Case series report: radiation-induced oropharyngeal carcinoma.

The incidence of radiation-induced secondary primary tumors (SPTs) is estimated to be between 1 and 20%. The oropharynx is not a common site for postradiotherapy head and neck SPTs. We describe the cases of eight patients, each with an SPT of the oropharynx. These developed after a long median latency of 17.7 years with each receiving two-dimensional radiation therapy and delivery of at least 5000 cGy per pharynx, except for one who was treated with IMRT. Tumor histological commonalities revealed squamous cell carcinoma p16 negative staining, local invasion, and limited lymphatic spread, with posterior wall of the oropharynx and the base of the tongue being the most common locations. Limited and challenging treatment options have been reported such as surgery, reirradiation, or clinical trials. Radiation-induced SP oropharyngeal carcinoma has unique clinical and pathological features. Patients with this disease have limited treatment options, which should be discussed in a multidisciplinary tumor board meeting. For this population, lifelong follow-up may help in early diagnosis and improve outcomes.

Mini-HoLEP (MILEP) vs HoLEP: a propensity score-matched analysis.

BACKGROUND AND PURPOSE: Minimal invasiveness improves outcome in many surgical fields including urology. We aimed to assess intraoperative performance and clinical outcome of miniaturized holmium laser enucleation of prostate (MiLEP) (22FR). METHODS: We ran a propensity score-matched analysis among all consecutive laser enucleations of prostate performed between 9/2022 and 2/2023. It resulted in two matched comparison groups: MiLEP 22 FR (n = 40) and holmium laser enucleation of prostate (HoLEP 26 Fr) (n = 40). Statistical analysis was performed. RESULTS: MiLEP was associated with significantly less intraoperative irrigation (20.5 L vs 15 L, p = 0.002E-3), less decrease in body core temperature (0.6°C vs 0.1°C, p = 0.003E-5), and less need for meatal dilation (25% vs 78%, p = 0.01E-3). These parameters were identified as being independent in the multivariate analysis. There was a trend toward less and a shorter period of postoperative stress incontinence (SI) for the MiLEP group compared to the HoLEP group: 15% and 42% (p = 0.01) at 1 month, 8% and 14% (p = 0.07) at 2 months, and 0 and 0.3% (p = 1) at 3 months, respectively. There were no differences in prostatic enucleation effectiveness, operative time, hospital stay, complications, and improvement in the international prostate symptom score and quality of life score. CONCLUSIONS: MiLEP is feasible and provides better maintenance of body core temperature, reduction in amount of fluid irrigation, and decrease in need for meatal dilation without affecting effectiveness in comparison with HoLEP. MiLEP may reduce early postoperative stress incontinence, thereby shortening the recovery period.

En bloc holmium laser enucleation of prostate in octogenarians and nonagenarians: clinical characteristics and outcome.

Extended longevity leads to greater numbers of elderly patients with benign prostatic hyperplasia (BPH) who seek surgical solutions. We assessed the clinical characteristics and outcomes of octogenarians and nonagenarians with BPH who underwent en bloc holmium laser enucleation of prostate (HoLEP). Retrospective cohort of all consecutive HoLEP patients treated in our medical center between January 2020 and January 2023. Cohort was divided into group aged < 80 years (n = 290) and group aged ≥ 80 years (n = 77). Their demographics, presentations, indications, and outcomes were compared. Octogenarians and nonagenarians had higher rates of indwelling catheters (p = 0.00001), chronic retention (p = 0.00006), larger prostates (p = 0.03), higher American Anesthesiology Association scores (p = 0.000001), and more antiplatelet medications (p = 0.0003) at presentation. They had longer operations (median 115 vs 90 min, respectively, p = 0.0008), longer hospital stay (median 2 vs 1 day, p = 0.01E-7), a higher complication rate (17% vs 7%, p = 0.02), and a higher transitory urinary incontinence (TUI) rate (54% vs 9%, p = 0.00001). TUI was more prevalent in the older group with indwelling catheters (61% vs, 13%, p = 0.00001). The functional outcome was similar for both age groups, and all patients could void spontaneously after the procedure. En-bloc HoLEP improves urinary symptoms and quality of life in patients ≥ 80 years of age despite larger prostates, more comorbidities, and higher complications rate, compared to younger men. HoLEP bestows a significant improvement in urologic quality of life regardless of age.

Case report: ado-trastuzumab as second-line treatment in HER2 positive salivary duct carcinoma.

