Side-specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study.

BACKGROUND: Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA). METHODS: We retrospectively analyzed two hundred and seventy-one patients aged > 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included. RESULTS: Intraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p < 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147-27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996-30.38, p < 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323-47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07-1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other. CONCLUSION: LRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI.

The impact of automatic tube current modulation related settings of a modern GE CT scanner on image quality and patient dose; details do matter.

PURPOSE: To investigate the operation principles of the automatic tube current modulation (ATCM) of a modern GE healthcare CT scanner, and the impact of related settings on image quality and patient dose. MATERIAL & METHODS: A dedicated phantom (Mercury 4.0) was scanned using two of the most frequently used clinical scanning protocols (chest and abdomen-pelvis). The preset protocol settings were used as starting points (reference conditions). Scan direction, scan mode (helical vs. axial), total beam width, tube potential (kVp), and ATCM settings were then modified individually to understand their impact on radiation dose and image quality. Regarding the ATCM settings, the SmartmA minimum and maximum mA limits, and the noise index (NI) values were varied. As surrogates of patient dose, the CTDIvol and DLP values of each scan were used. As surrogates of image quality were used the image noise and the detectability index (d') of five different materials (air, solid water, polystyrene, iodine, and bone) embedded in the Mercury phantom calculated with the ImQuest software. RESULTS: The scanning direction did not have any effect on ATCM curves, unlike what has been observed in CT scanners from other manufacturers. Total beam width does matter, however, the SmartmA limit settings and kVp selection had the greatest impact on image quality and dose. It was seen that improper minimum mA limit settings practically invalidated the ATCM operation. In contrast, when full modulation was allowed without restrictions, noise standard deviation, and detectability index became much more consistent across the wide range of phantom diameters. For lower kVp settings an impressive dose reduction was observed that requires further investigation. CONCLUSION: SmartmA is a tool that if not properly used may increase the patient doses considerably. Therefore, its settings should be carefully adjusted for each preset different clinical protocol.

Automatic image quality evaluation in digital radiography using for-processing and for-presentation images.

PURPOSE: To investigate the impact of digital image post-processing algorithms on various image quality (IQ) metrics of radiographic images under different exposure conditions. METHODS: A custom-made phantom constructed according to the instructions given in the IAEA Human Health Series No.39 publication was used, along with the respective software that automatically calculates various IQ metrics. Images with various exposure parameters were acquired with a digital radiography unit, which for each acquisition produces two images: one for-processing (raw) and one for-presentation (clinical). Various examination protocols were used, which incorporate diverse post-processing algorithms. The IQ metrics' values (IQ-scores) obtained were analyzed to investigate the effects of increasing incident air kerma (IAK) on the image receptor, tube potential (kVp), additional filtration, and examination protocol on image quality, and the differences between image type (raw or clinical). RESULTS: The IQ-scores were consistent for repeated identical exposures for both raw and clinical images. The effect that changes in exposure parameters and examination protocol had on IQ-scores were different depending on the IQ metric and image type. The expected positive effect that increasing IAK and decreasing tube potential should have on IQ was clearly exhibited in two IQ metrics only, the signal difference-to-noise-ratio (SDNR) and the detectability index (d'), for both image types. No effect of additional filtration on any of the IQ metrics was detected on images of either type. An interesting finding of the study was that for all different image acquisition selections the d' scores were larger in raw images, whereas the other IQ metrics were larger in clinical images for most of the cases. CONCLUSIONS: Since IQ-scores of raw and their respective clinical images may be largely different, the same type of image should be consistently used for monitoring IQ constancy and when results from different X-ray systems are compared.

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates-a retrospective cohort study.

BACKGROUND: In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. METHODS: We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. RESULTS: LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare's score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery-recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03-0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036-1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197-1.655, p < 0.001). CONCLUSIONS: LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. TRIAL REGISTRATION: Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.

High- and low-dose cyclophosphamide in Egyptian lupus nephritis patients: a multicenter retrospective analysis.

