The indication of fusion to the pelvis in neuromuscular scoliosis is based on the underlying disease rather than on pelvic obliquity.

INTRODUCTION: The decision to instrument to L5 or ilium, in NMS, is usually based on radiologic factors, including pelvic obliquity (PO) > 15°, apex of curvature < L3, and Cobb angle > 60°. Since scoliosis in these patients is caused by a neurologic disease, we based our decision to stop at L5 on the presence of spasticity or flaccidity. PATIENTS & METHODS: The senior author did 109 primary fusions in NMS. Of those with DMD or SMA only 16% were instrumented to the ilium. The main factor for our decision was the correction potential of the truncal shift and PO in the supine traction radiographs and the absence of severe spasticity. RESULTS: The 57 patients with DMD/SMA had a mean preoperative curvature of 68°, PO of 17°, and truncal shift of 20°. 74% should have been instrumented to the pelvis, but only 16% were. Those instrumented shorter as the rule, were corrected from 74° to 26° and had a postoperative PO of 8°. There was no significant difference in postoperative correction and PO compared to those instrumented to L5 on standard protocol. Subsequent extension to the pelvis was needed in 1 CP patient. There were no significant changes after 2 years. Of the 20 patients instrumented to the pelvis 11 had cerebral palsy and a preop curvature of 89°, a PO of 21° and a truncal shift of 25°. DISCUSSION: The decision on instrumentation length should take flexibility and disease into consideration. If the trunk is centred over the pelvis, deterioration will not occur in absence of spasticity.

Planning universal accessibility to public health care in sub-Saharan Africa.

Achieving universal health care coverage-a key target of the United Nations Sustainable Development Goal number 3-requires accessibility to health care services for all. Currently, in sub-Saharan Africa, at least one-sixth of the population lives more than 2 h away from a public hospital, and one in eight people is no less than 1 h away from the nearest health center. We combine high-resolution data on the location of different typologies of public health care facilities [J. Maina et al., Sci. Data 6, 134 (2019)] with population distribution maps and terrain-specific accessibility algorithms to develop a multiobjective geographic information system framework for assessing the optimal allocation of new health care facilities and assessing hospitals expansion requirements. The proposed methodology ensures universal accessibility to public health care services within prespecified travel times while guaranteeing sufficient available hospital beds. Our analysis suggests that to meet commonly accepted universal health care accessibility targets, sub-Saharan African countries will need to build ∼6,200 new facilities by 2030. We also estimate that about 2.5 million new hospital beds need to be allocated between new facilities and ∼1,100 existing structures that require expansion or densification. Optimized location, type, and capacity of each facility can be explored in an interactive dashboard. Our methodology and the results of our analysis can inform local policy makers in their assessment and prioritization of health care infrastructure. This is particularly relevant to tackle health care accessibility inequality, which is not only prominent within and between countries of sub-Saharan Africa but also, relative to the level of service provided by health care facilities.

Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study.

BACKGROUND: Patients with diabetic kidney disease (DKD) are at increased risk to develop post-contrast acute kidney injury (AKI). Diabetic patients under dipeptidyl peptidase 4 inhibitors (DPP4Is) experience a lower propensity to develop AKI. We speculated that linagliptin as a single agent or in combination with allopurinol may reduce the incidence of post-contrast AKI in stage 3-5 chronic kidney disease (CKD) patients with underlying DKD. METHODS: Out of 951 DKD patients eligible for this study, 800 accepted to sign informed consent. They were randomly allocated to 4 equal groups that received their prophylaxis for 2 days before and after radiocontrast. The first control group received N-acetyl cysteine and saline, the 2nd received allopurinol, the 3rd group received linagliptin, and the 4th received both allopurinol and linagliptin. Post-procedure follow-up for kidney functions was conducted for 2 weeks in all patients. RESULTS: 20, 19, 14, and 8 patients developed post-contrast AKI in groups 1 through 4, respectively. Neither linagliptin nor allopurinol was superior to N-acetyl cysteine and saline alone. However, the combination of the two agents provided statistically significant renal protection: post-contrast AKI in group 4 was significantly lower than in groups 1 and 2 (p < 0.02 and <0.03, respectively). None of the post-contrast AKI cases required dialysis. CONCLUSION: Linagliptin and allopurinol in combination may offer protection against post-contrast AKI in DKD exposed to radiocontrast. Further studies are needed to support this view. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT03470454.

