (Sp). Results: In both adjusted-for regression models and ROC analysis, ¹⁸F-FDG accumulation in RE (cut-off SUVₘₐₓ 1.18; Se 64%; Sp 64%; AUC 0.669; p = 0.035) could predict later metastases in EOC patients, as opposed to age, sex, primary tumor location, tumor grade, and histology. Conclusions: VAT SUVₘₐₓ is significantly associated with later metastases in EOC patients and can be used as their predictor.

Keywords: ¹⁸F-FDG, PET/CT, EOC, predictive value

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Authors: Sharon Harel, Rachel Kizony, Yoram Feldman, Gabi Zeilig, Mordechai Shani

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Multiple Sclerosis (MS) is a neurological disease that may cause restriction in participation in daily activities of young adults. Main symptoms include fatigue, weakness and cognitive decline. The appearance of symptoms, their severity and deterioration rate, change between patients. The challenge of health services is to provide long-term rehabilitation services to people with MS. The objective of this presentation is to describe a course of tele-rehabilitation service of a woman with MS. Methods; R is a 48 years-old woman, diagnosed with MS when she was 22. She started to suffer from weakness of her non-dominant left upper extremity about ten years after the diagnosis. She was referred to the tele-rehabilitation service by her rehabilitation team, 16 years after diagnosis. Her goals were to improve ability to use her affected upper extremity in daily activities. On admission her score in the Mini-Mental State Exam was 30/30. Her Fugl-Meyer Assessment (FMA) score of the left upper extremity was 48/60, indicating mild weakness and she had a limitation of her shoulder abduction (90 degrees). In addition, she reported little use of her arm in daily activities as shown in her responses to the Motor Activity Log (MAL) that were equal to 1.25/5 in amount and 1.37 in quality of use. R. received two 30 minutes on-line sessions per week in the tele-rehabilitation service, with the CogniMotion system. These were complemented by self-practice with the system. The CogniMotion system provides a hybrid (synchronous-asynchronous), the home-based tele-rehabilitation program to improve the motor, cognitive and functional status of people with neurological deficits. The system consists of a computer, large monitor, and the Microsoft’s Kinect 3D sensor. This equipment is located in the client’s home and connected to a clinician’s computer setup in a remote clinic via WiFi. The client sits in front of the monitor and uses his body movements to interact with games and tasks presented on the monitor. The system provides feedback in the form of ‘knowledge of results’ (e.g., the success of a game) and ‘knowledge of performance’ (e.g., alerts for compensatory movements) to enhance motor learning. The games and tasks were adapted for R. motor abilities and level of difficulty was gradually increased according to her abilities. The results of her second assessment (after 35 on-line sessions) showed improvement in her FMA score to 52 and shoulder abduction to 140 degrees. Moreover, her responses to the MAL indicated an increased amount (2.4) and quality (2.2) of use of her left upper extremity in daily activities. She reported high level of enjoyment from the treatments (5/5), specifically the combination of cognitive challenges while moving her body. In addition, she found the system easy to use as reflected by her responses to the System Usability Scale (85/100). To-date, R. continues to receive treatments in the tele-rehabilitation service. To conclude, this case report shows the potential of using tele-rehabilitation for people with MS to provide strategies to enhance the use of the upper extremity in daily activities as well as for maintaining motor function.

Keywords: motor function, multiple-sclerosis, tele-rehabilitation, daily activities

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Authors: Singh Deepeshwar, Suhas Vinchurkar