BACKGROUND: Lupus nephritis (LN) is a common serious presentation of systemic lupus erythematosus. Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are listed as the first-line drugs in induction therapy for LN. OBJECTIVE: This study aimed to compare high- and low-dose CYC in a cohort of Egyptian LN patients. PATIENTS AND METHODS: The data of 547 patients with class III/IV active LN who received CYC as induction therapy were retrospectively analyzed. Whereas 399 patients received 6­monthly 0.5-1 g/m2 CYC doses, 148 patients received six biweekly 500 mg CYC doses. Demographic data, laboratory test results, and disease activity index were recorded and compared at presentation and at 6, 12, 18, 24, and 48 months of follow-up. RESULTS: After 48 months, the proportion of patients maintaining normal creatinine levels was higher in the group receiving induction therapy with high-dose CYC (67.9%, 60.4%, p = 0.029), and these patients also had higher proteinuria remission at 36 (26.6%, 14.8%, p = 0.014) and 48 months (24.3%, 12.8%, p = 0.006). Comparison of patient outcomes according to both induction and maintenance therapy showed the best results in patients who received high-dose CYC and continued MMF as maintenance therapy. CONCLUSION: High- and low-dose CYC are comparable in early phases of treatment. However, after a longer duration of follow-up, high-dose CYC was associated with higher remission rates in the current cohort.

Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects: A Comparison Study.

Background and Objectives: Gingival recession results in adverse aesthetics and root sensitivity, and there is a need to treat and prevent its further progression. To overcome these problems, various advances have been made by clinicians in treating gingival recession based on the type of gingival recession. Miller's classification has been used for a long time to classify the type of recession. However, certain limitations have been found with use of Miller's classification such as a lack of clarity in the method for measuring soft and hard tissue loss in the interproximal area. Cairo classification was proposed to overcome limitations of Miller's classification to classify gingival recession. Cairo's classification is a treatment-oriented classification based on buccal and interproximal attachment loss. Therefore, the study was conducted to assess and compare the reliability of Miller's and Cairo's classifications in determining gingival recession. Material and methods: A total of 220 buccal gingival recession defects were included in the study based on the inclusion and exclusion criteria. Four examiners were included in the study. Two examiners classified the recession defects according to Miller's classification and the other two examiners classified recession defects according to Cairo's classification at baseline and at a 1-week interval. Statistical analysis was conducted using SPSS software version 25.0 using Cohen's kappa correlation coefficient and Chi-square test statistics to determine the intra- and inter-rater agreement among the examiners for the two gingival recession classification systems. A p value of <0.05 was considered statistically significant. Results: The intra-rater agreement for Cairo's classification was 0.86 and 0.82, whereas for Miller's classification, it was found to be 0.68. The inter-rater reliability agreement for Cairo's classification was 0.82 and 0.8, whereas for the Miller's classification, it was 0.56 and 0.67. Conclusions: Within the limitations of the study, it was found that Cairo's classification is clearer and more reliable than Miller's classification in the assessment of gingival recession.

Design, synthesis, insilco study and biological evaluation of new isatin-sulfonamide derivatives by using mono amide linker as possible as histone deacetylase inhibitors.

OBJECTIVE: Aim: To evaluate the cytotoxic activity of newly synthesized a series of novel HDAC inhibitors comprising sulfonamide as zinc binding group and Isatin derivatives as cap group joined by mono amide linker as required to act as HDAC inhibitors. PATIENTS AND METHODS: Materials and Methods: The utilization of sulfonamide as zinc binding group joined by N-alkylation reaction with ethyl-bromo hexanoate as linker group that joined by amide reaction with Isatin derivatives as cap groups which known to possess antitumor activity in the designed of new histone deacetylase inhibitors and using the docking and MTT assay to evaluate the compounds. RESULTS: Results: Four compounds have been synthesized and characterized successfully by ART-FTIR, NMR and ESI-Ms. the compounds were synthesized and characterized by successfully by ART-FTIR, NMR and ESI- Ms. Assessed for their cytotoxic activity against human colon adenocarcinoma MCF-7 (IC50, I=105.15, II=60.00, III=54.11, IV=56.57, vorinostat=28.41) and hepatoblastoma HepG2 (IC50, I=63.91, II=135.18, III=118.85, IV=51.46, vorinostat=37.50). Most of them exhibited potent HDAC inhibitory activity and significant cytotoxicity. CONCLUSION: Conclusions: The synthesized compounds (I, II, III and IV) showed cytotoxicity toward MCF-7 and HepG2 cancer cell lines and their docking analysis provided a preliminary indication that they are viable [HDAC6] candidates.