EI-GC-MS analysis and antidiabetic activity of Pedalium murex seed oil.

The pulverized manifestation of Pedalium murex seeds, excerpted by Soxhlets apparatus after treating with n-hexane. Oil sample was well scrutinized by EI-GC-MS, utilizing the full scan technique within mass ranges lies from 40-700 m/z. 73compounds were recognized among them, 63 compounds were identified and 10 were marked as unidentified (8, 22, 27, 43, 47, 61, 62, 64, 68 and 69). The method was executed by the conventional system of Mass spectroscopy and the data interpreted by considerable match factor ≥95 inspected by NIST library. Antidiabetic activity was carried out by Accu-Chek glucometer. Healthy albino mice were selected to perform antidiabetic activity of seed oil at 100mg/Kg and 200mg/Kg with a standard drug glibenclamide at 5mg/Kg. Antidiabetic activity was observed on 1st, 7th,14th, 21th,27th and 30th days. Statistical calculations and significant outcomes were obtained by One-way and Two-way analysis of variance, followed by Tuckey's test. The phytochemical n-hexadecanoic acid (19.53%) might be responsible for antidiabetic activity of the seed oil.

Derotation screws provide no advantage over polyaxial screws regarding coronal & sagittal correction in thoracic curves of AIS patients.

PURPOSE: We compared two techniques for thoracic apical derotation; one using conventional reduction screws (Single-Innie-SI) and one requiring special derotation screws that can be converted to monoaxial screws to enhance dorotation (Dual-Innie-DI) for coronal and sagittal correction and. METHODS: A total of 200 patients with thoracic AIS have been included. In the SI-Group (n = 127) the convex rod was applied first. Vertebral derotation was done by translation to the concave rod with the convex rod being in place and center of rotation (COR). In the DI-Group (n = 73) correction started with translation on the concave side as well but now followed by derotation around the concave rod using the DI-mechanism. RESULTS: The mean rotation according to Raimondi and coronal correction was not sig. affected (72 (± 12) % in the SI-Group versus 68 (± 15) % in the DI-Group), even when flexibility was respected (Cincinnati Correction Index CCI was 2.9 (± 4.9) versus 3.5 (± 4.4). (p < 0.01). The gain of kyphosis was sig greater (2.7°) in the SI-group, but not clinical relevant. CONCLUSION: The use of DI screws for apical derotation did not provide an advantage for coronal correction or derotation in thoracic curves. Presumably after translation is performed in the DI-group, there was too much tension and friction in the construct impeding further derotation. Simultaneous translation and derotation in the SI-group, with the convex rod being the COR, yielded similar correction with better kyphosis and was faster and more economic.

Occurrence, Phenotypic and Molecular Characteristics of Vancomycin-Resistant Enterococci Isolated from Retail Raw Milk in Egypt.

The aim of this study was to determine the occurrence, phenotypic and molecular characteristics of vancomycin-resistant enterococci (VRE), isolated from retail raw cow's milk. One hundred milk samples collected from retail shops in Egypt were examined for the occurrence of VRE by using kanamycin aesculin azide agar supplemented with 4 µg/mL vancomycin. PCR was conducted to determine enterococcal species and to screen the isolated strains for the presence of antibiotic resistance and virulence genes. All isolated strains were characterized by antimicrobial susceptibility testing for 12 antibiotics. From 24 samples (24%), we recovered 22 isolates (91.6%) classified as VRE (minimum inhibitory concentration ≥32) and 2 isolates (8.3%) classified as intermediate resistant to vancomycin (≤16). Enterococcus faecium (29.1%), Enterococcus faecalis (12.5%), Enterococcus casseliflavus (16.6%), and Enterococcus gallinarum (4.1%) were identified by using multiplex PCR. The genus Enterococcus was resistant to clindamycin (100%), linezolid (91.6%), teicoplanin (91.6%), erythromycin (87.5%), and tetracycline (29.1%). Co-resistance to vancomycin, teicoplanin, and linezolid was detected in 83.3% of isolates. Antibiotic resistance genes vanB, tet(M), tet(L), and erm(B) were identified in 29.1%, 16.6%, 8.3%, and 4.1% of isolates, respectively. Virulence genes gelE and esp were detected in 16.6% and 12.5% of isolates, respectively. In conclusion, the high occurrence of co-resistance to vancomycin, teicoplanin, and linezolid reported in this study is alarming. The high frequency of linezolid resistance prompts increased the attention of researchers to routinely perform linezolid susceptibility in food isolates. This study declares potential food safety risks from consumption and improper handling of raw milk regarding clinically important bacteria and promotes necessary legislation for forbidding the selling and consumption of retail raw milk.

