The superior efficacy of chloroquine over buparvaquone in reducing the chronic cerebral Toxoplasma gondii cysts load and improving the ultrastructural pathology in an immunocompromised murine model.

Toxoplasma gondii, the etiologic agent of toxoplasmosis, infects about 30 - 50% of the world population. The currently available anti-Toxoplasma agents have serious limitations. The present study aimed to investigate the effects of two antimalarials; buparvaquone (BPQ) and chloroquine (CQ), on immunocompromised mice with chronic cerebral toxoplasmosis, using spiramycin as a reference drug. The assessed parameters included the estimation of mortality rates (MR) among mice of the different study groups, in addition to the examination of the ultrastructural changes in the brain tissues by transmission electron microscopy. The results showed that only CQ treatment could decrease the MR significantly with zero deaths, while both spiramycin and BPQ caused an insignificant reduction of MR compared to the infected non-treated group. All the used drugs decreased the number of mature ruptured cysts significantly compared to the infected non-treated group, while only CQ increased the number of atrophic and necrotic cysts significantly. Furthermore, both spiramycin and BPQ improved the microvasculopathy and neurodegeneration accompanying the infection with different degrees of reactive astrocytosis and neuronal damage with the best results regarding the repair of the microvascular damage with less active glial cells, and normal neurons in the CQ-treated group. In conclusion, this study sheds light on CQ and its excellent impact on treating chronic cerebral toxoplasmosis in an immunocompromised mouse model.

Zinc oxide calcium silicate composite attenuates acute tramadol toxicity in mice.

BACKGROUND: Seizures are considered to be the most common symptom encountered in emergency- rushed tramadol-poisoned patients; accounting for 8% of the drug-induced seizure cases. Although, diazepam clears these seizures, the risk of central respiratory depression cannot be overlooked. Henceforth, three adsorbing composites were examined in a tramadol acute intoxication mouse model. METHODS: Calcium Silicate (Wollastonite) either non-doped or wet doped with iron oxide (3%Fe2O3) or zinc oxide (30% ZnO) were prepared. The composites' adsorption capacity for tramadol was determined in vitro. Tramadol intoxication was induced in Swiss albino mice by a parenteral dose of 120 mg/kg. Proposed treatments were administered within 1 min at 5 increasing doses, i.p. The next 30 min, seizures were monitored as an intoxication symptom. Plasma tramadol concentration was recorded after two hours of administration. RESULTS: The 3% Fe2O3-containing composite (CSFe3), was found to be composed of mainly wollastonite with very little alpha-hematite. On the other hand, hardystonite and wellimite were developed in the 30%ZnO-containing composite (CSZn3). Micro-round and irregular nano-sized microstructures were established (The particle size of CS was 56 nm, CSFe3 was 49 nm, and CSZn3 was 42 nm). The CSZn3 adsorption capacity reached 1497 mg of tramadol for each gram. Tramadol concentration was reduced in plasma and seizures were inhibited after its administration to mice at three doses. CONCLUSION: The calcium silicate composite doped with ZnO presented a good resolution of tramadol-induced seizures accompanied by detoxification of blood, indicating its potential for application in such cases. Further studies are required.

Cross-sectional imaging evaluation of atypical and uncommon extra-nodal head and neck Non-Hodgkin lymphoma: Case series.

Extra-nodal Non-Hodgkin lymphoma (ENHL) of the head and neck is not uncommon and has variable clinical and imaging presentations. It represents about 25% of extra-nodal lymphomas. In addition, lymphoma is the third most common malignancy of the head and neck just after squamous cell carcinoma (SCC) and salivary gland neoplasms. Unlike SCC, ENHL usually presents as a well-defined mass in the oral cavity, along the pharyngeal mucosa, sinonasal cavity, orbit, and other different neck spaces. One of the common presentations of ENHL is the glandular type which can arise within the salivary or thyroid glands as marginal zone non-Hodgkin lymphoma. ENHL can infiltrate the bone resembling high grade osseous malignancies. Rarely, ENHL can present as perineural spread without definitive mass and manifest clinically with several neuropathies. In this case series, we presented different imaging features and presentation of ENHL of the head and neck. The knowledge of various presentations of ENHL of the head and neck can help early diagnosis and prompt management of these patients' population.

