Preoperative localisation of parathyroid adenomas using ultrasound-guided methylene blue dye injection.

Purpose: Primary hyperparathyroidism is mainly caused by parathyroid adenomas. Preoperative imaging can be performed using different imaging modalities, e.g. ultrasound (US), radionuclide scanning, magnetic resonance imaging, and computed tomography, often used in combination. Currently, US-guided blue dyes, especially methylene blue (MB) injection, are used to identify parathyroid tumours. Material and methods: This was a retrospective study of 228 patients. Preoperative ultrasound, scintigraphy, and bio-chemistry were performed on all patients, and fine-needle aspiration procedures were performed on suspected patients. Using preoperative US-G injection with MB dye, target tumours were injected in all cases. Results: A total of 163 patients were female and 65 were male. The mean age was 42.5 years. US was positive in 203 (89%) cases, 25 (11%) were negative, and all had a positive sestamibi scan (100%). US-G needle injections with MB dye of target tumours were successful in all cases. The average diameter of the lesions was 18 mm. All had positive intraoperative identification of parathyroid adenoma and MB staining (100% accuracy, 100% sensitivity, and 100% specificity). Operating time (min ± SD) was 22.7 ± 11.5 minutes, and the success rate was 100%. All were parathyroid adenomas histologically. Intraoperative parathormone hormone decreased in all patients. In postoperative follow-up, all were normocalcaemic with no local or systemic complications. Conclusions: Localisation of small parathyroid adenomas by US-guided blue dye injection is a safe, simple, and useful tool when performing parathyroidectomy with no complications.

Biochar-enhanced anaerobic mixed culture for biodegradation of 1,2-dichloroethane: Microbial community, mechanisms, and techno-economics.

While anaerobic digestion (AD) has been employed for the degradation of chlorinated aliphatic hydrocarbons, the associated digester performance might suffer from volatile fatty acids accumulation, insufficient substrate-microbes interaction, and lower biogas yields. To overcome these limitations, this study is the first to augment the hydrocarbon-degrading microbial capacities by adding agricultural waste-based biochar to the digestion medium. 1,2-dichloroethane (1,2-DCA) was selected as the target pollutant because it is discharged in large quantities from oil refining, petrochemical, and chemical industries, causing serious environmental and human health concerns. A multi-chamber anaerobic reactor (MAR) was operated at a 1,2-DCA loading rate of 1.13 g/L/d, glucose dosage (as an electron donor) range of 200-700 mg/L, and hydraulic retention time of 11.2 h, giving dechlorination = 32.2 ± 6.9% and biogas yield = 210 ± 30 mL/g CODremoved. These values increased after biochar supplementation (100 mg/g volatile solids, VS, as an inoculum carrier) up to 60.2 ± 11.5% and 290 ± 40 mL/g CODremoved, respectively, owing to the enhancement of dehydrogenase enzyme activities. Burkholderiales (15.3%), Clostridiales (2.3%), Bacteroidales (3.5%), Xanthomonadales (3.3%), and Rhodobacterales (6.1%) involved in 1,2-DCA degradation were dominant in the reactor supplemented with biochar. It's suggested that biochar played a major role in facilitating the direct interspecies electron transfer (DIET) between syntrophic bacteria and methanogens, where chloride, ethylene glycol, and acetate derived from 1,2-DCA dechlorination could be further used to promote methanogenesis and methane production. The synergetic effect of adsorption and dechlorination towards 1,2-DCA removal was validated at various biochar dosages (50-120 mg/g) and 1,2-DCA concentrations (50-1000 mg/L). The techno-economic results showed that the cost of treating 1,2-DCA-laden discharge (100 m3/d) by the MAR module could be 0.83 USD/m3 with a payback period of 6.24 years (NPV = 2840 USD and IRR = 10%), retrieving profits from pollution reduction (9542 USD/yr), biogas selling (10418 USD/yr), and carbon credit (10294 USD/yr).

Tadalafil versus tamsulosin as combination therapy with 5-alpha reductase inhibitors in benign prostatic hyperplasia, urinary and sexual outcomes.