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Similar to neuroimaging findings through functional magnetic resonance imaging (fMRI) assessing regional cerebral blood oxygenation, the functional near infrared spectroscopy (fNIRS) has also been used to assess hemodynamic responses in the imaged region of the brain. The present study assessed hemodynamic responses in terms of changes in oxygenation (HbO), deoxygenation (HbR) and total hemoglobin (THb) on the prefrontal cortex (PFC), bilaterally, using fNIRS in 10 participants who performed three voluntary regulated breathing (pranayama) practices viz. (i) Left nostril breathing (LNB), (ii) Right nostril breathing (RNB); and (iii) Alternating nostril breathing (ANB) and compared with normal breathing as baseline (BS). For this, we used 64 channel NIRS system covering left and the right prefrontal cortex. The normal breathing kept as baseline (BS) measures as regressors in the investigation of hemodynamic responses when compared with LNB, RNB and ANB. In the results, we found greater oxygenation in contralateral side i.e., higher activation on the left prefrontal cortex (lPFC) during RNB, and right prefrontal cortex (rPFC) during LNB, whereas ANB showed greater deoxygenation responses on both sides of PFC. Interestingly, LNB showed increased oxygenation on ipsilateral side i.e., lPFC but not during RNB. This suggests that voluntary regulated breathing produced an immediate effect not only on contralateral but ipsilateral sides of the brain as well. In conclusion, breathing practices are tightly coupled to cerebral rhythms of alternating cerebral hemispheric activity during particular nostril breathing. These results of the specific nostril breathing do not support previous findings of contralateral hemispheric improvement while left or right nostril breathing only.

Keywords: hemodynamic responses, brain, pranayama, voluntary regulated breathing practices, prefrontal cortex

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Authors: Hani Albogami

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The internal audit function is considered as one of the internal corporate governance mechanisms that may have an impact on improving earnings quality by constraining earnings management. The internal audit function is also a unique corporate governance mechanism because internal auditors have more involvement with the day-to-day operations comparing to the audit committee, and also internal auditors audit their companies the whole year compared to the external auditor who audits only a certain time of the year. The relationships between internal audit function and earnings management can be understood by some theories. Therefore, this paper provides a theoretical background of the influence of the quality of internal audit function on earnings management. In particular, the agency theory, institutional theory, singling theory, and resource dependency theory are adapted by this paper to provide some understanding and analyses that can be a basis for future research to contribute to the corporate governance academic studies.

Keywords: internal audit, corporate governance, earnings management, accounting

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Authors: Saut Samuel Simamora

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PURPOSE: Nucleus drop is one of the most feared and severe complications of modern cataract surgery. The lens material may drop through iatrogenic breaks of the posterior capsule. The incidence of the nucleus as the complication of phacoemulsification increases concomitant to the increased frequency of phacoemulsification. Pars plana vitrectomy (PPV) followed by endofragmentation and secondary intraocular lens (IOL) implantation is the choice of management procedure. This case report aims to present the outcome of PPV for the treatment dropped nucleus after cataract surgery METHODS: A 65 year old female patient came to Vitreoretina department with chief complaints blurry vision in her left eye after phacoemulsification one month before. Ophthalmological examination revealed visual acuity of the right eye (VA RE) was 6/15, and the left eye (VA LE) was hand movement. The intraocular pressure (IOP) on the right eye was 18 mmHg, and on the left eye was 59 mmHg. On her left eye, there were aphakic, dropped lens nucleus and secondary glaucoma.RESULTS: The patient got antiglaucoma agent until her IOP was decreased. She underwent pars plana vitrectomy to remove dropped nucleus and iris fixated IOL. One week post operative evaluation revealed VA LE was 6/7.5 and iris fixated IOL in proper position. CONCLUSIONS: Nucleus drop generally occurs in phacoemulsification cataract surgery techniques. Retained lens nucleus or fragments in the vitreous may cause severe intraocular inflammation leading to secondary glaucoma. The proper and good management for retained lens fragments in nucleus drop give excellent outcome to patient.

