Cranioplasty using patient specific implants Polyether ether ketone versus ultra-high molecular weight polyethylene: A prospective study.

This prospective study aimed to compare ultra-high molecular weight polyethylene (UHMWPE) with polyetheretherketone (PEEK) in computer-designed patient-specific implants (PSIs) for cranial defect reconstruction, in terms of complications and aesthetic outcomes. Primary or secondary cranioplasty-eligible patients were included, while patients with active infection or hydrocephalus, or unfit for general anesthesia, were excluded from the study. All the implants were designed and fabricated by the same maxillofacial surgeon using CAD/CAM technology. UHMWPE PSIs were used in group 1 and PEEK PSIs in group 2. Technically, UHMWPE could be milled to a thinner margin thickness than PEEK, which resulted in better handling properties and a smoother end finish. All patients were evaluated over a period of 6 months in terms of overall complications or implant failure as the primary outcome, according to Clavien-Dindo (CVD) grading, and cosmetic satisfaction with the aesthetic results, using a Likert scale, as the secondary outcome. In total, 22 cranioplasty patients were included, with a mean age of 30.8 years (SD = 16.3). Across both groups, 17 patients (77.3%) did not develop postoperative complications. These occurred in three patients in group 1 (CVD grade I, II, and IIIb) (27.3%) and in two patients in group 2 (CVD grade II, IIIa, and IIIb) (18.2%), with no statistical difference (p = 0.6). None of the cases in both groups developed any clinical or radiographic signs of infection, or suffered implant failure. The mean satisfaction score was 4.8 in group 1 and 4.5 in group 2 (SD = 0.6). The difference in satisfaction scores between the two was not statistically significant (p = 0.23). Although UHMWPEE was comparable to PEEK in terms of overall complication rates and cosmesis after craniectomy, UHMWPEE as a material exhibited greater resiliency in technically challenging cases with large, complex/midline-crossing designs, previously fitted meshes, or single-stage resection-reconstruction, allowing better marginal adaptation.

Dexamethasone Plus Bupivacaine Versus Bupivacaine in Bilateral Transincisional Paravertebral Block in Lumbar Spine Surgeries: A Randomized Controlled Trial.

OBJECTIVES: Few studies examined the analgesic effects of dexamethasone in lumbar paravertebral block, specifically the transincisional approach. This study aimed to compare dexamethasone with bupivacaine versus bupivacaine alone for bilateral transincisional paravertebral block (TiPVB) for postoperative analgesia in lumbar spine surgeries. MATERIALS AND METHODS: Fifty patients who were aged 20 to 60 years and had American Society of Anesthesiologists Physical Status (ASA-PS) I or II of either sex were randomly allocated into 2 equal groups. Both groups received combined general anesthesia and bilateral lumbar TiPVB. However, in group 1 (dexamethasone group) (n=25), patients received 14 mL of bupivacaine 0.20% plus 1 mL containing 4 mg of dexamethasone on each side, while, in group 2 (control group) (n=25), patients received 14 mL of bupivacaine 0.20% plus 1 mL of saline on each side. Time to first analgesic need was the primary outcome, while total opioid consumption during the first 24 hours after surgery, the Visual Analog Scale for pain perception (0-10), and the incidence of side effects were secondary outcomes. RESULTS: The mean time to the first analgesic requirement was significantly prolonged among patients in the dexamethasone group than the control group (mean±SD: 18.4±0.8 vs. 8.7±1.2 h, respectively) ( P <0.001). Patients in the dexamethasone group had lower total opiates consumption than the control) P <0.001). Although nonsignificant, the incidence of postoperative nausea and vomiting was more frequent among the control group ( P =0.145). DISCUSSION: Adding dexamethasone to bupivacaine in TiPVB resulted in a prolonged analgesia-free period and lower opioid consumption in lumbar spine surgeries with comparable incidence of adverse events.

Diagnostic accuracy of point-of-care knee ultrasound for evaluation of meniscus and collateral ligaments pathology in comparison with MRI.