PURPOSE: To compare the urological and sexual outcomes of using either tamsulosin/finateride or tadalafil/finasteride as combination therapies in patients with large prostate. PATIENTS AND METHODS: Selection criteria included prostate volume > 40 ml and IPSS > 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were excluded. Patients were randomized into group I (tamsulosin/finasteride) and group II (tadalafil/finasteride). The primary endpoint was to define urinary and sexual function changes (IPSS, IPSS-quality of life, urinary flow rates and IIEF domains) within each group. The secondary endpoint was to compare the treatment induced changes between both groups. RESULTS: At 4th and 12th weeks, 131 and 127 patients were available in both groups, respectively. Both groups showed significant LUTS improvement (IPSS changes: - 4.9 ± 2.7 and - 4.3 ± 2.9 at 4th week and - 6.1 ± 3 and - 5.4 ± 2.8 points by the 12th week in both groups, respectively). Group I had better average flow rates at both follow-up visits. Meanwhile, maximum flow rates were comparable in both groups at 12th week (13.5 ± 3.9vs. 12.6 ± 3.7, p > 0.05). In group I, all IIEF domains were significantly lowered at both visits (p < 0.05). Group II showed significant increase in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2 at the 4th and 12th weeks) with a transient significant reduction of IIEF-orgasm and sexual desire noted only by the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively). CONCLUSION: Within three months, both combinations are comparably effective in improving BPH related LUTS. Tamsulosin/finasteride provided significantly better Qmax only at 4th week. Tadalafil/finasteride had the advantage of improving sexual performance over the other combination.

Whole-body diffusion-weighted imaging with background body signal suppression and quantitative apparent diffusion coefficient in the detection, staging, and grading of non-Hodgkin lymphoma.

Purpose: Assess reproducibility of detection, staging, and grading of non-Hodgkin lymphoma (NHL) using whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS). Material and methods: Thirty NHL patients underwent WB-DWIBS, divided into 2 groups according to staging and grading. Image analysis and apparent diffusion coefficient (ADC) measurement of the largest lymph node in each group were performed by 2 observers. Inter-observer agreement was performed. Results: Overall inter-observer agreement for detection of NHL was excellent (k = 0.843; 92.05%) with excellent inter-observer agreement of nodal disease (cervical, thoracic and abdominal) (k = 0.783, 0.769, and 0.856; 96.67%, 90.0%, and 93.3% respectively), extra-nodal disease (k = 1; 100%), and splenic involvement (k = 0.67; 83.3%). The overall inter-observer agreement of DWIBS in staging of NHL was excellent (k = 0.90; 94.9%) with excellent inter-observer agreement for stage I (k = 0.93; 96.4%), stage II (k = 0.90; 94.8%), stage III (k = 0.89; 94.6%), and stage IV (k = 0.88; 94.0%). There was significant difference between ADC in stage I, II (0.77 ± 0.13, 0.85 ± 0.09 × 10-3 mm2/s), and stage III, IV (0.63 ± 0.08, 0.64 ± 0.11 × 10-3 mm2/s, p < 0.002, < 0.001). Interclass correlation showed almost perfect agreement for ADC measurement in staging and grading groups (r = 0.96 and r = 0.85, respectively, p < 0.001). There was significant difference between ADC in aggressive lymphoma (0.65 ± 0.1, 0.67 ± 0.13 × 10-3 mm2/s) and indolent lymphoma (0.76 ± 0.14, 0.84 ± 0.09 × 10-3 mm2/s, p < 0.028, < 0.001). Conclusion: DWIBS is reproducible for detection and staging of nodal and extra-nodal involvement in patients with NHL. ADC can quantitatively participate in the staging and grading of NHL.

Combined Conduit Score in Contrast-Enhanced Magnetic Resonance Venography in Patients with Idiopathic Intracranial Hypertension : Neuro-interventionalists' vs. Radiologists' Assessment.