Keywords: secondary glaucoma, complication of phacoemulsification, nucleus drop, pars plana vitrectomy

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Khandoker Akib Mohammad

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While analyzing time-to-event data, it is possible that a certain fraction of subjects will never experience the event of interest, and they are said to be cured. When this feature of survival models is taken into account, the models are commonly referred to as cure models. In the presence of covariates, the conditional survival function of the population can be modelled by using the cure model, which depends on the probability of being uncured (incidence) and the conditional survival function of the uncured subjects (latency), and a combination of logistic regression and Cox proportional hazards (PH) regression is used to model the incidence and latency respectively. In this paper, we have shown the asymptotic normality of the profile likelihood estimator via asymptotic expansion of the profile likelihood and obtain the explicit form of the variance estimator with an implicit function in the profile likelihood. We have also shown the efficient score function based on projection theory and the profile likelihood score function are equal. Our contribution in this paper is that we have expressed the efficient information matrix as the variance of the profile likelihood score function. A simulation study suggests that the estimated standard errors from bootstrap samples (SMCURE package) and the profile likelihood score function (our approach) are providing similar and comparable results. The numerical result of our proposed method is also shown by using the melanoma data from SMCURE R-package, and we compare the results with the output obtained from the SMCURE package.

Keywords: Cox PH model, cure model, efficient score function, EM algorithm, implicit function, profile likelihood

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Authors: Sheng-Fen Fan, Sung-Hui Tseng

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Attention deficit hyperactivity deficit (ADHD) child display diverse sensory processing difficulty behaviors. There is less evidence to figure out how the association between executive function and sensory deficit. To determine whether sensory deficit influence the executive functions, we examined sensory processing by SPM and try to indicate hot/cold executive function (EF) by BRIEF2, respectively. We found that the hot executive function deficit might associate with auditory processing in a variety of settings, and vestibular input to maintain balance and upright posture; the cold EF deficit might opposite to the hot EF deficit, the vestibular sensory modulation difficulty association with emotion shifting and emotional regulation. These results suggest that sensory processing might be another consideration factor to influence the higher cognitive control or emotional regulation of EF. Overall, this study indicates the distinction between hot and cold EF impairments with different sensory modulation problem. Moreover, for clinician, it needs more cautious consideration to conduct intervention with ADHD.

Keywords: hot executive function, cold executive function, sensory processing, ADHD

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Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

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Authors: Ferruh Taspinar, Gulce K. Seyyar, Gamze Kurt, Eda O. Okur, Emrah Afsar, Ismail Saracoglu, Betul Taspinar

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Overweight and obesity has been associated with postural balance. The aim of this study was to investigate the relationship between body composition and balance. One hundred and thirty two young adults (58 male, 74 female) were included in the study. Mean age of participants were found as 21.21±1.51 years. Body composition (body mass index, total body fat ratio, total body muscle ratio) and balance (right anterior, right postero-medial, right postero-lateral, left anterior, left postero-medial, left postero-lateral) were evaluated by Tanita BC-418 and Y balance test, respectively. Pearson correlation analysis was used to evaluate the correlation between the parameters. Significance level in statistical analysis was accepted as 0.05. According to results, no correlation was found between body mass index and balance parameters. There was negative correlation between total body fat ratio and balance parameters (r=0.419-0.509, p˂0.05). On the other hand, positive correlation was found between total body muscle ratio and balance parameters (r=0.390-0.494, p˂0.05). This study demonstrated that body fat and muscle ratio affects the balance. Body composition should be considered in rehabilitation programs including postural balance training.

Keywords: balance, body composition, body mass, young adults

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Authors: Asaad Alhabsi, Alyaqdan Algafri

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Aim: Reporting 83 years old man with history of left upper eyelid swelling post 4-lids blepharoplasty diagnosed based on clinical presentation and Radiological imaging with pseudoaneurysm of frontal branch of Superficial Temporal Artery post blepharoplasty. METHODS: 83 years old who presented to a Tertiary ophthalmic center with painless left upper eyelids swelling for 2 months post 4-lids blepharoplasty. Left subcutaneous, sub-brow lesion, in the supertemporal pre-septal area, large mass found and excised surgically. Then he developed recurrent larger mass twice first time treated with aspiration of blood, second time diagnosed with superficial temporal artery (STA) pseudoaneurysm of frontal branch treated with endovascular embolization. RESULTS: Pseudoaneurysm of superficial temporal artery (STA) is a rare, presenting usual post head or face trauma .literature reported few cases of such conditions post operatively, and no reported cases post blepharoplasty. CONCLUSIONS: Surgical intervention is the gold standard of treatment either directly by dissecting the aneurysmal sac and ligate both ends, or endovascular method of injecting thrombin or embolization which was done in this patient by interventional radiologist.