Osteogenic potential of calcium silicate-doped iron oxide nanoparticles versus calcium silicate for reconstruction of critical-sized mandibular defects: An experimental study in dog model.

Objective: To evaluate bioactivity and osteogenic potential of calcium silicate (CS)-doped iron oxide (Fe2O3) nanoparticles versus pure CS in the reconstruction of induced critical-sized mandibular defects. Design: CS-doped Fe2O3 was prepared; morphological and microstructure identification of nanoparticles were made. An in vivo randomised design was developed on 24 adult male dogs where four critical-sized mandibular defects were created in each dog. Bone defects were allocated into control, CS, CS-3% Fe2O3 and CS-10% Fe2O3 group. Dogs were euthanized at 1 and 3 months (12 dog/time) for histopathologic and histomorphometric evaluation. Results: At three months, bone formation and maturation were evident where mean ± SD percent of mature bone was 2.66 ± 1.8, 9.9 ± 2.5, 22.9 ± 4.9, and 38.6 ± 8.1 in control, CS, CS-3% Fe2O3, and CS-10% Fe2O3 groups respectively. A high significant (P < 0.001) increase in area percent of mature bone was recorded in CS, CS-3% Fe2O3, and CS- 10% Fe2O3 groups compared to control group (73%, 88% and 93.3% respectively). Significant increase (P < 0.001) in area of mature bone was recorded in CS-3% Fe2O3 and CS-10% Fe2O3 groups compared to CS group. A significant increase (P < 0.001) in area of mature bone formation was detected in CS-10% Fe2O3 group compared to other groups. Conclusion: CS-doped Fe2O3 has good osteoconductive, biocompatible properties with promoted bone regeneration. Fe2O3 has synergistic effect in combination with CS to promote bone formation. Increasing concentration of Fe2O3 nanoparticles resulted in improved osteogenesis and maturation. Results suggests that the novel CS-Fe2O3 alloplasts could be used for reconstruction of critical-sized bone defects.

Developing the sensing features of copper electrodes as an environmental friendly detection tool for chemical oxygen demand.

The chemical oxygen demand (COD) of water bodies is an essential indicator of organic contaminants. The majority of current testing methods have the drawbacks of requiring multiple processes, being time-consuming, and requiring the use of harmful and hazardous reagents. In this work, a low-cost copper wire (Cu-wire) electrode was designed and fabricated to be used as a sensing electrode for the detection of chemical oxygen demand in water. The sensing features were developed by electrodeposition of copper nanoparticles (nano-Cu) that were prepared by fast-scan cyclic voltammetry (FSCV) deposition at the optimum preparation conditions. For improving the adherence and stability of the deposited nano-Cu thin layer, the Cu-wire electrode was scratched to increase the surface roughness. The surface morphology of the prepared nano-Cu/Cu-wire electrode was investigated by scanning electron microscope (SEM). Energy-dispersive X-ray spectrometer (EDX) was used for elemental analysis characterization. The non-modified and the nano-copper modified electrode were utilized and optimized for electrochemical assay of COD using glycine as a standard in 0.075 M NaOH as an electrolyte solution. The calibration curves (COD, mg L-1 vs. I, mA) were plotted from linear sweep voltammetry (LSV) and chronoamperometry (I-t) curves for a wide range of COD under the optimized conditions. It shows that the electroanalytical features of the proposed nano-Cu-based COD sensor exhibit a linear range from 2 to 595 mg L-1 and a lower limit of detection (LOD) of 2.6 mg L-1 (S/N = 3). The established electrochemical method demonstrated a high tolerance level to Cl- ions where 1.0 M Cl- exhibited a negligible influence. The sensor was employed for detecting the COD in diverse real water samples and the attained results were validated using the standard dichromate method. The obtained results could open the window toward using simple and cost effective tools in order to monitor the water quality.