BACKGROUND: Based on increased understanding of the idiopathic intracranial hypertension (IIH) pathophysiology, venous sinus stenting (VSS) has emerged as an effective treatment for patients with transverse sinus stenosis (TSS). The presence of a reliable TSS screening tool is warranted. The combined conduit score (CCS) is the most widely used score for evaluation of the cerebral sinovenous stenosis in contrast-enhanced magnetic resonance venography (CE-MRV). PURPOSE OF THE STUDY: To evaluate the interobserver agreement between neuro-interventionalists and radiologists with respect to the CCS in evaluation of transverse sinus stenosis in patients with idiopathic intracranial hypertension using CE-MRV. METHODS: A retrospective study was conducted on 26 consecutive patients diagnosed with IIH and underwent CE-MRV. The 2 neuro-interventionalists and 2 radiologists separately evaluated the cerebral venous sinuses using the CCS. RESULTS: The mean CCS was significantly different between the neuro-interventionalists and radiologists (p < 0.001), higher for the radiologists. The inter-rater reliability was excellent (ICC = 0.954, 95% CI: 0.898-0.979) between the 2 neuro-interventionalists, good between the 2 radiologists (ICC = 0.805, 95% CI: 0.418-0.921), but was not acceptable between the neuro-interventionalists and the radiologists (ICC 0.47 95% CI:-2.2-0.782). CONCLUSION: Despite the excellent agreement between the neuro-interventionists and the good agreement between the radiologists, there was no agreement between the neuro-interventionists and the radiologists. Our finding suggests that there is a gap between the 2 specialties but does not favor any of them. Factors related to the observers, the venous sinus system, the MRV or the CCS score may have resulted in this discrepancy. Automatic or semi-automatic feature extractions to produce quantifiable biomarkers for IIH are warranted. The clinical decisions should not depend only on strongly observer-dependent scores with training and/or experience-dependent influences.

Dynamic contrast-enhanced magnetic resonance lymphangiography of chylous leak before surgical ligation of the thoracic duct: case report.

We herein report a case of a 22-year-old male patient with an unusual presentation of recurrent chylous pericardial and pleural effusions. Lymphatic leak was suspected. Dynamic contrast-enhanced magnetic resonance lymphangiography (DC-MRL) was performed after ultrasound-guided intranodal injection of contrast through inguinal lymph nodes. DC-MRL could diagnose the presence of upper thoracic duct lymphatic leak. After open surgical ligation of the thoracic duct, the patient showed clinical improvement and pericardial and pleural effusions were cleared.

Synergistic effects of paper mill sludge and sulfonated graphene catalyst for maximizing bio-hydrogen harvesting from sugarcane bagasse de-polymerization.

In this study, hydrogen harvesting from fermentation of sugarcane bagasse (SCB) was promoted by maintaining synergism between sulfonated graphene (SGR) catalyst and paper mill sludge (PMS). The sulfonic acid (-SO3H) groups in the catalyst played a major role in destructing the ß-1,4 glycosidic bonds of sugarcane bagasse, releasing readily biodegradable sugars into the fermentation medium. The cellulose, hemicellulose, and lignin conversion efficiency were improved by 127.5%, 495.0%, and 109.2%, respectively with 20 mgSGR/gVS catalyst addition, compared with the control samples. These values were also higher than those obtained by non-sulfonated graphene catalyst. The hydrogenation of sugarcane bagasse was maximized at a sulfonated graphene catalyst dosage of 60 mgSGR/gVS, providing the highest hydrogen harvesting of 4104 ± 321 mL. This was associated with an increase of the Proteobacteria phyla up to 52.0%, Firmicutes phyla to 13.9%, and Acinetobacter sp. to 39.8% compared with only 37.0%, 11.3% and 11.1% in the control assay respectively. Moreover, sulfonated graphene catalyst supplementation promoted the acetate fermentation reaction pathway by increasing the acetate/butyrate ratio up to 4.1. Nevertheless, elevating the catalyst dosage up to 120 mgSGR/gVS reduced the hydrogen harvesting (1190 ± 92 mL) due to the release of furfural (1.76 ± 0.02 g/L) in the fermentation cultures, deteriorating the microbes' internal composition and metabolism bioactivities. Finally maximizing the hydrogen productivity from sugarcane bagasse is feasible by incorporation of paper mill sludge and sulfonated graphene catalyst at dosage not exceeding 60 mgSGR/gVS. However, investigating the recyclability and disposal of digestate containing sulfonated graphene catalyst and the associated economic feasibility needs more attention in the future.

Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema.