The objective of this report is to present the use and efficacy of ado-trastuzumab as an advanced line of therapy in salivary duct carcinoma (SDC) patient. An 84-year-old gentleman diagnosed with metastatic salivary duct tumor harboring overexpressed human epidermal growth factor receptor-2 has gone through resection surgery. The first line of treatment included initial doublet chemotherapy combined with trastuzumab, which was continued later as maintenance. PET-CT follow-up for 4 years has demonstrated no evidence of disease. However, upon recurrence, use of Ado-trastuzumab emtansine was prompted as second-line of treatment. This targeted patient-tailored therapy has accomplished a complete response. The effectiveness of ado-trastuzumab emtansine was notable within a short time period of two treatment cycles leading to full recovery. Specific agents aimed at altered oncogenes should be considered as a potential drug of choice in neoadjuvant HER2 positive SDC.

Anti-androgen for myoepithelial tumor: a potent therapy yet a potential misleader.

Myoepithelial tumor is a rare form of cancer, mainly arising from the salivary glands and extremities. Due to its rarity, no formal treatment guidelines exist. Here we report a case of a male patient diagnosed with metastatic myoepithelial tumor which was successfully treated with an androgen-receptor (AR) antagonist (bicalutamide), based on the results of molecular testing. Six years after the initiation of bicalutamide, patient was diagnosed with metastatic prostate cancer. To our knowledge, this is the first case described in literature that demonstrate the effectiveness of anti-androgens in treating myoepithelial tumor. Vigilance should be maintained when screening these patients for prostate cancer as their 'true' prostate specific antigen levels might be masked by the ongoing endocrine therapy.

Extracellular biosynthesis, OVAT/statistical optimization, and characterization of silver nanoparticles (AgNPs) using Leclercia adecarboxylata THHM and its antimicrobial activity.

BACKGROUND: The biosynthesis of silver nanoparticles (AgNPs) is an area of interest for researchers due to its eco-friendly approach. The use of biological approaches provides a clean and promising alternative process for the synthesis of AgNPs. We used for the first time the supernatant of Leclercia adecarboxylata THHM under optimal conditions to produce AgNPs with an acceptable antimicrobial activity against important clinical pathogens. RESULTS: In this study, soil bacteria from different locations were isolated and screened for their potential to form AgNPs. The selected isolate, which was found to have the ability to biosynthesize AgNPs, was identified by molecular methods as Leclercia adecarboxylata THHM and its 16S rRNA gene was deposited in GenBank under the accession number OK605882. Different conditions were screened for the maximum production of AgNPs by the selected bacteria. Five independent variables were investigated through optimizations using one variable at a time (OVAT) and the Plackett-Burman experimental design (PBD). The overall optimal parameters for enhancing the biosynthesis of AgNPs using the supernatant of Leclercia adecarboxylata THHM as a novel organism were at an incubation time of 72.0 h, a concentration of 1.5 mM silver nitrate, a temperature of 40.0 °C, a pH of 7.0, and a supernatant concentration of 30% (v/v) under illumination conditions. The biosynthesized AgNPs have been characterized by UV-visible spectroscopy (UV-Vis), transmission electron microscopy (TEM), and Fourier transform infrared spectroscopy (FTIR). The biosynthesized AgNPs showed an absorption peak at 423 nm, spherical shape, and an average particle size of 17.43 nm. FTIR shows the bands at 3321.50, 2160.15, and 1636.33 cm-1 corresponding to the binding vibrations of amine, alkyne nitrile, and primary amine bands, respectively. The biosynthesized AgNPs showed antimicrobial activity against a variety of microbial pathogens of medical importance. Using resazurin-based microtiter dilution, the minimum inhibitory concentration (MIC) values for AgNPs were 500 µg/mL for all microbial pathogens except for Klebsiella pneumoniae ATCC13883, which has a higher MIC value of 1000 µg/mL. CONCLUSIONS: The obtained data revealed the successful green production of AgNPs using the supernatant of Leclercia adecarboxylata THHM that can be effectively used as an antimicrobial agent against most human pathogenic microbes.

Investigation of the optimum conditions for electricity generation by haloalkaliphilic archaeon Natrialba sp. GHMN55 using the Plackett-Burman design: single and stacked MFCs.