Remote Sensing Methods for Flood Prediction: A Review.

Floods are a major cause of loss of lives, destruction of infrastructure, and massive damage to a country's economy. Floods, being natural disasters, cannot be prevented completely; therefore, precautionary measures must be taken by the government, concerned organizations such as the United Nations Office for Disaster Risk Reduction and Office for the coordination of Human Affairs, and the community to control its disastrous effects. To minimize hazards and to provide an emergency response at the time of natural calamity, various measures must be taken by the disaster management authorities before the flood incident. This involves the use of the latest cutting-edge technologies which predict the occurrence of disaster as early as possible such that proper response strategies can be adopted before the disaster. Floods are uncertain depending on several climatic and environmental factors, and therefore are difficult to predict. Hence, improvement in the adoption of the latest technology to move towards automated disaster prediction and forecasting is a must. This study reviews the adoption of remote sensing methods for predicting floods and thus focuses on the pre-disaster phase of the disaster management process for the past 20 years. A classification framework is presented which classifies the remote sensing technologies being used for flood prediction into three types, which are: multispectral, radar, and light detection and ranging (LIDAR). Further categorization is performed based on the method used for data analysis. The technologies are examined based on their relevance to flood prediction, flood risk assessment, and hazard analysis. Some gaps and limitations present in each of the reviewed technologies have been identified. A flood prediction and extent mapping model are then proposed to overcome the current gaps. The compiled results demonstrate the state of each technology's practice and usage in flood prediction.

Metabolic Complications in Liver Transplantation Recipients: How We Can Optimize Long-Term Survival.

Liver transplantation (LT) recipients have experienced a significant improvement in short-term survival during the past 3 decades attributed to advancements in surgical techniques, perioperative management, and effective immunosuppressive regimens. However, long-term survival is affected by a high incidence of metabolic disorders and their consequences, including cardiovascular disease (CVD) and malignancies. Pretransplant metabolic impairments especially in those with nonalcoholic steatohepatitis cirrhosis are aggravated by the addition of posttransplant weight gain, physical inactivity, and reversal from catabolic to anabolic state. Moreover, although immunosuppressants are vital to avoid graft rejection, long-term exposure to these medications is implicated in metabolic impairments after LT. In this review, we summarize the molecular pathogenesis of different metabolic disorders after LT, including diabetes mellitus, dyslipidemia, and nonalcoholic fatty liver disease. Furthermore, CVD, malignancies, and graft rejections were provided as significant complications of post-LT metabolic conditions threatening both the patient and graft survival. Ultimately, emerging preventive and treatment strategies for posttransplant diabetes mellitus are summarized. This review highlights the significant need for more clinical trials of antihyperglycemic agents in LT recipients. Also, translational studies will help us to better understand the molecular and genetic factors underlying these metabolic complications and could lead to more personalized management in this high-risk population.

Combined proteomic/transcriptomic signature of recurrence post-liver transplantation for hepatocellular carcinoma beyond Milan.

BACKGROUND AND AIMS: Liver transplantation (LT) can be offered to patients with Hepatocellular carcinoma (HCC) beyond Milan criteria. However, there are currently limited molecular markers on HCC explant histology to predict recurrence, which arises in up to 20% of LT recipients. The goal of our study was to derive a combined proteomic/transcriptomic signature on HCC explant predictive of recurrence post-transplant using unbiased, high-throughput approaches. METHODS: Patients who received a LT for HCC beyond Milan criteria in the context of hepatitis B cirrhosis were identified. Tumor explants from patients with post-transplant HCC recurrence (N = 7) versus those without recurrence (N = 4) were analyzed by mass spectrometry and gene expression array. Univariate analysis was used to generate a combined proteomic/transcriptomic signature linked to recurrence. Significantly predictive genes and proteins were verified and internally validated by immunoblotting and immunohistochemistry. RESULTS: Seventy-nine proteins and 636 genes were significantly differentially expressed in HCC tumors with subsequent recurrence (p < 0.05). Univariate survival analysis identified Aldehyde Dehydrogenase 1 Family Member A1 (ALDH1A1) gene (HR = 0.084, 95%CI 0.01-0.68, p = 0.0152), ALDH1A1 protein (HR = 0.039, 95%CI 0.16-0.91, p = 0.03), Galectin 3 Binding Protein (LGALS3BP) gene (HR = 7.14, 95%CI 1.20-432.96, p = 0.03), LGALS3BP protein (HR = 2.6, 95%CI 1.1-6.1, p = 0.036), Galectin 3 (LGALS3) gene (HR = 2.89, 95%CI 1.01-8.3, p = 0.049) and LGALS3 protein (HR = 2.6, 95%CI 1.2-5.5, p = 0.015) as key dysregulated analytes in recurrent HCC. In concordance with our proteome findings, HCC recurrence was linked to decreased ALDH1A1 and increased LGALS3 protein expression by Western Blot. LGALS3BP protein expression was validated in 29 independent HCC samples. CONCLUSIONS: Significantly increased LGALS3 and LGALS3BP gene and protein expression on explant were associated with post-transplant recurrence, whereas increased ALDH1A1 was associated with absence of recurrence in patients transplanted for HCC beyond Milan criteria. This combined proteomic/transcriptomic signature could help in predicting HCC recurrence risk and guide post-transplant surveillance.