BACKGROUND: The goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation. METHODS: Retrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 µm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months). RESULTS: After 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030). CONCLUSIONS: Combined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.

Sulphonated graphene catalyst incorporation with sludge enhanced the microbial activities for biomethanization of crude rice straw.

Biomethanization of crude rice straw (RS) was enhanced by a coupled effectiveness of sulphonated graphene (SGR) with sludge rich anaerobes (SRA). A reduction of 19.2 ± 1.32% for cellulose, 40.8 ± 3.7% for hemicellulose and 30.8 ± 2.4% for lignin was achieved with addition of SRA after fermentation of 60 days. The abundance of hydrolytic microbes in SRA i.e. Acidobacteria, Bacteroidetes, Chloroflexi and Proteobacteria caused RS structure liquefaction and dissolution. The reduction of cellulose, hemicellulose and lignin boosted to 92.3 ± 1.5, 84.9 ± 3.5 and 97.0 ± 1.8% respectively with SGR catalyst addition of 100 mg/gVS. Reducing sugars, phenols and volatile fatty acids (VFAs) were subsequently utilized by bacteria and archaea species of Methanosphaera, Methanocella, Candidatus Methanoregula, Methanolinea and Methanosaeta. The biogas yield was 92 ± 3.1 mL/gRS and methane content amounted to 68 ± 4.6% % at SGR catalyst of 80 mg/gVS. These findings show the potential of using SRA/SGR to improve the RS fermentation with a novel application for biogas productivity.

Unraveling the metabolic shift in anaerobic digestion pathways associated with the alteration of onion skin waste concentration.

Onion skin waste (OSW) is common waste in developing countries, which can cause severe environmental pollution when not properly treated. Value-added products can be chemically extracted from OSW; however, that process is not economically feasible. Alternatively, dry anaerobic digestion (DAD) of OSW is a promising approach for both energy recovery and environment protection. The main hurdles during DAD of OSW can be the hydrolysis and acidification. In batch tests, sludge digestate (SD) rich with methanogens was co-digested with different fractions of OSW for enhancing hydrolysis and raising biogas productivity. The cumulative biogas production (CBP) was 36.6 ± 0.3 mL for sole DAD of SD (100% SD) and increased up to 281.9 ± 14.1 mL for (50% SD: 50% OSW) batch. Self-delignification of OSW took place by SD addition, where the lignin removal reached 75.3 ± 10.5% for (85% SD: 15% OSW) batch. Increasing the fraction of OSW (45% SD: 55% OSW) reduced the delignification by a value of 68.8%, where initial lignin concentration was 9.48 ± 1.6% in dry weight. Lignin breaking down resulted a high fraction of phenolic compounds (345.6 ± 58.8 mg gallic acid equivalent/g dry weight) in the fermentation medium, causing CBP drop (219.0 ± 28.5 mL). The presence of elements (K, Ca, Mg, Fe, Zn, Mn, S and P) in OSW improved the enzymatic activity, facilitated phenolic compounds degradation, shifted the metabolism towards acetate fermentation pathway, and raised biogas productivity. Acidogenesis was less affected by phenolic compounds than methanogenesis, causing higher H2 contents and lower CH4 contents, at batches with high share of OSW.

A randomized controlled study of early versus standard cannulation of arteriovenous grafts in hemodialysis patients.

