Publications by authors named "Ahmed A Metwally"

29 Publications

  • Page 1 of 1

Early detection of SARS-CoV-2 and other infections in solid organ transplant recipients and household members using wearable devices.

Transpl Int 2021 Mar 18. Epub 2021 Mar 18.

Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.

The increasing global prevalence of SARS-CoV-2 and the resulting COVID-19 disease pandemic pose significant concerns for clinical management of solid organ transplant recipients (SOTR). Wearable devices that can measure physiologic changes in biometrics including heart rate, heart rate variability, body temperature, respiratory, activity (such as steps taken per day) and sleep patterns, and blood oxygen saturation show utility for the early detection of infection before clinical presentation of symptoms. Recent algorithms developed using preliminary wearable datasets show that SARS-CoV-2 is detectable before clinical symptoms in >80% of adults. Early detection of SARS-CoV-2, influenza, and other pathogens in SOTR, and their household members, could facilitate early interventions such as self-isolation and early clinical management of relevant infection(s). Ongoing studies testing the utility of wearable devices such as smartwatches for early detection of SARS-CoV-2 and other infections in the general population are reviewed here, along with the practical challenges to implementing these processes at scale in pediatric and adult SOTR, and their household members. The resources and logistics, including transplant-specific analyses pipelines to account for confounders such as polypharmacy and comorbidities, required in studies of pediatric and adult SOTR for the robust early detection of SARS-CoV-2, and other infections are also reviewed.
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http://dx.doi.org/10.1111/tri.13860DOI Listing
March 2021

The implications of a pathological complete response of the primary tumour after neoadjuvant chemotherapy for breast cancer on axillary surgery.

J Egypt Natl Canc Inst 2021 Feb 8;33(1). Epub 2021 Feb 8.

Department of Breast Surgery, Surgical Oncology, National Cancer Institute-Cairo University, Giza, Egypt.

Background: Management of the node-positive axilla after neoadjuvant chemotherapy is controversial. The aim of this study is to predict the group of patients who may require a less invasive approach for axillary management. One possible group are patients with pathological complete response of the primary after chemotherapy.

Results: A unicentral retrospective cohort study including all breast cancer patients with axillary node metastases at presentation who received neoadjuvant chemotherapy resulting in pathological complete response. Pathological complete response in the axillary lymph nodes was recorded. A correlation between the response in the primary tumour and the lymph nodes was assessed. A subgroup analysis was conducted for different biological groups. Complete response was seen in the axillary nodes in 80.5% of patients. Patients with lobular cancer were less likely to show a similar response in the axilla as the primary tumour (p = 0.077). A higher incidence of axillary response was observed in HER2-positive tumours (p = 0.082). All patients with grade 3 tumours achieved complete response in the axilla (p = 0.094). Patients with negative or weak positive hormone receptor status had a significantly higher rate of complete response in the axilla compared to strongly positive hormone receptor status (OR, 7.8; 95% CI, 1.7-34.5; p = 0.007).

Conclusion: A less invasive axillary surgery may be safely recommended in selected group of node-positive patients after neoadjuvant chemotherapy when the primary tumour shows complete response. This group may include HER2-positive, ER-negative and grade 3 tumours. Less response is expected in ER-positive and lobular carcinoma even with complete response in the primary.
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http://dx.doi.org/10.1186/s43046-021-00061-9DOI Listing
February 2021

Black soldier fly (Hermetia illucens) larvae meal in diets of European seabass: Effects on antioxidative capacity, non-specific immunity, transcriptomic responses, and resistance to the challenge with Vibrio alginolyticus.

Fish Shellfish Immunol 2021 Apr 25;111:111-118. Epub 2021 Jan 25.

Department of Aquatic Animal Medicine and Management, Faculty of Veterinary Medicine, University of Sadat City, Egypt.

Black soldier fly larvae meal (BSFLM) has been successfully demonstrated as a promising fish meal (FM) replacer in diets of several fish species including European seabass (Dicentrarchus labrax). However, its impacts on antioxidant capacity, and immune responses of treated fish are still poorly understood. A 60-day feeding trial was carried out to evaluate the effects of partial substitution of FM with different levels of dry BSFLM on the antioxidative status, non-specific immunity, transcriptomic responses, and resistance of European seabass to the challenge with Vibrio alginolyticus. Four isoproteic (45%) and isolipidic diets were formulated by replacing 0.0%, 25%, 35%, and 50% of the dietary FM. Each diet was randomly assigned to four fish groups (in triplicates) (initial mean body weight, 12.1 ± 0.21 g) (20 fish per aquarium) (n = 240). Fish were fed three times daily to the apparent satiation. At the end of the feeding trial, serum antioxidant biomarkers such as malondialdehyde levels, and catalase, superoxide dismutase, and glutathione peroxidase enzyme activities were significantly increased in all BSFLM groups in a dose-dependent manner compared to the control group (P < 0.05). The non-specific immune indices, including phagocytic activity, phagocytic index, serum lysozyme and respiratory burst activities were significantly elevated in BSFLM groups compared to those in the control group (P < 0.05). Significant upregulation of the mRNA expression levels of hepatic heat shock protein 70, interleukin-1beta and interleukin-10 genes were observed in all BSFLM groups compared to the control group (P < 0.05). Additionally, after the challenge with V. alginolyticus, the relative percent of survival was significantly elevated in fish groups fed on diets containing graded levels of BSFLM over the control group (P < 0.05). Conclusively, the present study suggests the potential efficacy of partial replacement of dietary FM protein for up to 50% by BSFLM without negative effects on fish health with possible potentiation of the antioxidative status, and the immune responses of the European seabass.
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http://dx.doi.org/10.1016/j.fsi.2021.01.013DOI Listing
April 2021

Pre-symptomatic detection of COVID-19 from smartwatch data.

Nat Biomed Eng 2020 12 18;4(12):1208-1220. Epub 2020 Nov 18.

Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.