Transcriptome analysis of potential candidate genes and molecular pathways in colitis-associated colorectal cancer of Mkp-1-deficient mice.

BACKGROUND: The nuclear phosphatase mitogen-activate protein kinase phosphatase-1 (MKP-1) is a key negative regulator of the innate immune response through the regulation of the biosynthesis of proinflammatory cytokines. In colorectal cancer (CRC), which is induced mainly by chronic inflammation, Mkp-1 overexpression was found in addition to disturbances in Mkp-1 functions, which may play a role in cancer development in different types of tumors. However, the potential molecular mechanisms by which Mkp-1 influences CRC development is not clear. Here, we performed global gene expression profiling of Mkp-1 KO mice using RNA sequencing (RNA-seq) to explore the role of Mkp-1 in CRC progression using transcriptome analysis. METHODS: Azoxymethane/dextran sodium sulfate (AOM/DSS) mouse models were used to examine the most dramatic molecular and signaling changes that occur during different phases of CRC development in wild-type mice and Mkp-1 KO mice. Comprehensive bioinformatics analyses were used to elucidate the molecular processes regulated by Mkp-1. Differentially expressed genes (DEGs) were identified and functionally analyzed by Gene Ontology (GO), Kyoto Enrichment of Genes and Genomes (KEGG). Then, protein-protein interaction (PPI) network analysis was conducted using the STRING database and Cytoscape software. RESULTS: Persistent DEGs were different in adenoma and carcinoma stage (238 & 251, respectively) and in WT and MKp-1 KO mice (221& 196, respectively). Mkp-1 KO modulated key molecular processes typically activated in cancer, in particular, cell adhesion, ion transport, extracellular matrix organization, response to drug, response to hypoxia, and response to toxic substance. It was obvious that these pathways are closely associated with cancer development and metastasis. From the PPI network analyses, nine hub genes associated with CRC were identified. CONCLUSION: These findings suggest that MKp-1 and its hub genes may play a critical role in cancer development, prognosis, and determining treatment outcomes. We provide clues to build a potential link between Mkp-1 and colitis-associated tumorigenesis and identify areas requiring further investigation.

Artificial intelligence facilitates decision-making in the treatment of lumbar disc herniations.

PURPOSE: Apart from patients with severe neurological deficits, it is not clear whether surgical or conservative treatment of lumbar disc herniations is superior for the individual patient. We investigated whether deep learning techniques can predict the outcome of patients with lumbar disc herniation after 6 months of treatment. METHODS: The data of 60 patients were used to train and test a deep learning algorithm with the aim to achieve an accurate prediction of the ODI 6 months after surgery or the start of conservative therapy. We developed an algorithm that predicts the ODI of 6 randomly selected test patients in tenfold cross-validation. RESULTS: A 100% accurate prediction of an ODI range could be achieved by dividing the ODI scale into 12% sections. A maximum absolute difference of only 3.4% between individually predicted and actual ODI after 6 months of a given therapy was achieved with our most powerful model. The application of artificial intelligence as shown in this work also allowed to compare the actual patient values after 6 months with the prediction for the alternative therapy, showing deviations up to 18.8%. CONCLUSION: Deep learning in the supervised form applied here can identify patients at an early stage who would benefit from conservative therapy, and on the contrary avoid painful and unnecessary delays for patients who would profit from surgical therapy. In addition, this approach can be used in many other areas of medicine as an effective tool for decision-making when choosing between opposing treatment options, despite small patient groups.