OBJECTIVE: Arteriovenous grafts (AVGs) are frequently needed in hemodialysis (HD) patients with unsuitable superficial veins. First cannulation of standard arteriovenous grafts (sAVGs) still require about 2 weeks after implantation. Early cannulation arteriovenous grafts (eAVGs) were suggested to overcome this shortcoming. The present randomized study proposed to compare the clinical outcomes of sAVGs and eAVGs in HD patients. METHODS: The present single-center randomized clinical study recruited 477 HD patients indicated for AVG creation. They included 236 in the sAVG group and 241 in the eAVG group. Eligible patients were simply randomized and allocated to the studied groups using 1:1 allocation ratio. Blinding was secured using the sealed envelope technique. Enrolled patients were followed up for 12 months. The primary outcome in the present study was primary, primary assisted, and secondary patency rates at 12 months. Other outcome parameters included time to first cannulation, graft complications, and mortality. RESULTS: Comparison between the studied groups regarding the primary outcomes revealed no statistically significant differences. Primary patency rate was 65.7% and 68.0% (P = .58) at 6 months and 53.8% and 56.4% (P = .57) at 12 months in the sAVG and eAVG groups, respectively. Primary assisted patency rate was 70.8% and 69.7% (P = .8) in patients with sAVG and eAVG, whereas the reported rates at 12 months were 59.3% and 61.0% (P = .71), respectively. Secondary patency rate was 78.4% and 73.9% (P = .25) at 6 months and 67.8% and 69.7% (P = .65) at 12 months in the sAVG and eAVG groups, respectively. As expected, patients in the eAVG group experienced significantly earlier cannulation when compared with patients in the sAVG group (median, 3.0 days; range, 1.0-9.0 days vs 19.0 days; range, 15.0-22.0 days; P < .001). CONCLUSIONS: Patients in the eAVG group have comparable outcomes to those in the sAVG group at 12 months with the added advantage of earlier time to first cannulation.

Economic and environmental sustainability for anaerobic biological treatment of wastewater from paper and cardboard manufacturing industry.

The sustainable application of an up-flow anaerobic baffled reactor (UABR) to treat real paper and cardboard industrial effluent (PCIE) containing bronopol (2-bromo-2-nitropropan-1, 3-diol) was investigated. At a hydraulic retention time (HRT) of 11.7 h and a bronopol concentration of 7.0 mg L-1, the removal efficiencies of total chemical oxygen demand (CODtotal), CODsoluble, CODparticulate, total suspended solids (TSS), volatile suspended solids (VSS), carbohydrates, and proteins were 55.3 ± 5.2%, 26.8 ± 2.3%, 94.4 ± 4.6%, 89.4 ± 2.6%, 84.5 ± 3.2%, 72.1 ± 1.8%, and 22.4 ± 1.8%, respectively. The conversion of complex organics (e.g., carbohydrates and proteins) into bio-methane (CH4) was assisted via enzyme activities of, in U (100 mL)-1, α-amylase (224-270), α-xylanase (171-188), carboxymethyl cellulase (CM-cellulase) (146-187), polygalacturonase (56-126), and protease (67,000-75300). The acidogenic condition was dominant at a short HRT of 2.9 h, where methane yield dropped by 32.5%. Under this condition, the growth of methanogenic bacteria could be inhibited by volatile fatty acids (VFA) accumulation. The analysis of Fourier-transform infrared (FTIR) spectra detected peaks relevant to methylene and nitro groups in the sludge samples, suggesting that entrapment/adsorption by the sludge bed could be a major mechanism for removing bronopol. The economic feasibility of UABR, as proposed to receive 100 m3 d-1 of PCIE, showed a payback period (profits from environmental benefits, biogas recovery, and carbon credit) of 7.6 yr. The study outcomes showed a high connection to the environmental-, economic-, and social-related sustainable development goals (SDGs).

Cardiac magnetic resonance imaging in patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients. METHODS: This cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI. RESULTS: At least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities. CONCLUSION: BD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.

Strengthen "the sustainable farm" concept via efficacious conversion of farm wastes into methane.

With escalating global demand for renewable energy, exploitation of farm wastes (i.e., agriculture straw wastes (ASWs), livestock wastewater (LW) and sewage sludge (SS)) has been considered to attain maximum methane yield (MY) via anaerobic digestion (AD). Results pointed that mixture of SS and LW as anaerobes' source with 20 g of ASWs/300 mL of working volume achieved maximum MY and volatile solid (VS) removal efficiency of 0.44 (±0.05) L/gVS and 51.4 (±4.1)%, respectively. This was mainly because of emerging heavy duty bacterial species (i.e., Syntrophorhabdaceae and Synergistaceae) and archaeal community (i.e, Methanosarcina and Methanoculleus) after 70 days of anaerobic incubation. This was acquired along with boosting enzymatic activity, especially xylanase, cellulase and protease up to 71.5(±7.9), 179.3(±14.3) and 207.2(±16.2) U/100 mL, respectively. Furthermore, the digestate contained high concentrations of NH4+ (960.1±(76.8) mg/L), phosphorus (126.3±(10.1) mg/L) and trace metals, making it a good candidate as organic fertilizer.