Consumer wearable devices that continuously measure vital signs have been used to monitor the onset of infectious disease. Here, we show that data from consumer smartwatches can be used for the pre-symptomatic detection of coronavirus disease 2019 (COVID-19). We analysed physiological and activity data from 32 individuals infected with COVID-19, identified from a cohort of nearly 5,300 participants, and found that 26 of them (81%) had alterations in their heart rate, number of daily steps or time asleep. Of the 25 cases of COVID-19 with detected physiological alterations for which we had symptom information, 22 were detected before (or at) symptom onset, with four cases detected at least nine days earlier. Using retrospective smartwatch data, we show that 63% of the COVID-19 cases could have been detected before symptom onset in real time via a two-tiered warning system based on the occurrence of extreme elevations in resting heart rate relative to the individual baseline. Our findings suggest that activity tracking and health monitoring via consumer wearable devices may be used for the large-scale, real-time detection of respiratory infections, often pre-symptomatically.
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http://dx.doi.org/10.1038/s41551-020-00640-6DOI Listing
December 2020

Deep longitudinal multiomics profiling reveals two biological seasonal patterns in California.

Nat Commun 2020 10 1;11(1):4933. Epub 2020 Oct 1.

Department of Genetics, Stanford University, Stanford, CA, 94305, USA.

The influence of seasons on biological processes is poorly understood. In order to identify biological seasonal patterns based on diverse molecular data, rather than calendar dates, we performed a deep longitudinal multiomics profiling of 105 individuals over 4 years. Here, we report more than 1000 seasonal variations in omics analytes and clinical measures. The different molecules group into two major seasonal patterns which correlate with peaks in late spring and late fall/early winter in California. The two patterns are enriched for molecules involved in human biological processes such as inflammation, immunity, cardiovascular health, as well as neurological and psychiatric conditions. Lastly, we identify molecules and microbes that demonstrate different seasonal patterns in insulin sensitive and insulin resistant individuals. The results of our study have important implications in healthcare and highlight the value of considering seasonality when assessing population wide health risk and management.
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http://dx.doi.org/10.1038/s41467-020-18758-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529769PMC
October 2020

Pediatric lung transplantation: Dynamics of the microbiome and bronchiolitis obliterans in cystic fibrosis.

J Heart Lung Transplant 2020 08 19;39(8):824-834. Epub 2020 May 19.

Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois; Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Department of Surgery, University of Illinois at Chicago, Chicago, Illinois. Electronic address:

Background: Compositional changes in the microbiome are associated with the development of bronchiolitis obliterans (BO) after lung transplantation (LTx) in adults with cystic fibrosis (CF). The association between the lower airway bacterial community and BO after LTx in children with CF remains largely unexplored and is possibly influenced by frequent antibiotic therapy. The objectives of this study were to examine the relationship between bacterial community dynamics and the development of BO and analyze antibiotic resistance trends in children after LTx for CF.

Methods: For 3 years from the time of transplant, 12 LTx recipients were followed longitudinally, with 5 subjects developing BO during the study period. A total of 82 longitudinal bronchoalveolar lavage samples were collected during standard of care bronchoscopies. Metagenomic shotgun sequencing was performed on the extracted microbial DNA from bronchoalveolar lavage specimens. Taxonomic profiling was constructed using WEVOTE pipeline. The longitudinal association between development of BO and temporal changes in bacterial diversity and abundance were evaluated with MetaLonDA. The analysis of antibiotic resistance genes was performed with the ARGs-OAP v2.0 pipeline.

Results: All recipients demonstrated a Proteobacteria-predominant lower airways community. Temporal reduction in bacterial diversity was significantly associated with the development of BO and associated with neutrophilia and antibiotic therapy. Conversely, an increasing abundance of the phylum Actinobacteria and the orders Neisseriales and Pseudonocardiales in the lower airways was significantly associated with resilience to BO. A more diverse bacterial community was related to a higher expression of multidrug resistance genes and increased proteobacterial abundance.

Conclusions: Decreased diversity within bacterial communities may suggest a contribution to pediatric lung allograft rejection in CF.
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http://dx.doi.org/10.1016/j.healun.2020.04.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437357PMC
August 2020

Molecular Choreography of Acute Exercise.

Cell 2020 05;181(5):1112-1130.e16

Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.

Acute physical activity leads to several changes in metabolic, cardiovascular, and immune pathways. Although studies have examined selected changes in these pathways, the system-wide molecular response to an acute bout of exercise has not been fully characterized. We performed longitudinal multi-omic profiling of plasma and peripheral blood mononuclear cells including metabolome, lipidome, immunome, proteome, and transcriptome from 36 well-characterized volunteers, before and after a controlled bout of symptom-limited exercise. Time-series analysis revealed thousands of molecular changes and an orchestrated choreography of biological processes involving energy metabolism, oxidative stress, inflammation, tissue repair, and growth factor response, as well as regulatory pathways. Most of these processes were dampened and some were reversed in insulin-resistant participants. Finally, we discovered biological pathways involved in cardiopulmonary exercise response and developed prediction models revealing potential resting blood-based biomarkers of peak oxygen consumption.
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http://dx.doi.org/10.1016/j.cell.2020.04.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299174PMC
May 2020

PopPhy-CNN: A Phylogenetic Tree Embedded Architecture for Convolutional Neural Networks to Predict Host Phenotype From Metagenomic Data.

IEEE J Biomed Health Inform 2020 10 11;24(10):2993-3001. Epub 2020 May 11.

Accurate prediction of the host phenotype from a metagenomic sample and identification of the associated microbial markers are important in understanding potential host-microbiome interactions related to disease initiation and progression. We introduce PopPhy-CNN, a novel convolutional neural network (CNN) learning framework that effectively exploits phylogenetic structure in microbial taxa for host phenotype prediction. Our approach takes an input format of a 2D matrix representing the phylogenetic tree populated with the relative abundance of microbial taxa in a metagenomic sample. This conversion empowers CNNs to explore the spatial relationship of the taxonomic annotations on the tree and their quantitative characteristics in metagenomic data. We show the competitiveness of our model compared to other available methods using nine metagenomic datasets of moderate size for binary classification. With synthetic and biological datasets, we show the superior and robust performance of our model for multi-class classification. Furthermore, we design a novel scheme for feature extraction from the learned CNN models and demonstrate improved performance when the extracted features. PopPhy-CNN is a practical deep learning framework for the prediction of host phenotype with the ability of facilitating the retrieval of predictive microbial taxa.
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http://dx.doi.org/10.1109/JBHI.2020.2993761DOI Listing
October 2020

Benefits of vaginal dinoprostone administration prior to levonorgestrel-releasing intrauterine system insertion in women delivered only by elective cesarean section: a randomized double-blinded clinical trial.