Hydroxyapatite nanoparticles derived from mussel shells for in vitro cytotoxicity test and cell viability.

Hydroxyapatite (HA) nanoparticles derived from mussel shells were prepared using the wet precipitation method and were tested on human mesenchymal and epithelial cells. Shells and HA powder were characterized via X-ray diffraction analysis (XRD) and scanning electron microscopy along with energy dispersive X-ray spectroscopy (SEM/EDX), high resolution transmission electron microscopy (HR-TEM) and Fourier transform infrared spectroscopy (FTIR). The in vitro cytotoxic properties of HA and mussel shells were determined using sulphorhodamine B (SRB) assays for MCF-7 cells (HepG2) and colon (Caco-2) cells. Cell viability tests confirmed the nontoxic effects of synthesized HA and mussel shells on human mesenchymal stem cells (h-MSCs) and epithelial cells. Toxicity values were less than 50% of the cell's validity ratio based on analyses using different concentrations (from 0.01 to 1,000 µg). The results indicate that MSC and epithelial cell attachment and proliferation in the presence of both HA and shell occurred. The proliferation capability was established after 3 and 7 days. SEM images revealed that stem cells and epithelial cells attached to the scaffold indicated full and complete integration between the cells and the material. It seems that due to the ion exchange between bovine serum albumin solutions (BSA) and HA, the FTIR data confirmed an increase in the amide I and amide II bands, which indicates the compatibility of the BSA helix structure. This study sheds light on the importance of merging stem cells and nanomaterials that may lead to improvements in tissue engineering to develop novel treatments for various diseases.

Proteomics Analysis of Trastuzumab Toxicity in the H9c2 Cardiomyoblast Cell Line and its Inhibition by Carvedilol.

OBJECTIVE: Heart dysfunctions are the major complications of trastuzumab in patients with Human Epidermal growth factor Receptor-2 (HER2)-positive breast cancers. METHODS: In this study, the cytotoxicity of trastuzumab on H9c2 cardiomyoblasts was demonstrated, and the proteome changes of cells were investigated by a tandem mass tagging quantitative approach. The Differentially Abundant Proteins (DAPs) were identified and functionally enriched. RESULTS: We determined that carvedilol, a non-selective beta-blocker, could effectively inhibit trastuzumab toxicity when administrated in a proper dose and at the same time. The proteomics analysis of carvedilol co-treated cardiomyoblasts showed complete or partial reversion in expressional levels of trastuzumab-induced DAPs. CONCLUSION: Downregulation of proteins involved in the translation biological process is one of the most important changes induced by trastuzumab and reversed by carvedilol. These findings provide novel insights to develop new strategies for the cardiotoxicity of trastuzumab.

Oral Administration of Recombinant Saccharomyces boulardii Expressing Ovalbumin-CPE Fusion Protein Induces Antibody Response in Mice.