Understanding the Aorta-Spine Relation in Idiopathic Scoliosis: Value of Noncontrast CT-Derived Curved Coronal Reformats and 3D Volume Images.

BACKGROUND: Investigating axial position and longitudinal bending of the aorta in relation to spine curvature in adolescent idiopathic scoliosis patients could help surgeons in planning of spine surgeries. METHODS: Noncontrast computed tomography (CT) scans of 27 consecutive patients with adolescent idiopathic scoliosis (19 right and 8 left curves) and 16 control subjects were retrospectively reviewed. Using semiautomated software, centerline was drawn along the descending aorta, and curved reformat was generated. Aorta tortuosity index (TI) was calculated as (centerline length/straight line distance) - 1 × 100. The spine centerline was drawn from T1 to L5, and curve index (CI) was similarly calculated. The aorta centerline angle was measured. Apical vertebral-rotation angle and multilevel aorto-vertebral angles were measured on axial CT. Three-dimensional volume-rendered images of the aorta were generated using a manual region grow function. RESULTS: Mean (± standard deviation) Cobb's angle was 63.8 ± 34.6°. The spine CI of patients (9.7 ± 7.11) was significantly higher than controls (0.28 ± 0.22), P = .00001. Aorta TI in scoliosis was significantly higher than controls (6.4 ± 7.2 versus 0.6 ± 0.5, P = .0001). The aorta centerline angle was steeper in scoliosis than controls (140 ± 26.8° versus 170 ± 3.6°). Correlations were excellent between the aorta TI and each of Cobb's angle, spine CI, and vertebral rotation angle (r = 0.851 to 0.867, all P < .001). Aorto-vertebral angles were significantly different between right scoliosis and left scoliosis patients and control groups at T6, T7, T8, L2, and L3 levels. CONCLUSIONS: Aortic curvature increases in proportion to the degree of scoliosis. The aorta follows the concavity of scoliosis in right and left curves. In the axial CT plane, the aorta in both right and left scoliosis is maximally rotated away from its normal position at T7 and is closest to its normal position at T11 to T12. CLINICAL RELEVANCE: Quantitative evaluation of aortic curvature combined with preoperative reconstructed CT images could be beneficial for surgeons in planning of spine surgeries.

The Adjunctive Value of Diffusion Weighted Imaging in Diagnosis and Follow Up of Uterovaginal Diffuse B-cell Lymphoma: A Case Report and Literature Review.

BACKGROUND: Lymphoma of the female gynecologic tract is extremely rare. Typically, lymphoma is managed nonsurgically unlike other non-lymphomatous malignant tumors raising the importance of differentiation between both entities. CASE PRESENTATION: We describe the Magnetic Resonance Imaging (MRI) features of a case of uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature regarding the diagnostic methods for female genital lymphoma. Forty-five cases, including our patient, were reviewed with an age range from 22 to 85 years. Vaginal bleeding was the most common presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45), endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45) and surgical diagnosis (8/45). Diffuse Large B-Cell Lymphomas (DLBCL) constitute the vast majority of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases (68%), while the uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy was found in 15 cases, while extra genital lymphomatous infiltration in 13 cases. Sonographic findings were nonspecific, while CT provided excellent data about extra-genital involvement. Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and parametric involvement. Diffusion restriction was reported only in one case without quantitative analysis of ADC map. CONCLUSION: MRI shows unique features that differentiate uterovaginal lymphoma from the much more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative changes.

Efficacy and safety of mirabegron versus solifenacin as additional therapy for persistent OAB symptoms after tamsulosin monotherapy in men with probable BPO.