Arch Gynecol Obstet 2020 06 20;301(6):1463-1471. Epub 2020 Apr 20.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Purpose: This study aimed at investigating the efficacy and safety of dinoprostone 3 mg vaginally prior to levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women undergoing elective cesarean delivery (CD).

Methods: We conducted a prospective, randomized, double-blinded, placebo-controlled trial at family planning clinic of Cairo University hospitals from August 2019 to January 2020. We included 200 women aged ≥ 18 years who previously delivered by elective CD willing to receive LNG-IUS. Women were randomly assigned with a 1:1 allocation ratio to receive 3 mg vaginal dinoprostone or placebo tablets two hours before LNG-IUS insertion. Our main outcomes were patient-reported pain during insertion and 30 min post-procedure, ease of insertion, satisfaction, duration of insertion, and different side effects.

Results: Patient-perceived pain during LNG-IUS insertion was significantly reduced in dinoprostone compared to placebo (4.1 ± 1.7 vs 6.4 ± 1.3; p < 0.001). Dinoprostone reduced pain scores 30 min post-procedure compared to placebo, but the difference was not statistically significant (3.5 ± 1.1 vs 3.7 ± 1.6; p = 0.25). Satisfaction score was higher in dinoprostone compared to placebo (7.9 ± 1.0 vs 5.9 ± 0.8; p < 0.001). The insertion was significantly easier and shorter in dinoprostone than placebo (3.9 ± 1.1 vs 5.9 ± 1.1; p < 0.001) and (5.6 ± 0.9 vs 7.2 ± 0.8; p < 0.001), respectively. Adverse events were not significantly different between both groups.

Conclusion: Dinoprostone administration 2 h before LNG-IUS insertion in women delivered by elective CD effectively reduced pain during insertion and 30 min post-procedure. Women received dinoprostone had easier and shorter insertion and were more satisfied with tolerable side effects.
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http://dx.doi.org/10.1007/s00404-020-05543-0DOI Listing
June 2020

Abundance of Multidrug Resistance Efflux Pumps in the Urinary Metagenome of Kidney Transplant Patients.

Biomed Res Int 2020 12;2020:5421269. Epub 2020 Mar 12.

Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60612, USA.

Antibiotic resistance including the emergence of multidrug resistant microbes has become a public health crisis. In this study, we analyzed the antibiotic resistance genes (ARGs) in the urinary metagenome of the kidney transplant and healthy subjects using metagenomic shotgun sequencing. Our data suggest an increased abundance of antibiotic resistance genes in the kidney transplant subjects. In addition, the antibiotic resistance genes identified in the transplant subjects were predominantly composed of multidrug efflux pumps (MDEPs) which are evolutionarily ancient, commonly encoded on chromosomes rather than plasmids, and have a low rate of mutation. Since the MDEPs had a low abundance in the healthy subjects, we speculate that the MDEPs may enhance the fitness of bacteria to survive in the high stress environment of transplantation that includes multiple stressors including surgery, antibiotics, and immunosuppressive agents.
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http://dx.doi.org/10.1155/2020/5421269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093903PMC
December 2020

Benefits of Self-administered Vaginal Dinoprostone 12 Hours before Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Adolescents and Young Women: A Randomized Controlled Trial.

J Pediatr Adolesc Gynecol 2020 Aug 28;33(4):382-387. Epub 2020 Feb 28.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Study Objective: To assess safety and efficacy of self-administered vaginal dinoprostone 12 hours before a 52-mg levonorgestrel intrauterine device (LNG-IUD) insertion in adolescents and young nulliparous women.

Design: Randomized controlled trial.

Setting: Tertiary referral hospital.

Participants: Nulliparous adolescents and young women aged 18-22 years.

Interventions: Participants were randomly assigned into 2 groups; the dinoprostone group (n = 65) received dinoprostone 3 mg vaginally, and the placebo group (n = 65) received placebo tablets vaginally.

Main Outcome Measures: Primary outcome was pain scores during LNG-IUD insertion measured using a visual analogue scale. Secondary outcomes were pain scores during speculum insertion, tenaculum placement, uterine sounding, and 20 minutes postprocedure, ease of insertion, Women's satisfaction score, need for additional analgesics, and side effects.

Results: The dinoprostone group had significantly lower pain scores during LNG-IUD insertion (2.83 ± 1.08 vs 3.95 ± 1.63), tenaculum placement (2.97 ± 1.41 vs 4.55 ± 1.53) and sounding of uterus (3.55 ± 1.71 vs 5.12 ± 1.37) compared with the placebo group (P < .001). No significant differences were found between both groups regarding anticipated pain scores (P = .85), pain during speculum insertion and 20 minutes postinsertion and insertion duration (P = .53). Women's satisfaction, provider reported ease of insertion, and need for additional analgesia were significantly better among dinoprostone users (P < .001, < .001, and .02, respectively). Side effects and procedure complications were similar for the 2 groups.

Conclusion: Self-administered dinoprostone 3 mg vaginally 12 hours before a 52-mg LNG-IUD insertion in nulliparous adolescent and young women effectively reduced pain during insertion and increased women's satisfaction and ease of insertion reported by clinicians.
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http://dx.doi.org/10.1016/j.jpag.2020.02.010DOI Listing
August 2020

Role of Oral Tramadol 50 mg in Reducing Pain During Colposcopy-Directed Cervical Biopsy: A Randomized Controlled Trial.

J Low Genit Tract Dis 2020 Apr;24(2):206-210

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: The aim of the study was to assess safety and efficacy of 50-mg tramadol in reducing patient-perceived pain during colposcopy.

Material And Methods: We conducted a randomized double-blind placebo-controlled trial in the colposcopy unit of a tertiary referral hospital, Cairo, Egypt, from April 2018 to October 2018. Our primary outcome was pain during colposcopy-guided ectocervical punch biopsy. Our secondary outcomes were pain during speculum insertion, acetic acid application, Lugol iodine application, endocervical curettage (ECC), endocervical brushing, 10-minute postprocedure, and additional analgesia requirement. Pain was assessed using 10-cm visual analog scale.