Saccharomyces boulardii, a subspecies of Saccharomyces cerevisiae, is a well-known eukaryotic probiotic with many benefits for human health. In the present study, a recombinant strain of S. boulardii was prepared to use as a potential oral vaccine delivery vehicle. In this sense, a ura3 auxotroph strain of S. boulardii CNCM I-745 (known as S. cerevisiae HANSEN CBS 5926, Yomogi®) was generated using CRISPR/Cas9 methodology. Then a gene construct encoding a highly immunogenic protein, ovalbumin (OVA), was prepared and transformed into the ura3- S. boulardii. To facilitate the transport of the recombinant immunogen across the intestinal barrier, a claudin-targeting sequence from Clostridium perfringens enterotoxin (CPE) was added to the C-terminus of the expression cassette. The recombinant S. boulardii strain expressing the OVA-CPE fusion protein was then administered orally to a group of mice, and serum IgG and fecal IgA levels were evaluated by ELISA. Our results demonstrated that anti-OVA IgG in serum significantly increased in test group (P < 0.001) compared to control groups (receiving wild type S. boulardii or PBS), and the fecal IgA titer was significantly higher in test group (P < 0.05) than control groups. In parallel, a recombinant S. boulardii strain expressing the similar construct lacking C-terminal CPE was also administered orally. The result showed an increased level of serum IgG in group receiving yeasts expressing the CPE negative construct compared to control groups; however, the fecal IgA levels did not increase significantly. In conclusion, our findings indicated that the yeast S. boulardii, as a delivery vehicle with possible immunomodulatory effects, and c-CPE, as a targeting tag, synergistically assist to stimulate systemic and local immunity. This proposed recombinant S. boulardii system might be useful in the expression of other antigenic peptides, making it as a promising tool for oral delivery of vaccines or therapeutic proteins.

Encapsulation of Biosynthesized Nanosilver in Silica Composites for Sustainable Antimicrobial Functionality.

Silver nanoparticles (AgNPs) have become known as a broad-spectrum antimicrobial agent. The antimicrobial activity of AgNPs is dependent on the particle size and the dispersion status. In this study, a simple and effective approach is developed for sequestering the biosynthesized AgNPs in silica composites during the gel formation of MCM-41. Composites with different Ag concentrations of 0.034% (Ag1@MCM-41), 0.151% (Ag2@MCM-41), and 0.369% (Ag3@MCM-41) are synthesized and then heated at 400 °C to produce Ag1@MCM-41H, Ag2@MCM-41H, and Ag3@MCM-41H, respectively. The samples are characterized by flame atomic absorption spectrometry, Fourier-transform infrared spectroscopy, X-ray diffraction, N2 physisorption, scanning electron microscopy, transmission electron microscopy, and thermogravimetric analysis. The AgNPs are confirmed to be highly dispersed in the amorphous silica framework. The antimicrobial activity of the AgNP-silica samples is investigated against Staphylococcus aureus, Escherichia coli, and Candida albicans using the cup-plate and the plate-count techniques. The results show an excellent antimicrobial effect of these samples against the studied microorganisms. Importantly, the AgNP-silica samples are found to be stable up to 58 months under ambient conditions. These stable and powerful antimicrobial composites provide a more practical and effective strategy for combating biomedical pathogens and public health threats.

Green Synthesis of Silver Nano-particles by Macrococcus bovicus and Its Immobilization onto Montmorillonite Clay for Antimicrobial Functionality.

Macrococcus bovicus was locally isolated from soil and used in the green synthesis of nano-scaling silver (NSAg). It was immobilized on a sodic-montmorillonite clay (MMT1) and cetyltrimethylammonium bromide-modified montmorillonite (MMT2) which was also calcined at 300 °C (MMT3). The NSAg clays were characterized by X-ray fluorescence, Fourier transform infrared spectra, X-ray diffractometry, surface area measurement, UV-Vis spectrometry, scanning electron microscope, transmission electron microscope and thermogravimetric analysis. NSAg was confirmed to be included in the interparticular cavities of the clay sheets and its mechanical stability was evidenced. The antimicrobial activity of the NSAg-modified clays was investigated against Staphylococcus aureus, Escherichia coli and Candida albicans using the cup plate and the plate count techniques. The antimicrobial activity of the NSAg clays was confirmed and attributed to the caging of NSAg in MMT cavities. MMT3 was found to inhibit the microbial growth to as high as 65 % as observed from the plate count method. Graphical Abstract Scheme of the biosynthesis of nano-scaling Ag and its immobilization and antimicrobial application.

Comparative susceptibilities of different life stages of the red palm weevil (Coleoptera: Curculionidae) treated by entomopathogenic nematodes.

