Dietary propolis complementation relieves the physiological and growth deterioration induced by Flavobacterium columnare infection in juveniles of common carp (Cyprinus carpio).

The current study was proposed to explore the role of dietary propolis (PR) supplementation in alleviating the negative effects of columnaris disease (CD) challenge on the growth performance, plasma biochemicals, antioxidant activity, stress indicators, and immunological reactions of common carp (Cyprinus carpio) fish. Five hundred forty common carp juveniles were evenly placed in thirty-six 100-L tanks and stocked for acclimatization to the lab conditions with a control diet within a started period of 14 days. Fish (average initial weight of 7.11±0.06 g) were randomly distributed into one of six treatment groups (6 replicate tanks × 15 fish per tank in each treatment group). Fish in the first group was assigned as a negative control without CD challenge or PR supplementation. Fish in the other five groups were challenged with CD by immersion of fish for 60 min into a 10-L water bath supplemented with 6×106 CFU/mL (median lethal dose, LD50) of pathogenic F. columnare bacteria. After infection, the fish were restored to their tanks and fed on a basal diet supplemented with PR at 0, 3, 6, 9, or 12 g/kg diet. The experimental period continued for 6 consecutive weeks in which the feed was introduced twice a day (8:00 and 15:00 h) at a rate of 2% of the fish biomass. Ten percent of water was siphoned and renewed after each meal every day, in addition to 50% of water refreshment after cleaning the tank every three days. The tanks were continuously aerated and provided with standard rearing conditions for carp fish (24.0±1.12°C, 7.7±0.22 pH, 6.3±0.16 mg/L O2, and 14L/10D photoperiod). The growth performance traits such as feed intake (FI), weight gain (WG), final weight (FW), specific growth rate (SGR), feed efficiency (FE), and cumulative mortality rates (CM) were recorded during the experimental period. At the end of the trial, blood samples were obtained from the fish to evaluate some plasma biochemicals, including aspartate aminotransaminase (AST), alanine aminotransferase (ALT), creatinine (CRE), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH), antioxidant biomarkers, including total antioxidant capacity (TAOC), total superoxide dismutase (TSOD), reduced glutathione (rGSH), and catalase (CAT), stress indicators, including heterophil to lymphocyte (H/L) ratio, cortisol (COR), malondialdehyde (MDA), and myeloperoxidase (MPO), and immunological reactions, including peripheral blood leukocyte proliferation (PBLP), phagocytosis activity (PHG), lysozyme activity (LYS), alternative complement hemolytic action (ACH50), and total immunoglobulin concentration (TIG). In addition, samples of infected fish gills were taken to quantify the number of F. columnare in the PR-supplemented groups using the quantitative real-time polymerase chain reaction (qPCR) technique. The results showed that incorporating PR into the dietary ingredients of common carp has a protective effect against the challenge with F. columnare infection. There were linear and quadratic positive trends (P < 0.05) in most parameters of growth performance, plasma biochemicals, antioxidant activity, stress indicators, and immunological reactions with the increased PR-supplemented levels in the diet of infected fish. The best results were obtained when using PR at 9 g/kg in the diet, while higher levels (12 g/kg PR) showed an adverse trend in the evaluated parameters. The FI, WG, FW, SGR, and FE were improved by approximately 37, 104, 34, 73, and 49% in the fish treated with 9 g/kg PR compared to none-PR-infected fish. In addition, adding PR at the 9 g/kg diet level was the best dose that reduced the H/L ratio, COR, MDA, and MPO by about 14, 52, 48, and 29%, respectively, in the infected fish. Furthermore, the mortality rate was reduced by 94%, and the number of pathogenic bacteria cells adherent to the fish gills was lowered by 96% in the infected fish treated with 9 g/kg PR compared to none-PR infected fish. Our results concluded that dietary supplementation with 9 g/kg PR could be a promising nutritional approach for improving the growth performance, physiological profile, and health status of common carp fish, particularly when challenged with F. columnare or similar bacterial infections.

Middle turbinate resection is unlikely to cause empty nose syndrome in first year postoperatively.