BACKGROUND: Although magnetic resonance imaging (MRI) is often the "gold standard" for diagnosing knee problems, it has many limitations. Therefore, ultrasonography has been suggested as an effective rapid alternative in many knee abnormalities, especially after injuries of the meniscus and collateral ligaments. PURPOSE: To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) in detecting injuries of the meniscus and collateral ligament compared to MRI. MATERIAL AND METHODS: An observational cross-sectional blinded study was conducted of 60 patients with clinically suspicious meniscus and collateral ligament injuries who were planned for an arthroscopy and or operative procedure. These patients underwent both blinded POCUS and MRI of the knees before the intervention procedure and results of both imaging modalities were compared according to the operative and arthroscopic findings. RESULTS: The preoperative reliability of POCUS compared to MRI for the assessment of meniscus injuries was sensitivity (92.9% vs. 90.5%), specificity (88.9% vs. 83.3%), positive predictive value (PPV; 95.1% vs. 92.7%), negative predictive value (NPV; 84.2% vs. 79%), and overall accuracy (91.7% vs. 88.3%). However, for diagnosing collateral ligament injures, POCUS versus MRI assessed sensitivity (92.3% vs. 88.5%), specificity (100% vs. 97.1%), PPV (100% vs. 95.8%), NPV (94.4% vs. 91.7%), and overall accuracy (96.7% vs. 93.3%). CONCLUSION: Ultrasonography is a useful screening tool for the initial diagnosis of meniscal and collateral ligament pathology compared to or even with potential advantages over MRI, especially when MRI is unavailable or contraindicated. As newly advanced portable ultrasonography becomes available, it could be considered as a point-of-injury diagnostic modality.

2D shear wave elastography (SWE) performance versus vibration-controlled transient elastography (VCTE/fibroscan) in the assessment of liver stiffness in chronic hepatitis.

BACKGROUND: The assessment of liver stiffness and the degree of fibrosis are important factors affecting the management strategy. Multiple non-invasive tools are now available to offer an adequate alternative to biopsy. In this study, we tried to compare the performance of 2D shear wave elastography (SWE) to the transient elastography/fibroscan as a non-invasive tool in the prediction of liver stiffness. This is a prospective study of 215 patients confirmed by serology to have positive virus C or B infection. 2D SWE was done followed by vibration-controlled transient elastography (VCTE) known as fibroscan at the same session. Biopsy results were collected. RESULTS: The mean age was 51.07 years ± 6.07 SD. Five cases were excluded due to insufficient data. Fibroscan failed in 30 cases out of 210 cases (failure rate of 14.3%) compared with only 12 patients (6.7% failure rate) while using SWE. Only 180 patients completed the study to the result analysis. SWE results showed significant agreement to the fibroscan results with 86.7% agreement with a tendency for overestimation of the degree of fibrosis (11.7%). The efficacy of SWE was the highest during the assessment of patients with F0 (98.9%), F1 (97.8%), and F4 (93.3%) respectively and relatively low in F2 (92.8%) and F3 (90.6%). CONCLUSION: 2D SWE is a relatively recent non-invasive tool in the assessment of liver fibrosis grading which can be used as an alternative to the fibroscan with almost similar diagnostic performance especially when fibroscan is not capable to obtain adequate results such as in obesity and ascites.

Elective Neck Dissection for Management of Early- Stage Oral Tongue Cancer

Background: The occult neck metastasis rate is very high with tongue cancers. The aim of this study was to assess the current role of elective neck dissection (END) in management of early-stage oral tongue cancer with a focus on lymph node metastasis. In addition, effects of END on regional or systemic disease recurrence and survival were investigated. Methods: This retrospective study included patients with stage I and II tongue cancer recruited from our National Cancer Institute (NCI) over a time period of six years (2007-2013). The collected data were analyzed for disease free survival (DFS) and recurrence rate. Results: A total of 144 patients presented to our NCI with oral tongue cancer but only 88 were staged clinically and radiologically as early stage (stage I, stage II). Some 53% were smokers. Most lesions were dealt with by surgery, either by wide local excision (22%) or hemiglossectomy (78%). Treatment of neck lesions was either by neck dissection (85.2%) or "wait and see" (14.8%). The rates for local and nodal recurrence were 7.9% and 20.4%, respectively. Analysis of associations between DFS and different factors revealed significance for adoption of adjuvant therapy and the dissected lymph node status. Conclusion: Controversy still exists regarding neck management.