The production of bioelectricity via the anaerobic oxidation of organic matter by microorganisms is recently receiving much interest and is considered one of the future alternative technologies. In this study, we aimed to produce electrical current by using facultative halophilic archaeon Natrialba sp. GHMN55 as a biocatalyst at the anode of a microbial fuel cell (MFC) to generate electrons from the anaerobic breakdown of organic matter to produce electrical current. Since the MFC's performance can be affected by many factors, the Plackett-Burman experimental design was applied to optimize the interaction between these factors when tested together and to identify the most significant factors that influence bioelectricity generation. We found that the factors that significantly affected electrical current generation were casein, inoculum age, magnet-bounded electrodes, NaCl, resistor value, and inoculum size; however, the existence of a mediator and the pH showed negative effects on bioelectricity production, where the maximum value of the 200 mV voltage was achieved after 48 h. The optimum medium formulation obtained using this design led to a decrease in the time required to produce bioelectricity from 20 days (in the basal medium) to 2 days (in the optimized medium). Also, the overall behavior of the cell could be enhanced by using multiple stacked MFCs with different electrical configurations (such as series or parallel chambers) to obtain higher voltages or power densities than the single chambers where the series chambers were recorded at 27.5 mV after 48 h of incubation compared with 12.6 mV and 1.1 mV for parallel and single chambers, respectively. These results indicate that the order of preferred MFC designs regarding total power densities would be series > parallel > single.

Tyrosine kinase inhibitor treatment and long-term follow-up for metastatic malignant struma ovarii.

Metastatic malignant struma ovarii (MMSO) is a very rare disease (in the United States, less than one case in 10 million females annually). However, this incidence rate is due to a paucity of data regarding diagnosis, treatment, and follow-up. Herein, we describe the case of a 14-year-old female who presented with MMSO, which later metastasized and was followed up on for over 10 years. The patient underwent right oophorectomy surgery and was then treated with a combination of radioactive iodine followed by iodine scans to detect the absorption of radioiodine in the metastatic sites, and radiation therapy to treat skeletal lesions. She subsequently received treatment with the tyrosine kinase inhibitors (TKIs), sorafenib and then lenvatinib, as treatments for advanced disease, thereby achieving long-term disease stability. This case report, which adds to the limited data available on MMSO treatment, suggests that patients treated with a combination of radioactive iodine, radiation therapy, and TKIs can result in good responses and long-term overall survival.

[ONCOLOGY CARE CHALLENGES TREATING COVID-19 CONFIRMED CANCER PATIENTS: A REVIEW AND RECOMMENDATIONS].

INTRODUCTION: The highly contagious virus, SARS-CoV-2 causing a human respiratory disease, COVID-19, imposed a global pandemic with significant short- and long-term health consequences. It has challenged the active treatment of oncology patients, having protocols that require frequent monitoring. Some patients' anxiety of the COVID-19 pandemic led to delays in treatment and impaired the effectiveness of anti-cancer therapy. Moreover, the stage migration term was coined to newly referred patients who postponed their doctor's appointment leading to late diagnosis. Prevention of COVID-19 disease among oncology patients is a priority, in order to avert morbidity, complications and mortality. In a recently published article, Waissengrin et al. compared the incidence of COVID-19 disease in oncology patients at Tel-Aviv Medical Center to the general population between March 2020 and October 2020. A lower rate of confirmed cases was demonstrated among oncology patients in comparison to the general population. This difference was attributed to the oncology patients' adherence to COVID-19 avoidance guidelines. In addition, no association was found between a specific type of cancer or oncological treatment and mortality from COVID-19. However, a significant correlation was presented between severe COVID-19 disease, old age and the presence of metastases. Waissengrin et al., support the importance of continuing the oncological care routine to avoid the devastating consequences of postponing treatments. Despite the development of a number of FDA-approved vaccines against the virus, the world is still facing challenges associated with the COVID-19 pandemic, e.g. variant B.1.617.2 ominous of yet more lockdowns due to a rapid rising wave of morbidity.

L-Glutaminase Synthesis by Marine Halomonas meridiana Isolated from the Red Sea and Its Efficiency against Colorectal Cancer Cell Lines.

L-glutaminase is an important anticancer agent that is used extensively worldwide by depriving cancer cells of L-glutamine. The marine bacterium, Halomonas meridian was isolated from the Red Sea and selected as the more active L-glutaminase-producing bacteria. L-glutaminase fermentation was optimized at 36 h, pH 8.0, 37 °C, and 3.0% NaCl, using glucose at 1.5% and soybean meal at 2%. The purified enzyme showed a specific activity of 36.08 U/mg, and the molecular weight was found to be 57 kDa by the SDS-PAGE analysis. The enzyme was highly active at pH 8.0 and 37 °C. The kinetics' parameters of Km and Vmax were 12.2 × 10-6 M and 121.95 µmol/mL/min, respectively, which reflects a higher affinity for its substrate. The anticancer efficiency of the enzyme showed significant toxic activity toward colorectal adenocarcinoma cells; LS 174 T (IC50 7.0 µg/mL) and HCT 116 (IC50 13.2 µg/mL). A higher incidence of cell death was observed with early apoptosis in HCT 116 than in LS 174 T, whereas late apoptosis was observed in LS 174 T more than in HCT 116. Also, the L-glutaminase induction nuclear fragmentation in HCT 116 was more than that in the LS 174T cells. This is the first report on Halomonas meridiana as an L-glutaminase producer that is used as an anti-colorectal cancer agent.

[VESICO-VAGINAL FISTULAS (VVF)].

INTRODUCTION: Vesico-vaginal fistula, is a known complication that can occur following damage to the bladder wall during pelvic surgery or prolonged birth. Prompt and accurate diagnosis and timely repair are essential for a quick solution to the problem, and a reduction in medico-legal claims. Successful treatment requires an accurate assessment of the size and the location of the fistula, determination of timing and the surgical technique. There is an approach that advocates postponing the surgery for several months until "tissue healing" subsides and some advocate immediate repair. In our department, the surgery is performed early, immediately upon diagnosis without delay. The aim of the work is to define the clinical manifestation of fistula after surgery, to analyze the factors, and to summarize the experience of an early intervention. METHODS: We reviewed the records of consecutive patients undergoing repair of urogenital fistulas at our institution. Patients with only vesico-vaginal fistulas were included. We recorded demographic characteristics, as well as surgical data, and postoperative complications were also collected. The follow-up period was at least 3 months. RESULTS: A total of 67 women with urogenital fistulas were identified, of whom 37 were only with vesico-vaginal fistulas. Iatrogenic injury, during hysterectomy was the main cause in 70.3%; 2 women were treated conservatively. A repair in the vaginal approach was performed in 31 women, and in 4 women the repair was performed in the abdominal approach, of them, two underwent urethral re-implantation simultaneously. Complications included sepsis in one case, and vaginal cuff dehiscence in another. The success rate of the repair was 92%. Recurrence occurred in 3 patients, of whom 2 had a history of previous radiation. CONCLUSIONS: A vesico-vaginal fistula can be successfully repaired by early repair, without delay, thus saving the patient considerable distress and discomfort.

Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign.

INTRODUCTION: Talus fractures are not uncommon and one of the serious fractures in the foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. They have been reported to be associated with calcaneum as well as talus fractures. AIM: To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. METHODS: We retrospectively reviewed 93 consecutive talus fractures in the period between 1/1/2011 to 1/11/2018. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and three view ankle plain radiographs. Two independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification, if any. Any dispute was resolved by the senior author.Patient records were reviewed for laterality, age, sex,mode of injury, associated injuries and operative interventions. 50 ankles met the inclusion criteria. 49 were males, mean age was 32.5 year and the predominant mode of injury was a fall from height. RESULTS: Peroneal tendon dislocation was found in ten patients out of 50 (20%). Risk of dislocation increased with severity of the fracture and neck fractures. Most of the dislocations were missed by surgeons and radiologist, and no additional procedures were done to address such an injury. The Fleck sign had a statistically significant correlation with peroneal tendons dislocations (p=.005) CONCLUSION: Peroneal tendons dislocation is associated with as high as 20% of talus fractures. The authors recommend carefully reviewing CT scans by surgeons and radiologists alike to avoid missing such injury and allow for appropriate surgical approach utilization. The Fleck sign is a highly specific radiographic sign that has a statistically significant correlation with PT dislocation and hence we recommend intra-operative assessment of peroneal tendons in patients with the fleck sign.

Potential Decontamination of Drinking Water Pathogens through k-Carrageenan Integrated Green Bottle Fly Bio-Synthesized Silver Nanoparticles.

The wide distribution of infections-related pathogenic microbes is almost related to the contamination of food and/or drinking water. The current applied treatments face some limitations. In the current study, k-carrageenan polymer was used as supporting material for the proper/unreleased silver nanoparticles that showed strong antimicrobial activity against six pathogenic bacteria and yeast. The bio-extract of the pupa of green bottle fly was used as the main agent for the synthesis of silver nanoparticles. The qualitative investigation of biologically synthesized silver nanoparticles was determined using UV-Vis spectrophotometric analysis; however, the size of nanoparticles was in range of 30-100 nm, as confirmed by scanning electron microscopy (SEM), transmission electron microscopy (TEM), and particle size analyzer. The proper integration of silver nanoparticles into the polymeric substrate was also characterized through fourier transform infrared (FT-IR), thermogravimetric analysis (TGA), SEM, and tensile strength. The antimicrobial activity of k-carrageenan/silver nanoparticles against Gram positive, Gram negative, and yeast pathogens was highly effective. These results indicate the probable exploitation of the polymeric/nanoparticles composite as an extra stage in water purification systems in homes or even at water treatment plants.

Cannabis Impacts Tumor Response Rate to Nivolumab in Patients with Advanced Malignancies.

BACKGROUND: There has been a significant increase in the use of immunotherapy and cannabis recently, two modalities that have immunomodulatory effects and may have possible interaction. We evaluated the influence of cannabis use during immunotherapy treatment on response rate (RR), progression-free survival (PFS), and overall survival (OS). SUBJECTS, MATERIALS, AND METHODS: In this retrospective, observational study, data were collected from the files of patients treated with nivolumab in the years 2015-2016 at our hospital, and cannabis from six cannabis-supplying companies. Included were 140 patients (89 nivolumab alone, 51 nivolumab plus cannabis) with advanced melanoma, non-small cell lung cancer, and renal clear cell carcinoma. The groups were homogenous regarding demographic and disease characteristics. A comparison between the two arms was made. RESULTS: In a multivariate model, cannabis was the only significant factor that reduced RR to immunotherapy (37.5% RR in nivolumab alone compared with 15.9% in the nivolumab-cannabis group (p = .016, odds ratio = 3.13, 95% confidence interval 1.24-8.1). Cannabis use was not a significant factor for PFS or OS. Factors affecting PFS and OS were smoking (adjusted hazard ratio [HR] = 2.41 and 2.41, respectively (and brain metastases (adjusted HR = 2.04 and 2.83, respectively). Low performance status (adjusted HR = 2.83) affected OS alone. Tetrahydrocannabinol and cannabidiol percentages did not affect RR in any group (p = .393 and .116, respectively). CONCLUSION: In this retrospective analysis, the use of cannabis during immunotherapy treatment decreased RR, without affecting PFS or OS and without relation to cannabis composition. Considering the limitations of the study, further prospective clinical study is needed to investigate possible interaction. IMPLICATIONS FOR PRACTICE: Although the data are retrospective and a relation to cannabis composition was not detected, this information can be critical for cannabis users and indicates that caution is required when starting immunotherapy.

Pain Control after Laparoscopic Radical Prostatectomy: Comparison between Unilateral Transversus Abdominis Plane Block and Wound Infiltration.

BACKGROUND AND OBJECTIVES: To determine the efficacy of unilateral transversus abdominis plane (TAP) block versus wound local infiltration for postoperative pain following laparoscopic radical prostatectomy (LRP). METHODS: Data of consecutive patients who underwent extraperitoneal LRP and received either wound infiltration or unilateral TAP block for analgesia were retrospectively analyzed. The patients were divided into 2 groups based on the technique used. We compared pain intensity scores and on-demand analgesic use both during the hospital stay and post-discharge between the 2 groups. RESULTS: A total of 48 patients were included, 27 received unilateral TAP blocks (group 1) and 21 were managed with wound infiltration (group 2). The unilateral TAP block group showed lower median pain scores on postoperative days (POD) 1 with pain scores being 0.2 (0-4) and 0.8 (0-4), respectively (p < 0.05). On POD2, the median pain intensity was 0.9 (0-5) and 1.6 (0-6) in groups 1 and 2, respectively (p < 0.05). The median number of on-demand analgesic doses during the POD1 was 0.2 (0-2) and 0.4 (0-2) in groups 1 and 2, respectively (p = 0.19). On POD2, the patients received 0.5 (0-2) and 1.1 (0-3) on-demand doses in groups 1 and 2, respectively (p < 0.05). CONCLUSION: Unilateral TAP block might improve pain control more pronounced after LRP than wound infiltration.

Breast Cancer Classification from Histopathological Images with Inception Recurrent Residual Convolutional Neural Network.

The Deep Convolutional Neural Network (DCNN) is one of the most powerful and successful deep learning approaches. DCNNs have already provided superior performance in different modalities of medical imaging including breast cancer classification, segmentation, and detection. Breast cancer is one of the most common and dangerous cancers impacting women worldwide. In this paper, we have proposed a method for breast cancer classification with the Inception Recurrent Residual Convolutional Neural Network (IRRCNN) model. The IRRCNN is a powerful DCNN model that combines the strength of the Inception Network (Inception-v4), the Residual Network (ResNet), and the Recurrent Convolutional Neural Network (RCNN). The IRRCNN shows superior performance against equivalent Inception Networks, Residual Networks, and RCNNs for object recognition tasks. In this paper, the IRRCNN approach is applied for breast cancer classification on two publicly available datasets including BreakHis and Breast Cancer (BC) classification challenge 2015. The experimental results are compared against the existing machine learning and deep learning-based approaches with respect to image-based, patch-based, image-level, and patient-level classification. The IRRCNN model provides superior classification performance in terms of sensitivity, area under the curve (AUC), the ROC curve, and global accuracy compared to existing approaches for both datasets.

Supplementation of Cerelac baby food with yeast-probiotic cocktail strains induces high potential for aflatoxin detoxification both in vitro and in vivo in mother and baby albino rats.

BACKGROUND: Aflatoxins (AFs) are a group of toxic, nephrotoxic, hepatotoxic and carcinogenic fungal metabolites. Heat- and acid-treated yeasts, probiotic bacteria and their combination were used to remove AFB1, AFB2, AFG1 and AFG2 from human and animal food. RESULTS: The in vitro study revealed that the highest removal percentage of AFs in phosphate-buffered saline was recorded after 72 h with the yeast-probiotic coctile, reaching 95.59%. Therefore, this coctile was added to Cerelac contaminated with AFB1, AFB2, AFG1 and AFG2, and the removal percentages were 8.17%, 36.12%, 44.75%, 64.72% and 93.21% after 6, 12, 24, 48 and 72 h of treatment, respectively. Cerelac yeast-probiotic coctile was administered to female rats and the results showed that all AFs (AFB1, AFB2, AFG1 and AFG2) were detected in the serum of mother rats for both AF groups III and IV. On the other hand, AFM1 and AFM2 metabolites were not observed in mothers' sera but were detected in all infants of groups III and IV. Meanwhile, AFB1, AFB2, AFG1 and AFG2 were not observed in infants' sera. CONCLUSION: A mixture of yeast-probiotic coctile was successful in reducing the level of AF in rat sera and diminished the deleterious effect of AFs on animal health. © 2017 Society of Chemical Industry.

Advanced trends in controlling Helicobacter pylori infections using functional and therapeutically supplements in baby milk.

Helicobacter pylori is a common human pathogen infecting about 30 % of children and 60 % of adults worldwide. It is responsible for diseases such as gastritis, peptic ulcer and gastric cancer. H. pylori treatment based on antibiotics with proton pump inhibitor, but therapy failure is shown to be higher than 20 % and is essentially due to an increasing in prevalence of antibiotic-resistant bacteria, which has led to the search for alternative therapies. In this study, we discuss the usage of natural extracts mixture as alternative or complementary agents in controlling H. pylori infection so here, we focused on the plant extracts of (Cloves, Pepper, Cumin, Sage, Pomegranate peel, Ginger, Myrrh and Licorice). To that end, Phytochemical constituents detection like Tannins, Glycosides, Alkaloids, Flavonoids, Terpenoids, Saponins, Phenolic compounds, Reducing sugars, Volatile oils, Amino acids and Proteins was demonstrated. Each plant extract was examined individually or in combination for its antimicrobial activity against H. pylori. Out of the used extracts, four mixes were prepared and tested against H. pylori. The antibacterial activities of the four mixes, represented by the diameter of inhibition clear zone, recorded 21, 39, 23 and 28 mm. The most potent mix (mix2) was chosen and mixed with baby milk as a new combination for H. pylori infections treatment in babies.

PD1 ligand functionality a biomarker of response to anti PD1 treatment in patients with HNSCC.

Therapies targeting the PD-1/PD-L1 pathway have transformed head and neck squamous cell carcinoma (HNSCC) treatment. However, predicting the response to anti-PD-1 therapy remains a clinical challenge. This study evaluated the functional binding of PD-1 ligands in 29 HNSCC patients and compared it to the standard PD-L1 Combined Positive Score (CPS). The assessment of PD-1 ligands' functionality advances the current ability to predict the response of HNSCC patients to anti-PD-1 therapy.