PURPOSE: Empty nose syndrome (ENS) is characterized by nasal dryness, crusting, and paradoxical nasal obstruction most commonly after inferior turbinate resection. ENS has also been reported to occur after middle turbinate resection (MTR), and concern for causing ENS is a possible reason surgeons preserve the MT during endoscopic sinus surgery (ESS). The objective was to determine whether MTR during ESS led to ENS. MATERIALS AND METHODS: This was a prospective case series of 95 consecutive patients that underwent bilateral subtotal MTR during ESS with either Draf IIB or Draf III frontal sinusotomies, for chronic rhinosinusitis with or without nasal polyps, and frontal sinus inverted papillomas. Demographic data and postoperative Empty Nose Syndrome 6-item Questionnaire (ENS6Q) scores were obtained. Nasal crusting was also documented on last postoperative nasal endoscopy. RESULTS: Pathologies included chronic rhinosinusitis with nasal polyps (69), without nasal polyps (12), and inverted papillomas (14). Fifty-six patients underwent subtotal MTRs during ESS with Draf IIB, and 39 with Draf III. Mean follow-up was 19.4 months (range 12-49). Mean postoperative ENS6Q score was 2.1. Only 2.1% had ENS6Q scores ≥ 11, and 6.3% had nasal crusting at last follow-up. None of the patients with ENS6Q scores ≥ 11 had nasal crusting at last follow-up. There were no significant differences in outcomes between ages, genders, surgery types, or pathologies. CONCLUSIONS: Patients who underwent bilateral subtotal MTR during ESS were unlikely to develop ENS by at least 1 year postoperatively, based on patients rarely experiencing ENS6Q scores ≥ 11 or persistent nasal crusting.

Influence of Dietary Garlic (Allium sativum) and/or Ascorbic Acid on Performance, Feed Utilization, Body Composition and Hemato-Biochemical Parameters of Juvenile Asian Sea Bass (Lates calcarifer).

The current study investigated effects of garlic (Allium sativum) and/or ascorbic acid on growth performance, feed utilization, biochemical body composition, and hemato-biochemical parameters of juvenile Asian sea bass. A total of 600 fish (43.14 ± 0.23 g body weight) were divided into four groups. Fish in the first group were fed basal diet and served as a control group. Fish in groups 2, 3 and 4 were fed a basal diet mixed with garlic (40 g/kg diet), ascorbic acid (1.5 g/kg diet), or garlic (20 g/kg diet)/ascorbic acid (0.75 g/kg diet) mixture, respectively, for 12 weeks. A significant (p < 0.05) increase was observed in growth performance, feed utilization, and chemical body composition in fish fed garlic alone in comparison with the control and other treated groups. All hematological indices, biochemical parameters, and survival rate were not changed significantly (p > 0.05) in all groups throughout the experimental period when compared with the control. Total cholesterol and feed conversion ratio were significantly (p < 0.05) decreased in fish fed garlic alone in comparison to the control and other treated groups. Conclusively, dietary supplementation of garlic alone (40 g/kg diet) was highly effective in improving most of the studied parameters in comparison with that of ascorbic acid alone or a mixture of garlic (20 g/kg diet) and ascorbic acid (0.75 g/kg diet).

Effect of perioperative selective alpha-1 blockers in non-stented ureteroscopic laser lithotripsy for ureteric stones: a randomized controlled trial.