Comparison of AFP-L3 and p53 Antigen Concentration with Alpha-Fetoprotein as Serum Markers for Hepatocellular Carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) has the worst prognosis among all major cancers, largely due to the lack of sensitive diagnostic markers. We aimed to compare three HCC tumor markers, alpha-fetoprotein (AFP), p53, and AFP-L3%, to evaluate whether measuring serum p53 levels and AFP-L3% has an additive diagnostic value for detection of HCC. METHODS: A total of 86 patients with chronic liver diseases were included. HCC was detected in 68 (79.1%) patients. Twenty healthy age-matched volunteers served as healthy controls. Serum concentrations of AFP, AFP-L3, and p53 protein were measured. The correlations between the three markers with status of viral hepatitis, liver function tests, and Child-Pugh scores were determined. RESULTS: HCC patients showed significantly higher percentages of cirrhosis and Child-Pugh grade C (p < 0.001 and 0.05, respectively) compared with non-HCC group. AFP-L3% and p53 levels were significantly (p < 0.001, 0.0001, respectively) higher in HCC than non-HCC patients. AFP-L3% was found significantly correlated with Child-Pugh classification (p < 0.05) and alkaline phosphatase (p < 0.01). While, p53 significantly correlated with age and HCV positivity. ROC curve analysis showed that the highest specificity and sensitivity of the studied parameters are gained at cutoffs of 15%, 120.5 ng/mL, and 0.14 ng/mL for AFP-L3, AFP, and p53; respectively. Combining AFP-L3 and p53 improved sensitivity to 95.4% with a specificity of 85%. CONCLUSIONS: No significant correlation was found between AFP, AFP-L3%, and p53; however, the simultaneous determination of the three tumor markers yielded a better diagnostic accuracy and sensitivity in the detection of HCCs than each biomarker alone.

Morphologic and molecular characteristics of Sarcocystis atraii n. sp. (Apicomplexa: Sarcocystidae) infecting the common coot (Fulica atra) from Egypt.

A single morphologic type of Sarcocystis cysts found in two out of 43 examined common coots, Fulica atra, is considered to represent a new species for which the name Sarcocystis atraii n. sp. is proposed and its description is provided. Coots were hunted from the vicinity of Brolos Lake located at KafrElsheikh province, Egypt. The structural morphology of the revealed sarcocysts was described using light and transmission electron microscopy. Sarcocysts were found in the leg and thigh muscles. The cysts were microscopic and measured 165-850 µm in length × 50-85 µm in width. Histologically; the sarcocyst wall was wavy and had minute undulations. Ultrastructurally, it measured 1-3 µm in thickness and possessed many mushroom-like villar protrusions sometimes originating from other mushroom-like villar protrusions that measured approximately 0.5-2 µm in length and up to 2 µm in width, with the presence of electron dense ground substance of 300 nm to 1 µm thick. The bradyzoites were elongated, banana-shaped and measured 7.5-14 × 1.5-2.5 µm, with centrally or terminally located nuclei. The ultrastructural features of the cyst wall belonged to type 24. On the basis of sequencing and phylogenic analyses for 18S rRNA , 28S rRNA genes and ITS-1 region; S. atraii n. sp. is considered a genetically distinct species, being most closely related to avian Sarcocystis spp. whose definitive hosts are predatory mammals.

Morphologic identification of a new Sarcocystis sp. in the common moorhen (Gallinula chloropus ) (Aves: Gruiformes: Rallidae) from Brolos Lake, Egypt.

Sarcocystis species are among the most common and widespread protozoan parasites of mammals and birds. The current study provides the first record of infection with Sarcocystis species in the common moorhens from Brolos Lake, KafrElsheikh province, Egypt. Morphology of the parasite cysts was described using light and transmission electron microscopy. Out of 25 examined birds, sarcocysts were found in neck, thigh, and legs muscles of two birds. The cysts were microscopic and measured 150-650 µm in length×45-185 µm in width. Histologically, the sarcocyst wall appeared striated and characterized by the presence of radial spines. Ultrastructurally, it measured 2-4.5 µm in thickness and had irregularly shaped crowded finger-like villar protrusions that measured 1.5-4 µm in length and up to 0.4-2 µm in width with the presence of dense electron ground substance of 200-750 nm thick. Several septa derived from the ground substance were present and divided the cyst into compartments containing both bradyzoites and metrocytes. The bradyzoites were banana-shaped and measured 6-12 × 1-2 µm with centrally or posteriorly located nuclei. The ultrastructural features of the cyst wall belonged to type 10 cyst wall according the classification of Dubey et al. (1989) and Dubey and Odening (2001).

Mono and binuclear Ag(I), Cu(II), Zn(II) and Hg(II) complexes of a new azo-azomethine as ligand: synthesis, potentiometric, spectral and thermal studies.