Keywords: superficial temporal artery, pseudoaneurysm, blepharoplasty, Oculoplasty

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Authors: Dae-gun Kim, Hyun-joo Kang

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Purpose: The purpose of this study was to investigate the effects of aging on center of pressure, gait angle and gait time. Methods: 29 healthy female college students(FCS) and 28 elderly women (EW) were recruited to participate in this study. A gait analysis system( Gaitview, Korea) was used to collect the center of pressure in static state and gait angle with gait time in dynamic state. Results: Results of the center of pressure do not have significant differences between two groups. In the gait angle test, the FCS showed 1.56±5.2° on their left while the EW showed 9.76±6.54° on their left. In their right, the FCS showed 2.85±6.47° and the EW showed 10.27±6.97°. In the gait angle test, there was a significant difference in the gait time between the female college students and elderly women. A significant difference was evident in the gait time. The FCS on the left was 0.87±0.1sec while the EW’s was 1.28±0.44sec. The FCS on the right was 0.86±0.09sec and the EW was 1.1±0.21sec. The results of this study revealed that the elderly participants aging musculoskeletal system and subsequent changes in their posture altered gait angle and gait time. Therefore, this widening is due to their need to leave their feet on the ground longer for stability slowing their movement. Conclusions: In conclusion, it is advisable to develop an exercise program for the elderly focusing on stability the prevention of falls.

Keywords: center of pressure, gait angle, gait time, elderly women

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Authors: M. R. Al-Rashidi, K. M. El-Naggar, M. F. Al-Hajri

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The fuel cost function describes the electric power generation-cost relationship in thermal plants, hence, it sheds light on economical aspects of power industry. Different models have been proposed to describe this relationship with the quadratic function model being the most popular one. Parameters of second order fuel cost function are estimated in this paper using cuckoo search algorithm. It is a new population based meta-heuristic optimization technique that has been used in this study primarily as an accurate estimation tool. Its main features are flexibility, simplicity, and effectiveness when compared to other estimation techniques. The parameter estimation problem is formulated as an optimization one with the goal being minimizing the error associated with the estimated parameters. A case study is considered in this paper to illustrate cuckoo search promising potential as a valuable estimation and optimization technique.

Keywords: cuckoo search, parameters estimation, fuel cost function, economic dispatch

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Authors: Sohrab Jafarpour, Hamed Farokhi, Mohammad Rahmati, Alireza Gholipour

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In the current study, a nonlinear fluid-structure interaction (FSI) biomechanical model of atherosclerosis in the left anterior descending (LAD) coronary artery is developed to perform a detailed sensitivity analysis of the geometrical features of an atheroma plaque. In the development of the numerical model, first, a 3D geometry of the diseased artery is developed based on patient-specific dimensions obtained from the experimental studies. The geometry includes four influential geometric characteristics: stenosis ratio, plaque shoulder-length, fibrous cap thickness, and eccentricity intensity. Then, a suitable strain energy density function (SEDF) is proposed based on the detailed material stability analysis to accurately model the hyperelasticity of the arterial walls. The time-varying inlet velocity and outlet pressure profiles are adopted from experimental measurements to incorporate the pulsatile nature of the blood flow. In addition, a computationally efficient type of structural boundary condition is imposed on the arterial walls. Finally, a non-Newtonian viscosity model is implemented to model the shear-thinning behaviour of the blood flow. According to the results, the structural responses in terms of the maximum principal stress (MPS) are affected more compared to the fluid responses in terms of wall shear stress (WSS) as the geometrical characteristics are varying. The extent of these changes is critical in the vulnerability assessment of an atheroma plaque.

Keywords: atherosclerosis, fluid-Structure interaction modeling, material stability analysis, and nonlinear biomechanics

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