Results: One hundred fifty women were randomized into 2 groups: tramadol group (n = 75) received oral 50-mg tramadol tablets, and control group (n = 75) received placebo tablets. Both groups showed no significant difference in anticipated pain score (p = .56), pain scores during speculum insertion (p = .70), application of acetic acid (p = .40), and Lugol iodine (p = .79). However, the mean pain scores were significantly lower in tramadol group compared with placebo at ectocervical biopsy (p = .001), ECC (p = .001), endocervical brushing (p = .001), and 10 minutes after colposcopy (p = .001). Need for additional analgesia was significantly lower in tramadol group (p = .03).

Conclusions: Oral tramadol 50 mg significantly reduces pain perception during colposcopy-guided ectocervical biopsy, ECC, endocervical brushing, and 10 minutes after colposcopy with tolerable adverse effects.
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http://dx.doi.org/10.1097/LGT.0000000000000522DOI Listing
April 2020

Protein Subcellular Localization Prediction Based on Internal Micro-similarities of Markov Chains.

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:1355-1358

Elucidating protein subcellular localization is an essential topic in proteomics research due to its importance in the process of drug discovery. Unfortunately, experimentally uncovering protein subcellular targets is an arduous process that may not result in a successful localization. In contrast, computational methods can rapidly predict protein subcellular targets and are an efficient alternative to experimental methods for unannotated proteins. In this work, we introduce a new method to predict protein subcellular localization which increases the predictive power of generative probabilistic models while preserving their explanatory benefit. Our method exploits Markov models to produce a feature vector that records micro-similarities between the underlying probability distributions of a given sequence and their counterparts in reference models. Compared to ordinary Markov chain inference, we show that our method improves overall accuracy by 10% under 10-fold cross-validation on a dataset consisting of 10 subcellular locations. The source code is publicly available on https://github.com/aametwally/MC MicroSimilarities.
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http://dx.doi.org/10.1109/EMBC.2019.8857598DOI Listing
July 2019

Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis.

Fertil Steril 2020 01 18;113(1):224-233.e6. Epub 2019 Nov 18.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objective: To synthesize evidence on the most effective pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy.

Design: Systematic review and network meta-analysis of randomized controlled trials (RCTs).

Setting: Not applicable.

Patients: Trials assessing efficacy of pharmacological interventions during different types of myomectomy.

Interventions: Misoprostol, oxytocin, vasopressin, tranexamic acid (TXA), epinephrine, or ascorbic acid.

Main Outcome Measures: Intraoperative blood loss and need for blood transfusion.

Results: The present review included 26 randomized control trials (RCTs) (N = 1627). For minimally invasive procedures (9 RCTs; 474 patients), network meta-analysis showed that oxytocin (mean difference [MD] -175.5 mL, 95% confidence interval [CI] -30.1.07, -49.93), ornipressin (MD -149.6 mL, 95% CI - 178.22, -120.98), misoprostol, bupivacaine plus epinephrine, and vasopressin were effective in reducing myomectomy blood loss, but the evidence is of low quality. Ranking score of treatments included in subgroup analysis of minimally invasive myomectomy showed that oxytocin ranked first in reducing blood loss, followed by ornipressin. For open myomectomy (17 RCTs; 1,153 patients), network meta-analysis showed that vasopressin plus misoprostol (MD -652.97 mL, 95% CI - 1113.69, -174.26), oxytocin, TXA, and misoprostol were effective; however, the evidence is of low quality. Vasopressin plus misoprostol ranked first in reducing blood loss during open myomectomy (P = .97).

Conclusion: There is low-quality evidence to support uterotonics, especially oxytocin, and peripheral vasoconstrictors as effective options in reducing blood loss and need for blood transfusion during minimally invasive myomectomy. Oxytocin is the most effective intervention in minimally invasive myomectomy. For open myomectomy, a combination of uterotonics and peripheral vasoconstrictors is needed to effectively reduce blood loss.
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http://dx.doi.org/10.1016/j.fertnstert.2019.09.016DOI Listing
January 2020

Vaginal Dinoprostone in Reducing Pain Perception During Diagnostic Office Hysteroscopy in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Trial.

J Minim Invasive Gynecol 2020 May - Jun;27(4):847-853. Epub 2019 Aug 1.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt (Drs. Samy, Rashwan, Metwally, Hammad, Ibrahim, Elzahaby, Zaki, and Sharkawy).

Study Objective: To evaluate the efficacy of vaginal dinoprostone in reducing pain perception during diagnostic office hysteroscopy (OH) in postmenopausal women.

Design: Randomized, double-blind controlled trial.

Setting: Tertiary university hospital.

Participants: Postmenopausal patients scheduled for OH.

Interventions: Eligible participants were randomized in a 1:1 ratio to the dinoprostone and placebo groups. The severity of pain was assessed with a visual analog scale (VAS) ranging from 0, no pain to 10, worst pain during OH and 30 minutes after OH.

Measurements And Main Results: The difference in the intensity of pain using the VAS score during the procedure. One hundred women (50 in each arm) were included in the study. The mean VAS score during OH was significantly lower in the dinoprostone group compared with the placebo group (3.9 ± 0.8 vs 5.6 ± 0.7; p <.001). The passage of the hysteroscope through the cervical canal was easier in the dinoprostone group (62.4 ± 9.5 vs 42.8 ± 10.8; p <.001). The 2 groups were comparable in terms of the duration of the procedure (p = .91) and the rate of adverse effects.

Conclusion: Vaginal dinoprostone is effective in relieving pain during diagnostic OH in postmenopausal women with few adverse effects.
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http://dx.doi.org/10.1016/j.jmig.2019.07.026DOI Listing
August 2019

The Effect of Zumba Exercise on Reducing Menstrual Pain in Young Women with Primary Dysmenorrhea: A Randomized Controlled Trial.

J Pediatr Adolesc Gynecol 2019 Oct 11;32(5):541-545. Epub 2019 Jun 11.

Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Study Objective: To study the effectiveness of performing Zumba exercise on the severity and duration of pain in patients with primary dysmenorrhea.

Design: Randomized controlled trial.

Setting: Cairo University gynecology Hospital and Bahgat gym and fitness center.

Participants: Ninety-eight women diagnosed with primary dysmenorrhea.