Molecular docking, synthesis, characteristics and preliminary cytotoxic study of new coumarin-sulfonamide derivatives as histone deacetylase inhibitors.

OBJECTIVE: Aim: To evaluate the cytotoxic activity of newly synthesized a series of novel HDAC inhibitors comprising sulfonamide as zinc binding group and Coumarin as cap groups. PATIENTS AND METHODS: Materials and Methods: The utilization of sulfonamide as zinc binding group and Coumarin as cap groups known to possess antitumor activity in the designed of new histone deacetylase inhibitors and using the docking and MTT assay to evaluate the compounds. RESULTS: Results: Four compounds have been synthesized and characterized successfully by ART-FTIR, NMR and ESI-Ms. The synthesized compound assessed for their cytotoxic activity against hepatoblastoma HepG2 (IC50, I=0.094, II=0.040, III=0.032, IV=0.046, SAHA=0.141) and human colon adenocarcinoma MCF-7 (IC50, I=0.135, II=0.050, III= 0.065, IV=0.059, SAHA=0.107). The binding mode to the active site of [HDAC6] were determined by docking study which give results that they might be good inhibitors for [HDAC6]. CONCLUSION: Conclusions: The synthesized compounds (I, II, III and IV) showed a comparable cytotoxic result with FDA approved drug (SAHA) toward HepG2 and MCF-7 cancer cell lines and their docking analysis provided a preliminary indication that they are viable [HDAC6] candidates.

Genomic analysis of SARS-CoV-2 omicron sublineage BA.5.2.1 in Erbil/Iraq.

Due to several mutations in its genomic sequence, particularly in the spike protein region, the recently-discovered SARS-CoV-2 variant B.5.2.1 has alarmed health policy authorities worldwide. The World Health Organization (WHO) has labelled it "Omicron" and classified it as a worldwide variant of concern (VOC). Following the appearance of Omicron in Iraq, new cases were also detected and analyzed in Kurdistan regions. Two hundred patients were recruited in this study from Erbil/Iraq. The RNA genome samples were extracted,  the qRT-PCR performed, and 10 samples were sequenced. The sample sequence was published (EPI ISL 15921492) in the GISAID international gene bank for COVID-19. When compared to the BA.1 Omicron sublineage, 17 new mutations and five deletions in the  Omicron subvariant BA.5.2.1 sequence were detected. The spike region includes eight of these variations and one deletion. Overall, 30 substitutions were shared between those previously seen in the BA.1 sublineage and the newly-detected BA.5.2.1 Omicron subvariant. We detected eight new substitutions in our BA.5.2.1 subvariants (T112I, A27S, V213G, T376F, D405N, R408S, L452R, F486V), which were not mentioned previously, should be cause for concern and may be related to immune escape or viral oligomerization. Omicron might be more immune-escape-capable than the current VOCs/VOIs. However, the predicted mutational research shows no conclusive evidence that the Omicron variant may be more virulent or fatal than other variations, including Delta. The greater capacity for immunological evasion may cause the current increase in Omicron cases in Erbil/Iraq.

A Scanning Electron Microscopy Study Comparing 3 Obturation Techniques to Seal Dentin to Root Canal Bioceramic Sealer in 30 Freshly Extracted Mandibular Second Premolars.