Toxigenic Potential of Bacillus cereus Strains Isolated from Retail Dairy Products in Egypt.

Little is known about the virulence in Bacillus cereus strains isolated from retail dairy products in the Middle East and particularly from Egypt. In this study, the occurrence of B. cereus in 290 samples of dairy products (raw milk, Ras cheese, pasteurized extended shelf life [ESL] milk) collected from retail shops was investigated. The potential of 126 selected isolates of B. cereus to possess genes encoding nonhemolytic enterotoxin, hemolysin BL, and cytotoxin K (cytK), and to grow at 7°C was verified. The highest occurrence of B. cereus was found in raw milk (85%, 85/100) followed by Ras cheese (10%, 10/100) and ESL milk samples (8.8%, 8/90). A large proportion of the B. cereus isolates from raw milk (48.9%, 48/99) and Ras cheese (71.4%, 10/14) had at least one complete set of toxin genes (nhe or hbl). Enterotoxin genes, nheA, nheB, nheC, hblA, hblD, and hblC, were detected in 38.4% (5/13), 53.8% (7/13), 61.5% (8/13), 46.1% (6/13), 46.1% (6/13), and 23.1% (3/13) of ESL milk isolates, respectively. cytK was identified in 42.4% (42/99), 50% (7/14), and 46.2% (6/13) of raw milk, Ras cheese, and ESL milk isolates, respectively. The psychrotrophic ability was observed in 22.2% and 15.3% of isolates recovered from raw milk and ESL milk, respectively. The toxigenic potential of B. cereus strains described in this study may pose a health risk to the consumer and, therefore, the presence of these bacteria in retail dairy products should be monitored to ensure consumers' safety.

Economic Analysis of Adjuvant Chemoradiotherapy Compared with Chemotherapy in Resected Pancreas Cancer.

BACKGROUND: Population-based survival and costs of pancreas adenocarcinoma patients receiving adjuvant chemoradiation and chemotherapy following pancreaticoduodenectomy are poorly understood. METHODS: This retrospective cohort study used linked administrative and pathological datasets to identify all patients diagnosed with pancreas adenocarcinoma and undergoing pancreaticoduodenectomy in Ontario between April 2004 and March 2014, who received postoperative chemoradiation or chemotherapy. Stage and margin status were defined by using pathology reports. Kaplan-Meier and Cox proportional hazards regression survival analyses were used to determine associations between adjuvant treatment approach and survival, while stratifying by margin status. Median overall health system costs were calculated at 1 and 3 years for chemoradiation and chemotherapy, and differences were tested using the Kruskal-Wallis test. RESULTS: Among 709 patients undergoing pancreaticoduodenectomy for pancreas cancer during the study period, the median survival was 21 months. Median survival was 19 months for chemoradiation and 22 months for chemotherapy. Patients receiving chemoradiation were more likely to have positive margins: 47.7% compared with 19.2% in chemotherapy. After stratifying by margin status and controlling for confounders, adjusted hazard ratio of death were not statistically different between chemotherapy and chemoradiation [margin positive, hazard ratio (HR) = 0.99, 95% confidence interval (CI) = 0.88-1.27; margin negative, HR 0.95, 95% CI 0.91-1.18]. Overall 1-year health system costs were significantly higher for chemoradiation (USD $70,047) than chemotherapy (USD $54,005) (p ≤ 0.001). CONCLUSIONS: Chemotherapy and chemoradiation yielded similar survival, but chemoradiation resulted in higher costs. To create more sustainable healthcare systems, both the efficacy and costs of therapies should be considered.

Symptom trajectories and predictors of severe symptoms in pancreatic adenocarcinoma at the end-of-life: a population based analysis of 2,538 patients.

