Significance of ERCC1 and Hormonal Receptor Expression in Ovarian Cancer.

Background & Objectives : Ovarian carcinoma usually has a relatively poor prognosis. A rational approach to identify patients, who are likely to benefit from therapy, is urgently needed. Excision repair cross-complementation group 1 enzyme (ERCC1) has been proposed as a molecular predictor of clinical resistance to platinum-based chemotherapy. Steroid hormone receptors are important determinants of prognosis and predictive behavior in tumor tissues of several origins. The present study aimed to investigate the expression profile of ERCC1, ER & AR in patients with Ovarian carcinoma and their association with patient outcome. Methods : This is a prospective study which included 77 patients with ovarian carcinoma who were treated with platinum based chemotherapy at the National Cancer Institute (NCI) in Egypt during the period 7/2016- 7/2018. We evaluated the expression of ER, AR, and Excision repair cross-complementation group 1 enzyme (ERCC1) by immunohistochemistry. Expression profiles were compared to clinical, histologic and prognostic factors, the clinical outcome and survival. All patients received platinum containing chemotherapy regimen. Result : Of the 77 patients with ovarian cancer, 66.2 % (51/77) were ERCC1-positive, 49.4 % (38/77) were AR positive & 75.3 % (58/77) were ER positive. Platinum resistance was found in eight of the tumors with positive ERCC1 protein expression compared with two among the patients with negative tumor staining for ERCC1 (P = 0.643). There was significant association between ER & AR expression and pathological subtypes (p = 0.004, 0.007) respectively. There were no significant association between ER, AR& ERCC1 expression and PFS (P = 0.447,P = 0.162, P = 0.508 respectively) or OS (P = 0.781, P = 0.569, P = 0.381 respectively). Based on Cox proportional hazards regression analysis ERCC1, ER &AR were not independent factors affecting the prognosis of patients with ovarian carcinoma. Conclusion : These results demonstrate that positive ERCC1 expression is not associated with clinical resistance to platinum-based chemotherapy, ERCC1, AR& ER expression are not independent factors affecting the prognosis of patients with epithelial ovarian tumors and not associated with survival benefits. J. Med. Invest. 67 : 391-398, August, 2020.

Corrosion behavior of pure titanium anodes in saline medium and their performance for humic acid removal by electrocoagulation.

The corrosion behavior of Ti electrodes and the dependence of their anodic dissolution with the experimental conditions, namely pH, current density (j) and supporting electrolyte nature, have been investigated. Potentiodynamic polarization and electrochemical impedance spectroscopy (EIS) tests have been performed. It has been found that pH has a relevant effect on the electrochemical dissolution of Ti. In chloride medium, metal dissolution was partially caused by pitting corrosion and the corrosion potential was shifted to more cathodic values. Conversely, in phosphate medium, corrosion was inhibited by the formation of a compact passive layer of titanium hydroxide/phosphate. Further, the mechanisms of sacrificial Ti anode dissolution during the electrocoagulation process are discussed. The influence of the supporting electrolyte, pH and j on the effectiveness of the electrocoagulation process for humic acid (HA) removal was assessed. Under optimized conditions, total decolorization was achieved in 60 min, eventually attaining 94% total organic carbon (TOC) removal.

Thoracoscopic versus conventional open repair of tracheoesophageal fistula in neonates: A short-term comparative study.

PURPOSE: Esophageal atresia with or without a tracheo-esophageal fistula is a challenging anomaly in neonates. Thoracoscopic repair is gaining popularity now in pediatric surgery community. The present study aims at comparing the short term outcomes of thoracoscopy versus classic thoracotomy for repair of such conditions. METHODS: Thirty neonates with tracheoesophageal fistula were randomly divided into two equal groups (n=15) after excluding patients with birth weight <2000g, multiple associated anomalies and cardiorespiratory instability. One group had conventional open repair while the other had thoracoscopic repair. Demographic data, intraoperative result and post-operative findings were recorded and compared between both groups. RESULTS: Both groups showed similar results regarding demographic and patients' characteristics. Thoracoscopic repair had relatively longer, yet non-significant operative time but with highly significant difference in preserving azygos vein. There was low conversion rate with thoracoscopy (6.66%). Open repair resulted in a longer hospital stay (11.73±5.68 vs 9.2±2.95). Complication rate was comparable in both groups; however, thoracoscopy was associated with better cosmetic results as reported by parents and surgeons (p=0.00). CONCLUSION: Compared to thoracotomy, thoracoscopic repair offers a less invasive, effective and safe technique with similar short term outcomes, but with superior cosmetic results and better ability to spare azygos vein. TYPE OF STUDY: Therapeutic/Treatment study LEVEL OF EVIDENCE: Level II.

Clinical spectrum of neonates presenting with pneumoperitoneum: A retrospective study.

BACKGROUND: Neonatal pneumoperitoneum is attributed, in most of the reported cases, to necrotising enterocolitis (NEC). There are also other causes leading to free intraperitoneal air. The aim of this study is to describe the clinical spectrum, causes, management and outcome of neonates admitted with pneumoperitoneum in the paediatric surgery unit of a university hospital. SUBJECTS AND METHODS: This retrospective study included neonates having radiographic evidences of pneumoperitoneum from 2012 to the end of 2014. Patients' files were analysed regarding age at admission, birth weight, history, clinical picture, management, operative findings and subsequent outcome. RESULTS: Fifty-six out of 379 neonates (14.7%) were found to have pneumoperitoneum during the study period. There were 35 males (62.5%) and 21 females (37.5%). Cases diagnosed as NEC represented 27 neonates (48.2%). There were 29 cases (51.8%) with causes not related to NEC. Non-NEC causes were spontaneous intestinal perforation (8.9%), ano-rectal malformations (7.1%), Hirschsprung's disease (14.2%), ileal atresia (3.5%), incarcerated inguinal hernia (1.7%), gastric perforation (1.7%) and meconium ileus (1.7%). In seven patients (12.5%), those who were managed conservatively (8.9%) or whose laparotomy was negative (3.6%), no cause of pneumoperitoneum could be reached. Overall mortality was 25%, 78.5% of which was NEC-related. CONCLUSIONS: Neonatal pneumoperitoneum is an alerting finding for paediatric surgeons. Most cases imply serious causes with a significant morbidity and mortality, NEC being the most common cause. On the other hand, pneumoperitoneum is not an absolute indication for surgery. Careful assessment and tailored management can limit the morbidity of unnecessary laparotomies.

Diagnosis and predictive molecular analysis of non-small-cell lung cancer in the Africa-Middle East region: challenges and strategies for improvement.

The identification of tumor biomarkers provides information on the prognosis and guides the implementation of appropriate treatment in patients with many different cancer types. In non-small cell lung cancer (NSCLC), targeted treatment plans based on biomarker identification have already been used in the clinic. However, such predictive molecular testing is not currently a universally used practice. This is the case, in particular, in developing countries where lung cancer is increasingly prevalent. In September 2012 and November 2013, a committee of 16 lung cancer experts from Africa and the Middle East met to discuss key issues related to diagnosis and biomarker testing in NSCLC and the implementation of personalized medicine in the region. The committee identified current challenges for effective diagnosis and predictive analysis in Africa and the Middle East. Moreover, strategies to encourage the implementation of biomarker testing were discussed. A practical approach for the effective diagnosis and predictive molecular testing of NSCLC in these regions was derived. We present the key issues and recommendations arising from the meetings.

Reactive iron sulfide (FeS)-supported ultrafiltration for removal of mercury (Hg(II)) from water.

This study investigated removal of Hg(II) from water using FeS(s) with batch and continuous contact filtration systems. For the batch system, kinetic experiments showed that removal of Hg(II) by FeS(s) was rapid at lower concentration (500 µM), but at higher concentration (1000 and 1250 µM), more time was required to achieve greater than 99% removal. The concentration of iron released to the solution remained relatively low, typically below 3 µM. This would theoretically present less than 1% of the Hg(II) removed. Thus, a simple exchange of Hg(II) for Fe(II) in the solid (FeS(s)) does not explain the results, but if the Fe(II) released could react to form another solids, low concentrations of Fe do not preclude a mechanism in which Hg(II) reacts to form HgS and release Fe(II). A continuous contact dead-end ultrafiltration (DE/UF) system was developed to treat water containing Hg(II) by applying a FeS(s) suspension with stirred or non-stirred modes. A major reason for applying stirring to the system was to investigate the role of "shear" flow in rejection of Hg(II)-contacted FeS(s) by a UF membrane and the stability of Hg on the FeS(s). The Hg(II)-contacted FeS(s) was completely rejected by the DE/UF system and mercury was strongly retained on the FeS(s) particles. Almost no release of Hg(II) (≈0 mM) from the FeS(s) solids was observed when they were contacted with 0.1M-thiosulfate, regardless of whether the system was operated in stirred or non-stirred mode. However, rapid oxidation of FeS(s) was observed in the stirred system but not in the non-stirred system. Determining the mechanism of oxidation requires further study, but it is important because oxidation reduces the ability of the solids to remove additional Hg(II).

Kinetic and mechanistic investigations of mesotrione degradation in aqueous medium by Fenton process.

In this work, chemical oxidation of mesotrione herbicide by Fenton process in acidic medium (pH 3.5) was investigated. Total disappearance of mesotrione and up to 95% removal of total organic carbon (TOC) were achieved by Fenton's reagent under optimized initial concentrations of hydrogen peroxide (H(2)O(2)) and ferrous iron (Fe(2+)) at pH 3.5. The time-dependent degradation profiles of mesotrione were satisfactorily fitted by first-order kinetics. Competition kinetic model was used to evaluate a rate constant of 8.8(± 0.2) × 10(9)M(-1) s(-1) for the reaction of mesotrione with hydroxyl radicals. Aromatic and aliphatic intermediates of mesotrione oxidation were identified and quantified by high performance liquid chromatography (HPLC). It seems that the degradation of mesotrione by Fenton process begins with the rupture of mesotrione molecule into two moieties: cyclohexane-1,3-dione derivative and 2-nitro-4-methylsulfonylbenzoic acid. Hydroxylation and release of sulfonyl and/or nitro groups from 2-nitro-4-methylsulfonylbenzoic acid lead to the formation of polyhydroxylated benzoic acid derivatives which undergo an oxidative opening of benzene ring into carboxylic acids that end to be transformed into carbon dioxide.

Modification and implementation of NCCN guidelines on prostate cancer in the Middle East and North Africa region.

A prostate cancer committee was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Prostate Cancer for adaptation and implementation in the Middle East and North Africa (MENA) region. The objective was to enhance the multidisciplinary approach to the treatment of prostate cancer. The committee, comprising regional experts in the fields of urologic, medical, and radiation oncology, reviewed the 2009 version of the NCCN Guidelines on Prostate Cancer and suggested modifications based on the unique needs of the regions determined through published evidence and local expertise. The committee identified several areas in the NCCN Guidelines that they believed required modification, which are presented in this article. The treatment of prostate cancer in the MENA region has numerous challenges. The hope is that this effort to modify the NCCN Guidelines on Prostate Cancer for practical use in the MENA region will improve regional awareness and patient care.

Gemcitabine plus doxorubicin as first-line treatment in advanced or metastatic breast cancer (MBC), a phase II study.

INTRODUCTION: Doxorubicin and Gemcitabine have promising antineoplastic activity and manageable toxicity as a single agent in the treatment of patients (pts) with advanced breast cancer. AIM OF THE STUDY: This study evaluated the efficacy and toxicity of the combination of gemcitabine plus doxorubicin as first-line treatment of advanced or MBC patients. PATIENTS AND METHODS: Patients with advanced or MBC received gemcitabine 1250mg/m2 IV on days 1 and 8 plus doxorubicin 60mg/m2 IV on day 1 every 21 days for a maximum of 6 cycles. RESULTS: Thirty-five patients were included, and all are evaluable for safety and efficacy. Median age was 47 years (range, 33 to 60 years). Fourteen patients (40%) were post-and 21 (60%) were premenopausal. Prior treatment included mastectomy (23pts); adjuvant nonanthracycline containing combination chemotherapy (18pts); adjuvant hormonal therapy (3pts) and 2 pts did not receive any adjuvant therapy. Twelve patients had metastatic disease at presentation. Seventeen pts were chemonaive. Hormonal receptors were positive in 6, negative in 21, and unknown in 8 pts. Site of metastasis included one site in 15 pts, two sites in 14, and three sites in 6 pts. Complete remission was observed in 6/35 (17.1%) and partial remission in 14/35 (40%) pts, for an overall response rate of 57.1%. Stable disease was observed in 8 (22.9%) and progressive disease in 7 (20%) pts. The median time to tumor progression was 7 months (range, 5-23 months; 95% CI, 6-8 months) and the median survival time was 16 months (range, 6-43 months; 95% CI, 13-19 months). The overall survival at 1 and 2 years was 74.2% and 34.2%; respectively; with 4/35 (11.4%) patients alive at 40 months. A total of 186 cycles of treatment were administered (range2-6 cycles, median 6 cycles). The doses of both doxorubicin and gemcitabine were modified after interim analysis of toxicity following the first 22 cycles administered to the first 10 patients [Mucositis grade 3-4 occurred in 6/10 (60%), grade 3-4 neutropenia in 3/10 (30%), and febrile neutropenia grade 3 in 2/10 (20%) patients] to doxorubicin 50mg/m2 on day 1 and gemcitabine to 1000 mg/m2 on days 1 and 8 in the remaining cycles. After doses reduction, the toxicity was generally tolerable. CONCLUSION: The combination of gemcitabine plus doxorubicin after doses modification can be safely administered every 21 days with promising response as first-line therapy for MBC. The response rate, time to disease progression and overall survival rates of this regimen are comparable to other standard therapies for MBC, as well as other gemcitabine combinations.