The red palm weevil, Rhynocophorus ferrugineus (Olivier) (Coleoptera: Curculionidae) has become the most important pest of the date palm trees in the world. It has been reported in the kingdom of Saudi Arabia since 1987 and in Egypt since 1992. Studies were conducted to compare preferences among red palm weevil life stages for infection by 12 entomopathogenic nematodes (EPNs), under no choice and five stage choice experiments, and curative trials by some of EPNs isolates. All EPN isolates proved to be pathogenic for the first instars of red palm weevil larvae. Some of the test EPNs exhibited a preference for larvae over pupae, and a lesser degree of preference for adults. In contrast some strains showed no preference for any stage. The local Egyptian isolates of EPNs were most efficient nematodes against red palm weevil than foreign strains. Field assessments using trunk injection resulted in a substantial decline in the population of red palm weevil after two successive applications within 3 wk. Efficacies ranging 48-88% were achieved in the curative assay resulting in a significant increase in palm survival compared with the untreated control. In conclusion, there is a great potential for the use of EPNs, in particular the Steinernema sp. (EGG4), against the red palm weevil when injected in the date palm.

Higher circulating levels of OxLDL % of LDL are associated with subclinical atherosclerosis in female patients with systemic lupus erythematosus.

Because systemic lupus erythematosus (SLE) is associated with a high risk of atherosclerosis, a process that involves low-density lipoprotein (LDL) oxidation, we examined the hypothesis that raised fraction of LDL that is converted to oxidized (Ox) LDL expressed in OxLDL % of LDL (OxLDL %) is associated with the subclinical atherosclerosis in SLE. A cohort of 60 SLE patients with no previous history of cardiovascular disease had carotid artery ultrasound to identify plaques and to measure intima-media thickness (IMT). Forty females with rheumatoid arthritis (RA) were also enrolled in the study to serve as a control group. Plasma OxLDL concentrations were measured, and the OxLDL % of LDL were calculated. Traditional and SLE-related risk factors for atherosclerosis were evaluated. OxLDL % were significantly higher in SLE patients compared to patients with RA (p = 0.0311). OxLDL % were significantly higher in SLE patients with plaques than in those without plaques (p < 0.001). SLE patients in the highest IMT quartile have higher OxLDL % than patients in the lower three quartiles (p < 0.001). The odd ratio (OR) for the OxLDL % in patients with plaques was 6.143 (p < 0.001) when compared to patient without plaques, while OR for the OxLDL % was 8.34 (p < 0.001) in the patients with highest IMT quartile as compared to patients in the lower three quartiles after adjustment for confounding factors in logistic regression analysis. Our data provide evidence of an association between the circulating levels of OxLDL % of LDL with the risk for developing atherosclerosis in patients with SLE.

Interaction of the koinobiont parasitoid Microplitis rufiventris of the cotton leafworm, Spodoptera littoralis, with two entomopathogenic rhabditids, Heterorhabditis bacteriophora and Steinernema carpocapsae.

Entomopathogenic nematodes are generally considered beneficial organisms. However, they can affect beneficial insects such as parasitoids. The interaction between the entomopathogenic nematodes Heterorhabditis bacteriophora Poinar (Rhabditida: Heterorhabditidae) and Steinernema carpocapsae Weiser, and the parasitoid Microplitis rufiventris Kokujev (Hymenoptera: Braconidae) was investigated in the laboratory. In non-parasitized hosts, Spodoptera littoralis Boisduval (Lepidoptera: Noctuidae) larvae exposed to H. bacteriophora showed a higher percent mortality than those exposed to S. carpocapsae. Both nematodes were able to invade and propagate in non-parasitized S. littoralis larvae and those parasitized by M. rufiventris. Both nematode species reproduced in Microplitis-parasitized hosts, but there was a higher number of nematodes in non-parasitized larvae. S. carpocapsae yielded higher numbers of infective juveniles than H. bacteriophora. Generally, the number of nematodes harvested increased as their host's size increased. The interaction between the nematodes and parasitoid favored the nematodes when the nematodes were inoculated during the parasitoid egg stage or the young parasitoid larvae, thus giving the nematodes a better chance to grow and reproduce, resulting in the death of the parasitoid larvae. Conversely, when the nematodes were inoculated during the late larval instar of the parasitoid, the competition partially favored the wasp, thus giving approximately 50% of the wasps a better chance to develop, emerge, and reproduce, providing evidence that both nematodes and wasps could reproduce in the same host. Egg maturation of female wasps derived from nematode-infected hosts was not significantly different than those from control hosts. The combined application of nematodes and parasitoids may be beneficial if the detrimental effects of the nematodes on the parasitoid could be avoided by precisely timing the application strategies. It is clear that Microplitis larvae and the nematodes share the host larva and engage in a trophic interaction with each other. Intraguild predation is briefly discussed.