New azo-azomethine dyes were prepared by reaction of p-aminobenzoic acid, o-anisidine, o-nitroaniline, and p-bromoaniline with salicylaldehyde respectively to form azo compounds and then condensation by urea to form 4-(R-arylazo 2-salicylaldene)-urea azo-azomethine derivatives (I(a-d)). The complexes of these ligands with Ag(I), Cu(II), Zn(II) and Hg(II) metal ions were prepared. The structure of the free ligands and their complexes were characterized by using elemental analysis (C, H, N), (1)H NMR, IR and UV-Vis-spectra. The proton dissociation constants of the ligands and the stability constant of their complexes have been determined potentiometrically in 40% (v/v) alcohol-water medium as well as the stoichiometry of complexes were determined conductometrically. The data reveal that the stoichiometries for all complexes were prepared in molar ratios (1:1) and (1:2) (M:L). The electrolytic and nonelectrolytic natures of the complexes were assigned based on molar conductance measurements. The thermogravimetric (TG), and differential thermal analyses (DTA) were studied in nitrogen atmosphere with heating rate 10°C/min. The kinetic and thermodynamic parameters for thermal decomposition of complexes have been calculated by graphical method using Coats-Redfern (CR) method.

Elevated renin levels in patients with liver cirrhosis and hepatocellular carcinoma.

Liver fibrosis is the common consequence of chronic liver injury of any etiology, disrupting the normal architecture,and causing hepatocellular dysfunction and portal hypertension. Since the renin-angiotensin system (RAS) may be involved in chronic liver diseases, in the present study we assayed renin levels using ELISA in groups of Egyptian patients with liver cirrhosis (N=32) and hepatocellular carcinoma (HCC) (N=67), for comparison with twenty five healthy controls. The results showed significant differences between the control and liver cirrhosis patients (P<0.001) and also the controls and HCC patients (P<0.001), without significant variation between the patient groups. Furthermore, in HCC patients, it was found that the renin levels negatively correlated with serum albumin and prothrombin time (P=0.003 for each) and positively with α-fetoprotein (P=0.04). Thus, it is concluded that renin levels are elevated in patients with liver cirrhosis and HCC and suitable medical intervention should be placed for management of such alteration. Moreover, further studies are warranted to explore its prognostic significance.

The efficacy of some wild medicinal plant extracts on the survival and development of third instar larvae of Chrysomyia albiceps (Wied) (Diptera: Calliphoridae).

Four crude wild plants extract of Artemisia herba-alba Asso, Artemisia monosperma Del., Euphorbia aegyptiaca Boiss. and Francoeuria crispa (Forsk.) extracted with four successive solvents; hexane, diethyl ether, ethyl acetate and ethanol were evaluated against the third instar larvae of Chrysomyia albiceps using dipping and thin film techniques. In dipping technique, larvae were immersed in the concentrations of plant extracts for 30 seconds. However, in thin film technique, larvae were exposed to thin layer from each plant extract in the Petri-dishes. Results showed that all extracts had toxic effects on larvae in both two treatments. Hexane and diethyl ether extracts of A. herba-alba and ethyl acetate extract of A. monosperma recorded the highest effect in both two treatments. Ethanol extracts of E. aegyptiaca and A. monosperma were the highest in dipping and thin film treatments, respectively. In dipping treatment, most plant extracts revealed extending effect on pupae especially while in thin film treatment most larvae which succeeded to develop to pupae produced normal flies. Deformed pupae were only recorded with the high concentration of diethyl extracts of A. herba-alba. Hexane, diethyl ether and ethyl acetate extracts of F. crespa only produced low percentages of deformed flies. Histological examination conducted on larvae confirmed that extracts in thin film treatment penetrated to the gut and destroyed its epithelial cells and wall. It concluded that the crude extracts of the four tested plants can be used in controlling of C. albiceps larvae while hexane extracts of E. aegyptiaca, A. herba-alba and A. monosperma are considered the most promising plant preparations against the larvae by using thin film technique.

Mutant p53 protein in the serum of patients with colorectal cancer: Correlation with the level of carcinoembryonic antigen and serum epidermal growth factor receptor.

INTRODUCTION: Enzyme-linked immunosorbent assay (ELISA) was used for analysis of serum mutant p53 protein, carcinoembryonic antigen (CEA), and epidermal growth factor receptor (EGFR). Serum samples were obtained from 48 patients with colorectal cancer (CRC) and a control group of twenty healthy individuals. RESULTS: The results demonstrated a significant increase of serum mutant p53, EGFR, and CEA levels in CRC patients compared to the control group (P<0.001 for each). Mutant p53 protein was significantly different in the different CRC grades (P=0.028). p53, CEA, and EGFR can differentiate successfully between different CRC grades and normal control (P<0.001 for each). Sensitivities of p53, CEA, and EGFR were 39.6, 31, and 71%, respectively. There was no correlation between CEA, EGFR, and p53 indicating that these variables were independent. Positive status of serum CEA and (or) p53 was found in 29 out of 48 (60%) patients. Also, positive status of serum CEA and (or) EGFR was found in 39 out of 48 (81%) patients. CONCLUSION: Thus, the simultaneous determination of p53 or EGFR combined with the CEA may increase the sensitivity to diagnose CRC patients and may aid in disease prognosis.