INTRODUCTION: The aim of this studywas to assess the efficacy of perioperative alpha-1 blockers on improving the success rate and decreasing complications of non-stented ureteroscopic laser lithotripsy for ureteric stones. MATERIAL AND METHODS: A randomized control trial was conducted at two high volume urological centers from September 2017 to December 2018. We enrolled 150 patients with lower ureteric stones. They were randomly divided into two groups. Patients in group A, underwent non-stented ureteroscopy using Ho-YAG laser for stone disintegration and received alpha-1 blockers for one week preoperatively and another two weeks postoperatively. Patients in group B, underwent non-stented ureteroscopy and laser and received a placebo. RESULTS: One hundred and twenty patients were available for analysis at the end of our study. There was no statistically significant difference found between both groups regarding demographic data and stone parameters. The need for intraoperative ureteric dilatation was 32.7% and 51.6% for both groups A and B respectively with a statistically significant difference. The incidence of lower urinary tract symptoms (LUTS) and the need for analgesics were higher in group B with a statistically significant difference. CONCLUSIONS: Administration of perioperative tamsulosin seems to not only to significantly decrease the need for intra-operative dilatation and hence operative time, but also leads to a significant decrease in the development of postoperative LUTs, postoperative pain and the need for analgesia and hospital stay.

One week stenting after pediatric laparoscopic pyeloplasty; is it enough?

INTRODUCTION: The use of ureteric stents for urinary diversion after pediatric dismembered pyeloplasty and its duration remain debatable. Classically, an indwelling Double J ureteric stent has to be left for 4-6 weeks. However, such a duration is not free of stent-related complications, in addition to the need to remove it under general anesthesia in the pediatric age group. OBJECTIVES: This study aims to evaluate the outcome of short-term stenting after laparoscopic pyeloplasty in pediatric sector. METHODS: A prospective randomized study of 37 children (less than 16 years-old) with pelvi-ureteric junction obstruction (PUJO) were managed by laparoscopic pyeloplasty by the same surgeon in the period between April 2015 and September 2017. In group A (18 patients), the DJ was removed after 4 weeks under general anesthesia, while in group B (19 patients), the DJ was fixed to the urethral catheter by a stitch, and it was removed with the urethral catheter after one week in the outpatient office. All patients were followed regularly for symptomatic improvement. Urine culture and sensitivity was done 1 month postoperatively. Abdominal ultrasound was done at 3, 6, 12 months and annually thereafter, while renal isotope scanning was done after 6 months. RESULTS: There were no significant differences between both groups regarding operative duration, postoperative leakage, hospital stay, early postoperative complications. Both groups improved after pyeloplasty with no significant differences regarding symptoms, follow-up ultrasound, and renal scanning. The incidence of irritative symptoms and need for anticholinergics after catheter removal as well as urinary tract infection after 1 month were significantly higher in group A (P-value: 0.004 and 0.029, respectively) (Table). DISCUSSION: To the authors knowledge, this is the first prospective controlled randomized study comparing short-term stenting with the classic 4 weeks stenting after laparoscopic pyeloplasty in the pediatric age group. In addition, the used technique of stenting not only allows stent removal on outpatient basis without anesthesia but also benefits from the pre-operative retrograde study so as not to miss any associated pathology in the ureter. CONCLUSION: Short-term ureteric stenting after laparoscopic pyeloplasty in pediatric age group is safe and not inferior to the standard 4-week stenting. It also avoids the stent-related complications.

Evaluation of prognostic factors affecting lenght of stay in hospital and mortality rates in acute burn patients.

Burns are considered mostly a serious illness with devastating consequences and prolonged length of hospital stay. Moreover, burns are among the traumatic lesions with the highest costs for care due to their hospitalization time, treatment required and the need for rehabilitation therapy. This study aims to evaluate the factors affecting length of hospital stay and mortality rates in acute burn patients. The study was conducted on 82 patients who presented with acute burn and were admitted to the Plastic and Reconstructive Surgery Department Burn Unit, Tanta University Hospital, in the period from June 2016 to June 2017. A prospective study was carried out using the data of acutely burned patients, and a statistical analysis conducted with the data collected on different factors affecting burn patient length of hospital stay and mortality. The mean age of our patients was 16.5 years, mean LOS was 24.23 days and mortality rate was 9.8% of the total admitted cases, with half of the cases with inhalation injury dying in hospital. The most influencing factors on prediction of length of hospital stay were: incidence of infection, wound depth, TBSA% and inhalation injury. The most influencing factors on patient mortality were: TBSA%, age of the patient, cause of burn and inhalation injury, therefore these factors should be carefully evaluated in every burn patient.

Les brûlures sont considérées comme une pathologie grave aux conséquences dévastatrices responsables d'hospitalisations prolongées. En outre, elles font partie des pathologies traumatiques responsables des coûts de prise en charge les plus élevés, en raison de la durée d'hospitalisation, des traitements nécessaires et de la nécessité de rééducation. Cette étude a pour but d'évaluer les facteurs influant sur la durée de séjour et la mortalité chez les brûlés. Elle a été réalisée chez 82 brûlés hospitalisés dans l'unité de brûlés du service de chirurgie plastique et reconstructrice du CHU Tanta entre juin 2016 et juin 2017. Les données des patients ont été recueillies de manière prospective et différents paramètres supposés prédictifs ont été analysés. L'âge moyen était de 16,5 ans; la durée de séjour de 24,23 jours et la mortalité de 9,8%. La moitié des brûlés avec lésion d'inhalation sont décédés. Les facteurs influant le plus clairement la durée de séjour sont la survenue d'une infection, la profondeur, la surface et l'inhalation de fumées. Ceux influant sur la mortalité sont la surface brûlée, l'âge, l'agent causal et l'inhalation. Ces facteurs doivent donc être précisément évalués chez tout brûlé.

Genetically-Tunable Mechanical Properties of Bacterial Functional Amyloid Nanofibers.

Bacterial biofilms are highly ordered, complex, dynamic material systems including cells, carbohydrates, and proteins. They are known to be resistant against chemical, physical, and biological disturbances. These superior properties make them promising candidates for next generation biomaterials. Here we investigated the morphological and mechanical properties (in terms of Young's modulus) of genetically-engineered bacterial amyloid nanofibers of Escherichia coli (E. coli) by imaging and force spectroscopy conducted via atomic force microscopy (AFM). In particular, we tuned the expression and biochemical properties of the major and minor biofilm proteins of E. coli (CsgA and CsgB, respectively). Using appropriate mutants, amyloid nanofibers constituting biofilm backbones are formed with different combinations of CsgA and CsgB, as well as the optional addition of tagging sequences. AFM imaging and force spectroscopy are used to probe the morphology and measure the Young's moduli of biofilm protein nanofibers as a function of protein composition. The obtained results reveal that genetically-controlled secretion of biofilm protein components may lead to the rational tuning of Young's moduli of biofilms as promising candidates at the bionano interface.

Role of computer technology in neurosurgery.

In the clinical office, during surgical planning, or in the operating room, neurosurgeons have been surrounded by the digital world either recreating old tools or introducing new ones. Technological refinements, chiefly based on the use of computer systems, have altered the modus operandi for neurosurgery. In the emergency room or in the office, patient data are entered, digitally dictated, or gathered from electronic medical records. Images from every modality can be examined on a Picture Archiving and Communication System (PACS) or can be seen remotely on cell phones. Surgical planning is based on high-resolution reconstructions, and microsurgical or radiosurgical approaches can be assessed precisely using stereotaxy. Tumor resection, abscess or hematoma evacuation, or the management of vascular lesions can be assisted intraoperatively by new imaging resources integrated into the surgical microscope. Mathematical models can dictate how a lesion may recur as well as how often a particular patient should be followed. Finally, virtual reality is being developed as a training tool for residents and surgeons by preoperatively simulating complex surgical scenarios. Altogether, computerization at each level of patient care has been affected by digital technology to help enhance the safety of procedures and thereby improve outcomes of patients undergoing neurosurgical procedures.

Transmission electron microscopy of the rabbit posterior capsule irrigated with thapsigargin and 5-fluorouracil in a sealed-capsule irrigation device.

PURPOSE: To investigate, by transmission electron microscopy (TEM), the effect on the posterior capsule of a young rabbit eye of 5-fluorouracil (5-FU) or thapsigargin in a sealed-capsule irrigation device. SETTING: St Erik's Eye Hospital, Stockholm, Sweden. METHODS: Clear lens extraction was performed unilaterally in eight 4-week-old rabbits. A sealed-capsule irrigation device was irrigated for 2 min with 20 ml of one of the following: balanced salt solution (BSS; n=2), thapsigargin 300 muM (n=2), 5-FU 50 mg/ml (n=2), or 5-FU 25 mg/ml (n=2). The substances were washed out for 10 s with BSS. The eyes were left aphakic. Six weeks postoperatively, the animals were killed, and the posterior capsule was extracted and fixed for TEM. As a control, we also evaluated the capsules from the two fellow eyes in the BSS group that did not undergo surgery. RESULTS: The ultrastructure of the posterior capsule in eyes irrigated with 5-FU or thapsigargin did not differ from that in the eyes irrigated with BSS or in the eyes that did not have surgery. The membranes had the same ultrastructure with thin collagen fibres on the anterior and posterior face of the posterior capsule and an amorphic matrix. CONCLUSION: Thapsigargin or 5-FU used in a sealed-capsule irrigation device does not seem to harm the posterior capsule, which appeared similar to when the capsule is irrigated with BSS.

Irrigation with thapsigargin and various concentrations of 5-fluorouracil in a sealed-capsule irrigation device in young rabbit eyes to prevent after-cataract.

AIM: To investigate the effect on after-cataract and synechiae formation after clear lens extraction and irrigation with different substances in a sealed-capsule irrigation device. SETTING: St Erik's Eye Hospital, Stockholm, Sweden. METHODS: Clear lens extraction was performed in one eye of 42 4-week-old rabbits. The sealed-capsule irrigation device was applied and the sealed system was irrigated for 2 min with 20 ml of one of four substances: balanced salt solution (BSS), thapsigargin, 5-fluorouracil (5-FU) 50 mg/ml, or 5-FU 25 mg/ml. The substance then was washed out for 10 s with BSS. The eyes were left aphakic. Formation of after-cataract and synechiae was evaluated during two clinical examinations 3.5 and 5.5 weeks postoperatively, by photographs 5 weeks postoperatively, and by histologic evaluation of haematoxylin-eosin-stained slides after the 6-week end point postoperatively. After-cataract and synechiae were graded on a scale from 0 to 4. Kruskal-Wallis analysis of variance with multiple comparisons was used for statistical analyses. RESULTS: 5-FU 50 mg/ml prevented after-cataract and synechiae formation best when compared with all other substances at all evaluations. 5-FU 25 mg/ml was not as effective, and thapsigargin was ineffective in this animal model. CONCLUSION: 5-FU 50 mg/ml used in the sealed-capsule irrigation device satisfactorily prevents after-cataract and synechiae. Thapsigargin was ineffective in this animal model.

Modified PAIR technique for percutaneous treatment of high-risk hydatid cysts.

PURPOSE: This paper presents a modification of the known method for percutaneous treatment of hydatid cyst, the PAIR technique. It aimed to achieve safe aspiration of large symptomatic cysts and cysts with a danger of impending rupture. METHODS: We designed a coaxial catheter system to achieve concomitant evacuation of cyst contents while infusing scolicidal agent. Hypertonic saline is used to wash out cyst contents and to kill protoscolices. This was followed by injection of a sclerosant (ethyl alcohol 95%) into the residual cyst cavity to prevent formation of a cyst collection after the procedure. Seventeen cysts in 14 patients were successfully aspirated. Follow-up plain radiographs, ultrasonography and CT were performed weekly in the first 4 weeks and then at 3, 6 and 12 months for all patients. Seven patients (9 drained cysts) were followed up for 2 years and 1 patient for 3 years. RESULTS: All cysts were successfully aspirated. The following morphologic changes were noticed: a gradual decrease in cyst size (17 cysts, 100%), thickening and irregularity of the cyst wall due to separation of endocyst from pericyst (7 cysts, 41%), development of a heterogeneous appearance of the cyst components (8 cysts, 47%) and development of pseudotumor (2 cysts, 12%). None of the treated cysts disappeared completely. No significant procedure-related complications were encountered. CONCLUSION: This modified PAIR technique is a reliable method for percutaneous treatment of risky and symptomatic hydatid cysts.

Percutaneous technique for sclerotherapy of vertebral hemangioma compressing spinal cord.

PURPOSE: In this study we report a percutaneous technique to achieve sclerosis of vertebral hemangioma and decompression of the spinal cord and nerve roots. METHODS: Under CT guidance the affected vertebral body is punctured by a biopsy needle and sclerosant is injected directly into the tumor. In the case of large paravertebral extension, additional injection is given in the paravertebral soft tissue component to induce shrinkage of the whole tumor mass and release of the compressed spinal cord. RESULTS: Using this technique we treated five patients in whom vertebral hemangioma gave rise to neurologic symptoms. In three patients, sclerotherapy was the only treatment given. In the other two patients, sclerotherapy was preceded by transcatheter embolization. Neither decompressive surgery, radiation therapy nor stabilization was required with this technique. CONCLUSION: Our experience with CT-guided intraosseous sclerotherapy has proved highly satisfactory.

Distribution and determinants of low birthweight in central Sudan.

Two studies were conducted during 1989-90 in Central Sudan to determine the incidence of low birthweight and to ascertain the major risk factors which influence birthweight. In a hospital-based investigation, surveillance of all births was accompanied by a nested case-control study, and in a community based investigation, all midwife-assisted births were studied. There were 4868 and 1523 livebirths among the hospital and community populations, respectively. The incidence of low birthweight was 18.1% in the community and 8.2% in the hospitals. The ratio of term to pre-term low birthweight was 2.9 in the community but only 1.3 in the hospitals. Several risk factors showed consistent and significant associations with low birthweight in the hospital and community studies. Two important and modifiable predictors of term and preterm low birthweight were low maternal weight and malaria infection during pregnancy. Other risk factors included low socio-economic status and, among the hospital population, lack of antenatal care, short birth intervals, poor obstetric history and complications of pregnancy.

Levels and determinants of perinatal mortality in central Sudan.

OBJECTIVES: To determine levels and risk factors for perinatal mortality in Central Sudan. METHODS: Hospital and community based studies were conducted during the period 1989-1990. Of 5328 births registered in the hospital, 197 stillborns and 812 live-born infants were included in a nested case-control study. In the community, a follow-up study was conducted on 1592 midwife-assisted home deliveries. Multivariate logistic regression analysis was used to identify predictors of perinatal mortality and adjusted population attributable risks were estimated to assess the contribution of each factor. RESULTS: The perinatal mortality rate was 85.4/1000 births in the hospital population and 29.4/1000 births in the community population. The major risk factors for perinatal mortality in the hospital and the community studies were similar and modifiable. CONCLUSIONS: To lower perinatal mortality, improvements in maternal nutrition, malaria treatment and control, avoidance of agricultural pesticides during pregnancy, and adequate antenatal and intrapartum care are recommended.

Determinants of neonatal mortality in central Sudan.

A follow-up study was conducted in six community health centres during the period April 1989 to March 1990 to determine the risk factors which influence neonatal survival in central Sudan. The estimated neonatal mortality rate ranged between 20.0 and 36.0 per 1000 live births per year, and the major cause of death was tetanus neonatorum (29% of neonatal deaths). The mortality rate was lowest when tetanus toxoid was received during pregnancy and the umbilical cord was cleaned by a modern hygienic method (mortality rate of 11 per 1000). In contrast, the mortality rate was highest when no tetanus toxoid was received and no or traditional cord cleaning was used (mortality rate of 62 per 1000; relative risk (RR) = 5.6, 95% confidence interval (CI) 2.0-14.9). The major predictors of neonatal mortality were tetanus, short birth-to-conception interval, multiparity, reported malaria during pregnancy, low birthweight, low maternal weight and low socio-economic status. The population attributable risks were high, and the preventable factors collectively accounted for 93.5% of neonatal mortality. Safe deliveries and wider immunization coverage are needed to control neonatal tetanus in this community. Other interventions to lower neonatal mortality in central Sudan should include accessible family planning programmes and measures to lower the incidence of low birthweight.