PURPOSE: To investigate the efficacy and safety of mirabegron versus solifenacin as add-on for persistent OAB symptoms after tamsulosin monotherapy in men with probable BPO. PATIENTS AND METHODS: This prospective randomized single-blind study was conducted on patients with persistent OAB symptoms after at least 12 weeks of tamsulosin 0.4 mg. The patients were randomized into group A in which mirabegron (50 mg once daily) was added and group B in which solifenacin (5 mg once daily) was added. Before and 12 weeks after addition of either drugs, we assessed the efficacy of the treatment using the OABSS, IPSS, Q max, MVV/mic and PVR. RESULTS: Ninety two men were included in this study (46 patients in each group). All the study parameters were significantly improved after the 12-week treatment period in both groups except mean PVR which showed non-significant change in group A and a significant change in group B despite of being clinically irrelevant with only one case of acute urine retention. Overall, no significant difference has been observed between both groups after 12 weeks of treatment regarding all studied parameters except PVR. The incidence of side effects in group A was 10.9% versus 26.1% in group B. Main side effects included dry mouth in 2.2% and 8.7% and constipation in 2.2% and 6.5% in group A and B, respectively. CONCLUSION: Our results indicate that the addition of either mirabegron or solifenacin to patients with persistent OAB symptoms after tamsulosin monotherapy has significant efficacy in controlling these symptoms. The adequate balance between efficacy and tolerability reported in this study with mirabegron may result in better QOL and overall patient satisfaction if compared with antimuscarinics.

Value of Urinary Neutrophil Gelatinase-Associated Lipocalin versus Conventional Biomarkers in Predicting Response to Treatment of Active Lupus Nephritis.

INTRODUCTION: Lupus nephritis (LN) affects almost two-thirds of systemic lupus erythematosus (SLE) patients. Despite initial aggressive therapy, up to 25% of patients with LN will progress to permanent renal damage. Conventional serum markers for LN lack the sensitivity of an ideal biomarker. Urinary neutrophil gelatinase-associated lipocalin (UNGAL) is an excellent biomarker for early diagnosis of acute kidney injury and predicting renal outcomes. OBJECTIVE: To measure UNGAL among LN patients to correlate its levels with renal disease activity and to investigate its predictive performance in response to induction therapy. Patients and Methods. 40 SLE patients with biopsy-proven LN class III, IV, or V were randomly selected. The study was conducted in the internal medicine department and outpatient clinic in Ain Shams University Hospitals and completed after six months. UNGAL was measured at baseline, three-month follow-up, and after complete induction therapy. RESULTS: In LN patients at baseline, the mean serum creatinine was 2.57 ± 0.96 mg/dL and the mean UNGAL was 33.50 ± 18.34 ng/dL. Mean UNGAL levels of complete response, partial response, and nonresponse groups were 14.48 ± 2.99 ng/mL, 34.49 ± 4.09 ng/mL, and 62.07 ± 14.44 ng/mL, respectively. Based on the ROC curve, we found a better performance of baseline UNGAL to discriminate the complete response group from partial and nonresponse groups to predict response to induction, outperforming conventional biomarkers. The area under the curve was 0.943, and the best cutoff level was 26.5 ng/mL (92.31% sensitivity and 88.89% specificity). CONCLUSION: UNGAL performed better than conventional biomarkers in predicting response to treatment of active LN.

Robustness of anaerobes exposed to cyanuric acid contaminated wastewater and achieving efficient removal via optimized co-digestion scheme.

The impact of various industrial pollutants on anaerobes and the biodegradation potentials need much emphasis. This study aims to investigate the response of anaerobic microbial systems to cyanuric acid (CA) exposure; CA is toxic and possible carcinogen. First, the long-term exposure of mixed culture bacteria (i.e., municipal sludge) to low-strength wastewater containing 20 mg/L CA was conducted in an up-flow anaerobic staged reactor. Stable performance and sludge granulation were observed, and the microbial community structure showed the progression of genus Acinetobacter known as CA degrader. Second, batch-mode experiment was performed to examine the CA biodegradability at higher doses (up to 250 mg/L of CA) in the absence and presence of glucose as a co-substrate; response surface-based optimization was used to design this experiment and to estimate the optimum CA-glucose combination. CA removal of 77-98% was achieved when CA was co-digested with glucose (250-1,000 mg/L), after 7 days-incubation at temperature of 37 °C, compared to 34% when CA was solely digested. Further, the obtained methane yield dropped when CA exceeded over 125 mg/L, though the deterioration was mitigated by addition of higher concentration of glucose. Overall, we conclude that CA is efficiently degraded under anaerobic conditions when being co-digested with readily assimilable substrate.

Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center Observational Study.

Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.