Pepsin assay: a marker for reflux in pediatric glue ear.

OBJECTIVE: To evaluate if analysis of pepsin/pepsinogen in middle ear effusions can be considered a diagnostic marker for laryngopharyngeal reflux (LPR) in children with otitis media with effusion (OME). MATERIAL AND METHODS: Ambulatory 24-hour dual-probe pH monitoring was carried out on 31 children with OME. Middle ear effusions were collected from 17 children during myringotomy. Total pepsin/pepsinogen concentrations in effusions were measured by ELISA using antipepsin antibody. RESULTS: Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant LPR. The concentrations of pepsin/pepsinogen in middle ear effusions, ranged from 0.085 to 5.02 microg/ml, were found to be up to 4.5 to 231.44 times higher than the serum levels. There was a significant positive correlation between the level of pepsin/pepsinogen assayed in the effusions of the 17 children and the number of pharyngeal reflux episodes measured by pH monitoring. CONCLUSIONS: Control of LPR may be an essential component in the successful management of OME in pediatric patients. Pepsin/pepsinogen analysis in effusions of children, using ELISA, can be considered a reliable marker for assessment of reflux in children with OME.

In vitro evaluation of bovine turbinate cells and Sarcocystis falcatula proliferation in response to serum-free medium and other media supplements.

A serum-free medium (SFM) was evaluated for the growth of bovine turbinate (BT) cells used for the production of Sarcocyvstis falcatula merozoites. Serum free cultures used to propagate S. falcatula were compared to cultures maintained in media supplemented with fetal calf serum (FCS) or horse serum (HS). Serum free cultures were more.effective and very promisin, than the others in supporting the proliferation of S. falcatula merozoites. However, the serum free cultures were unable to adequately support BT cell proliferation compared to the serum-supplemented cultures. No significant differences were seen between cultures supplemented with HS or FCS used for the production of S. falcatula merozoites or BT cells. The rate of BT cell proliferation in response to SFM and different media supplements was assessed in a 96-well plate format using methylene blue staining assay. This technique was superior to manual counting method and allowed quick and accurate quantitative comparison bet-ween the response of proliferating BT cells to different growth conditions

Excitatory amino acids and magnesium sulfate in neonatal asphyxia.

OBJECTIVE: The excitatory amino acids (EAA); glutamate and aspartate are released into the cerebrospinal fluids (CSF) of asphyxiated newborns. The objectives of this study were: (a) to examine the relation of the concentration of EAA in the CSF with the degree of brain injury, (b) To determine the time of the release of these EAA into the CSF, and (c) to detect the effect of magnesium sulfate (MgSO(4)) on their levels. DESIGNS AND METHODS. A randomized controlled trial was conducted on 47 full term asphyxiated newborns. Twenty three infants received an intravenous 10% solution of MgSO(4) at a dose of 250 mg/kg within the first 24h of life while the other 24 newborns received isotonic saline (0.9%) of an equal volume. Levels of glutamate and aspartate were measured before and 72 h after giving the trial solution. Results. In the study population (n=47) both glutamate and aspartate were significantly elevated in infants with higher grades of HIE compared to those with lower grades (P=0.013 and 0.031, respectively). Compared to baseline level, glutamate decreased significantly over time in placebo group (-8.28+/-14.26, P=0.025) and in MgSO(4) group (-14.39+/-18.72, P=0.005). Glutamate concentration did not differ between groups when measured at baseline (29.26+/-16.31 vs. 31.27+/-22.62, P=0.82) and at 72 h (19.28+/-15.63 vs. 19.6+/-16.54, P=0.87). The change in aspartate concentration over time was not significant in placebo group (-0.45+/-1.96, P=0.34) or in MgSO(4) group (-0.7+/-3.19, P=0.37). Aspartate did not differ between groups when measured at baseline (3.52+/-2.4 vs. 3.92+/-2.59, P=0.49) or at 72 h (2.79+/-1.24 vs. 3.05+/-2.48, P=0.92). Conclusions. The EAA; glutamate and aspartate are released in the CSF of asphyxiated newborns immediately after birth and declined by 72 h. Their initial concentrations correlated with the severity of HIE. Postnatal administration of MgSO(4) did not alter the levels of these 2 EAA.