BACKGROUND: We evaluated symptom trajectories and predictors of reporting severe symptoms in the last 6 months of life among non-resected pancreatic adenocarcinoma (PAC) decedents. METHODS: A retrospective cohort study of non-resected PAC decedents receiving care at regional cancer centres between January 2007 and December 2015. Symptoms were measured using the Edmonton Symptom Assessment System (ESAS). We described the proportion of patients reporting severe (score ≥7) symptoms by 2-week intervals during the six months prior to death. Multivariable modified Poisson regression models identified predictors of reporting severe symptom scores in the last 6 months of life. RESULTS: 2538 non-resected PAC decedents treated at regional cancer centres had ≥1 symptom ESAS record in the last six months of life, totaling 10,893 unique symptom assessments. Tiredness was the most commonly reported symptom (59% reporting ≥1 severe score), followed by lack of appetite (57%), impaired-wellbeing (49%) and drowsiness (42%). All symptoms increased closer to death. Older age, female sex, higher comorbidity status, survival less than 6 months, and urban residence were associated with a significantly higher risk of reporting severe symptoms. CONCLUSION: Non-resected PAC patients experience significant symptom burden nearing death. Patient subsets may benefit from personalized supportive care interventions.

The Impact of Preoperative Hemoglobin Level on the Short-Term Outcomes After Living Donor Liver Transplantation.

BACKGROUND: Preoperative anemia was reportedly associated with increased morbidity and mortality after various types of surgeries. However, its impact on the outcomes after liver transplantation has not been thoroughly investigated. METHODS: We retrospectively investigated the clinical outcome of 216 consecutive adult patients who underwent living donor liver transplantation at our institute between January 2010 and June 2017 and stratified them according to the hemoglobin level before transplant. Risk factors for 90-day patient mortality, especially infection-related mortality and early graft loss, were evaluated. RESULTS: We found that patients with preoperative hemoglobin below 10 g/dl required more intraoperative packed red blood cell transfusions (p = 0.002) and had significantly higher early 90-day postoperative mortality rate (p = 0.007), particularly infection-related mortality (p = 0.002), lower overall graft, and patient survival rates (p = 0.007, p = 0.013, respectively). Preoperative hemoglobin below 10 g/dl was an independent risk factor for increased post-transplant 90-day patient mortality (OR 2.92, p = 0.02), infection-related mortality (OR 6.81, p = 0.02), and early graft loss (OR 3.26, p = 0.01). CONCLUSION: Preoperative hemoglobin level below 10 g/dl is associated with poorer short-term outcomes after liver transplantation and should be corrected preoperatively if possible through safe and effective treatment modalities.

Size controlled ultrafine CeO2 nanoparticles produced by the microwave assisted route and their antimicrobial activity.

Cerium oxide (CeO2) nanoparticles (NPs) have a wide range of biological and biomedical applications. This work describes a new methodology for producing ultrafine, highly uniform NPs with controlled sizes using the chemical microwave assisted route. The size of CeO2-NPs decreased from 10 to 5 nm by increasing the molar ratio of cerium nitrate Ce(NO3)3.(6H2O) to that of hexamethylenetetramine (C6H12N) from 1:20 to 20:20. Detailed information about their structural characterization was obtained from the XRD, UV-visible, photoluminescence, Raman spectroscopy, SEM, TEM and AFM. These CeO2-NPs were tested as antimicrobial agent against Gram-negative (Escherichia.coli), Gram-positive (Bacillus.subtilis) bacteria and yeast (Saccharomyces cerevisiae). The obtained results showed significant inhibition of these strain even at low concentration of CeO2-NPs. The CeO2-NPs with the molar ratio 5:20 had the most effective inhibition against E.coli (~70%) at a concentration of 20 µL. The CeO2-NPs with the ratio 12:20 were found to be the most effective against B.subtilis (inhibition ~68%). On the other hand, CeO2-NPs synthesized with the 20:20 molar ratio caused the highest inhibition for S. cerevisiae (~60%). It is observed that at higher NPs concentration (i.e., >20 µL) the inhibition of these strains decreased. The antimicrobial activity may be attributed to the penetrating power of CeO2-NPs size beside the generated oxygen species radicals that caused inhibition of bacterial growth.

Nicotine consumption may lead to aseptic loosening in proximal mega-prosthetic femoral replacement.

BACKGROUND: Aseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement. MATERIALS AND METHODS: A consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic. RESULTS: Twenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher's exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003). CONCLUSIONS: Smoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement. LEVEL OF EVIDENCE: Level 4 according to Oxford Centre of Evidence-Based Medicine 2011.

Muscle Steatosis is an Independent Predictor of Postoperative Complications in Patients with Hepatocellular Carcinoma.

BACKGROUND: Skeletal muscle depletion, referred to as sarcopenia, has been shown to be an independent predictor of lower disease-free and overall survivals in various kinds of diseases. The quality of skeletal muscle has recently attracted much attention as a new parameter of sarcopenia, but its impact on surgical complications is still unknown. METHODS: A retrospective analysis of 492 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) in our institution between April 2005 and December 2014 was performed. The quality of skeletal muscle was evaluated by intramuscular adipose tissue content (IMAC) using preoperative CT imaging at the umbilical level. The impact of sarcopenia on postoperative complications and the predictors of surgical complications after hepatectomy for HCC were analyzed. RESULTS: Patients with high IMAC were older and had higher body mass index, higher indocyanine green retention test at 15 min, and more operative blood loss. Among 492 patients, 108 (22 %) patients had major postoperative complications (Clavien grade ≥ III), and infectious complications were found in 74 (15 %) patients. Twelve (2 %) patients died from postoperative complications. On multivariate analysis, preoperative high IMAC was an independent risk factor for increased major postoperative complications [odds ratio (OR) 1.580; P = 0.049] and infectious complications (OR 1.903; P = 0.021). CONCLUSIONS: Preoperative muscle steatosis evaluated with IMAC was closely correlated with increased postoperative complications, especially infectious complications. The preoperative nutritional intervention and rehabilitation might lead to the improvement of postoperative outcomes after hepatectomy for HCC.

Liver transplantation for advanced hepatocellular carcinoma in patients with Child-Pugh A and B.

PURPOSE: To investigate the outcomes of living donor liver transplantation for advanced hepatocellular carcinoma in Child-Pugh A/B patients and the usefulness of our expanded selection criteria, the Kyoto criteria. METHODS: A total of 82 recipients with a Child-Pugh class A (n = 27) or B (n = 55) status having either multiple hepatic nodules or solitary tumors ≥5 cm in size treated between February 1999 and August 2012 were enrolled in this study. RESULTS: The overall recurrence rate was significantly less for the Child-Pugh B patients than for the Child-Pugh A patients (P = 0.042), while the survival rates did not differ. In the Child-Pugh A and B patients, the survival rate was significantly greater, while the recurrence rate was lower among the patients meeting the Kyoto criteria than those exceeding these criteria (P = 0.006, P = 0.001, P = 0.032 and P < 0.001, respectively). In the Child-Pugh B patients, the overall survival and recurrence rates did not differ between the patients treated with and without pretreatment for hepatocellular carcinoma. In the Child-Pugh B patients treated with pretreatment, the overall survival rate was significantly greater, while the recurrence rate was lower among the patients meeting the Kyoto criteria than those exceeding these criteria (P < 0.001, P < 0.001, respectively). CONCLUSIONS: Living donor liver transplantation performed within the Kyoto criteria achieves excellent overall survival and recurrence rates, especially for Child-Pugh B patients, even those with advanced hepatocellular carcinoma.

Levels of pesticides residues in the White Nile water in the Sudan.

Twenty-two commonly used pesticides were monitored during autumn, winter, and summer of 2004-2005 in 27 water samples from three sites along the White Nile in Sudan (former Sudan). Sites were selected to reflect pesticides gathered from drainage canals in central Sudan and from upstream sources. Collected samples were extracted and subjected to gas chromatographic analysis. Pesticides levels were measured in nanograms per liter. Pesticides residues were detected in 96 % of the samples with a total residue burden of 4132.6 ng L(-1), and an overall mean concentration and range of 50.99 and not detected-1570 ng L(-1), respectively. Ororganochlorines were the most frequently detected contaminants, which were found in 70 % of the samples, causing a total burden of 2852.8 ng L(-1), followed by pyrethroids 15 % of the samples, with a total burden of 926.5 ng L(-1). The tested herbicides were detected in ˂4 % of the samples with a total burden of 353.3 ng L(-1), while organophosphorus levels were below the detection limit. The most frequent contaminants were the following: heptachlor and its epoxide (52 % of samples), followed by DDTs (dichlorodiphenyltrichloroethanes) (DDT and DDE, in 19 % of the samples), cypermethrin and fenvalerate (in 11 % of the samples), and pendimethalin (in <4 % of the samples). Residues of hexachlorocyclohexane (HCH) isomers (α, ß, γ and δ), endosulfan (α and ß), p, p-DDD, λ cyhalothrin, deltamethrin, and oxyfluorfen were not detected in the analyzed samples. Generally, levels were least in autumn, and followed by summer and winter. Sources of contamination might include agricultural lands in central Sudan and upstream sources. Both recent and old contaminations were indicated.