BACKGROUND Obturation is a crucial step in dentistry, involving the filling and sealing of a prepared root canal with sealer and core material to prevent bacterial invasion and ensure successful treatment. This study employed scanning electron microscopy to compare the effectiveness of 3 obturation techniques - single-cone technique (SCT), cold lateral compaction technique (CLCT), and continuous-wave technique (CWT) - in sealing dentin to recently introduced root canal bioceramic sealer in 30 extracted mandibular second premolars. The goal was to determine the optimal technique for minimizing gaps at the sealer-dentin interface. MATERIAL AND METHODS Thirty premolars were divided into 3 groups (n=10 each) based on obturation technique: SCT, CLCT, and CWT. All groups used CeraSeal bioceramic root canal sealer. Root samples were sectioned at apical, middle, and coronal thirds, and high-resolution scanning electron microscopy was performed to measure marginal/internal gaps. Data were analyzed using one-way ANOVA and Tukey range test, with P≤0.05 considered statistically significant. RESULTS CWT showed fewer voids at all levels, with non-significant differences within a technique. Among the techniques, SCT had the largest mean gaps at all levels [apical (5.43±0.16), middle (5.28±0.20), coronal (5.73±0.24)], while CWT had the smallest mean gaps [apical (3.02±0.19), middle (2.95±0.14), coronal (2.76±0.15)]. The differences in means between techniques were statistically significant (P≤0.05). CONCLUSIONS CWT obturation with CeraSeal root canal sealer produces fewer marginal gaps at the sealer-dentin interface.

Ultrasound-Assisted Liposuction (UAL) Arm Contouring in Non-Post-Bariatric Patients: No Rush for Brachioplasty.

BACKGROUND: A witnessed rise in patients' requests for arm contouring reflects the parallel public's pursuit of slimmed bodies and rapid advancement in weight reduction methods. Brachioplasty with its known complications is still the traditional method of management, but nearly all patients feel worried about the length and appearance of the scar and seek other non-excisional alternatives. The authors wanted to share their experience in arm contouring in non-post-bariatric patients using ultrasound-assisted liposuction (UAL). PATIENTS AND METHODS: Over 16 month period, 28 female patients complaining of arm lipodystrophy (classes IIA, IIB, III) underwent UAL contouring under general anesthesia. Preoperative and postoperative mid-arm circumferences were measured and recorded. Outcome evaluation was done by the complication incidence, patient satisfaction survey, and independent surgeon evaluation of patients' photographs. RESULTS: There were no complications in the study group. The outcome evaluation survey has shown high patient satisfaction. The outcome survey demonstrated that 85.71% of the patients were very satisfied, while 14.29 % were satisfied with the procedure and all of them recommend the procedure to others. On the other hand, the independent surgeon evaluation showed that 92.86% of the results were excellent and 7.14 % were very good. CONCLUSION: Our work has shown how versatile is the UAL in contouring a wide spectrum of arm lipodystrophy stages in non-post-bariatric patients and presents a non-excisional alternative for arm aesthetic refinements without a rush for brachioplasty with its unpleasant complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research.

OBJECTIVES: To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. DESIGN: Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. RESULTS: Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. CONCLUSION: There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.

Efficacy of prophylactic pre-operative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis of randomised placebo-controlled trials.

OBJECTIVES: To examine the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). SETTING: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18 March 2022. PARTICIPANTS: Patients undergoing FESS. MAIN OUTCOME MEASURES: Primary efficacy endpoints comprised intraoperative blood loss, visual clarity, and operation time. Secondary endpoints comprised side effects. The efficacy endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS: Five RCTs comprising 380 patients (desmopressin = 191 patients and placebo = 189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n = 5 RCTs, MD = -37.97 ml, 95% CI [-56.97, -18.96], p < .001), 5-point Boezaart scores (n = 2 RCTs, MD = -.97, 95% CI [-1.21, -.74], p < .001), and 10-point Boezaart scores (n = 2 RCTs, MD = -3.00, 95% CI [-3.61, -2.40], p < .001) were significantly reduced in favour of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n = 5 RCTs, MD = -3.73 min, 95% CI [-14.65, 7.18], p = .50). No patient in both groups developed symptomatic hyponatremia (n = 3 RCTs, 194 patients) or thromboembolic events (n = 2 RCTs, 150 patients). CONCLUSIONS: Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihaemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS.

Comparison of Digital Planimetry and Ruler Methods for the Measurement of Extraction Socket Wounds.

Background and objectives: The purpose of the study was to evaluate and compare ruler and digital planimetry methods to measure extraction socket wounds. Materials and Methods: In total, 41 extraction socket wounds were selected for assessment of wound area by ruler and digital planimetry methods. In the simple ruler method, the periodontal probe was utilized to measure the length and breadth of the extraction wound, whereas in the digital planimetry technique, Pictzar software was used. Data were analyzed using R software version 4.1.1 and Excel. For intergroup comparisons of wound surface area, Welch t-tests were used, and paired t-tests were used for intragroup comparisons. Intra-class correlation coefficients (ICC) and 95% confidence intervals (CIs) were used to evaluate the inter-method reliabilities of surface area. Results: Both ruler and digital planimetry techniques showed post-operative reductions in surface area. A significant difference was reported between the two techniques; however, the ruler method measurements were overestimated compared to those obtained with digital planimetry. Conclusions: This study concludes that digital planimetry techniques provide more accurate results when compared with the simple ruler method.

Estimation of postmortem interval using histological and oxidative biomarkers in human bone marrow.

In forensic medicine, estimating the postmortem interval (PMI) is of great importance for the timeline and the reconstruction of the events surrounding death. Bone marrow (BM) is one of the largest organs in the body, with good resistance to autolysis and contamination. Therefore, the present study aims to correlate different postmortem intervals and bone marrow antioxidant enzyme levels using an Enzyme-linked immunosorbent assay (ELISA). In addition, detection of the changes in the histological structure of human bone marrow in relation to the time passed since death. BM samples from 20 forensic autopsy cadavers were obtained from cases referred to the Department of Forensic Medicine in the Ministry of Justice, Dakahlia Governorate, processed for histopathological examination as well as estimation of reduced glutathione (GSH), glutathione peroxidase (GPX), and glutathione reductase (GRX) using ELISA. Results of ELISA analysis showed a significant decrease in the level of antioxidant enzymes with increasing PMI; regarding histopathological examination, from 6 to > 18 h PMI, the changes in morphology after death were gradual, progressive, and regular, indicating great value in PMI determination. Also, 18 h of PMI showed loss of cellular details, absence of fat cells, and necrosis of BM with the nucleus dispersed as eosinophilic debris. Estimation of antioxidant enzymes level in human bone marrow using ELISA and detection of the changes in the histological structure of human bone marrow in relation to time passed since the death, either separately or in combination, can be used to estimate PMI accurately.

PROSPECTIVE SINGLE CENTER ANALYSIS OF OUTCOME STEM CELLS TRANSPLANTS IN PATIENTS WITH CEREBRAL PALSY.

OBJECTIVE: Aim: To evaluate efficacy and safety of autologous bone marrow-derived mononuclear stem cell transplantation intrathecal in children with cerebral palsy. PATIENTS AND METHODS: Materials and Methods: 35 children have levels I-V cerebral palsy aged 8-months to 8-years-old were enrolled from September (2021-2022) at Iraqi private hospital. Gross Motor Function was assessed by a pediatrician and neurologist specialist, 5 mcg/kg/day of G-CSF subcutaneous single injection daily for three consecutive days. Bone marrow harvested from posterior iliac crest under light general anesthesia. Bone marrow mononuclear cells (BMMNCs) separation was performed using density gradient centrifugation with Ficoll, the cell viability checked by propidium iodide dye in a TALI machine (Invitrogen) in average 98%. The viable BMMNCs injected intrathecal in L4-L5 over a period of 5-10 min. RESULTS: Results: Males accounted for 57.14% (20/35) while female 42.86% (15/35), and main neurological symptoms included spastic disorder spastic disorder (quadriplegia 24 (68.6), tetraplegia 2 (5.7), diplegia 5 (14.28), hemiplegia4 (11.42)). Gross Motor Function Classification System and Gross Motor Function Measure-66 (GMFM-66) showed II 10 (28.58), III 11(31.42) and IV 14 (40). On mean follow-up of 3 months post-stem cell transplant improvement was observed in 80% cases. The improvement showed in gross motor function (6/8) p=0.01, and speech (2/4) p=0.04, neck holding (5/5) p=0.0003, sitting balance (4/4) p=0.04, postural tone (5/5) p=0.0003, as well as significant reduction in seizure frequency (2/3) p=0.04 and improvement in cognition (6/7) p=0.01 were observed. CONCLUSION: Conclusion: Stem cell therapy for cerebral palsy shows a significant positive effect on the gross motor function, without long adverse effects.

Molecular Determination of Vascular Endothelial Growth Factor, miRNA-423 Gene Abnormalities by Utilizing ARMS-PCR and Their Association with Fetal Hemoglobin Expression in the Patients with Sickle Cell Disease.

Recent studies have indicated that microRNA and VEGF are considered to be genetic modifiers and are associated with elevated levels of fetal haemoglobin HbF, and thus they reduce the clinical impact of sickle haemoglobin (HbS) patients. This cross-sectional study was performed on clinical confirmed subjects of SCD cases. miR-423-rs6505162 C>T and VEGF-2578 C>A genotyping was conducted by ARMS-PCR in SCD and healthy controls. A strong clinical significance was reported while comparing the association of miR-423 C>T genotypes between SCD patients and controls (p = 0.031). The microRNA-423 AA genotype was associated with an increased severity of SCD in codominant model with odd ratio (OR = 2.36, 95% CI, (1.15-4.84), p = 0.018) and similarly a significant association was observed in recessive inheritance model for microRNA-423 AA vs (CC+CA) genotypes (OR = 2.19, 95% CI, (1.32-3.62), p < 0.002). The A allele was associated with SCD severity (OR = 1.57, 95% CI, (1.13-2.19), p < 0.007). The distribution of VEGF-2578 C>A genotypes between SCD patients and healthy controls was significant (p < 0.013). Our results indicated that in the codominant model, the VEGF-2578-CA genotype was strongly associated with increased SCD severity with OR = 2.56, 95% CI, (1.36-4.82), p < 0.003. The higher expression of HbA1 (65.9%), HbA2 (4.40%), was reported in SCD patients carrying miR-423-AA genotype than miR-423 CA genotype in SCD patients carrying miR-423 CA genotype HbA1 (59.98%), HbA2 (3.74%) whereas SCD patients carrying miR-423 CA genotype has higher expression of HbF (0.98%) and HbS (38.1%) than in the patients carrying AA genotype HbF (0.60%), HbS (36.1%). ARMS-PCR has been proven to be rapid, inexpensive and is highly applicable to gene mutation screening in laboratories and clinical practices. This research highlights the significance of elucidating genetic determinants that play roles in the amelioration of the HbF levels that is used as an indicator of severity of clinical complications of the monogenic disease. Further well-designed studies with larger sample sizes are necessary to confirm our findings.

Improving patient care pathways in otitis externa.