Application of Yang-Monti Principle in Ileal Ureter Substitution: Is It a beneficial Modification?

Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. In this study, we evaluate its safety, surgical outcome and impact on renal function.

Sixteen patients underwent ileal ureter replacement using the Yang-Monti principle to overcome long ureteric defects. Exclusion criteria included patients with elevated serum creatinine > 1.8 mg/dL, inflammatory bowel syndrome or irradiated bowel. Antireflux implantation into the bladder was performed in 12 patients while 4 patients with intact healthy lower ureters underwent distal ileal-ureteral anastomosis. Follow-up protocol was carried out for up to 3 years in 9 patients.

No intra-operative or postoperative mortality or significant complications occurred. There were minor complications in the form of urinary leakage that necessitated prolonged ureteric stenting in one patient, superficial wound infection in another one and 3 patients developed treatable urinary tract infection without late harmful effects. During follow up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function (improved in 13 patients and stabilized in 3) without any evidence of urinary obstruction.

The reconfigured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antireflux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction. .

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development.

PURPOSE: To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow-up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow-up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2 %). Reoperation rate was 9.6 %. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

Development and bioactivity evaluation of bioglasses with low Na2O content based on the system Na 2O-CaO-MgO-P 2O 5-SiO 2.

Osteoconductive bioglasses, free of K(2)O and Al(2)O(3) and with content of Na(2)O lower than 10 mol%, were designed based on the ratio (SiO(2) + MgO)/(P(2)O(5) + CaO + Na(2)O) in the system Na(2)O-CaO-MgO-P(2)O(5)-SiO(2). The developed glasses have shown a strong potential for the formation of hydroxycarbonated apatite (HCA) in vitro. The particles of HCA aggregates tend to be of finer size with increasing the ratio of (SiO(2) + MgO)/(CaO + P(2)O(5) + Na(2)O) in the glass chemical composition indicating significant bioactivity. Critical size bone defects created in the femurs of albino adult female rats, and grafted with the glass particles for 12 weeks post implantation, were completely healed by filling with mineralized bone matrix without infection showing a strong potential for new bone formation in vivo. Osteoblasts and osteocytes were observed close to the surface of the granular implants with active areas of bone deposition, resorption and remodelling. The bioglass with lowest (SiO(2) + MgO)/(CaO + P(2)O(5) + Na(2)O) ratio has shown the highest bioactivity while the bioglass with the highest (SiO(2) + MgO)/(CaO + P(2)O(5) + Na(2)O) has shown the lowest bioactivity. The newly formed bone in vivo has shown a similar structure to that of the original bone as indicated by the histology and microstructural results. In addition, Ca/P molar ratio of the newly formed bone was found to be (~1.67), which is similar to that of the original bone.