Interventions: Study participants were divided randomly into 2 equal groups: group I included women who engaged in Zumba exercise for 60 minutes twice weekly for 8 weeks, and group II was a control group with no intervention.

Main Outcome Measures: The primary outcome was the menstrual pain intensity measured using the visual analogue scale scores at 4 and 8 weeks after starting Zumba exercise. The secondary outcome was the difference in the duration of pain in both groups.

Results: Both groups were homogeneous regarding the baseline demographic characteristics. The severity of primary dysmenorrhea at the beginning of the study was not significantly different between the 2 groups. Menstrual pain intensity was significantly decreased in the Zumba group after 4 and 8 weeks of Zumba compared with the control group (mean difference, -2.94 [95% confidence interval, -3.39 to -2.48] and -3.79 [95% confidence interval, -4.16 to -3.43], respectively; P = .001). Also, the duration of pain was shorter in the Zumba group compared with the control group at 8 weeks (4.92 ± 1.90 vs 9.10 ± 2.92 hours, respectively; P = .001).

Conclusion: The Zumba intervention can reduce the severity and duration of menstrual pain thus suggesting that regularly performing Zumba might be a possible complementary treatment for primary dysmenorrhea.
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http://dx.doi.org/10.1016/j.jpag.2019.06.001DOI Listing
October 2019

Longitudinal multi-omics of host-microbe dynamics in prediabetes.

Nature 2019 05 29;569(7758):663-671. Epub 2019 May 29.

Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.

Type 2 diabetes mellitus (T2D) is a growing health problem, but little is known about its early disease stages, its effects on biological processes or the transition to clinical T2D. To understand the earliest stages of T2D better, we obtained samples from 106 healthy individuals and individuals with prediabetes over approximately four years and performed deep profiling of transcriptomes, metabolomes, cytokines, and proteomes, as well as changes in the microbiome. This rich longitudinal data set revealed many insights: first, healthy profiles are distinct among individuals while displaying diverse patterns of intra- and/or inter-personal variability. Second, extensive host and microbial changes occur during respiratory viral infections and immunization, and immunization triggers potentially protective responses that are distinct from responses to respiratory viral infections. Moreover, during respiratory viral infections, insulin-resistant participants respond differently than insulin-sensitive participants. Third, global co-association analyses among the thousands of profiled molecules reveal specific host-microbe interactions that differ between insulin-resistant and insulin-sensitive individuals. Last, we identified early personal molecular signatures in one individual that preceded the onset of T2D, including the inflammation markers interleukin-1 receptor agonist (IL-1RA) and high-sensitivity C-reactive protein (CRP) paired with xenobiotic-induced immune signalling. Our study reveals insights into pathways and responses that differ between glucose-dysregulated and healthy individuals during health and disease and provides an open-access data resource to enable further research into healthy, prediabetic and T2D states.
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http://dx.doi.org/10.1038/s41586-019-1236-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6666404PMC
May 2019

Serotonin Transporter Deficiency is Associated with Dysbiosis and Changes in Metabolic Function of the Mouse Intestinal Microbiome.

Sci Rep 2019 02 14;9(1):2138. Epub 2019 Feb 14.

Division of Gastroenterology & Hepatology, University of Illinois at Chicago, Chicago, USA.

Serotonin transporter (SERT) plays a critical role in regulating extracellular availability of serotonin (5-HT) in the gut and brain. Mice with deletion of SERT develop metabolic syndrome as they age. Changes in the gut microbiota are being increasingly implicated in Metabolic Syndrome and Diabetes. To investigate the relationship between the gut microbiome and SERT, this study assessed the fecal and cecal microbiome profile of 11 to 12 week-old SERT and SERT mice. Microbial DNA was isolated, processed for metagenomics shotgun sequencing, and taxonomic and functional profiles were assessed. 34 differentially abundant bacterial species were identified between SERT and SERT. SERT mice displayed higher abundances of Bacilli species including genera Lactobacillus, Streptococcus, Enterococcus, and Listeria. Furthermore, SERT mice exhibited significantly lower abundances of Bifidobacterium species and Akkermansia muciniphilia. Bacterial community structure was altered in SERT mice. Differential abundance of bacteria was correlated with changes in host gene expression. Bifidobacterium and Bacilli species exhibited significant associations with host genes involved in lipid metabolism pathways. Our results show that SERT deletion is associated with dysbiosis similar to that observed in obesity. This study contributes to the understanding as to how changes in gut microbiota are associated with metabolic phenotype seen in SERT deficiency.
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http://dx.doi.org/10.1038/s41598-019-38489-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375953PMC
February 2019

Utilizing longitudinal microbiome taxonomic profiles to predict food allergy via Long Short-Term Memory networks.

PLoS Comput Biol 2019 02 4;15(2):e1006693. Epub 2019 Feb 4.

Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Food allergy is usually difficult to diagnose in early life, and the inability to diagnose patients with atopic diseases at an early age may lead to severe complications. Numerous studies have suggested an association between the infant gut microbiome and development of allergy. In this work, we investigated the capacity of Long Short-Term Memory (LSTM) networks to predict food allergies in early life (0-3 years) from subjects' longitudinal gut microbiome profiles. Using the DIABIMMUNE dataset, we show an increase in predictive power using our model compared to Hidden Markov Model, Multi-Layer Perceptron Neural Network, Support Vector Machine, Random Forest, and LASSO regression. We further evaluated whether the training of LSTM networks benefits from reduced representations of microbial features. We considered sparse autoencoder for extraction of potential latent representations in addition to standard feature selection procedures based on Minimum Redundancy Maximum Relevance (mRMR) and variance prior to the training of LSTM networks. The comprehensive evaluation reveals that LSTM networks with the mRMR selected features achieve significantly better performance compared to the other tested machine learning models.
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http://dx.doi.org/10.1371/journal.pcbi.1006693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361419PMC
February 2019

Parallel Protein Community Detection in Large-scale PPI Networks Based on Multi-source Learning.

IEEE/ACM Trans Comput Biol Bioinform 2018 Aug 31. Epub 2018 Aug 31.

Protein interactions constitute the fundamental building block of almost every life activity. Identifying protein communities from Protein-Protein Interaction (PPI) networks is essential to understand the principles of cellular organization and explore the causes of various diseases. It is critical to integrate multiple data resources to identify reliable protein communities that have biological significance and improve the performance of community detection methods for large-scale PPI networks. In this paper, we propose a Multi-source Learning based Protein Community Detection (MLPCD) algorithm by integrating Gene Expression Data (GED) and a parallel solution of MLPCD using cloud computing technology. GED under different conditions is integrated with the original PPI network to reconstruct a Weighted-PPI network. To flexibly identify protein communities of different scales, we define community modularity and functional cohesion measurements and detect protein communities from WPPI. In addition, we compare the detected communities with known protein complexes and evaluate the function enrichment of protein functional modules using Gene Ontology annotations. We implement a parallel version of MLPCD on the Apache Spark platform to enhance the performance of the algorithm. Extensive experimental results indicate the superiority and notable advantages of the MLPCD algorithm over the relevant algorithms in terms of accuracy and performance.
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http://dx.doi.org/10.1109/TCBB.2018.2868088DOI Listing
August 2018

Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management of Pulmonary Hypertension in Mitral Valve Surgery. A Randomized Controlled Study.

J Cardiothorac Vasc Anesth 2018 12 18;32(6):2540-2546. Epub 2018 Apr 18.

Cardiothoracic Anesthesia and ICU, National Heart Institute, Cairo, Egypt.

Objective: To compare the effects of dobutamine and nitroglycerin to milrinone in young patients with severe pulmonary hypertension undergoing mitral valve replacement.

Design: A prospective randomized, double-blinded, controlled study.

Setting: Single university hospital.

Participants: Forty patients had systolic pulmonary arterial pressure ≥60 mmHg and were scheduled for elective mitral valve replacement. The patients were divided randomly into 2 equal groups according to the drugs given during the study.

Interventions: The patients in group I received 5 to 20 µg/kg/min of dobutamine and 0.5 to 3 µg/kg/min of nitroglycerin, and patients in group II received a loading dose of milrinone, 50 µg/kg over 10 minutes, followed by a maintenance dose of 0.25 to 0.75 µg/kg/min.

Measurements And Main Results: The primary outcome was the effects of interventional drugs on mean pulmonary artery pressure. The secondary outcomes were the effects of interventional drugs on systemic and pulmonary hemodynamic parameters measured from induction of anesthesia until the first 12 hours in the intensive care unit stay. There was a more significant decrease in mean pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure in group II than group I at all time points after cardiopulmonary bypass. There were more significant increases in heart rate, mean arterial pressure, cardiac output, and mixed venous oxygen tension in group I than group II, which became more obvious in time. In both groups, there was a significant decrease in systemic vascular resistance and pulmonary vascular resistance at all times.

Conclusion: Milrinone provides adequate cardiac performance, causing a greater reduction in pulmonary artery pressure and pulmonary capillary wedge pressure.
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http://dx.doi.org/10.1053/j.jvca.2018.04.032DOI Listing
December 2018

Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial.

Taiwan J Obstet Gynecol 2018 Jun;57(3):346-350

Anaesthesia and Pain Department, National Cancer Institute, Cairo University, Egypt.

Objective: To compare the effect of local infiltration and intravenous dexamethasone on postoperative pain and recovery after Cesarean Section (CS).

Material And Methods: A Prospective, randomized study conducted on 120 pregnant women attending the labor wards. All participants were scheduled for elective CS under spinal anaesthesia and were randomly divided into 3 equal groups. Group 1 received 16 mg Dexamethasone IV drip. Group II received 16 mg Dexamethasone subcutaneous injection around the caesarean section scar after skin closure and Group III received Placebo (500 cc saline infusion). All cases were followed up for 48 h for assessment of level of pain by using a 10-cm visual analog scale (VAS). Primary outcome parameters were VAS score and the need for additional analgesics. Other parameters were hemodynamic changes and occurrence of side effects or complications.

Results: there was a highly statistically significant difference between placebo and local infiltration groups and between the placebo and IV groups regarding the needs for postoperative morphine. Comparing both interventional groups revealed statistically significant difference between local infiltration and IV groups regarding the needs for postoperative morphine.

Conclusion: Local infiltration of dexamethasone is more effective than systemic administration to decrease postoperative pain with weaker antiemetic effect. NCT02784340.
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http://dx.doi.org/10.1016/j.tjog.2018.04.004DOI Listing
June 2018

MetaLonDA: a flexible R package for identifying time intervals of differentially abundant features in metagenomic longitudinal studies.

Microbiome 2018 02 13;6(1):32. Epub 2018 Feb 13.

Department of Bioengineering, University of Illinois at Chicago, Chicago, 60607, IL, USA.

Background: Microbial longitudinal studies are powerful experimental designs utilized to classify diseases, determine prognosis, and analyze microbial systems dynamics. In longitudinal studies, only identifying differential features between two phenotypes does not provide sufficient information to determine whether a change in the relative abundance is short-term or continuous. Furthermore, sample collection in longitudinal studies suffers from all forms of variability such as a different number of subjects per phenotypic group, a different number of samples per subject, and samples not collected at consistent time points. These inconsistencies are common in studies that collect samples from human subjects.

Results: We present MetaLonDA, an R package that is capable of identifying significant time intervals of differentially abundant microbial features. MetaLonDA is flexible such that it can perform differential abundance tests despite inconsistencies associated with sample collection. Extensive experiments on simulated datasets quantitatively demonstrate the effectiveness of MetaLonDA with significant improvement over alternative methods. We applied MetaLonDA to the DIABIMMUNE cohort ( https://pubs.broadinstitute.org/diabimmune ) substantiating significant early lifetime intervals of exposure to Bacteroides and Bifidobacterium in Finnish and Russian infants. Additionally, we established significant time intervals during which novel differentially relative abundant microbial genera may contribute to aberrant immunogenicity and development of autoimmune disease.

Conclusion: MetaLonDA is computationally efficient and can be run on desktop machines. The identified differentially abundant features and their time intervals have the potential to distinguish microbial biomarkers that may be used for microbial reconstitution through bacteriotherapy, probiotics, or antibiotics. Moreover, MetaLonDA can be applied to any longitudinal count data such as metagenomic sequencing, 16S rRNA gene sequencing, or RNAseq. MetaLonDA is publicly available on CRAN ( https://CRAN.R-project.org/package=MetaLonDA ).
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http://dx.doi.org/10.1186/s40168-018-0402-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812052PMC
February 2018

Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia: A randomised double-blinded trial.

Eur J Anaesthesiol 2018 05;35(5):372-378

From the Department of Anesthesia, ICU and Pain Therapy, Faculty of Medicine (AME, AAM, A-EAA, EME, IME), Department of Biochemistry, National Liver Institute, Menoufiya University, Shibin El-koom (MAO) and Department of Bioequivalence, Egyptian Centre for Research and Development, Cairo, Egypt (OAA-E).

Background: During general anaesthesia, endotracheal intubation of patients with pre-eclampsia causes stimulation of the sympathetic nervous system and catecholamine release, which may lead to maternal and neonatal complications.

Objective: To attenuate both the stress response and the haemodynamic response to tracheal intubation in patients with pre-eclampsia.

Design: A randomised, double-blind, controlled study.

Setting: Single University Hospital.

Patients: Sixty patients aged 18 to 45 years with pre-eclampsia receiving general anaesthesia for caesarean section.

Interventions: The patients were randomly allocated to three groups. Groups D1and D2 received an infusion of dexmedetomidine 1 μg kg over the 10 min before induction of general anaesthesia, then 0.4 and 0.6 μg kg h dexmedetomidine, respectively. Group C received equivalent volumes of 0.9% saline.

Main Outcome Measures: The primary outcome was the effect of dexmedetomidine on mean arterial blood pressure measured before induction of general anaesthesia at 1 and 5 min after intubation, and then every 5 min until 10 min after extubation. The secondary outcomes were blood glucose and serum cortisol (measured before induction of general anaesthesia, and at 1 and 5 min after intubation), postoperative visual analogue pain scores, time to first request for analgesia, the total consumption of analgesia, Ramsay sedation score, maternal and placental vein blood serum levels of dexmedetomidine and neonatal Apgar score at 1 and 5 min.

Results: At all assessment times, the mean arterial pressures were significantly lower in the dexmedetomidine groups than in the control group. Compared with group C, the heart rate was significantly lower in both groups D1 and D2. In group D2, the heart rate was lower than in group D1. Serum glucose and cortisol were significantly higher in the controls than in either group D1 or D2. Group D2 patients were significantly more sedated on arrival in the recovery room followed by D1. Time to first analgesia was significantly longer in groups D2 and D1 than in group C, and the visual analogue pain scores were significantly lower in groups D1 and D2 than in group C at 1, 2, 3 and 5 h. Total morphine consumption was significantly lower in groups D1 and D2 than in the control group. There was no difference in Apgar scores across the three groups despite significantly higher dexmedetomidine concentrations in group D2 (both maternal and placental vein) than in group D1.

Conclusion: Administration of dexmedetomidine in doses 0.4 and 0.6 μg kg h was associated with haemodynamic and hormonal stability, without causing significant adverse neonatal outcome.

Trial Registration: Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org).
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http://dx.doi.org/10.1097/EJA.0000000000000776DOI Listing
May 2018

Diagnostic accuracy of serum miR-122 and miR-199a in women with endometriosis.

Int J Gynaecol Obstet 2018 Apr 16;141(1):14-19. Epub 2017 Dec 16.

Department of Obstetrics & Gynecology, Beni-Suef University, Beni-Suef, Egypt.

Objective: To evaluate the value of serum microRNA-122 (miR-122) and miR-199a as reliable noninvasive biomarkers in the diagnosis of endometriosis.

Methods: During 2015-2016, at a teaching hospital in Egypt, a prospective cohort study was conducted on 45 women with pelvic endometriosis and 35 women who underwent laparoscopy for pelvic pain but were not diagnosed with endometriosis. Blood and peritoneal fluid (PF) samples were collected; interleukin-6 (IL-6) was detected by enzyme-linked immunosorbent assay and miR-122 and miR-199a expression was measured by quantitative real-time polymerase chain reaction.

Results: The serum and PF levels of IL-6, miR-122, and miR-199a were significantly higher in women with endometriosis than in controls (P<0.001 for all comparisons). Serum miR-122 expression was positively correlated with serum IL-6 (r=0.597), PF IL-6 (r=0.603), PF miR-122 (r=0.934), serum miR-199a (r=0.727), and PF miR-199a (r=0.653). Serum miR-199a expression was positively correlated with serum IL-6 (r=0.677), PF IL-6 (r=0.678), PF miR-122 (r=0.744), and PF miR-199a (r=0.932). Serum miR-122 and miR-199a had a sensitivity of 95.6% and 100.0%, and a specificity of 91.4% and 100%, respectively, for the detection of endometriosis.

Conclusion: Serum miR-122 and miR-199a were significantly increased in endometriosis, indicating that these microRNAs might serve as biomarkers for the diagnosis of endometriosis.
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http://dx.doi.org/10.1002/ijgo.12392DOI Listing
April 2018

Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle.

Int J Gynaecol Obstet 2018 Feb 18;140(2):211-216. Epub 2017 Nov 18.

Department of Obstetrics and Gynecology, Beni-Suef University, Beni Suef, Egypt.

Objective: To assess whether endometrial injury in the cycle preceding controlled ovarian hyperstimulation during intracytoplasmic sperm injection (ICSI) improves the implantation and pregnancy rates.

Methods: Between January 1, 2016, and March 31, 2017, a randomized controlled trial was conducted at a center in Egypt among 300 women who met inclusion criteria (first ICSI cycle, aged <40 years, day-3 follicle-stimulating hormone <10 IU/L, normal serum prolactin, no uterine cavity abnormality). The women were randomly allocated using a web-based system to undergo endometrial scratch in the cycle preceding controlled ovarian hyperstimulation (n=150) or to a control group (n=150). Only data analysts were masked to group assignment. The primary outcomes were the implantation and clinical pregnancy rates at 14 days and 4 weeks after embryo transfer, respectively. Analyses were by intention to treat.

Results: The implantation rate was significantly higher in the endometrial scratch group (41.3% [90/218]) than in the control group (30.0% [63/210]; P<0.001). The clinical pregnancy rate was also significantly higher in the endometrial scratch group (44.2% [61/138]) than in the control group (30.4% [41/135]; P<0.001).

Conclusion: Endometrial injury in the cycle preceding the stimulation cycle improved implantation and pregnancy rates during ICSI. CLINICALTRIALS.GOV: NCT02660125.
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http://dx.doi.org/10.1002/ijgo.12355DOI Listing
February 2018

Cervical Priming by Vaginal or Oral Misoprostol Before Operative Hysteroscopy: A Double-Blind, Randomized Controlled Trial.

J Minim Invasive Gynecol 2016 Nov - Dec;23(7):1107-1112. Epub 2016 Aug 11.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt.

Study Objective: To evaluate whether misoprostol oral is as effective as vaginal tablets for cervical ripening.

Design: Randomized controlled trial involving a parallel, double-blinded study (Canadian Task Force Classification IB).

Setting: Department of Obstetrics and Gynecology, Cairo University Hospital, between January 2014 and January 2016.

Patients: Patients undergoing operative hysteroscopy for various indications.

Interventions: At 12 hours before hysteroscopy, the oral group received a 400-μg misoprostol tablet and 2 vaginal starch tablets. The vaginal group received 400 μg of misoprostol and 2 oral starch tablets. The control group received 2 oral starch and 2 vaginal starch tablets as placebo. Preoperative preparation was the same in all patients.

Measurements And Main Results: The main outcome measures were width of the endocervical canal, ease of dilatation, time to dilatation, and adverse effects. All subjects eligible for operative hysteroscopy (n = 430) were invited to participate. Twenty subjects refused, and 20 subjects were excluded. The enrolled subjects (n = 390) were randomized to oral misoprostol, vaginal misoprostol, or placebo. The differences in mean width of the endocervical canal between the oral and the control groups (4.79 ± 1.07 mm vs 3.92 ± 0.92 mm), and also between the vaginal and the control groups (4.25 ± 0.71 mm vs 3.92 ± 0.92 mm) were significant (p < .001 for both). Moreover, the difference in mean width of the endocervical canal between the oral and the vaginal groups was significant (4.79 ± 1.07 mm vs 4.25 ± 0.71 mm; p = .009). Cervical entry was easier in the oral and vaginal groups compared with the control group (mean Likert score, 4.25 ± 0.64 vs 4.22 ± 0.74 vs 2.55 ± 0.87; p < .001). In addition, the ease of cervical entry did not differ significantly between the oral and vaginal groups (p = .998). The mean time to dilatation was shorter in the oral group and the vaginal group (compared with the control group (48.98 ± 12.6 seconds vs 46.55 ± 15.32 seconds vs 178.05 ± 74.18 seconds; p < .001), but the difference between the oral and vaginal groups was not significant (p = .987). Adverse effects were comparable between groups (p > .05).

Conclusion: We found no statistically significant difference in the efficacy of cervical priming between oral misoprostol and vaginal misoprostol.
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http://dx.doi.org/10.1016/j.jmig.2016.08.002DOI Listing
July 2017

WEVOTE: Weighted Voting Taxonomic Identification Method of Microbial Sequences.

PLoS One 2016;11(9):e0163527. Epub 2016 Sep 28.

Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, United States of America.

Background: Metagenome shotgun sequencing presents opportunities to identify organisms that may prevent or promote disease. The analysis of sample diversity is achieved by taxonomic identification of metagenomic reads followed by generating an abundance profile. Numerous tools have been developed based on different design principles. Tools achieving high precision can lack sensitivity in some applications. Conversely, tools with high sensitivity can suffer from low precision and require long computation time.

Methods: In this paper, we present WEVOTE (WEighted VOting Taxonomic idEntification), a method that classifies metagenome shotgun sequencing DNA reads based on an ensemble of existing methods using k-mer-based, marker-based, and naive-similarity based approaches. Our evaluation on fourteen benchmarking datasets shows that WEVOTE improves the classification precision by reducing false positive annotations while preserving a high level of sensitivity.

Conclusions: WEVOTE is an efficient and automated tool that combines multiple individual taxonomic identification methods to produce more precise and sensitive microbial profiles. WEVOTE is developed primarily to identify reads generated by MetaGenome Shotgun sequencing. It is expandable and has the potential to incorporate additional tools to produce a more accurate taxonomic profile. WEVOTE was implemented using C++ and shell scripting and is available at www.github.com/aametwally/WEVOTE.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163527PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040256PMC
September 2016

Isoflurane preserves central nervous system blood flow during intraoperative cardiac tamponade in dogs.

Can J Anaesth 2004 Dec;51(10):1011-7

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, Illinois 60657-5193, USA.

Purpose: The present study tested the hypothesis that the anesthetic technique will influence the changes in regional blood flow (RBF) during intraoperative cardiac tamponade.

Methods: Twenty-four dogs were divided into three equal groups: Group I, anesthesia was maintained with ketamine (25 mg.kg(-1).hr(-1)); Group II, with fentanyl and midazolam (F-M; 10 mug.kg(-1).hr(-1) and 0.5 mg.kg(-1).hr(-1), respectively); Group III with 1 minimum alveolar concentration (MAC; 1.4%) isoflurane. Radioactive microspheres were used to measure RBF in myocardium, brain, spinal cord, abdominal viscera, skeletal muscle and skin. Cardiac output (CO) was measured by thermodilution and arterial pressure with a catheter situated in the thoracic aorta. Catheters were introduced into the pericardial cavity to infuse isotonic saline and to measure intrapericardial pressure (IPP). Measurements were obtained under control conditions and during tamponade, as defined by an increase in IPP sufficient to reduce mean arterial pressure by 40%.

Results: Tamponade caused decreases in CO and RBF that were comparable under the three anesthetics, except that RBF in subcortical regions of the brain and in the spinal cord were maintained under isoflurane but decreased under ketamine or F-M.

Conclusions: In dogs, intraoperative cardiac tamponade caused comparable changes in RBF under the different anesthetic techniques except that autoregulation was effective in maintaining RBF within the central nervous system only under isoflurane anesthesia. Our findings provide no compelling reason to recommend one anesthetic over the others for maintenance of anesthesia in situations with increased risk for intraoperative cardiac tamponade. However, they cannot be extrapolated to anesthesia induction in the presence of cardiac tamponade.
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http://dx.doi.org/10.1007/BF03018490DOI Listing
December 2004