INTRODUCTION: Referrals for otitis externa (OE) have dramatically increased but the reasons for this remain unclear. We aim to characterize management of patients both pre- and post-referral to identify areas of improvement at the primary-secondary care interface. METHODS: Questionnaire study from consultant-led research clinic specifically set up to prospectively analyse OE referrals at a tertiary referral centre for Otolaryngology. RESULTS: Sixty-two patients were included; 63% female, median age 57 years. One was excluded (clinically not OE). Most patients had multiple primary care visits before referral (average 4 GP; 2 practice nurse). Sixty per cent had received oral antibiotics (16% multiple classes). Eighteen per cent had never had ear drops. Thirty-nine per cent were not advised to keep ears dry. Twenty-one per cent had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. Less than 10% had narrow canals. Thirty-six per cent had active discharge but <7% needed a wick. Approximately 75% appear suitable for community aural care clinics. CONCLUSIONS: OE occurs most commonly in female patients, often with associated risk factors. Patients often consult primary care several times prior to referral. Lifestyle advice and ototopical drops are frequently overlooked; instead, often inappropriately treated with oral antibiotics. Most ears were anatomically normal, and community aural care clinics may have a role in more timely and accessible treatment.

Digital radiography image quality evaluation using various phantoms and software.

PURPOSE: To investigate the effect of the exposure parameters on image quality (IQ) metrics of phantom images, obtained automatically using software or from visual evaluation. METHODS: Three commercial phantoms and a homemade phantom constructed according to the instructions given in the IAEA Human Health Series No. 39 publication were used, along with the respective software that estimate automatically various IQ metrics. Images with various exposure parameters were acquired in a digital radiography (DR) unit. For the commercial phantoms, visual evaluations were also performed. The IQ scores obtained were analyzed to investigate the effects of increasing incident air kerma (IAK), tube potential (kVp), additional filtration, and acquisition protocol on IQ. RESULTS: The effects of the exposure parameters on the IQ metrics, determined with the commercial and the IAEA phantoms, were not the same. For example, clear trends of improvement of IQ scores with increased IAK and reduction of most IQ scores with increased kVp were observed mostly with the IAEA phantom, but not with the commercial phantoms (for both automatic and visual scoring methods). For all phantoms, the maximum variations in IQ scores observed for repeated identical exposures were almost always below 10% with automatic evaluation whereas, for visual evaluation, reached 17%. CONCLUSIONS: Failure to detect some expected trends with the complex commercial phantoms may be attributed to the fact that IQ in DR is more strongly affected by the post-processing procedures, which may mask the effect of other parameters on IQ, something that was not observed with the simple IAEA phantom.

Evaluation of automatic tube current modulation of CT scanners using a dedicated and the CTDI dosimetry phantoms.

PURPOSE: To investigate the operation principles of the automatic tube current modulation (ATCM) of a CT scanner, using a dedicated phantom and the CT dosimetry index (CTDI) phantom. MATERIAL AND METHODS: The Mercury 4.0 phantom and three different configurations of the CTDI dosimetry phantom were employed. A frequently used clinical scanning protocol was employed as a basis for the acquisitions performed with all phantoms, using both scanning directions. Additional acquisitions with different pitch and examination protocols were performed with Mercury phantom, to further explore their effect on ATCM and the resulting image quality. Different software named DICOM Info Extractor, ImageJ, and imQuest, were used to derive CTDIvol and table position, image noise, and water equivalent diameter (WED) of each phantom CT image, respectively. ImQuest was also used to derive the detectability index (d') of five different materials (air, solid water, polystyrene, iodine, and bone) embedded in the Mercury phantom. RESULTS: It was exhibited with all four phantoms that the scanning direction greatly affects the modulation curves. The fitting of the dose modulations curves suggested that for each table position what determines the CTDIvol value is the WED values of the phantom structures laying ahead towards the scanning direction, for a length equal to the effective width of the X-ray beam. Furthermore, it was also exhibited that ATCM does not fully compensate for larger thicknesses, since images of larger WED phantom sections present more noise (larger SD) in all four phantoms and in Mercury 4.0 phantom smaller detectability (d'). CONCLUSION: Mercury 4.0 is a dedicated phantom for a complete and in-depth evaluation of the ATCM operation and the resulting image quality. However, in its absence, different CTDI configurations can be used as an alternative to investigate and comprehend some basic operation principles of the CT scanners' ATCM systems.