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

PURPOSE:To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2%). Reoperation rate was 9.6%. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

PURPOSE: To assess safety and efficacy of supine percutaneous nephrolithotomy in patients for whom prone position or general anesthesia is contraindicated or not preferable due to associated comorbidities, overweight or ipsilateral upper ureteric calculi. MATERIALS AND METHODS: Fifty two patients (37 males and 15 females, mean age 33 ± 10.2 years) were included in this study. Supine position was selected due to anesthetic considerations (preexisting compromised cardiopulmonary status, morbid obesity (body mass index > 40 kg/m²) and/or other associated medical comorbidities), impossible prone position due to bone deformities or associated ipsilateral upper ureteric stone. Regional anesthesia was used in 24 patients while 28 patients underwent general anesthesia. After standard cystoscopy and retrograde ureteropyelography in the dorsal lithotomy position, the position was modified using 3 liters of saline bag below the ipsilateral upper flank. Percutaneous access to the pelvicalyceal system was performed through the posterior axillary line under fluoroscopic guidance. RESULTS: Successful renal puncture was achieved in all cases. Single access via the lower calyx was the most commonly used access (36 cases). Stone-free rate was 92.3%. Postoperative complications classified according to Clavien Dindo classification included bleeding requiring transfusion (3.8%), prolonged fever (7.7%), deep venous thrombosis (1.9%) [grade II in all] and urinary leakage requiring ureteric stenting (5.8%) [grade IIIa]. CONCLUSIONS: The modified supine position for percutaneous nephrolithotomy is a safe and effective option that offers several advantages with an excellent outcome. It can be performed safely for morbidly obese patients and those with cardiopulmonary compromise.

When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

PURPOSE: To assess safety and efficacy of supine percutaneous nephrolithotomy in patients for whom prone position or general anesthesia is contraindicated or not preferable due to associated comorbidities, overweight or ipsilateral upper ureteric calculi. MATERIALS AND METHODS: Fifty two patients (37 males and 15 females, mean age 33 ± 10.2 years) were included in this study. Supine position was selected due to anesthetic considerations (preexisting compromised cardiopulmonary status, morbid obesity (body mass index > 40 kg/m²) and/or other associated medical comorbidities), impossible prone position due to bone deformities or associated ipsilateral upper ureteric stone. Regional anesthesia was used in 24 patients while 28 patients underwent general anesthesia. After standard cystoscopy and retrograde ureteropyelography in the dorsal lithotomy position, the position was modified using 3 liters of saline bag below the ipsilateral upper flank. Percutaneous access to the pelvicalyceal system was performed through the posterior axillary line under fluoroscopic guidance. RESULTS: Successful renal puncture was achieved in all cases. Single access via the lower calyx was the most commonly used access (36 cases). Stone-free rate was 92.3%. Postoperative complications classified according to Clavien Dindo classification included bleeding requiring transfusion (3.8%), urinary leakage requiring ureteric stenting (5.8%), prolonged fever (7.7%), deep venous thrombosis (1.9%) [grade III in all] and urinary leakage requiring ureteric stenting (5.8%) [grade IIIa]. CONCLUSIONS: The modified supine position for percutaneous nephrolithotomy is a safe and effective option that offers several advantages with an excellent outcome. It can be performed safely for morbidly obese patients and those with cardiopulmonary compromise.

Application of Yang-Monti principle in ileal ureter substitution: is it a beneficial modification?

PURPOSE: Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. In this study, we evaluate its safety, surgical outcome and impact on renal function. MATERIALS AND METHODS: Sixteen patients underwent ileal ureter replacement using the Yang-Monti principle to overcome long ureteric defects. Exclusion criteria included patients with elevated serum creatinine > 1.8 mg/dL, inflammatory bowel syndrome or irradiated bowel. Antireflux implantation into the bladder was performed in 12 patients while 4 patients with intact healthy lower ureters underwent distal ileal-ureteral anastomosis. Follow-up protocol was carried out for up to 3 years in 9 patients. RESULTS: No intra-operative or postoperative mortality or significant complications occurred. There were minor complications in the form of urinary leakage that necessitated prolonged ureteric stenting in one patient, superficial wound infection in another one and 3 patients developed treatable urinary tract infection without late harmful effects. During follow-up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function (improved in 13 patients and stabilized in 3) without any evidence of urinary obstruction. CONCLUSIONS: The reconfigured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antireflux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction.